Refractive outcomes, corneal haze and endothelial cell loss after myopic photorefractive keratectomy in an Asian population: The Singapore Armed Forces' experience.

IMPORTANCE: This study reports outcomes of myopic photorefractive keratectomy (PRK) in a mainly ethnic Chinese population in Singapore. BACKGROUND: To assess the incidence and associations of corneal haze and endothelial cell count (ECC) loss up to 12 months after PRK. DESIGN: This was a retrospective case series conducted in a tertiary eye centre. PARTICIPANTS: A total of 158 patients (309 eyes) with a mean age of 22.1 ± 3.4 years were included. The majority was Chinese (97.4%) and male (97.4%). Mean preoperative spherical equivalent was -3.33 ± 1.15 D. METHODS: Eyes were categorized based on postoperative haze severity. A multivariate analysis adjusting for age and use of intraoperative mitomycin-C (MMC), preoperative sphere and cylinder was performed. MAIN OUTCOME MEASURES: Refractive outcomes and corneal haze 3 and 12 months after PRK were assessed. ECC measurements were obtained before PRK and at variable periods postoperatively. RESULTS: At 12 months, overall efficacy index was 0.98, and safety index was 1.09. Eight (2.5%) eyes underwent enhancement surgery. An analysis was performed on 295 eyes that did not undergo enhancement and had complete clinical data, which demonstrated a decrease in the incidence of haze from 38.2% at 3 months to 9.3% at 12 months. Higher myopia was associated with increased haze severity at 3 months (OR, 1.36; P = .005). Higher astigmatism was associated with increased haze severity at 3 (OR, 1.65; P = .018) and 12 months (OR, 2.32; P = .015). Intraoperative MMC was not associated with haze severity or ECC loss. CONCLUSIONS AND RELEVANCE: Myopia and astigmatism were associated with increased corneal haze severity. Intraoperative MMC did not accelerate ECC loss. Overall, PRK is effective, predictable and safe in Asian eyes.

International globe and adnexal trauma epidemiology study (IGATES): a report from Central India on visual outcome in open globe injuries and correlation with ocular trauma score.

PURPOSE: To evaluate the factors influencing final visual outcome after surgical repair of open globe injuries (OGIs) and to correlate the Ocular Trauma Score (OTS) system. METHODS: Prospective cross-sectional study of patients with OGIs from International Globe and Adnexal Trauma Epidemiology Study (IGATES) database at a tertiary referral eye centre in Central India over 2 years. Pre-operative factors affecting final visual outcome and correlation with OTS were evaluated. RESULTS: 208 patients had ocular trauma, of which data from 42 eyes with OGIs were reviewed. The majority of the patients were men (32, 76.2%) below the age of 40 (31, 73.8%). Patients were followed up for at least 6 months. Initial visual acuity (VA) was ≥ 20/40; 2 (4.8%), 20/200 to 20/50; 2 (4.8%), 1/200 to 19/200; 7 (16.7%), LP to HM; 26 (61.9%) and NLP (5, 11.9%). Final VA was ≥ 20/40; 1 (2.4%), 20/50 to 20/200; 8 (19.1%), 1/200 to 19/200; 9 (21.4%), LP to HM; 17 (40.5%) and NLP; 7 (16.7%). Univariate analysis of pre-operative variables showed initial VA (p = 0.0004), presence of hyphaema (p = 0.0323), laceration involving cornea visual axis (p = 0.0192) and retinal detachment (p = 0.0299) were significant prognostic factors in final visual outcome. OTS in our study does not fully correlate with international OTS system. CONCLUSIONS: Initial VA, hyphaema, visual-axis involving cornea laceration and retinal detachment are significant prognostic factors in OGIs. OTS remains a largely effective tool in counselling trauma patients.

International Globe and Adnexal Trauma Epidemiology Study (IGATES): Visual outcomes in open globe injuries in rural West India.

BACKGROUND/OBJECTIVES: To evaluate the factors influencing final visual outcome after surgical repair of open globe injuries (OGIs) in a rural population using the International Globe and Adnexal Trauma Epidemiology Study (IGATES) online registry. SUBJECTS/METHODS: Retrospective cohort study of patients with OGI. OGIs were identified from the IGATES database at a tertiary referral eye care centre in rural West India over a period of 12 years. Patient demographics, clinical and pre-operative factors affecting final visual outcome was evaluated. RESULTS: A total of 791 eyes with OGIs were included in data analysis. 11 eyes that were lost to follow-up and 12 eyes with incomplete data were excluded. Most of the patients were male (559, 70.6%) and mean age of all patients was 23.9 years ± 19.4 years. Occupational hazards (including domestic housework) (307, 38.8%) and leisure play (324, 41.0%) were the leading causes of OGI. The most common mechanism of injury was being struck by a wooden stick (250, 31.6%). Univariate analysis of pre-operative variables showed initial visual acuity (VA), zone of injury, size of wound, structures involved in the injury and presence of infection were significant prognostic factors for worse final visual outcome (p < 0.001). Multivariate analysis showed VA ≤ 3/60 or worse at presentation had statistically significantly higher odds ratio of ending up with worse visual outcomes (p < 0.012). CONCLUSIONS: Males in working age groups suffer from OGIs more frequently, usually from agricultural and pastoral activities. Initial VA, zone 3 injuries, corneoscleral wound, large wound size and presence of post-traumatic infections are significant prognostic factors.

Case of unilateral anaemic retinopathy unmasking colorectal carcinoma.

Anaemic retinopathy presents commonly with bilateral retinal haemorrhages and soft exudates. Unilateral optic disc oedema in these patients has rarely been mentioned. We report a case of an atypical presentation of anaemic retinopathy with recurrent unilateral optic disc oedema and retinal haemorrhages secondary to iron deficiency anaemia from a newly diagnosed colorectal adenocarcinoma.A man in his 70s with multiple ischaemic risk factors was referred for unilateral optic disc oedema associated with a few retinal haemorrhages. Initial diagnosis was that of impending central retinal vein occlusion. The optic disc oedema initially resolved but recurred 8 months later with worsening unilateral disc oedema, 'coin-shaped' retinal haemorrhages, Roth's spots and venous tortuosity. Full blood count showed microcytic hypochromic anaemia secondary to iron deficiency and colonoscopy revealed colorectal adenocarcinoma. The patient received blood transfusions, oral iron replacement and underwent surgical resection of the tumour. The anaemia resolved, and the fundus findings resolved as well.

Vogt-Koyanagi-Harada Disease Associated with COVID-19 mRNA Vaccine.

A 54-year-old Chinese male with no previous ocular history presented to the ophthalmology department for the bilateral acute painless blurring of vision after receiving the 1st dose of COVID-19 mRNA vaccine (PFIZER-BioNTech/COMIRNATY). Clinical examination and imaging tests were consistent with Vogt-Koyanagi-Hara disease. The patient responded well with a high dose of intravenous methylprednisolone followed by a tapering dose of oral prednisolone.

Diagnostic dilemma: Unilateral panuveitis mimicking endophthalmitis in very severe HLA B27-associated uveitis.

PURPOSE: To report a case of a 28-years-old male who presented with a worsening unilateral panuveitis after intensive topical steroid therapy which resulted in a diagnostic and treatment dilemma as to whether the patient should be treated as for infective endophthalmitis despite no immediate known infective risk factors. OBSERVATIONS: A patient presented initially with unilateral non-granulomatous acute anterior uveitis which worsened after being started on intensive steroid therapy, developing fibrinous panuveitis. The rapid worsening of inflammation and vision deterioration despite being on intensive steroid therapy resulted in the patient subsequently being treated as for infective endophthalmitis. Anterior chamber and vitreous tap were done and intravitreal antibiotics were administered, along with topical antibiotics therapy. Vitrectomy was withheld due to the lack of conclusive evidence of infective etiology and risk factors. Full uveitis and infective workup were done. Investigations were largely unremarkable, and fluid and vitreous cultures were negative. HLA B27 was positive. The patient was subsequently started on systemic oral corticosteroids and improved in terms of his visual acuity, signs and symptoms. CONCLUSIONS: HLA B27-associated uveitis can present in a range of clinical spectrum with the extreme being of unusual severity in the form of fibrinous panuveitis that can mimic infective endophthalmitis. This can lead to a dilemma in management and subject patients to unnecessary risks from diagnostic and therapeutic interventions. Patients under this subgroup may require long term systemic immunosuppression therapy for disease remission and will require long term follow up.

Effects of primary glaucoma on sleep quality and daytime sleepiness of patients residing at an equatorial latitude.

AIM: To investigate the impact of primary glaucoma on sleep quality and daytime sleepiness of patients. METHODS: Prospective cross-sectional study with consecutive sampling in South-East Asian population was performed. Validated questionnaires: the Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were administered prospectively. Subjects with non-glaucomatous optic neuropathy or concomitant retinal pathology were excluded. Glaucoma severity was based on HVF 24-2 perimetry. Binocular single vision was represented based on the better eye. Frequency of and predictive factors for poor sleep quality and excessive daytime sleepiness were compared. RESULTS: A total of 79 primary open angle glaucoma (POAG), 27 primary angle-closure glaucoma (PACG) patients, and 89 controls were recruited. PACG patients had higher median PSQI scores (P=0.004) and poorer sleep quality (P<0.001). Compared to controls, PACG patients were 3.34 times more likely to have poor sleep quality (P=0.008), which remained significant after adjustment for demographics (P=0.016) and predictive variables (P=0.013). PACG patients have poorer sleep quality when visual acuity (VA) was 6/15 or worse (P=0.009). Univariate and multivariate analysis of predictive variables for poor sleep quality and daytime sleepiness did not find statistical significance. CONCLUSION: PACG patients have poorer sleep quality but not daytime sleepiness. This is important in South-East Asian population with heavy disease burden. Evaluations on sleep disturbances can be considered to provide more holistic care.