Phacoemulsification vs phacoemulsification with micro-bypass stent implantation in primary angle closure and primary angle closure glaucoma: A randomized single-masked clinical study.

IMPORTANCE: Primary angle closure glaucoma (PACG) is a major cause of irreversible visual impairment in Asia, but there is no published data on the effect of iStent on these patients. BACKGROUND: To compare the efficacy and safety of combined phacoemulsification and iStent implantation with standard phacoemulsification in an Asian population. DESIGN: A prospective, single-masked, randomized study in a public tertiary eye clinic. PARTICIPANTS: Patients with concomitant visually significant cataracts and primary angle closure (PAC) or PACG. METHODS: Patients were randomized and underwent either phacoemulsification alone (phaco) or with concurrent iStent injection (phaco-iStent). Demographic and clinical data were collected. MAIN OUTCOME MEASURES: Complete and qualified success rates at 12 months were compared between both treatment arms. RESULTS: Thirty-two patients were recruited between September 2015 and February 2016. All patients completed 12 months of follow-up. There was no statistically significant difference in preoperative IOP (phaco, 17.5 ± 3.1 mmHg; phaco-iStent, 18.6 ± 4.7 mmHg, P = .65) and 12-months postoperative IOP (phaco, 15.0 ± 2.5 mmHg; phaco-iStent, 14.7 ± 3.1 mmHg, P = .86) between both groups. Complete success rates were 43.8% (95% CI, 19.8-65.6) for the Phaco group and 87.5% (95% CI, 58.6-96.7) for the Phaco-iStent group (P = .01). Thinner preoperative optical coherence tomography (retinal nerve fibre layer) thickness (hazard ratio [HR] = 7.34 [95% CI, 1.53-35.30]) and phacoemulsification alone (HR = 0.93 [95% CI, 0.87-0.02]) were independent factors associated with failure to achieve complete success. CONCLUSIONS AND RELEVANCE: Combined phacoemulsification with iStent implantation is associated with a higher likelihood of complete success compared with phacoemulsification alone in eyes with primary angle closure disease at 12 months postoperatively. Further studies are required to establish the longer term efficacy of iStent implantation and to identify other predictors for surgical success.

Ocular Toxoplasmosis in Tropical Areas: Analysis and Outcome of 190 Patients from a Multicenter Collaborative Study.

PURPOSE: To describe clinical findings and outcomes for ocular toxoplasmosis in an international multicenter collaborative study. METHODS: Retrospective analysis of 190 patients diagnosed with ocular toxoplasmosis from three study sites (Brazil, India, and Singapore). RESULTS: There were 93 (48.9%) females with a mean age of 32.8 years. The most common symptoms were isolated blurring of vision (36.8%), followed by blurring of vision with floaters (21.1%). Treatment regimens varied largely from monotherapy to multiple combination therapies. Final visual acuity of ≥20/40 was achieved in 106 (74.2%) patients. In a median follow-up period of 31 weeks (range 12-749 weeks), 83/190 (43.7%) patients suffered a relapse. CONCLUSIONS: There appears to be geographical variation in the presentation of ocular toxoplasmosis. Compared to previous studies, we did not observe the '"dual peak" phenomenon of chronic and active disease based on age at presentation, and there was less bilateral and macular involvement (but more peripheral involvement).

Visual Disturbance as the first Symptom of Chronic Myeloid Leukemia.

Chronic myeloid leukemia (CML) is a well-studied entity and advances made in diagnosis and treatment have improved the disease outcome. Patients with ophthalmic manifestation of CML have been reported to have lower 5-year survival rates. Hence, recognizing the early fundus changes may improve outcome by allowing earlier diagnosis and treatment. We report a case of a previously healthy 30-year-old Myanmarese male, who presented with a minor visual disturbance, complaining of seeing a 'black dot' in his left visual field for the past 1 week. Fundoscopic examination revealed bilateral retinal blot hemorrhages, white-centered hemorrhage, and preretinal hemorrhage over the left fovea. The full blood count and peripheral blood film were abnormal, and bone marrow biopsy confirmed the diagnosis of CML. Cytoreduction therapy was promptly commenced and his symptoms resolved, with improvement in visual acuity. No complications were recorded at 1-year follow-up.