BACKGROUND AND OBJECTIVES

The global pandemic caused by Coronavirus Disease 2019 (COVID-19) has affected millions, with growing evidence of the potential role of ocular tissues in viral transmission. At the time of writing, local data regarding the phenomenon was limited. This study investigated external ocular manifestations in patients with COVID-19 at a referral center in the Philippines, examined correlations between demographics, systemic manifestations, and laboratory results with ocular manifestations, and determined their timing relative to systemic symptoms.

This single-center, descriptive cross-sectional study was carried out from December 8 to 18, 2020 at the adult COVID-19 wards of the Philippine General Hospital involving 72 participants. Data collection involved relevant clinical history taking and performing gross eye examination. The prevalence of ocular manifestations was described with 95% confidence intervals. Correlations between ocular manifestations and quantitative variables were analyzed with point-biserial correlation, and associations with qualitative variables were tested using chi-square or Fisher’s exact tests.

Among participants, 31.9% presented with ocular manifestations with foreign body sensation as the most prevalent ocular symptom (11.1%) and conjunctival hyperemia as the most prevalent ocular finding (19.4%). The median age of patients with ocular manifestations was 41 years old with a higher prevalence in the male population (73.9%, CI=95%, p=0.001). No significant correlation was observed between presence of external ocular manifestations and the different systemic and ocular co-morbidities as well as with COVID-19 clinical classification. Among those who experienced symptoms, majority (29.2%) of the patients experienced systemic symptoms prior to the onset of ocular symptoms. Ocular complaints may present as the sole manifestation (13.9%). Several laboratory parameters were measured and only temperature and AST levels showed a low positive correlation with the presence of ocular manifestations. 

Ocular manifestations occur in roughly one third of patients with COVID-19 based on this study population. With some individuals presenting with ocular signs or symptoms as the initial and sole manifestation, healthcare practitioners must exercise caution and remain vigilant in managing patients who present as such. At the time of writing, this is the first local study investigating the different external ocular manifestations in patients with COVID-19. There is a need to pursue more robust studies and conduct more local investigations which will guide both ophthalmologists and other practitioners in strengthening existing guidelines regarding precautionary practices, clinical diagnosis, and management of COVID-19 patients.

Objective: Toric intraocular lens implantation has been used to correct corneal astigmatism during cataract surgery. The study aimed to compare the visual outcomes between manual vs markerless toric intraocular lens implantation in astigmatic correction. Methods: The medical records of patients at American Eye Center who underwent phacoemulsification by multiple surgeons with insertion of monofocal or multifocal toric lenses via manual marking and markerless method from 2010-2019 were reviewed. Results: A total of 70 patients were included in the study. Results showed no significant difference in the following characteristics between manual and markerless method at one month and two months post-cataract surgery: uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near vision acuity (UNVA), corrected near vision acuity (CNVA), refraction spherical equivalent. The UDVA, CDVA, UNVA, CNVA and astigmatism had significantly lower median/mean-rank at one and two months postoperatively compared to preoperative values. Conclusion In conclusion, our findings indicated that both manual-based and markerless systems effectively facilitated accurate placement of the toric IOL on the desired axis. Notably, there was no significant difference observed between the two methods. Both systems are straightforward to execute. In low-resource settings like the Philippines, the manual marking method can be employed when markerless guidance equipment is unavailable.
Phacoemulsification ; Astigmatism ; Philippines

OBJECTIVE

Toric intraocular lens implantation has been used to correct corneal astigmatism during cataract surgery. The study aimed to compare the visual outcomes between manual vs markerless toric intraocular lens implantation in astigmatic correction.

The medical records of patients at American Eye Center who underwent phacoemulsification by multiple surgeons with insertion of monofocal or multifocal toric lenses via manual marking and markerless method from 2010-2019 were reviewed.

A total of 70 patients were included in the study. Results showed no significant difference in the following characteristics between manual and markerless method at one month and two months post-cataract surgery: uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near vision acuity (UNVA), corrected near vision acuity (CNVA), refraction spherical equivalent. The UDVA, CDVA, UNVA, CNVA and astigmatism had significantly lower median/mean-rank at one and two months postoperatively compared to preoperative values.

In conclusion, our findings indicated that both manual-based and markerless systems effectively facilitated accurate placement of the toric IOL on the desired axis. Notably, there was no significant difference observed between the two methods. Both systems are straightforward to execute. In low-resource settings like the Philippines, the manual marking method can be employed when markerless guidance equipment is unavailable.

OBJECTIVE

Successful intraocular lens (IOL) placement in cataract surgery is synonymous with the IOL being placed in the capsular bag. When the capsular bag is violated, the ciliary sulcus becomes an option to approximate an inthe- bag position. Studies report that single-piece foldable acrylic (SPA) IOLs are a poor choice for the sulcus. This study aimed to report the visual outcomes and complications of sulcus placement of single-piece intraocular lenses and three-piece intraocular lenses, and compare the design and characteristics to the occurrences of complications.

The medical records of patients were retrospectively reviewed in a single center from 2016-2019.

A total of 245 eyes from 237 patients were included in the study with a mean age of 61 years and male predominance. Majority of sulcus implantation occurred during phacoemulsification (87%). Around 82% (n=202) were implanted with single-piece IOLs and 18% (n=43) were three-piece IOLs. Best corrected distance visual acuity (BCDVA) was 20/20 after six months for both groups. Comparison between two groups showed no superiority with each other. Complications notable were elevated intraocular pressure, corneal edema, loss of IOL centration, and pigment dispersion. Smaller optic diameter and overall length predispose to higher probabilities of loss of centration. Pliability, hydrophobicity/hydrophilicity, and material do not correlate with postoperative complications. There were significantly higher numbers of pigment dispersions in IOLs with square-edged design.

In conclusion, visual outcomes remain equally excellent for both single-piece and threepiece groups. In contrast, there were more notable complications in single-piece group. Loss of centration tends to occur more with mean optic diameters lower than or equal to 5.50 mm and an overall length of less than 12.50 mm or lower. While appropriate for the capsular bag, square-edged designs were found to be inappropriate for the sulcus. The retrospective design does not allow strong inferences hence caution should be taken in correlating results.

Objectives: We described the demographic and clinical profiles of patients with carotid-cavernous fistula (CCF), determined the prevalence of increased intraocular pressure (IOP), and described the IOP outcomes after endovascular treatment. Methods: This was a single-center, retrospective review of records of patients with clinical signs and radiologic evidence of CCF from January 2012 to December 2017. Outcome measures included the prevalence of increased IOP in those with CCF, mean and range of IOPs, average number of IOP-lowering medications needed, and percentage of eyes with normal, controlled, and uncontrolled IOP before and after endovascular intervention. Results: Ninety-six (96) eyes of 92 patients with radiologic evidence of CCF on 4-vessel cerebral angiography were included. Fifty-nine (59) percent were between the ages of 20 to 39 years. Majority (65%) were males. Direct CCFs accounted for 70% of cases. Increased IOP was the third most common ocular sign with a prevalence of 78%, ranging from 10 to 56 mmHg (mean 20.3 ± 8.0). The average number of antiglaucoma medications for IOP control was 2. Eleven (11) underwent definitive management for CCF. Post-treatment, 33% of 13 eyes had normal, 27% controlled, and 40% uncontrolled IOPs. Conclusion There was a high prevalence of increased IOP in patients with CCF. Those who did not achieve IOP control should be referred for endovascular intervention to prevent serious complications, including secondary glaucoma.
Intraocular Pressure

Objectives: This study translated the Glaucoma Medication Adherence Self-Efficacy Questionnaire (GMASQ) and tested the reliability of Filipino-adapted GMASQ. Methods: A Filipino-adapted GMASQ was developed using the guidelines recommended for translating a validated health-related questionnaire into a culturally-adapted one. The methods included: (1) forward translation, (2) back-translation, (3) review and modification, (4) pre-testing and cognitive interviewing, and (5) final version testing. The provisional questionnaire was pre-tested on 20 glaucoma patients to determine its value and correspondence, generating a final forward questionnaire. The final version was administered to 48 patients. Its reliability was determined by computing for the Cronbach’s α for each item, per section, and overall. An item was removed if the α was <0.7. Results: Eleven (11) pre-test subjects (55%) preferred the Filipino-adapted questionnaire, 6 (20%) had no preference, and 3 (25%) preferred the source questionnaire. The provisional Filipino-adapted GMASQ proved to be acceptable and with no changes made, the questionnaire was marked as the final version. The medication adherence self-efficacy scale showed Cronbach’s α of > 0.8 for all items with a section α = 0.84. The eye-drop technique had an α > 0.7 for each item and a section α = 0.80. Conclusion This study provided preliminary evidence of the feasibility, acceptance and reliability of the Filipino GMASQ.
Glaucoma ; Medication Adherence ; Surveys and Questionnaires

Background. Childhood glaucoma is a rare multifactorial disease with limited information regarding the demographics and characteristics in the Filipino setting. It can be categorized via the Childhood Glaucoma Research Network Classification scheme. Objective. Determine the clinical classification of patients diagnosed with childhood glaucoma in the ophthalmology service of a government tertiary hospital in Manila, Philippines. Methods. Medical records of all patients ≤16 years-old referred to Glaucoma Section of Philippine General Hospital from January 2015 to December 2017 were reviewed retrospectively and classified. Results. One-hundred four (104) eyes in 77 children were classified. Glaucoma associated with acquired conditions was the most prevalent in 44.2% of the patients with trauma consisting of 19.5% of all patients. Primary childhood glaucoma consisted of 15.6% and juvenile open-angle glaucoma was diagnosed in 5.2%. Glaucoma following cataract surgery was noted in 7.8% of patients. Trabeculectomy was the primary surgical intervention in 22.2% of eyes, with 78.9% of eyes reaching an IOP control of <21mmHg on final follow-up. Conclusion. Glaucoma associated with acquired conditions was the most common childhood glaucoma in the patient population. Trabeculectomy was the most common surgery done. Trauma was the most prevalent cause of glaucoma from acquired conditions.

Human ; Glaucoma

OBJECTIVES: To compare the rate of progression of visual field loss in mean defect (MD) decibels (dB)/year in primary open angle glaucoma (POAG) versus primary angle closure glaucoma (PACG) patients managed in a tertiary hospital and to assess the impact of baseline age, baseline MD, and intraocular pressure (IOP) on the rate of progression of visual field loss. METHODS: This was a retrospective review of medical records of patients who were seen at the Glaucoma Clinic of a tertiary hospital from August to October 2018. The following data were recorded: diagnosis, number of reliable automated visual fields (AVFs), number of years followed, baseline age, baseline MD, MD of all subsequent AVFs, IOP at the time of each test, and IOP-lowering interventions. Rate of visual field progression expressed in dB/year was calculated using linear regression analysis. T–test was done to compare the baseline data and rates of progression of visual field loss between the POAG and PACG cohorts. Correlation using Pearson’s r and multivariate analyses were performed to evaluate the effect of baseline age, baseline MD, and IOP on rate of progression of visual field loss. RESULTS: The mean rates of progression of visual field loss in POAG and PACG eyes were 0.12 ± 0.68 dB/year and 0.10 ± 0.59 dB/year, respectively (p=0.8525). Despite treatment, 4.35% of the study eyes were identified as fast progressors while 1.09% were catastrophic progressors. In the POAG group (n=33), laser treatment was negatively correlated with rate of progression of visual field loss (r= -0.5072, p=0.0026). Multivariate analysis showed that baseline MD (p=0.017), mean IOP on follow–up (p=0.020), and laser treatment (p=0.004) were significant factorsaffecting the rate of progression of visual field loss in POAG eyes. In the PACG group (n=59), both baseline MD (r= -0.2798, p=0.0318) and mean IOP on follow–up (r= 0.368, p=0.0041) correlated with rate of progression of visual field loss. Only mean IOP on follow–up was found to be significant on multivariate analysis. CONCLUSION: While most glaucoma patients managed in a tertiary hospital have a slow rate of progression of visual field loss, a few were still identified as fast and catastrophic progressors. Factors associated with rate of progression of visual field loss were baseline MD, mean IOP on follow–up, and laser treatment for POAG, and mean IOP on follow–up for PACG.
Visual Fields ; Visual Field Tests ; Vision Disorders ; Glaucoma

OBJECTIVE: This study aimed to calculate and compare the costs of different brands of ocular hypotensive eye drops available in the Philippines. METHODS: This was a single-center research conducted at a local laboratory. Triplicate samples of 21 different brands of locally-available ocular hypotensive drops were tested. The mass of ten drops, total usable mass, number of drops per bottle, and mass of 200-µL aliquots were measured for each sample. These were used to calculate for the total usable bottle volume, drop volume, and number of drops per milliliter of each sample. Lastly, the daily, monthly, and annual costs were computed and compared. RESULTS: Available brands of β-blockers were the most affordable options for topical glaucoma therapy, with costs ranging from Php1,838 to 8,472 per year. Innovator brands of α-agonists and carbonic anhydrase inhibitors were the most expensive, with annual costs ranging from Php7,641 to 24,295 and Php7,361 to 25,327, respectively. Fixed-combination preparations, with yearly costs ranging from Php4,307 to 22,200, were generally more costeffective than individual preparations. The cost of topical anti-glaucoma therapy can amount up to 3.3 to 66.9% of a minimum-wage earner’s annual income depending on the number and combination of drugs being used. CONCLUSIONS: The price range of ocular hypotensive eye drops available in the Philippines is wide. Cost of therapy is an important consideration for patients who acquire medications through out-of-pocket expenditure. Optimization of bottle designs and volumes is crucial to maximize the cost-effectiveness of eye drop solutions. Information on the cost of therapy should be available to both patients and physicians.
Glaucoma ; Tetrahymenina ; Eye ; Ophthalmic Solutions ; Costs and Cost Analysis