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Biomedical subjects

A Jap

Publications and source records attributed to A Jap.

12 recordsLinked to original sources
PubMed2006

Correlation between peripapillary atrophy and corticosteroid therapy in patients with Vogt-Koyanagi-Harada disease.

AIMS: To determine the correlation between systemic corticosteroid therapy and the occurrence and size of peripapillary atrophy (PPA) in patients with Vogt-Koyanagi-Harada (VKH) disease. METHODS: All patients with VKH disease were retrospectively reviewed for their corticosteroid regimen. The extent of the PPA, if present, was measured using digitized imaging software, by two masked observers. Eyes with myopia greater than 6 dioptres or glaucoma were excluded. The patients were classified into three groups: early high (EH), late high (LH), and low dose (LD), according to the dose and timing of corticosteroids received during the acute phase of the disease. RESULTS: There were 40 eyes in the EH group, 25 eyes in the LH group, and 23 eyes in the LD group. Multivariate analysis showed that corticosteroid therapy was the main determinant of PPA occurrence. All the eyes in the LD group had PPA and eyes in the LH groups were 4.02 times (95% confidence interval 1.24-13.07) more likely to develop PPA than those in the EH group. The LD group also had larger PPA to disc ratios than the EH group. (Mean of 2.83 vs0.19, P<0.001). CONCLUSION: The development and extent of PPA in patients with VKH disease appear to be dependent on the dose and timing of systemic corticosteroids.

Adult↗
PubMed2001

Is Posner Schlossman syndrome benign?

PURPOSE: To determine the clinical course of patients with Posner Schlossman syndrome (PSS). DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Fifty-three eyes of 50 patients. METHODS: The case notes of all patients with PSS seen at the Uveitis Clinic of Singapore National Eye Centre were reviewed for evidence of glaucoma damage and risk factors. MAIN OUTCOME MEASURES: Visual field and optic disc changes consistent with glaucoma. RESULTS: There were 28 men and 22 women, and their mean age at onset was 35 years. Fourteen eyes (26.4%) were diagnosed to have developed glaucoma as a result of repeated attacks of PSS. Patients with 10 years or more of PSS have a 2.8 times higher risk (95% confidence interval 1.19-6.52) of developing glaucoma compared with patients with less than 10 years duration of the disease. Nine eyes (17%) underwent glaucoma filtering surgery with antimetabolites. Their postoperative follow-up ranged from 15 to 50 months (mean, 37 months). Four eyes continued to have episodes of iritis after surgery, and one of these eyes had elevated intraocular pressure during the event. CONCLUSIONS: A significant number of patients with PSS have glaucoma develop over time, and they need to have their optic disc appearance and visual fields carefully monitored.

Adolescent↗
PubMed2001

Endogenous endophthalmitis.

Endogenous endophthalmitis still presents a diagnostic and therapeutic challenge even with improvements in therapeutic modalities. The main prognostic factor is the virulence of the causative organism: once the organism enters the eye, it rapidly destroys ocular tissues. With the increasing ability to prolong the life of very ill patients, incidence of endogenous endophthalmitis is expected to increase. Ophthalmologists must be ever more vigilant, because prompt treatment offers the best chance of saving the eye.

Endophthalmitis↗
PubMed2000

Capsular block syndrome: A case series.

Capsular block syndrome (CBS) or capsular bag distension syndrome has been described after cataract removal with in-the-bag placement of a posterior chamber intraocular lens in the presence of an anterior continuous curvilinear capsulorhexis. Features of CBS include shallowing of the anterior chamber and an unexpected myopic overrefraction; occasionally, there is a persistent uveitis. The patient may be mistakenly diagnosed with pupil block glaucoma or endophthalmitis. We report 9 cases of CBS and their initial diagnoses and management. In 1 case, the capsular bag distention and anterior chamber shallowing are illustrated by ultrasound biomicroscopy.

Adult↗
PubMed1999

Conjunctival rotation autograft for pterygium. An alternative to conjunctival autografting.

OBJECTIVE: To determine the safety and efficacy of conjunctival rotation autografting (CRA) as an alternative to conventional conjunctival autograft after pterygium excision. DESIGN: Prospective noncomparative case series. PARTICIPANTS: Consecutive patients seen at the Pterygium Clinic of the Singapore National Eye Centre who were thought to be unsuitable for conventional conjunctival autografting underwent a modified surgical procedure, which the authors describe as CRA. There were 51 rotation autografts performed on 45 eyes of 43 patients. INTERVENTION: In this procedure, the underlying fibrovascular pterygium tissue was removed and the original epithelium (with minimal subepithelial tissue included) replaced over the bare sclera with a 180 degrees rotation. Surgeries were performed by one surgeon (DT) from April 1995 to May 1996. MAIN OUTCOME MEASURE: Pterygium recurrence and complications of CRA were measured. RESULTS: The mean follow-up time was 12 months (range, 2-22 months). There were 46 primary and 5 recurrent pterygia. The indications for CRA were combined cataract and pterygium surgery (39.2%), double pterygia (31.4%), the need to preserve the superior conjunctiva (21.6%), and superior conjunctival scarring (7.8%). There were two recurrences (4% recurrence rate), one occurring at 4 months and the other occurring at 7 months after surgery. No significant complications were encountered. However, 50% of the grafts remained mildly injected for more than 3 months, and some remained injected for up to 13 months after surgery (average of 4 months). Pigmentary changes were also noted in six grafts (12%). CONCLUSION: Conjunctival rotation autografting is a useful technique of conjunctival grafting in cases in which it is not possible or desirable to use the superior conjunctiva as a donor source.

Adult↗
PubMed1998

Test-retest variability of blue-on-yellow perimetry is greater than white-on-white perimetry in normal subjects.

PURPOSE: To compare long-term fluctuation of blue-on-yellow automated perimetry with white-on-white automated perimetry in normal subjects. METHODS: White-on-white and blue-on-yellow automated perimetry were performed on a Humphrey Visual Field Analyzer and an Octopus perimeter, both modified for blue-on-yellow perimetry. The study sample consisted of 31 eyes of 31 normal subjects for the Humphrey perimeter and 33 eyes of 33 normal subjects for the Octopus perimeter. After one practice session, each subject completed four testing sessions over a period of 2 to 8 weeks, each separated by at least 1 day. Each testing session consisted of both white-on-white and blue-on-yellow perimetry performed on one eye; the order of the tests was alternated for successive sessions. Long-term fluctuation (expressed as statistical variance) was calculated for each test location. Intersubject variability (expressed as statistical variance) across all subjects was determined for each test location. RESULTS: On the Humphrey perimeter, the long term fluctuation for blue-on-yellow perimetry (4.07 +/- 3.07 dB2) was significantly greater than that for white-on-white perimetry (1.97 +/- 0.99 dB2; P < .001). Long-term fluctuation increased as a function of eccentricity for both blue-on-yellow and white-on-white perimetry. Short-term fluctuation was significantly greater for blue-on-yellow (0.46 +/- 0.25 dB) than that for white-on-white perimetry (0.29 +/- 0.19 dB; P < .02). Finally, the intersubject variability was significantly greater in blue-on-yellow (13.2 +/- 2.8 dB2) than it was in white-on-white perimetry (4.25 +/- 1.13 dB2; P < .001). Similar results were found with the Octopus perimeter. CONCLUSIONS: Long-term fluctuation and short-term fluctuation of blue-on-yellow perimetry are greater than those of white-on-white perimetry in normal subjects. The increased long-term fluctuation requires appropriate statistical approaches when evaluating serial change of blue-on-yellow perimetry.

Adult↗
PubMed1997

Incidence of acute primary angle-closure glaucoma in Singapore. An island-wide survey.

OBJECTIVES: To determine the incidence of acute primary angle-closure glaucoma (APACG) in Singapore and to identify demographic and meteorological risk factors. DESIGN: A prospective, island-wide incidence study. SETTING: All government and private ophthalmological practices in Singapore, from March 1, 1995, to February 29, 1996. METHODS: New cases of APACG were identified by all ophthalmologists in Singapore during a 1-year period. Demographic and clinical details were recorded. RESULTS: One hundred eighty-nine people (208 eyes) were seen with APACG for the first time during the 1-year period. These new cases represent an incidence of 12.2 per 100,000 per year (95% confidence interval, 10.5-13.9) in those aged 30 years and older. Major risk factors identified were female sex (relative risk, 2.4), Chinese ethnic origin (relative risk, 2.8), and age of 60 years or older (relative risk, 9.1). Half of those affected were seen 3 days or more after the onset of symptoms. Attacks were more frequent on hotter days. There also was a relationship between the number of attacks per day and the mean number of sunspots and mean solar radio flux during the previous 30 days. CONCLUSIONS: There is a high incidence of APACG in Singapore, with elderly women being the highest risk group. Chinese Singaporeans are at higher risk than other ethnic groups (Malay and Indian). There is often a substantial delay before these patients consult a physician. The onset of APACG seems to be associated with meteorological factors.

Acute Disease↗
PubMed1996

Cataract surgery after trabeculectomy.

BACKGROUND AND OBJECTIVE: To determine the effect of cataract surgery on glaucomatous eyes with good intraocular pressure (IOP) control after trabeculectomy. PATIENTS AND METHODS: Twenty-two eyes with functional blebs that underwent cataract extraction were retrospectively analyzed. RESULTS: The mean (+/- SD) preoperative IOP was 11.0 +/- 4.3 mm Hg. The mean (+/- SD) postoperative IOPs at 1, 2, 6, and 9 months were 15.5 +/- 4.9, 12.6 +/- 4.7, 14.6 +/- 5.6, and 19.0 +/- 7.9 mm Hg, respectively. At each interval except for the second month, the mean IOP was statistically significantly higher than the preoperative value (P = .0003, .24, .02, and .0009, respectively). The total number of medications was also higher (3 preoperatively versus 27 postoperatively). The interval between the two surgeries had no influence on IOP control. Intraoperative complications during cataract surgery, particularly vitreous loss, were associated with poor IOP control. Phacoemulsification had less of an effect on the postoperative IOP control than did extracapsular cataract extraction. CONCLUSIONS: Eyes with previous successful trabeculectomies had higher IOPs and required more medications after subsequent cataract surgeries.

Aged↗
PubMed1995

Mass screening for diabetic retinopathy--a report on diabetic retinal screening in primary care clinics in Singapore.

INTRODUCTION: Mass screening for diabetic retinopathy is expensive and inaccessible if done by institutional ophthalmalogists. Most diabetics are seen in primary care. Hence it is logical to provide mass screening in primary care clinics. In Singapore, government polyclinics are ideal centres of screening as they are well organised and accessible to the community. SCREENING METHOD: An effective mass screening strategy must provide wide coverage, be low cost and have the ability to assess diabetic eyes accurately and quickly. Non-mydriatic fundal photography was used as the screening method. Mass coverage was achieved by rotating two cameras around six government polyclinics. Cost was reduced by training existing staff and organising the programme to provide a high turnover of screenees. The photographs were read by ophthalmologists in a government-owned hospital. Patients that required referral were referred to specialist eye clinics. RESULTS: A total of 13,296 patients were screened or rescreened during a period of 2 years (25 months). 2,911 patients or 21.8% of the total screened were found to have diabetic retinopathy. About half of these (10.8%) had sight threatening retinopathy. The most common sight threatening retinopathy was maculopathy (8.0%). Twenty-two percent of cases screened were referred. These include referral for other ocular conditions detected during the screening. CONCLUSION: Non-mydriatic fundal photography has proven to be both accessible and effective in screening diabetic eyes in urban Singapore and can be recommended for mass screening of diabetic eyes in the community.

Adult↗
PubMed1994

Contact transscleral cyclophotocoagulation for end stage glaucoma.

Contact transscleral cyclophotocoagulation is a form of cyclodestructive procedure, which is effective in the lowering of intraocular pressure in eyes with refractory glaucoma by destroying the aqueous humor-producing ciliary processes. Continuous wave Nd:YAG (Neodymium: Yttrium-Aluminium-Garnet) laser is used in the cyclodestruction, the laser energy being delivered to the target tissues transsclerally via a fibre-optic probe. We used the Lasag microruptor III Nd:YAG laser to treat 16 cases of refractory glaucoma to evaluate the effectiveness of laser in pain relief and intraocular pressure control. The mean preoperative intraocular pressure of 48.3 +/- 9.3 mm Hg decreased to 30.6 +/- 17.4 mm Hg (p = 0.0001) during an average follow-up of 294.2 +/- 94.2 days (range, 181-465 days). Retreatment was required in eight of 16 eyes (50%). Four eyes (27%) had decreased vision from perception of light to no perception of light. None of the 15 patients developed phthisis bulbi or other serious complications. We conclude that transscleral cyclophotocoagulation is an effective modality of therapy for refractory and end stage glaucoma. The lower than recommended total energy we used in the treatment protocol was associated with lower incidence of complications but also lower success rate and higher retreatment rate.

Adult↗
PubMed1993

Laser iridoplasty in the treatment of severe acute angle closure glaucoma.

Twenty eyes of 19 patients presenting with acute angle closure glaucoma (AACG) which failed to respond to medical treatment were treated with laser iridoplasty. In all 20 eyes, laser peripheral iridectomy (PI) was prevented by a hazy cornea. In all cases, iridoplasty resulted in a rapid and significant reduction in intraocular pressure. Laser iridoplasty appears to have a useful role in the management of medically unresponsive AACG, particularly in those cases where laser peripheral iridotomy (PI) has failed or is not possible to perform.

Acute Disease↗