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Long-term results of mini-monoka® monocanalicular intubation in the repair of canalicular lacerations

Philippine Journal of Ophthalmology.2018;43(1):19-27.

Objective: To report the epidemiology of canalicular lacerations and surgical outcomes of canalicular laceration repair with Mini-Monoka® (FCI Ophthalmics, Issy-les-Moulineaux, Cedex, France) intubation. Methods: This is a retrospective interventional case series of patients who underwent Mini-Monoka® intubation in the repair of canalicular laceration from 2010 to 2015 at a tertiary state-owned hospital in Manila, Philippines. Patient demographics, surgical outcomes, and complications were analyzed. Results: Fourteen patients (12 males and 2 females) underwent Mini-Monoka® intubation for monocanalicular laceration. The mean age at presentation was 27 years (range, 16-47 years). The mean duration of follow-up was 2.92 years (range, 1.28-6.15 years). Canalicular patency was achieved in 12 out of the 14 patients (86%). None of the 12 patients experienced epiphora following stent removal resulting in a functional success rate of 100%. Two patients had punctal slitting (14%). Premature stent loss occurred in 2 out of the 14 patients (14%). Conclusion Mini-Monoka® intubation is effective in maintaining the long-term anatomical patency of the lacerated canaliculus. It is a simple and minimally invasive procedure making it a safe and reasonable alternative to the traditional methods of canalicular repair.
Lacerations ; Eyelid Diseases

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Ciliary sulcus diameter measurements in normal adult Filipino eyes Using ultrasound biomicroscopy

Barbara Joy Masna-Hidalgo ; Victor B. Lopez ; Maria Elizabeth T. Concepcion ; Santiago A. B. Sibayan

Philippine Journal of Ophthalmology.2018;43(1):34-37.

Objective: To measure the ciliary sulcus diameters (CSD) in phakic eyes of adult Filipinos using ultrasound biomicroscopy (UBM). Methods: This was an observational, cross-sectional study involving Filipino patients recruited from the Outpatient Department of Makati Medical Center, Philippines from September 2006 to December 2006. Vertical and horizontal CSDs in phakic eyes were measured using a UBM Scan 1000 (Ophthalmic Technologies Inc., Toronto, Ontario, Canada). Three repeated measurements of each meridian were taken and averaged. The average CSD for each eye was computed as the average of the horizontal and vertical CSDs. Student’s t-test was used to analyze data. Results: Seventy-one (71) patients (142 eyes) were included in the study. Mean CSD measurements were as follows: horizontal CSD = 9.76 ± 0.42 mm; vertical CSD = 10.00 ± 0.48 mm; average CSD = 9.88 ± 0.47 mm. There was a significant difference between the means of the vertical and horizontal CSD measurements (P<0.01). There was no significant difference in the mean CSD measurements of the right and left eyes (P= 0.50). Conclusions In this cohort of adult Filipino patients, the UBM-measured vertical CSD is significantly greater than the horizontal CSD. Establishment of CSD measurements of adult Filipino eyes may be helpful in selecting appropriately-sized intraocular lenses for ciliary sulcus implantation.
Microscopy, Acoustic

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Ischaemic optic neuropathy in Southeast Asia a different pattern of disease

James F. Cullen

Philippine Journal of Ophthalmology.2018;43(2):40-45.

Ischaemic optic neuropathy (ION) is the commonest adult optic neuropathy encountered in Southeast Asia and will increase in incidence with an ageing population. It occurs in two forms: arteritic and non-arteritic. The latter variety being by far the commoner encountered in the region and presenting as an anterior optic neuropathy with optic disc swelling. The clinical presentation of both varieties is described with particular reference to the hyperaemic disc appearance of the non-arteritic disease as opposed to the ischaemic, pale, swollen, infarcted disc seen in arteritic anterior ION. Essential visual field defects found in both varieties are emphasized; the prognosis and treatment are discussed. Pathological specimens are also illustrated. Posterior ION is briefly mentioned being a diagnosis of exclusion. The anatomy, especially the blood supply of the optic nerve head, is discussed along with its role in the production of the different varieties of ION.
Optic Nerve Diseases ; Pathology

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Comparison of retinal nerve fiber layer thickness in elderly diabetic patients with and without peripheral neuropathy

Bonifacio Buñ ; o II ; Darby Santiago

Philippine Journal of Ophthalmology.2018;43(2):46-50.

Objectives: The primary goal of this study was to determine the relationship between diabetic peripheral neuropathy and retinal nerve fiber layer (RNFL) thickness among elderly Filipinos with type 2 diabetes mellitus. Methodology: This was a cross-sectional study involving 106 subjects aged 60 years or older with type 2 diabetes mellitus recruited from the General Medicine and Diabetes Clinics of a tertiary government hospital. The diagnosis of peripheral neuropathy was made by performing a 10-gram monofilament test. Peripapillary retinal nerve fiber layer thickness was measured using the optic disc cube 200 x 200 protocol of the Cirrus® HD-OCT. T-test was used to compare RNFL thickness in those with and without peripheral neuropathy. The effects of age, sex, duration of diabetes, presence or absence of peripheral neuropathy, and retinopathy status on global and quadrantal RNFL thickness was assessed using multivariate analysis. Results: Compared to subjects without peripheral neuropathy, significant thinning of the superior (P=0.011), inferior (P=0.004), and global (P=0.008) RNFL thickness were observed in subjects with peripheral neuropathy. There were no significant differences in RNFL thickness in the temporal (P=0.211) and nasal (P=0.263) quadrants between the 2 groups. Multivariate regression analysis revealed that presence of peripheral neuropathy has a significant effect on their superior (P=0.036), inferior (P=0.010), and global (P=0.024) RNFL thickness. Other factors such as age, sex, duration of diabetes, and retinopathy had no effect on global and quadrantal RNFL thickness. Conclusion RNFL thinning in the superior, inferior, and global indices on optical coherence tomography has a significant correlation with diabetic peripheral neuropathy
Tomography, Optical Coherence ; Diabetes Mellitus

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Baseline retinal nerve fiber layer thickness and visual outcomes of eyes with ethambutol toxic optic neuropathy

Franz Marie Cruz

Philippine Journal of Ophthalmology.2018;43(2):60-64.

Objectives: To determine the retinal nerve fiber layer thickness (RNFL) in eyes with ethambutol-induced toxic optic neuropathy (ETON) at the time of diagnosis and to describe the visual outcomes at 1, 3, and 6 months after discontinuation of ethambutol Methods: This was a retrospective chart review of 8 patients (15 eyes) diagnosed with ETON that had RNFL thickness measurements using Cirrus® spectral-domain optical coherence tomography (OCT) at the time of diagnosis. Visual function was measured on initial visit and at 1, 3, and 6-month follow-up. Snellen visual acuity was converted to logMAR. Color vision was measured using Ishihara 14-plate test chart. Results: The mean duration from commencement of ethambutol intake to onset of visual symptoms was 16 weeks (range: 8-24). While, the mean duration from onset of visual symptoms to discontinuation of ethambutol was 4 weeks (range: 2-14). The mean global RNFL thickness at time of diagnosis was 101.2 ± 17.0 microns. Mean RNFL in the temporal, superior, nasal, and inferior sectors were as follows: 79.2 ± 15.4, 119.7 ± 27.9, 71.7 ± 9.2, and 136.7 ± 25.8 microns. Global and sectoral RNFL thicknesses were either normal or thick when compared to age-matched normal database. No eye displayed global or sectoral RNFL thinning. Mean baseline visual acuity and color vision were logMAR 1.2 and 5 plates, respectively. At 1, 3, and 6 months after discontinuation of ethambutol, mean visual acuity and color vision were 0.96 and 6, 0.63 and 11, and 0.44 and 13, respectively. Conclusion Patients with early ETON have normal or thick RNFL at time of diagnosis. They display good visual recovery 6 months following discontinuation of ethambutol.
Ethambutol ; Toxic Optic Neuropathy ; Tomography, Optical Coherence

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Cross-cultural adaptation and reliability of a Filipino dry eye screening questionnaire

Frances Marie DC. Roa-Lingad ; Ruben Lim Bon Siong

Philippine Journal of Ophthalmology.2018;43(2):65-71.

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

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Translation and validation of a Filipino version of the children’s visual function questionnaire

James Abraham B. Lee ; Andrea Kristina F. Monzon-Pajarillo ; Alvina Pauline D. Santiago

Philippine Journal of Ophthalmology.2018;43(2):72-76.

Objective: The objectives of this study were to translate into Filipino the Children’s Visual Function Questionnaire for children 3 years and above (CVFQ3plus), and to validate the translated CVFQ3plus to be used locally to assess the quality of life (QoL) of Filipino children aged 3 to 7 years old with visual impairment. Methods: Study Design: The study was a single-center, non-randomized translation and validation study. Translation: The CVFQ3plus translation into Filipino involved translation, reconciliation, pretesting, and small group discussion, based on the KIDSCREEN Group Translation and Validation procedures. Participants and Sampling: Convenience sampling was done to select the participants of the study. Participants were included in the study if they were parents or primary caregivers of children aged 3-7 years old who were noncompliant with treatment and/or those with non-treatable visual impairment defined as mild, moderate, severe unilateral, and severe bilateral. Procedure: All patients underwent complete ophthalmologic examination, including determination of the visual acuity using either the LEA chart or HOTV chart, prior to the administration of both the Filipino and English versions of the CVFQ3plus to their parents or caregivers. Participants were also asked to do a self-rating of their English proficiency, and their preferred version of the CVFQ. Statistical Analysis: Chronbach’s Alpha with a 95% confidence interval was used to determine the validity and internal consistency of the Filipino version of the CVFQ3plus questionnaire. Results: A total of 122 participants were included in the study. Chronbach’s Alpha score (α=0.86, CI=95%) for the translated Filipino version of the CVFQ3plus suggests high reliability and internal consistency, comparable to the original English version of the questionnaire. Conclusion This study was able to produce a highly reliable and internally consistent Filipino version of the CVFQ3plus.
Surveys and Questionnaires ; Quality of Life

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Landmark studies in neuro-ophthalmology

Franz Marie Cruz ; Prem S. Subramanian

Philippine Journal of Ophthalmology.2019;44(1):3-8.

High-quality clinical evidence, derived from well-designed and implemented clinical trials, serves to advance clinical care and to allow physicians to provide the most effective treatments to their patients. The field of ophthalmology, including the subspecialty of neuro-ophthalmology, abounds with such high-quality clinical trials that provide Level 1 clinical evidence. This review article summarizes the research design, key findings, and clinical relevance of select monumental clinical studies in neuro-ophthalmology with the primary goal of providing the readers with the rationale for current standard of care of various neuro-ophthalmic diseases. This includes the Optic Neuritis Treatment Trial, Ischemic Optic Neuropathy Decompression Trial, Idiopathic Intracranial Hypertension Treatment Trial, Rescue of Hereditary Optic Disease Outpatient Study, and Controlled High-Risk Avonex® Multiple Sclerosis Study
Optic Neuritis ; Optic Neuropathy, Ischemic ; Intracranial Hypertension

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A comparison between the efficacy of human corneal lenticule with single blood donor fibrin glue versus sutures for sealing induced corneal penetrating wounds in porcine eyes

Jimmy Jarvis Gene C. Lo ; Raymond Nelson C. Regalado ; Ruben Lim Bon Siong

Philippine Journal of Ophthalmology.2019;44(1):9-13.

Objective: To determine the efficacy of human corneal lenticule from small incision lenticule extraction (SMILE) with single blood donor fibrin glue as corneal patch for sealing induced corneal penetrating wounds in cadaveric porcine eyes compared to suturing using 2 simple interrupted nylon 10-0 sutures. Methodology: This is an in vitro comparative experimental study using cadaveric porcine eyes. Twenty (20) porcine eyes were randomized into control and treatment groups. A 3-mm metal keratome was used to create a fullthickness incision with the keratome angled perpendicular to the central cornea. Seidel’s test was done to confirm leakage. An anterior chamber maintainer connected to the Centurion® Vision System (Alcon, USA) was inserted into a peripheral corneal incision with the infusion turned off. Induced corneal penetrating wounds were sealed by application of single blood donor fibrin glue and human corneal lenticule obtained from SMILE in the treatment group. In the control group, 2 simple interrupted nylon 10-0 sutures were used for wound closure. Intraocular pressure (IOP) was set at 30 mmHg using the Centurion® Vision System and IOP was increased by increments of 5 mmHg until leakage is documented. Results: All porcine eyes in the control group showed no leakage immediately after sealing. One out of 10 eyes in the experimental group showed positive Seidel’s test after application of lenticule patch graft (odds ratio = 1.11 [0.904-1.336]). The mean leakage pressure for the suture group was significantly higher at 87.00 ± 4.83 mmHg compared to the lenticule group at 30.00 + 0.00 mmHg (p-value <0.001). Conclusion Human corneal lenticule from SMILE with single blood donor fibrin glue as cornel patch is less effective in sealing induced corneal penetrating wounds in cadaveric porcine eyes at IOP equal to or greater than 30 mmHg as compared to suturing using 2 simple interrupted nylon 10-0 sutures.
Fibrin Tissue Adhesive

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Effects of visual impairment on quality of life in children aged 3-7 years

Bonifacio Buñ ; o II ; Andrea Kristina Monzon-Pajarillo

Philippine Journal of Ophthalmology.2019;44(1):14-18.

Objective: The primary goal of this study was to determine the effect of visual impairment (VI) on the quality of life (QoL) in children aged 3-7 years. Methodology: This was a cross-sectional study involving 138 parents or caregivers of children aged 3-7 years from Pediatric Ophthalmology and General Ophthalmology Clinics of a tertiary government hospital. The Filipino version of the Children’s Visual Function Questionnaire (CVFQ3plus), an instrument that measures the impact of visual impairment on the QoL of children aged 3-7 years and their families, was used. It has 6 subscales: general health, general vision, competence, personality, family impact, and treatment. T-test was used to compare the total index QoL score and subscale scores between children with VI (n=69) and the control group (n=69). The multivariate regression model based on the total index QoL score in children with VI was used to assess the effect of other demographic factors. Results: Children with VI had significantly lower total index QoL score (p=0.02), general vision (p=0.04), competence (p=0.00), and personality (p=0.02) subscale scores than the control group. The visual acuity of children with VI had a significant effect on the total index QoL score (p=0.04). Demographic factors like patient’s age and sex, and parental age, sex and educational attainment had no effect on total index QoL score. Conclusion Visual impairment has a negative effect on the quality of life of Filipino children aged 3-7 years as shown by the use of the CVFQ3plus.
Vision Disorders ; Quality of Life ; Vision, Low

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