We report a case of a 76-year old Filipino male from the province of Porac, Pampanga who presented with pain, redness, and blurring of vision of the right eye (oculus dexter, OD) on 25 February 2009. One and a half weeks prior to consultation, patient complained of right eye discharge and lid swelling. The patient consulted an ophthalmologist and was given unrecalled topical eye medications. There was no improvement from the symptoms and patient complained of worsening pain and redness in the right eye. The patient was a non-contact lens wearer and he denied any trauma to the right eye. However, he admitted to washing both eyes with tap water. Visual acuity in the right eye was counting fingers at 3 feet. Slit lamp examination showed diffuse conjunctival injection. There was note of a ring-like infiltrate in the cornea almost extending to the limbus. There was also note of significant anterior chamber cells reaction and hypopyon. Primary working impression was Acanthamoeba keratitis (AK), OD. Corneal scraping was done and sent to the St. Luke's Research and Biotechnology for detection and identification of the infectious agent. Morphological detection was done by allowing the organism from the scraping to grow in 1.5% non-nutrient agar plate with heat-killed E. coli. Trophozoites with acanthopodia and double-walled cysts characteristic of Acanthamoeba were observed within the first and second week of observations, respectively. Molecular identification of the amoebae at the genus level based on the presence of Acanthamoeba-specific amplimer S1, ASA. S1 (a partial 18S ribosomal DNA gene) confirmed the morphological identification (band at 461-bp). Genotyping through sequence revealed that the organism belonged to T4, which is the genotype commonly present from the eye of keratitis patients.

We report the case of a 76-year old Filipino male who presented with pain, redness, and blurring of vision of the right eye. Corneal scraping was done and sent to the St. Luke’s Research and Biotechnology Group for detection and identification of the infectious agent. Morphological detection was performed by allowing the organism from the scraping to grow in 1.5% non-nutrient agar plate with heat-killed E. coli. Trophozoites with acanthopodia and double-walled cysts characteristic of Acanthamoeba were observed within the first and second week of observations, respectively. Molecular identification of the amoebae at the genus level based on the presence of Acanthamoeba-specific amplimer S1, ASA.S1 confirmed the morphological identification. Genotyping through sequence revealed that the organism belonged to T4, which is the genotype commonly present in the eye of keratitis patients.

OBJECTIVE: To determine the efficacy of fibrin glue derived from a single human donor for sealing induced penetrating corneal wounds on cadaveric porcine eyes compared to conventional suturing.

METHODS: Forty (40) porcine eyes were randomized into two groups. In the experimental group, the corneal incisions were sealed using fibrin glue prepared from a single human donor. Eyes in the control group were sealed using two interrupted nylon 10-0 sutures. Baseline intraocular pressures were obtained and an anterior chamber maintainer connected to the Centurion Vision System was inserted through a side port. A 3 mm metal keratome was used to create a uniform, central, full-thickness straight incision in all eyes. After making the incision, the presence or absence of leakage was determined using Seidel's test. The eyes were then sealed according to the group they were randomized in. The intraocular pressure (IOP) was gradually increased using the Centurion Vision System to determine the leakage pressure of all sealed eyes in both groups.

RESULTS: The mean baseline IOP was comparable between the two groups (control group = 21.15 + 1.66 mmHg; experimental group = 21.65 + 1.81, p value = 0.299). All eyes in the control group, showed no leakage immediately after sealing the corneal wounds with sutures. One out of twenty eyes in the experimental group was positive for leakage after application of the fibrin glue (p value = 0.5). The mean leakage pressure was significantly higher for the suture group at 90.25 + 14.9 mmHg compared to the fibrin glue group at 32.30 + 7.6 mmHg (p value = <0.001).

CONCLUSION: Fibrin glue prepared from a single donor is comparable to two nylon 10-0 sutures in sealing 3 mm corneal penetrating wounds at IOP of up to 32 mmHg. For higher IOP, nylon 10-0 suture is more effective than fibrin glue in sealing the corneal penetrating wounds in cadaveric porcine eyes. 

Human ; Male ; Female ; Swine ; Fibrin Tissue Adhesive ; Intraocular Pressure ; Nylons ; Sutures ; Corneal Injuries ; Cornea ; Suture Techniques ; Anterior Chamber ; Wounds, Penetrating ; Metals

Objective: To compare the efficacy, safety, predictability, stability, contrast sensitivity, and higher-order aberration (HOA) of patients who had femtosecond lenticule extraction (FLEx) and femtosecond laser in-situ keratomeleusis (LASIK) for the correction of moderate myopia and astigmatism. Method: A retrospective review of charts was conducted at the Vision Laser Center of the St. Luke’s Medical Center-Global City. All patients that underwent FLEx from November 2011 to June 2012, with adequate follow-up, were included in the study. Age-matched and refraction-matched patients, who underwent femtosecond LASIK in the same review period, were chosen as comparators. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BCVA), attempted refraction versus achieved refraction, contrast sensitivity, HOA, and adverse events were compared preoperatively and one-day, one-week, one-month, and three-month postoperatively in both groups. Results: Twenty-six eyes of 13 patients who underwent FLEx and 22 eyes of 11 patients who underwent femtoLASIK were included in the study. The preoperative mean spherical equivalent were -4.61 ± 1.17 D (range -2.50 D to -6.75 D) and -5.30 ± 1.14 D (range -2.63 to -6.88) for the FLEx and the femto-LASIK groups respectively. At 1-day postoperatively, 12% and 100% achieved UCVA of 20/30 or better in the FLEx and femto-LASIK groups respectively. At 3 months follow-up, 96% achieved UCVA of 20/32 or better in the FLEx group and 3% lost >2 lines and 23% lost 1 line of BCVA. None in the femto-LASIK group lost any line of BCVA. Mean spherical equivalent after 3 months was +0.06 ±0.21 D in the FLEx and -0.44 ±0.35 D in the femto-LASIK groups (p<0.001). HOA, analyzed as root mean square (RMS), were similar preoperatively and postoperatively in both groups. Contrast sensitivity increased postoperatively in the lower spatial frequencies for both groups but were similar in the higher spatial frequencies. No adverse events were noted in either group. Conclusion FLEx was comparable to femtosecond LASIK in terms of visual outcomes in the treatment of moderate myopia and astigmatism. The FLEx group showed better accuracy and stability within the three-month follow-up period. However, delayed visual improvement and loss of BCVA were noted.
Keratomileusis, Laser In Situ ; Myopia ; Astigmatism

OBJECTIVE: To compare the efficacy, refractive predictability, stability and safety of Small Incision Lenticule Extraction (SMILE) and Femtosecond Laser In-Situ Keratomileusis (F-LASIK) for the correction of myopia and astigmatism.

METHOD: This study was approved by the Institutional Review Committee of the St. Luke's Medical Center. A retrospective chart review was conducted at the Vision Laser Center of the St. Luke's Medical Center-Global City. All patients that underwent SMILE from January 2014 to July 2014, with adequate follow-up at 1 day, 1 week, 1 month, 3 months and 1 year, were included in the study. Age-matched and refraction-matched patients, who underwent F-LASIK from January 2012 to April 2014, were chosen as comparators. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), attempted refraction versus achieved refraction and adverse events at 1 day, 1 week, 1 month, 3 months and 1 year were compared postoperatively in both groups. Primary outcome measures were efficacy expressed as the percentage of eyes achieving UCVA of 20/25 or better during the postoperative follow-up, refractive predictability, safety and stability. 

RESULTS: Thirty-five eyes of 18 patients who underwent SMILE and 38 eyes of 19 patients who underwent FLASIK were included in the study. The mean preoperative spherical equivalent of both groups had no statistical difference, with -3.84 ± 1.31 D and -4.07 ± 1.39 D for SMILE and F-LASIK, respectively (p=0.801). At 1 week postoperatively, 51% and 97% achieved UCVA of 20/25 or better in the SMILE and F-LASIK groups. At 3 months, 97% had 20/25 vision or better for the SMILE group, while 100% had 20/25 vision or better for the F-LASIK group. At 1 year, both groups achieved 100% 20/25 or better vision. Three percent lost one line of BCVA in both groups at 1 year. Mean spherical equivalent (SE) between groups at 1 year showed no statistically significant difference (p=0.21), with 0.05 ± 0.18 D in the SMILE group and -0.1 ± 0.15 D in the F-LASIK group. No significant change in mean SE was observed within groups from 1 day to 1 year post op, p=0.166 for SMILE and p=0.226 for F-LASIK. At 1 year, 100% of the SMILE and F-LASIK groups were within ± 0.5 D of target refraction. No adverse events were noted in either group. 

CONCLUSION: SMILE was comparable to F-LASIK in terms of visual outcomes (efficacy, refractive predictability, stability) and safety for the treatment of myopia and astigmatism. However, a slight delay in visual improvement during the first week was observed in the SMILE group.

Human ; Male ; Female ; Adult ; Keratomileusis, Laser In Situ ; Astigmatism ; Eyeglasses ; Advisory Committees ; Myopia ; Visual Acuity ; Eye ; Outcome Assessment (health Care)