Comparison Between Continuous Buried Suture and Interrupted Buried Suture Methods for Double Eyelid Blepharoplasty.

PURPOSE: The objective of this study was to compare the surgical outcomes between interrupted and continuous buried suture methods in double eyelid blepharoplasty in Koreans. METHODS: Medical records of 204 patients (392 eyes) who underwent double eyelid operation by buried suture method and who were followed up for at least more than 3 months were reviewed. Patients were divided into 2 groups according to the buried suture method; an interrupted group (88 patients) and a continuous group (116 patients). RESULTS: The rate of loss of formed double eyelid is 19.3 % (17 of 88 patients) in interrupted buried method and 8.6 % (10 of 116 patients) in continuous group (P = 0.026). One patient experienced an exposure of suture knot in a continuous group, whereas 5 patients experienced an exposure of suture knot and 1 patient suffered from granuloma in an interrupted group (P = 0.021). CONCLUSIONS: The continuous buried suture method has a lower rate of the loss of double folds and less complication than the interrupted buried suture method for double fold formation in Koreans.

The association of lacrimal gland inflammation with alopecia areata.

PURPOSE: To describe the association of lacrimal gland inflammation with alopecia areata. METHODS: We reviewed the medical records of 4 patients diagnosed with lacrimal gland inflammation who had an antecedent or subsequent episode of alopecia. Data was collected on the presentation age, gender, medical history, disease onset, symptoms and signs, imaging, histopathology, systemic evaluation, management and outcome. Pathology and imaging results were correlated with clinical findings. RESULTS: Three patients were Asian and one Caucasian. Two developed alopecia after presentation for lacrimal inflammation. The remaining two had a history of alopecia totalis (2 years and 10 years). Three of the 4 patients presented or developed other systemic disorders, including seizures, thrombocytopenia, optic neuritis, ulcerative colitis, allergic rhinitis, lymphadenopathy, vasculitic rash and positive p-ANCA values. All received oral corticosteroids, with the addition of methotrexate therapy in one for relapsing inflammation. CONCLUSIONS: Lacrimal gland inflammation and alopecia areata are autoimmune processes that can be seen in association with each other.

Chronic eyelid swelling as an initial manifestation of myeloma-associated amyloidosis.

Orbital amyloidosis is uncommon and difficult to diagnose due to their variable clinical presentations. The authors report a case of a patient who presents with chronic eyelid swelling as an initial manifestation of myeloma-associated amyloidosis. This patient was also found to have retrobulbar infiltration with no visual impairment. The authors also describe the first documentation of the atypical necrotic appearance of amyloidosis in the involved eyelid tissues. Myeloma-associated amyloidosis can present as chronic, nonspecific periorbital swelling, hence a biopsy of the affected tissues is important in preventing a delay in the correct diagnosis.

Inflammatory mass formation secondary to hydroxyapatite orbital implant leakage.

A 28-year-old woman with a history of an hydroxyapatite implantation performed 2 years earlier, presented with complaints of a poorly fitting prosthesis, and fullness of the left upper eyelid accompanied by eyelid erythema. Computed tomography scan showed a mass adjacent to the implant medially. Surgical removal of the implant and mass was performed. Histological examination of the implant revealed degradation on the medial side of the implant while the mass consisted of fibrous tissue with chronic inflammation and lymphoid follicle formation around a foreign material.

Prospective audit of ptosis surgery at the Singapore National Eye Centre: two-year results.

PURPOSE: To evaluate the demographics, presentation, and surgical outcomes of patients undergoing ptosis surgery in an Asian population in a prospective manner. METHODS: A prospective ptosis audit was conducted over a 2-year period from January 2010 to December 2011 in a tertiary eye hospital in Singapore. All patients undergoing ptosis surgery by, or under the supervision of, an oculoplastic-trained consultant in the institution were included. Institutional Review Board approval was obtained for the study. RESULTS: This study comprises 302 patients, of which 236 were acquired and 66 were congenital ptosis cases. Levator repair (77.2%) was the most commonly performed procedure, followed by levator resection (13.9%) and brow suspension (8.9%). Forty-seven (10.1%) eyes had readjustment within 2 weeks, the reasons for readjustment being eyelid height undercorrection (n = 35), eyelid height overcorrection (n = 9), and unsatisfactory eyelid contour (n = 4). Postoperatively, 93.8% of patients showed an increase in marginal reflex distance-1 (MRD1), 91.3% achieved symmetry or <1 mm of asymmetry in MRD1, 98.5% had good eyelid contour, and 74.3% had symmetric eyelid crease. On a scale of 1 to 10, 83.1% of patients gave a subjective grade of 7 or better. CONCLUSIONS: This study is the first prospective ptosis surgery audit in an Asian population and takes a leading step in assessing both subjective and objective surgical outcomes in a prospective manner. With the continuation of this audit in years to come, it will allow us to generate clinical outcomes in a robust manner and allow for more reliable benchmarking with major centers elsewhere.

A survey of the histopathology of lacrimal gland lesions in a tertiary referral centre.

PURPOSE: To describe the histopathological distribution of biopsied lacrimal gland lesions in a tertiary referral centre in Singapore. METHODS: This was a retrospective chart review. Clinical records of patients who underwent lacrimal gland biopsy at a tertiary referral centre in Singapore between 2000 to 2010, were reviewed. Data collated included patient demographics, clinical presentation, association with systemic disease and histopathological diagnosis. RESULTS: Sixty-nine patients were studied. Median age of presentation was 50 years. Forty patients (58%) were female and the majority (84%, n = 29) were Chinese. The mean follow-up duration was 35.0 ± 34.5 months. 30.4% (n = 21) of the patients had bilateral disease. Chronic dacryoadenitis (46%, n = 32) was the most common histopathological diagnosis, followed by lymphoproliferative disorders (38%, n = 26) and pleomorphic adenoma (10%, n = 7). The diagnoses in four other patients included adenoid cystic carcinoma, lacrimal gland hypertrophy, lacrimal duct cyst and orbital vascular malformation. CONCLUSION: Chronic dacryoadenitis and lymphoproliferative disorders are the two commonest causes of lacrimal gland lesions in our series. Although many cases remain non-specific, about 60% have a specific inflammation that may be associated with a systemic disease. As one third of our patients with lymphoproliferative disease of the lacrimal gland had an associated systemic lymphoma, patients with such lesions should be referred for investigation of possible systemic lymphoma. The results of our study can aid in providing a more targeted approach to patient management.

Osteotome as an adjunctive instrument in endoscopic dacryocystorhinostomy.

PURPOSE: To report the novel use of the osteotome as an adjunctive instrument in Endoscopic Dacryocystorhinostomy (DCR). MATERIALS AND METHODS: A retrospective interventional case series of 15 patients, underwent endoscopic DCR at the Singapore National Eye Centre, by a single ophthalmologist and rhinologist between April 2009 and April 2011.All patients' case records were reviewed and the information recorded included: patients' demographics, level of obstruction of the lacrimal system, operative time, postoperative symptoms and complications (if any), and the length of follow-up. All patients had preoperative syringing to determine the level of obstruction, and had postoperative syringing only if there were any complaints of epiphora.All surgeries were recorded on video. The osteotome and mallet were used in all patients to augment the bone removal, and Crawford stent (MIRA®) intubation was done in all patients and left in situ for 2 months. RESULTS: A total of 15 patients were reviewed and analyzed from April 2009 to August 2010. Ages ranged from 22 to 77 years of age underwent endoscopic DCR with Crawford stent (MIRA ®) intubation. All patients had syringing before surgery and all had only nasolacrimal duct obstruction except 1 patient who had common canalicular obstruction. The surgery was carried out as described above with no intraoperative or postoperative complications in any of the patients. Duration of surgery ranged from 22 to 65 minutes with a mean time of 42.6 minutes. All patients were followed up from 2 to 11 months with resolution of epiphora in all cases. CONCLUSION: The use of the osteotome and mallet, in combination with the Kerrison rongeur and diamond drill, has been found to be useful in creating a large osteotomy in endoscopic DCR. It has allowed greater ease and speed in performing this procedure, especially for patients with thicker bone and narrower nasal cavities.

Trends in contemporary advanced heart failure management: an in-depth review over 30 years of heart transplant service in Hong Kong.

Background: The year 2022 marks the 30th anniversary of heart transplant service in Hong Kong (HK). In this study, we describe prevailing trends and outcomes of advanced heart failure (AHF), including heart transplantations (HTx), in HK over the past 30 years. Methods: Trends in heart failure prevalence in HK from 1993 to 2021 were analyzed based on data from the Hospital Authority Clinical Data and Reporting System. All AHF patients referred for HTx consideration between 1992 and 2021 were reviewed. The bridge-to-transplant (BTT) utilization of short-term mechanical circulatory support (ST-MCS) devices, including venoarterial extracorporeal membrane oxygenation (VA-ECMO) and durable left ventricular assist devices (LVADs), from 2010 to 2021 was reviewed. Results: Overall, 237 heart transplants were performed in HK, with 10-year posttransplant and median survival of 68.1% and 18.7 years, respectively. An increase in AHF clinic referrals was correlated with increasing heart failure prevalence (R2=0.635, P<0.001). In total, 146 referrals were made for ST-MCS, and an observed increase in ST-MCS referrals was correlated with increasing VA-ECMO utilization (R2=0.849, P<0.001). Among 62 patients accepted for AHF therapy, those with durable LVAD implementation had better 1-year survival (71.5%) than those receiving an extracorporeal CentriMag (Levitronix) device as BTT (40%, P=0.008). In total, 143 LVADs were implanted, with 130 as BTT or bridge-to-candidacy (BTC) methods. The survival rate among the 130 BTT/BTC LVAD patients resembled that of HTx recipients (73.8% vs. 69.8% at 9 years, P=0.296). Conclusions: The burden of AHF management has increased and gained complexity over the past 30 years in Hong Kong.

Asian blepharoplasty--an overview.

Asian blepharoplasty has evolved over the years as greater understanding of the differences between the Asian and Caucasian eyelid anatomy has led to the development of modified techniques for upper lid blepharoplasty. The aim of Asian upper blepharoplasty is to create a pleasing and permanent upper lid crease. This article reviews the differences in the anatomy and the various techniques currently employed.

The burden of acute conjunctivitis attributable to ambient particulate matter pollution in Singapore and its exacerbation during South-East Asian haze episodes.

INTRODUCTION: Urban air quality in South-East Asia is influenced by local and transboundary sources of air pollutants. Research studies have well characterized the short-term effects of air pollution on cardiovascular and respiratory health but less so on ocular health. We investigated the relationship between air pollution and acute conjunctivitis in Singapore, a tropical city-state located in South-East Asia. METHODS: Assuming a negative-binomial distribution, we examined the short-term associations between all-cause acute conjunctivitis reports from 2009 to 2018 and contemporaneous ambient air pollutant concentrations using a time-series analysis. In separate pollutant models for PM2.5 and PM10, we fitted fractional polynomials to investigate the linearity between air pollutant exposures and conjunctivitis, adjusting for long-term trend, seasonality, climate variability, public holidays, immediate and lagged exposure effects, and autocorrelation. RESULTS: There were 261,959 acute conjunctivitis reports over the study period. Every 10 µg/m3 increase in PM2.5 was associated with a 3.8% (Incidence Rate Ratio (IRR): 1.038, 95% Confidence Interval (CI): 1.029-1.046, p < 0.001) cumulative increase in risk of conjunctivitis over the present and subsequent week. Every 10 µg/m3 increase in PM10 was associated with a 2.9% (Incidence Rate Ratio (IRR): 1.029, 95% Confidence Interval (CI): 1.022-1.036, p < 0.001) cumulative increase in risk of conjunctivitis over the present and subsequent week. Acute conjunctivitis reports exhibited an inverse dependence on ambient air temperature and relative humidity variability. Approximately 3% of all acute conjunctivitis reports were attributable to PM2.5. Particulate matter attributed acute conjunctivitis was disproportionately higher during transboundary haze episodes. CONCLUSION: Our study strengthens the evidence linking particulate matter exposure to an increased risk of conjunctival disease, with a disproportionately higher disease burden during South-East Asia transboundary haze episodes. Our findings underscore the importance of reducing the health impact of indigenous and transboundary sources of ambient particulate matter pollution.

Onodi sinusitis presenting with orbital apex syndrome.

This article reports the unusual presentation of a patient with an intraconal abscess secondary to sinusitis in an onodi cell in a healthy 63 year old Chinese female. She presented with limited extraocular movements, decreased corneal sensation, rapid drop in visual acuity and signs of optic neuropathy, in the absence of any inflammatory signs in the right eye. MRI scans showed a well-encapsulated mass in the posterior two thirds of the orbit, with the presence of an onodi cell on the right side. She underwent an extended lateral orbitotomy, which revealed frank pus that was positive for Staphylococcus aureus. She was treated with intravenous antibiotics with complete resolution of her presenting signs.

Rationale and design of a randomized trial of early intensive blood pressure lowering on cerebral perfusion parameters in thrombolysed acute ischemic stroke patients.

BACKGROUND AND RATIONALE: Uncertainty persists over the optimal management of blood pressure (BP) in the early phase of acute ischemic stroke (AIS). This study aims to determine the safety and effects of intensive BP lowering on cerebral blood flow (CBF) and functional in AIS patients treated with intravenous thrombolysis. METHODS: In a randomized controlled trial, 54 thrombolysed AIS patients with a systolic BP of 160 to 180 mm Hg will be randomized to early intensive BP lowering (systolic target range 140-160 mm Hg) or guideline-based BP management (systolic range 160-180 mm Hg) during first 72-hours using primarily intravenous labetalol. We hypothesize that early intensive BP lowering will not reduce CBF by 20% and/or increase the volume of hypoperfused tissue by >20% on computed tomographic perfusion. Clinical outcome will be assessed using a dichotomized modified Rankin scale (scores 0-1 as excellent outcome vs scores 2-6 as dead or dependent) at 90 days. Other outcome would be symptomatic intracerebral hemorrhage. The trial is registered at ClinicalTrials.gov, NCT03443596. CONCLUSION: This randomized study will provide important information about the physiological effects of BP reduction on cerebral perfusion after intravenous thrombolysis in AIS.

Enhanced Visualization of Myopic Macular Changes with Three-Dimensional OCT.

This observational case series presents three eyes of three myopic patients to illustrate the pathomorphologic features of the myopic macular changes using three-dimensional optical coherence tomography (OCT). The OCT system records the interferometric information using a Fourier-domain spectrometer method, with an acquisition rate of 20,000 axial scans/second, an axial resolution of 5 mum, and a lateral resolution of 20 mum. Three-dimensional images of the macular pathology and corresponding simultaneous acquisition of OCT fundus photographs were obtained for all patients. Three-dimensional OCT imaging using the Fourier-domain system has enabled unprecedented precise views of macular pathology, facilitating understanding and visualization of the pathology of macular diseases. This multidimensional view of retina structures will aid in early detection and monitoring of disease progression in the future.

Comparison of prevalence of dengue maculopathy during two epidemics with differing predominant serotypes.

PURPOSE: To compare the prevalence of dengue maculopathy among patients hospitalized for dengue fever during a 2007 epidemic with its prevalence during the 2005 epidemic. DESIGN: Cross-sectional observational study of consecutive patients hospitalized in two general hospitals with dengue fever during the dengue epidemic. METHODS: A standard questionnaire on ocular history and symptoms was completed by all patients. Their near and distance vision, Amsler grid test results, and dilated fundal findings were recorded. Biochemical tests included dengue immunoglobulin M results, serum complement 3 level, platelet count, hematocrit, and transaminase levels. The main outcome measure was presence of dengue maculopathy. Risk factors were compared with the data from a 2005 study group. Dengue serotype results were obtained from population sampling. RESULTS: None of 87 patients who had positive results for dengue immunoglobulin M in the 2007 study group had maculopathy, whereas it was seen in 10% of the 2005 group (P = .002). The patients in the 2005 study group were younger and were more likely to have high transaminase levels. In 2005, the predominant serotype was type 1, and in 2007 it was type 2. CONCLUSIONS: The prevalence of dengue maculopathy, age of clinical disease, and extent of liver damage differs between epidemics with different predominant serotypes.

Orthokeratology-related infectious keratitis: a case series.

PURPOSE: To describe five patients who developed infectious keratitis after the use of overnight orthokeratology contact lenses. METHODS: Retrospective case report of five patients with infectious keratitis seen in Singapore National Eye Centre between 2001 and 2006. RESULTS: Five children between the ages of 9 and 14 years, who wore their lenses for an average of 1.5 months before developing orthokeratology-related infectious keratitis, were seen and treated at the Singapore National Eye Centre. All five patients had cultures that were positive for Pseudomonas aeruginosa. They were treated with fortified cefazolin (50 mg/mL) and gentamicin (14 mg/mL) and responded well, with resolution of the infectious keratitis. Although most patients had a best-corrected visual acuity of 20/40 or better after the resolution of the acute infection, they all showed a central or paracentral residual scar. CONCLUSIONS: Because of the safety issues involved, orthokeratology should be used with caution in children.