EXCIMER laser vision correction in the form of LASIK and PRK/LASEK has been proved to be highly effective and safe in the treatment of low-to moderate myopia (less than -6 diopters [D]) and astigmatism. It is the most common refractive-surgery procedure done worldwide. However, the outcome of laser vision correction among those with high myopia (greater than -6D) may not be the same as in those with low to moderate myopia CLINICAL SCENARIO: A 26-year-old, female, myopic patient unhappy with spectacle correction and contact lenses heard about LASIK and sought opinion regarding the probability of her achieving 20/20 vision. Her last refraction was -7.00 sphere -1.00 cylinder x 100 in the right eye (OD) and -9.00 sphere -0.50 cylinder x 90 in the left eye (OS). Best-corrected visual acuity (BCVA) was 20/20 OD and 20/20 OS. Her refraction has been stable for 5 years CLINICAL QUESTION: The patient has high myopia and is concerned about her chances of seeing 20/20 after undergoing laser vision correction. Among patients with high myopia, how effective is LASIK in achieving 20/20 vision? SEARCH METHOD: An electronic literature search was performed using MEDLINE (PubMed). The following search terms were used: "Myopia," "LASIK," "laser in situ keratomileusis," "technology assessment." The search was further limited to the English language and human studies published from 1968 to April 2005. The search yielded 5 articles but only one was relevant to the clinical question CITATION: Sugar A, Rapuano CJ, Culbertson WW, et al. Laser in situ keratomileusis for myopia and astigmatism: safety and efficacy. A Report by the American Academy of Ophthalmology. Ophthalmology 2002; 109:175-187. (Author)
LASER SURGERY, KERATOMILENSIS, LASER IN SITU, KERATECTOMY, LASER

OBJECTIVES: To describe a rare case of bilateral stromal keratitis and demonstrate the effectiveness of penetrating keratoplasty in the management of toxocara keratitis. METHOD: This is a case report. RESULTS: A 53-year-old male farmer had a 10-month history of bilateral corneal opacity, photophobia, redness, foreign body sensation, and eye pain. The diagnosis was central microbial keratitis with the following etiologies considered: Epstein-Barr virus, herpes simplex, fungal, syphilis, tuberculosis (TB), myobacteria other than TB, and acanthamoeba. Despite treatment with topical steroids and antibiotics, both eyes worsened. Penetrating keratoplasty markedly improved the patient's visual acuity. Histopathology of the left corneal button revealed toxocara keratitis. CONCLUSION: Good history taking, complete systemic and ocular examinations, and a histopathology of the corneal tissues are vital to the diagnosis of toxocara keratitis. Penetrating keratoplasty was shown to be effective in its management. Emphasis is given on prevention to decrease the incidence of the disease.
Human ; Male ; Middle Aged ; KERATITIS ; CORNEAL TRANSPLANTATION ; CASE REPORTS

Purpose: To compare the efficacy of carbomer alone and carbomer with triglyceride in relieving ocular discomfort and improving ocular-surface condition and tear-film stability in patients with dysfunctional-tear syndrome. Methods: We conducted an institution-based, double masked, randomized, controlled trial involving 45 patients (90 eyes) diagnosed with dysfunctional-tear syndrome who were randomly assigned to receive either carbomer alone (Vidisic) or carbomer with triglyceride (Lipolin) eye gels. Corneal and conjunctival staining with fluorescein and lissamine green, tear-breakup time (TBUT), Schirmer test with anesthesia, and subjective gradings of ocular discomfort were measured at baseline and at 1, 2,4, and 8 weeks after treatment. Outcome measures from both groups were subjected to statistical analyses. Results: Fifteen patients in the Vidisic group and 20 patients in the Lipolin group completed the study. The mean age was 53 +/- 12 years (range, 21 to 71). Both groups exhibited significant improvement from baseline in conjunctival lissamine green staining (p=0.001), TBUT (p=0.001), and subjective improvement of symptoms (/> = 0.001) after 8 weeks of treatment. The decrease in conjunctival staining by lissamine green and improvement in Schirmer test were significantly greater for Vidisic (p=0.03 for both). Conjunctival fluorescein staining worsened in the Lipolin group (p=0.02). Corneal fluorescein (p=0.25) and lissamine green (p=0.08) staining, and Schirmer test (p=0.28) were not significantly different for both groups. Conclusion: Vidisic and Lipolin are both well tolerated and effective in reducing dry-eye symptoms, improving ocular-surface integrity, and stabilizing the tear film. There is a trend toward better treatment response with Vidisic.
Human ; Adult ; DRY EYE SYNDROMES ; TRIGLYCERIDES ; LACRIMAL APPARATUS DISEASES ; EYE DISEASES

Methods: This is a report of a case of cryptophthalmos seen at the University of the Philippines-Philippine General Hospital (UP-PGH). Differential diagnosis and management options are discussed. Results: A 12-day old boy presented with no right palpebral fissure, eyelashes, or eyebrow. The skin overlying the right orbit was continuous from the forehead to the cheek. Under this skin was a 17 mm x 15 mm soft, round, movable mass anterior to the globe. The left upper lid was colobomatous with no eyebrow and fornix. The left cornea measured 9 mm x 6 mm with exposure keratitis and large ulcer. Ultrasound of the right orbit identified the presence of the right globe with normal posterior segment. Cranial computed tomography (CT) showed a cystic mass anterior to the right globe with absent lens. Visual-evoked response of the left eye established nonspecific severe optic-nerve damage, delayed visual-pathway maturation and visual-pathway affectation. Conclusion: Management of complete cryptophthalmos is difficult and requires separation of the lids and placement of mucous membrane grafts to allow for fitting of prosthesis. Reconstruction of the lid coloboma is necessary to prevent exposure keratitis. Genetic counseling is also important in the management of cryptophthalmos.
Human ; Male ; Child ; FRASER SYNDROME ; COLOBOMA ;

This study is proposed as an alternative method of sterilization in developing countries Purpose: To determine the efficacy of using a commercially available convection broiler in sterilization of ophthalmic surgical instruments Methods: Surgical ophthalmic instruments were contaminated artificially with Staphylococcus epidermidis, Pseudomonas aeruginosa, and Aspergillus. The instruments were subjected to heat sterilization using the convection broiler at different temperature settings. After which, the instruments were cultured with appropriate media to determine contamination Results: 15 minutes heat sterilization at 260 degrees centigrade was enough to sterilize the contaminated ophthalmic surgical instruments Conclusion: Heat sterilization using a convection broiler provide a cheaper yet effective method of sterilization. (Author)
Human ; STERILIZATION, INFECTION CONTROL

CLINICAL SCENARIO: A 46-year-old male consulted for refraction. Best-corrected visual acuity was 20/20 for both eyes (OU), Jaeger 1 for near. Slit-lamp examination was normal. Intraocular pressure (IOP) was 25 mm Hg OU. Gonioscopy revealed iridocorneal angles that were open up to the ciliary body band OU. Funduscopy revealed clear media with no exudates or hemorrhages in the retina. Cup-disc ratio was 0.7 vertically and 0.6 horizontally with notching of the inferotemporal neuroretinal rim OU. Automated visual-field examination showed superior arcuate scotomas OU with no threat to fixation. The working diagnosis upon consultation was primary open-angle glaucoma. After all treatment options had been explained to the patient, a trial of medical therapy was chosen. Given the severity of the glaucoma, a target IOP range was initially set at 15 to 17 mm Hg. Nonselective beta-adrenergic blockers and prostaglandin analogues are two classes of medications that will most probably lower the IOP to the desired levels CLINICAL QUESTION: Among patients undergoing initial medical therapy for primary open-angle glaucoma, would latanoprost be more effective in lowering the IOP compared with timolol? SEARCH METHOD: An electronic literature search was performed using Medline (PubMed). The key words used were "latanoprost" and "timolol." The search was further limited to randomized clinical trials or metaanalysis published in the English language. Table 1 shows the search process performed The search was narrowed down to 5 articles. Abstracts of the articles were reviewed. One article employed ocular hypertensive subjects while another compared brimonidine and timolol. These studies were, therefore, excluded. Among all the metaanalyses obtained from the search, Zhang et al.s had the most number of subjects and outcome measures. It was for this reason that the article was chosen for appraisal in resolving the clinical scenario. (Author)
TIMOLOL

Human ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; EYE INJURIES ; EYE INJURIES, PENETRATING ; PENETRATING EYE INJURIES

Objectives: This is a study to determine the relative wound strength of a commercial fibrin tissue adhesive (Beriplast P, Aventis Behring) compared to 10-0 nylon sutures in sealing experimentally induced corneal perforations in cadaver porcine eyes. Methodology: Single Blind Completely Randomized Design. Sixty freshly enucleatedporcine eyes with an average corneal diameter of 11.5 mm were used. These were randomly allocated into the 3.2 mm perforation group (n = 30) and the 5.2 mm perforation group (n = 30). All perforations were made perpendicular to the corneal surface with a standard preset metal keratome at the central portion of the cornea. Fifteen corneal perforations in each group were again randomly sealed with either interrupted nylon 10-0 sutures or Beriplast P (65-115 mg/mL). Intraocular pressure was raised by injecting normal saline into the anterior chamber and determined by a manometer attached to it. The presealing and postsealing leaking pressures were recorded. Wound leak was determined by Seidels test Results: The mean leaking pressure of the 3.2 mm group sealed with nylon suture was 237.47 mm Hg and 237.33 mm Hg for those sealed with fibrin tissue adhesive. The mean leaking pressures of the 5.2-mm group was 1984 mm Hg for both sealing techniques. The difference in leakingpressures of both sealing techniques was not significant using a power of 80 percent to detect a difference of 30 mm Hg Conclusion: The wound strength of corneal perforations sealed with fibrin tissue adhesive, as measured by the leaking pressures, is comparable to that of those sealed with nylon 10-0 sutures in cadaveric porcine eyes. (Author)
WOUND HEALING ; CORNEAL PERFORATION ; FIBRIN TISSUE ADHESIVE/ADVERSE EFFECT ; CADAVER ; NYLONS ; NYLONS/ADVERSE EFFECT ; NYLONS/CLASSIFICATION ; SUTURES/ADVERSE EFFECT ; EYES

Objective: The objectives of this study were to develop a cross-culturally adapted, Filipino version of the Ocular Surface Disease Index (OSDI) questionnaire and to assess its reliability. Methods: A Filipino-adapted version of the OSDI was developed following guidelines for language-specific questionnaires: forward translation into Filipino by 2 independent bilingual translators, back-translation into English by a language institution, and a final forward translation to Filipino resolved by a review committee. To check for equivalence, the English and Filipino versions of the OSDI were pretested on 16 patients in a dry eye clinic. The Filipino version was then administered to 36 participants, and a Cronbach alpha coefficient for reliability of the overall instrument and the alpha that would result if each item were removed were computed. Finally, the questionnaire was then retested on 11 dry eye patients to see if the coefficient would increase. Results: All reported no difficulty with the Filipino questionnaire, with 81.3% expressing preference in answering it. Most (81.3%) chose the same answer in at least half of the items in both languages, though the range of similar responses varied from 41.7% to 91.7%. Reliability testing of the Filipino questionnaire showed this to have fair internal consistency (α=0.5958). The value increased to moderate internal consistency (0.7576) when 3 items were removed. Conclusion A culturally-adapted OSDI in Filipino was successfully produced and was the preferred tool by most patient participants.
Dry Eye Syndromes