Clinical profile of Keratoconus patients at the Philippine General Hospital

Objectives@#This study described the clinical profile of patients with keratoconus at a single tertiary referral hospital.@*Methods@#This was a single-center, retrospective, cross-sectional study that reviewed medical records of patients diagnosed with keratoconus from January 2015 to August 2022. Data on the clinical profile, intervention, and clinical outcomes were collected from the chart review. @*Results@#Forty (40) patients (79 eyes) were included in the study. Majority (98%) had bilateral disease in which 22 (55.5%) were affected asymmetrically. The mean age was 21 years. Most patients (72.5%) were male. Blurring of vision was the chief complaint in all patients. Atopy was present in 23 patients (57.5%). History of vigorous eye rubbing was present in 31 (77.5%). The mean interval from onset of symptoms to consult was 46.4 ± 33.38 months. The mean pinhole corrected distance visual acuity was 0.47 ± 0.41 (Snellen equivalent of 20/59). The average spherical equivalent was -7.48D ± 6.99D. Corneal protrusion on slit-lamp biomicroscopy was seen in 78 eyes (98.7%). Other findings included Fleischer ring (53.2%), Vogt's striae (19.0%), and apical corneal scar (24.0%). Only one eye (1.3%) had no corneal findings. Thirty-nine eyes (49.3%) were classified as advancedsevere keratoconus. Rigid contact lens was planned for 60 eyes (75.9%). Sixty-two eyes (78.5%) were for collagen cross-linking. Deep anterior lamellar keratoplasty was planned in 10 eyes (12.7%) and penetrating keratoplasty in two eyes (2.5%).@*Conclusion@#Keratoconus at the Philippine General Hospital was most frequently seen in young males and asymmetrically affects both eyes. Patients consulted relatively late and presented with a more advanced stage of the disease. History of ocular allergy and eye rubbing were significant risk factors. Improving awareness of this condition must be emphasized to detect keratoconus earlier.

Recalcitrant gram-positive bacterial keratitis treated with intrastromal levofloxacin 1.5% ophthalmic solution: A case report and review of literature

Objective@#This paper demonstrated the effectiveness of intrastromal injection of levofloxacin 1.5% ophthalmic solution in the management of recalcitrant Gram-positive bacterial keratitis.@*Methods@#This is a report on two cases of recalcitrant bacterial keratitis encountered at the External Diseases and Cornea Clinic of the Department of Ophthalmology and Visual Sciences at the Philippine General Hospital. @*Results@#Two middle-aged females presented with bacterial keratitis unresponsive to previous antibiotic treatment with impending corneal perforation. The Gram stain of the corneal scraping in the first case revealed Gram-positive cocci, while the second case showed encapsulated Gram-positive bacilli and encapsulated Grampositive cocci in chains. In both cases, repeated intrastromal injections of levofloxacin 1.5% in addition to increasing the frequency of topical levofloxacin 1.5% resulted in marked improvement in visual acuity and resolution of deep stromal infiltrates and hypopyon. @*Conclusion@#These cases highlighted the utility of intrastromal levofloxacin 1.5% ophthalmic solution in the management of recalcitrant Gram-positive bacterial keratitis.

Fulminant acute postoperative endophthalmitis caused by Pseudomonas stutzeri in a healthy elderly male

Objective@#To report a case of acute postoperative endophthalmitis following cataract surgery due to Pseudomonas stutzeri in a healthy elderly male. @*Methods@#This is a case report.@*Results@#A non-hypertensive, non-diabetic male in his late 60s consulted due to eye pain and blurred vision 5 days after an uncomplicated extracapsular cataract extraction with posterior chamber intraocular lens implantation (PCIOL) on his left eye. On examination, the visual acuity was light perception. Slit-lamp examination showed ciliary injection, conjunctival congestion, mild corneal edema with Descemet membrane folds, hazy anterior chamber with fibrin and a 2-millimeter hypopyon, and a visible PCIOL. IOP was 10 mmHg with no leak on Seidel’s test, and there was poor view of the fundus. B-scan ultrasonography showed findings consistent with endophthalmitis. He was given topical, intravitreal, and systemic antibiotics, and emergency vitrectomy was done. The vitreous sample culture revealed Pseudomonas stutzeri. Despite aggressive medical and surgical management, vision loss was not prevented.@*Conclusion@#Acute postoperative endophthalmitis from Pseudomonas stutzeri is rare; if not recognized and treated promptly, this complication has devastating outcomes. It may present with a fulminant course regardless of the associated risks for infection. Prevention, early recognition, and timely management can prevent unfavorable visual outcomes.

Clinical profile and corneal complications of staphylococcal blepharitis at the Philippine General Hospital

Objectives@#Staphylococcal blepharitis is a common ocular condition that can cause significant visual morbidities due to corneal complications. This study described the clinical profile of patients with staphylococcal blepharitis seen in a tertiary referral eye center, and determined the frequency and the type of corneal complications, the possible reasons for the delay in diagnosis, and the management prior to the consult.@*Methods@#This study was a single-center, five-year retrospective case series design. The charts of all patients from January 2016 to December 2021 with the diagnosis of staphylococcal blepharitis seen at the External Disease and Cornea Clinic of the Philippine General Hospital that have fulfilled the inclusion and exclusion criteria were included. The data extracted were age, sex, chief complaint, laterality, time of onset of symptoms to consult, previous consults, lid and lid margin findings, conjunctival and corneal findings, pre- and post-treatment uncorrected distance visual acuity, duration of follow-up, and treatments received.@*Results@#Fifty-five (55) charts out of 107 charts with a diagnosis of staphylococcal blepharitis were included. Eighty percent (80%) or 44 patients had bilateral disease. Ninety-nine (99) eyes of 55 patients were analyzed. The median age of the study population was 19 years. Sixty-seven percent (67%) were female, and 33% were male. The mean duration of follow-up at the External Disease and Cornea Clinic was 10.8 ± 14.61 months. Corneal opacity, eye redness, and blurring of vision comprised 70% of the reasons for consult. The mean time from the onset of symptoms to consult was 18.36 ± 25.69 months. Sixty-seven percent (67%) had prior consults elsewhere and 45% came in with a different diagnosis. Seventy-eight (78) eyes had fibrin or crust on the lashes. Fifty percent (50%) of the eyes had concomitant conjunctivitis, while 30% had meibomitis. Fifty-eight percent (58%) of patients had corneal complications. Seventy-two percent (72%) of eyes had bilateral involvement. The median age of patients with corneal complications subgroup was 13 years. The most common corneal complications noted were neovascularization, phlyctenulosis, pannus formation, and marginal infiltrates or ulcers. Twenty-two percent (22%) of all study eyes had visually disabling corneal complications like corneal ulcer, descemetocele, corneal perforation, and corneal scar. Ninety percent (90%) of the patients received standard medical treatment and three patients underwent penetrating keratoplasty. The mean uncorrected distance visual acuity at initial consult of eyes with corneal complication was 20/55 (LogMAR 0.43 ± 0.51) and 20/35 (LogMAR 0.25 ± 0.40) after treatment (p = 0.032).@*Conclusion@#Staphylococcal blepharitis was most prevalent among young female patients, and it affected both eyes. Almost all patients manifested the typical lid margin lesions. Nearly 60% of the patients presented with corneal complications and 22% had corneal lesions that were potentially blinding. Close to 50% had delay in treatment due to misdiagnosis.

Clinical profile of dry eye disease at the Philippine General Hospital

Objectives@#To describe the population of dry eye disease (DED) patients seen at the Philippine General Hospital (PGH) Dry Eye Clinic, and to compare the diagnosis, type, and severity of DED using Oculus Keratograph® 5M (Oculus GmbH, Wetzlar, Germany) with clinical diagnosis.@*Methodology@#This was a single-center comparative, cross-sectional study. Newly-diagnosed DED patients were recruited for the dry eye group. A subset of healthy volunteers without DED was also recruited for the control group. The clinical data for both groups were collected, and the Ocular Surface Disease Index (OSDI) questionnaire was administered. Standard clinical dry eye testing and Keratograph testing were subsequently done. The PGH Dry Eye Clinic definitions were used to classify the types of dry eye. @*Results@#Eighty (80) eyes of 40 patients per group were examined. For the dry eye group, the mean age and OSDI scores were significantly higher, while the average tear break up time (TBUT) was significantly lower. There was no significant difference in average basal secretion test (BST) and Schirmer 1 measurements between the two groups. 73% had evaporative type dry eye, while 27% had mixed type. Majority of the DED patients were females of >50 years old with mild evaporative type. Foreign body sensation was the most common symptom. Overall, there was poor agreement between clinical and Keratograph assessments of diagnosis and severity among patients in the dry eye group, but there was acceptable agreement when assessment was done in the control group.@*Conclusions@#DED patients at the PGH have similar characteristics to reported DED of other Asian populations. Evaporative or short TBUT type dry eye is the most frequently seen. Further formal validity study is needed for Oculus Keratograph® 5M to increase the value of its data to be included in routine dry eye screening.

Time reduction of new patient consultation at the Department of Ophthalmology and Visual Sciences of a Philippine Tertiary Hospital

Objective@#To decrease the total time spent of new patients on a General Clinic consult at the Department of Ophthalmology and Visual Sciences of a Philippine Tertiary Hospital. @*Methods@#A time quality management team was formed. The description of the process of a General Clinic new patient consult was elucidated and was consolidated in a data collection form. Convenience sampling of the population was done. The collection and analysis of the data were done with institution of interventions to address the factors causing the prolonged consultation visit; then, pre-intervention analysis, post-intervention analysis and comparison were done. @*Results@#Thirty-five new patients were tracked prior to and after intervention. Among the identified causes for prolonged new patient consult were delay in temporary chart, front of chart and blue card issuance, insufficient examination tools and resident dedicated to the General Clinic, unnecessary examination and patient not being around when called. Most causes were addressed. A mean decrease of 68±112 minutes or approximately 18% in total time stay was noted. @*Conclusion@#This study showed that the total consultation time of a new patient in General Clinic decreased. This was achieved with the help of most of the personnel involved in the system after identifying factors causing the prolonged consultation visit and instituting interventions to address these identified factors. The improvement in health service delivery was taken as a step by step process. A preliminary step was demonstrated in this paper for future interventions for better service delivery.