Clinical profile and corneal complications of staphylococcal blepharitis at the Philippine General Hospital

Objectives@#Staphylococcal blepharitis is a common ocular condition that can cause significant visual morbidities due to corneal complications. This study described the clinical profile of patients with staphylococcal blepharitis seen in a tertiary referral eye center, and determined the frequency and the type of corneal complications, the possible reasons for the delay in diagnosis, and the management prior to the consult.@*Methods@#This study was a single-center, five-year retrospective case series design. The charts of all patients from January 2016 to December 2021 with the diagnosis of staphylococcal blepharitis seen at the External Disease and Cornea Clinic of the Philippine General Hospital that have fulfilled the inclusion and exclusion criteria were included. The data extracted were age, sex, chief complaint, laterality, time of onset of symptoms to consult, previous consults, lid and lid margin findings, conjunctival and corneal findings, pre- and post-treatment uncorrected distance visual acuity, duration of follow-up, and treatments received.@*Results@#Fifty-five (55) charts out of 107 charts with a diagnosis of staphylococcal blepharitis were included. Eighty percent (80%) or 44 patients had bilateral disease. Ninety-nine (99) eyes of 55 patients were analyzed. The median age of the study population was 19 years. Sixty-seven percent (67%) were female, and 33% were male. The mean duration of follow-up at the External Disease and Cornea Clinic was 10.8 ± 14.61 months. Corneal opacity, eye redness, and blurring of vision comprised 70% of the reasons for consult. The mean time from the onset of symptoms to consult was 18.36 ± 25.69 months. Sixty-seven percent (67%) had prior consults elsewhere and 45% came in with a different diagnosis. Seventy-eight (78) eyes had fibrin or crust on the lashes. Fifty percent (50%) of the eyes had concomitant conjunctivitis, while 30% had meibomitis. Fifty-eight percent (58%) of patients had corneal complications. Seventy-two percent (72%) of eyes had bilateral involvement. The median age of patients with corneal complications subgroup was 13 years. The most common corneal complications noted were neovascularization, phlyctenulosis, pannus formation, and marginal infiltrates or ulcers. Twenty-two percent (22%) of all study eyes had visually disabling corneal complications like corneal ulcer, descemetocele, corneal perforation, and corneal scar. Ninety percent (90%) of the patients received standard medical treatment and three patients underwent penetrating keratoplasty. The mean uncorrected distance visual acuity at initial consult of eyes with corneal complication was 20/55 (LogMAR 0.43 ± 0.51) and 20/35 (LogMAR 0.25 ± 0.40) after treatment (p = 0.032).@*Conclusion@#Staphylococcal blepharitis was most prevalent among young female patients, and it affected both eyes. Almost all patients manifested the typical lid margin lesions. Nearly 60% of the patients presented with corneal complications and 22% had corneal lesions that were potentially blinding. Close to 50% had delay in treatment due to misdiagnosis.

Descemet’s membrane detachment in a corneal graft after removal of a Baerveldt Shunt Intraluminal Stent

Objective@#We reported a case of Descemet's membrane detachment (DMD) following ripcord removal of a Baerveldt shunt in a post-corneal transplant eye, and the interventions done.@*Method@#This is a case report@*Results@#A 65-year-old male with multiple surgeries (phacoemulsification, two corneal transplants, and Baerveldt shunt implantation) in the right eye developed increased intraocular pressures, prompting removal of the intraluminal stent (ripcord) of the shunt. This was complicated by hypotony and DMD. Ripcord reinsertion and viscoelastic injection were performed to reattach the Descemet's membrane (DM) but failed. 0.1mL of 14% perfluoropropane (C3F8) gas was injected into the anterior chamber that successfully reattached the DM with return to pre-operative best-corrected visual acuity after 1 week. @*Conclusion@#Injection of an expansive gas (C3F8) was effective in repairing a corneal graft DMD in an eye with a Baerveldt shunt.

Clinical profile of dry eye disease at the Philippine General Hospital

Objectives@#To describe the population of dry eye disease (DED) patients seen at the Philippine General Hospital (PGH) Dry Eye Clinic, and to compare the diagnosis, type, and severity of DED using Oculus Keratograph® 5M (Oculus GmbH, Wetzlar, Germany) with clinical diagnosis.@*Methodology@#This was a single-center comparative, cross-sectional study. Newly-diagnosed DED patients were recruited for the dry eye group. A subset of healthy volunteers without DED was also recruited for the control group. The clinical data for both groups were collected, and the Ocular Surface Disease Index (OSDI) questionnaire was administered. Standard clinical dry eye testing and Keratograph testing were subsequently done. The PGH Dry Eye Clinic definitions were used to classify the types of dry eye. @*Results@#Eighty (80) eyes of 40 patients per group were examined. For the dry eye group, the mean age and OSDI scores were significantly higher, while the average tear break up time (TBUT) was significantly lower. There was no significant difference in average basal secretion test (BST) and Schirmer 1 measurements between the two groups. 73% had evaporative type dry eye, while 27% had mixed type. Majority of the DED patients were females of >50 years old with mild evaporative type. Foreign body sensation was the most common symptom. Overall, there was poor agreement between clinical and Keratograph assessments of diagnosis and severity among patients in the dry eye group, but there was acceptable agreement when assessment was done in the control group.@*Conclusions@#DED patients at the PGH have similar characteristics to reported DED of other Asian populations. Evaporative or short TBUT type dry eye is the most frequently seen. Further formal validity study is needed for Oculus Keratograph® 5M to increase the value of its data to be included in routine dry eye screening.

Survey on the knowledge, attitudes, and practice patterns of ophthalmologists in the Philippines on the diagnosis and management of dry eye disease

Objective@#To determine the knowledge, attitudes, and practice patterns of ophthalmologists practicing in the Philippines on the diagnosis and management of dry eye disease through a survey using an online questionnaire.@*Methods@#A simple online survey was designed to determine the knowledge of ophthalmologists practicing in the Philippines on the definition, symptoms, diagnostics, as well as their management of dry eye disease. Respondents also provided information regarding setting and characteristic of practice, years of practice, field of practice, and number of new dry eye patients weekly.@*Results@#A total of 148 ophthalmologists responded to the survey with a 16% response rate. Most believed dry eye disease was associated with symptoms of ocular discomfort (99%), tear deficiency (98%), and tear film instability (97%). Symptoms believed to be associated with dry eye were dryness (97%), burning sensation (94%), foreign body sensation (93%), and discomfort/pain (93%). Most ophthalmologists diagnosed dry eye based on patient symptoms (99%), tear break-up time (93%), and fluorescein staining (91%). Very few tested for tear osmolarity to diagnose dry eye (6%). Only few used dry eye questionnaires (27%) and lissamine staining (32%). The most valuable tests included tear break-up time (92%), fluorescein staining (88%), Schirmer test (85%), and meibomian gland evaluation (83%). Treatments most commonly used were artificial tear supplements (100%), lid hygiene (94%), environmental modification (92%), and work and lifestyle modification (88%). Artificial tear supplements were the most valuable treatment (100%), followed by lid hygiene (89%) then environmental modification (85%). The most common first-line medications were carboxymethylcellulose (89%), propylene glycol (85%), and hypromellose (83%). Very few ophthalmologists classified dry eye by type (19%) and by severity (35%), but 80% tailored their treatment to the severity of the dry eye.@*Conclusion@#Dry eye disease is a common yet frequently underrecognized clinical condition whose etiology and management challenge clinicians and researchers alike. This study showed that ophthalmologists practicing in the Philippines who answered the survey lacked awareness on the new definition of dry eye disease, the newer diagnostic tests, and therapeutics available for diagnosing and managing dry eye disease.

Quality of life after ocular trauma: A prospective, longitudinal, questionnaire based study in a tertiary hospital in the Philippines

Purpose@#To determine the health-related quality of life of patients sustaining ocular injuries prognosticated to be visually disabling and to correlate baseline characteristics with quality of life indices.@*Methods@#A prospective, questionnaire-based health-related quality of life study was conducted in a tertiary hospital in the Philippines among 33 patients prognosticated to have visually-disabling ocular injuries using the ocular trauma score (OTS). Clinical and demographic data were collected and quality of life indices were measured using the EuroQoL five-dimension five-level (EQ-5D-5L) questionnaire at baseline and on three subsequent follow-up visits. Data was analyzed by OTS and type of injury. Baseline characteristics were described and correlated with quality of life indices. @*Results@#Of the 33 participants recruited at baseline, 26 were able to return to at least 1 of the 3 recommended follow-up visits. The median age of study participants upon admission was 35 years old with 31 (94%) being males. The patients were admitted at a median of 4 days from injury. Thirty-one (31) or 94% of the participants sustained open globe injuries, with 14 (42%) being penetrating lacerations and 10 (30%) classified as having intraocular foreign bodies. Most patients reported pain and discomfort (82%), problems in usual activities (70%), and anxiety and depression (70%) at baseline. Those with an OTS of 1 had lower median EQ index score (0.447) and EQ visual analog scale (VAS) score (56). A diagnosis of globe rupture was associated with lower median EQ index scores (0.448) and EQ VAS scores (56). EQ index and VAS scores were lowest at baseline. A statistically significantly increase in EQ VAS was seen from baseline to the first month of follow-up (p=0.01). Using univariate regression analysis, no statistically significant correlation between baseline characteristics and baseline quality of life indices was identified.@*Conclusion@#Health-related quality of life was lowest shortly after admission for management of ocular trauma and significantly improved at 1 month. Most patients reported pain and discomfort, problems in usual activities, and anxiety and depression. None of the clinical characteristics were shown to be significantly associated with quality of life indices, including visual acuity.

Long-term effect on corneal curvature of corneal collagen cross-linking for keratoconus

Objective@#To determine the effect of corneal collagen cross-linking on the corneal curvature of eyes with keratoconus measured using an Oculus Pentacam® at 2 years and annually thereafter. @*Methods@#This was a descriptive, retrospective study involving patients with keratoconus who had undergone uncomplicated collagen cross-linking using the Dresden protocol from January 2012 to March 2016. Baseline measurements of best-corrected visual acuity (BCVA), maximum K value (Kmax), corneal astigmatism, anterior and posterior elevation map changes were recorded and compared with data taken at 2 and 3 years@*Results@#This study included 32 patients (48 eyes) with a mean follow-up of 28.88 ± 6.23 months. Only 4 patients (6 eyes) had 3-year follow-up data with a mean follow-up of 42.83 ± 4.58 months. When all eyes were considered, significant changes were noted in Kmax, BCVA, and anterior and posterior elevation maps between baseline and 2-year follow-up. Specifically, there were significant decreases in Kmax (p<0.0001) and anterior elevation (p<0.05), and significant improvement in BCVA (p<0.01) while posterior elevation (p<0.0001) was found to have increased significantly at 2nd year follow-up compared to baseline. When only eyes with 3-year follow-up data was analyzed, only BCVA showed significant change (p<0.05). Corneal astigmatism remained stable during the study period.@*Conclusion@#Two to 3 years after collagen cross-linking for keratoconus, corneal curvature parameters and BCVA showed improved and stable outcomes when compared to baseline.

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

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.

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

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.

Comparison of Small Incision Lenticule Extraction (SMILE) and Femtosecond Laser In-Situ Keratomileusis (F-LASIK) for the correction of myopia and astigmatism: 1-year clinical outcome

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> 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.</p> <p style="text-align: justify;"><strong>METHOD:</strong> 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. </p> <p style="text-align: justify;"><strong>RESULTS:</strong> 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. </p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> 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.</p>

Prevalence of dry eye disease in an urban community

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the prevalence of dry eye disease in an urban community in the Philippines.</p> <p style="text-align: justify;"><strong>METHODS:</strong> This was a community-based cross-sectional study. Convenience sampling was conducted on residents of Barangay 733, Sampaloc, Manila, Philippines. One hundred fifty-seven participants, 19 years old and above, underwent investigator-led interview using a dry-eye questionnaire, followed by dry-eye examination consisting fluorescein tear break-up time (TBUT), corneal staining with fluorescein, conjunctival and posterior lid margin staining (PLM) with lissamine green, and Schirmer I test with and without anesthesia.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> Of the 157 participants recruited, 148 (94%) fulfilled the inclusion criteria. The mean age was 52.35 years; 95 (64.2%) were females and 53 (35.8%) males. Thirty-four (22.9%) were diagnosed with dry eye disease, and the most common symptom reported was itching (76%). Those with dry eye had significantly higher ocular surface disease index score and subjective grading of ocular discomfort compared with those without the disease. Mean TBUT for those without dry eye was 12.74 seconds compared with 8.84 seconds for the dry eye group. The mean fluorescein corneal staining scores were 2 and 20 for the none and the dry eye groups respectively. The mean lissamine green conjunctival staining scores were 14 and 55 respectively. A positive PLM sign was present in 67.6% with dry eye vs. 5.6% in the none dry eye group. Mean Schirmer I test without anesthesia was 18.53 mm and 17.09 mm in the none and dry eye groups respectively. Mean Schirmer I test with anesthesia was 13.36 mm vs. 11.94 mm respectively.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> The prevalence rate of dry eye disease in an urban community in Manila was 22.9%. This figure was similar to those reported by neighboring Asian countries.</p>

Safety of intracameral moxifloxacin/dexamethasone fixed-dose formulation on the corneal endothelium in a rabbit model

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the safety of intracamerally injected preservative-free 0.5% moxifloxacin/0.1% dexamethasone fixed-dose combination on the corneal endothelium in a rabbit model and compare it to intracamerally injected preservative-free 0.5% moxifloxacin.</p> <p style="text-align: justify;"><strong>METHODS:</strong> This experimental study included twenty eyes from ten albino rabbits. The eyes were assessed for baseline corneal clarity and anterior chamber (AC) inflammation using slit-lamp biomicroscopy. A specular microscope measured the corneal endothelial cell density (ECC) and corneal thickness (CT). Intracameral injections of 0.1 mL 0.5% moxifloxacin ophthalmic solution were administered to the 10 right eyes (IPFM group) and 0.1 mL of 0.5% moxifloxacin/0.1% dexamethasone fixed-dose preparation were administered to the 10 left eyes (IPFMDex group). In both groups, ECC, CT, corneal clarity, and AC inflammation at Day 1 (one day post-injection) and Day 7 (seven days post-injection) were compared with Day 0 (baseline). The IPFMDex group was also compared with the IPFM group at Days 0, 1, and 7. The endothelial cells of harvested corneas from both groups at Day 1 and 7 were stained with trypan blue and alizarin red, and compared for endothelial cell damage (ECD). Data were analyzed using paired and independent sample t-tests.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> In both the IPFM and IPFMDex groups, ECC and CT at Day 1 (IPFM: ECC p=0.07, CT p=0.76; IPFMDex: ECC p=0.41, CT p=0.94) and Day 7 (IPFM: ECC p=0.95, CT p=0.28; IPFMDex: ECC p=0.29, CT p=0.34) were not different from Day 0 (baseline). No significant difference in ECC, CT, and ECD were found between the IPFM and IPFMDex groups at Day 1 (ECC p=0.82, CT p=0.36, ECD p=0.96) and Day 7 (ECC p=0.95, CT p=0.22, ECD p=0.61). Throughout the study, the cornea in both groups were clear and showed no signs of AC inflammation.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> Intracameral injection of preservative-free moxifloxacin/dexamethasone fixed-dose formulation was safe on the rabbit corneal endothelium and was no different from preservative-free moxifloxacin.</p>

Safety of Intracameral Moxifloxacin/Dexamethasone fixed-dose formulation on the Corneal Endothelium in a rabbit model

Objective@#To determine the safety of intracamerally injected preservative-free 0.5% moxifloxacin/0.1% dexamethasone fixed-dose combination on the corneal endothelium in a rabbit model and compare it to intracamerally injected preservative-free 0.5% moxifloxacin. @*Methods@#This experimental study included twenty eyes from ten albino rabbits. The eyes were assessed for baseline corneal clarity and anterior chamber (AC) inflammation using slit-lamp biomicroscopy. A specular microscope measured the corneal endothelial cell density (ECC) and corneal thickness (CT). Intracameral injections of 0.1 mL 0.5% moxifloxacin ophthalmic solution were administered to the 10 right eyes (IPFM group) and 0.1 mL of 0.5% moxifloxacin/0.1% dexamethasone fixed-dose preparation were administered to the 10 left eyes (IPFMDex group). In both groups, ECC, CT, corneal clarity, and AC inflammation at Day 1 (one day post-injection) and Day 7 (seven days post-injection) were compared with Day 0 (baseline). The IPFMDex group was also compared with the IPFM group at Days 0, 1, and 7. The endothelial cells of harvested corneas from both groups at Day 1 and 7 were stained with trypan blue and alizarin red, and compared for endothelial cell damage (ECD). Data were analyzed using paired and independent sample t-tests.@*Results@#In both the IPFM and IPFMDex groups, ECC and CT at Day 1 (IPFM: ECC p=0.07, CT p=0.76; IPFMDex: ECC p=0.41, CT p=0.94) and Day 7 (IPFM: ECC p=0.95, CT p=0.28; IPFMDex: ECC p=0.29, CT p=0.34) were not different from Day 0 (baseline). No significant difference in ECC, CT, and ECD were found between the IPFM and IPFMDex groups at Day 1 (ECC p=0.82, CT p=0.36, ECD p=0.96) and Day 7 (ECC p=0.95, CT p=0.22, ECD p=0.61). Throughout the study, the cornea in both groups were clear and showed no signs of AC inflammation. @*Conclusion@#Intracameral injection of preservative-free moxifloxacin/dexamethasone fixed-dose formulation was safe on the rabbit corneal endothelium and was no different from preservative-free moxifloxacin.

Dry eye after clear cornea phacoemulsification

Objective@#To determine the incidence of dry eye in patients undergoing clear cornea phacoemulsification and to investigate its effects on dry eye symptoms and tear function. @*Methods@#This was a single-center, prospective, non-randomized study involving forty-nine (49) eyes from fortyfour (44) patients without preoperative dry eye, who underwent clear cornea phacoemulsification for age-related cataract. Main outcome measures were subjective grading of ocular discomfort, ocular surface disease index (OSDI), fluorescein tear break-up time (FTBUT), and Schirmer tests without anesthesia and with anesthesia. They were measured before surgery and 1 week, 1 month, and 3 months after surgery. @*Results@#None of the patients qualified for the definition of dry eye disease before and after clear cornea phacoemulsification. Preoperative FTBUT (14.01 ± 0.56 seconds) decreased at 1 week (3.97 ± 0.21 seconds; p<0.001) and at 1 month (5.82 ± 0.32 seconds; p<0.001) after the surgery and gradually improved by 3 months (8.26 ± 0.54 seconds; p<0.001) after surgery. Preoperative Schirmer test without anesthesia (18.78 ± 1.17 mm) decreased at 1 week (14.02 ± 1.52 mm; p<0.001) and subsequently recovered by 3 months (16.31 ± 1.34 mm; p>0.05). Preoperative Schirmer test with anesthesia (14.24 ± 0.94 mm) decreased at 1 week (11.98 ± 1.00 mm; p=0.046) after surgery and went back to baseline levels by 3 months (13.80 ± 1.12 mm; p>0.05). @*Conclusion@#Patients without dry eye disease, who underwent clear cornea phacoemulsification, did not develop dry eye disease after the surgery. Temporary reduction in physiologic tear levels seen one week postsurgery gradually returned to near-normal baseline levels by the third postoperative month.

Comparison between the Wong Incision and stromal hydration of corneal incisions in phacoemulsification

Objective@#To determine the efficacy of the Wong incision in providing wound seal compared to stromal wall hydration in clear cornea phacoemulsification in cadaveric porcine eyes.@*Method@#This was an in vitro comparative experimental study using ten porcine eyes. All eyes were randomly assigned to the stromal wall hydration (control) or the Wong incision group (experimental). A side port was made and the anterior chamber formed with viscoelastic device. The main incision was made 180 degrees away. In the experimental group, a Wong incision was made first anterior to the main incision. Phacoemulsification surgery with IOL insertion was simulated. The main incision was sealed by hydration. The anterior chamber (AC) was infused with balanced salt solution (BSS) through an AC maintainer and leakage of fluid from the main incision was assessed. Samples from the AC were taken before and after tryphan blue drip and were sent for analysis by UV spectrophotometry. Trypan blue was dripped over the main incision and the whole eyeball was sent for histopathology.@*Results@#There was a significant increase in density from the pre-dye to the post-dye AC samples of the control (0.0052 to 0.0074, p=0.01) and the experimental groups (0.0076 to 0.0094, p=0.02), although the final samples showed an optical density comparable to pure BSS, indicating that there was no significant amount of trypan blue detected in both groups. On histology, trypan blue staining was not seen in the incision tracts of both groups. After infusing the AC with BSS, there was outward wound leakage in all eyes of the control group and none in the experimental group.@*Conclusion@#The Wong incision was as effective as the lateral stromal wall hydration in preventing fluid influx. Furthermore, the Wong incision showed a more stable wound seal against outward wound leakage in an in-vitro porcine model of clear corneal phacoemulsification.

Comparing Femtosecond Lenticule Extraction (FLEx) and Femtosecond Laser In-situ Keratomileusis (LASIK) for myopia and astigmatism

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.

Petroleum jelly versus tea tree oil and tea tree facial wash lid scrub in patients with Blepharitis associated with above-normal Demodex count

Purpose@#To determine the effectiveness of lid scrub with petroleum jelly versus lid scrub with tea tree oil and tea tree facial wash in patients with symptomatic blepharitis associated with above-normal Demodex counts@*Methods@#Patients with symptomatic anterior blepharitis (AB), meibomian gland dysfunction (MGD), or mixed blepharitis (MB) were recruited into the study. Pertinent data, including ocular symptoms and findings, were recorded. Digital photographs of the lid margins were taken. Lash sampling was done using the modified Coston method for lash epilation. Patients with below-normal Demodex counts (DC <5) were excluded while those with DC ≥5 were randomly assigned to one of either treatment regimen: (1) lid scrub with tea tree oil and tea tree facial wash (The Body Wash®, control group), or (2) lid scrub with petroleum jelly (Apollo Pure Petroleum Jelly®, study drug). Lid scrub with the tea tree oil (TTO) or petroleum jelly was administered at the clinic during the initial visit and at 2-week intervals thereafter for 6 weeks. Patients were instructed to apply tea tree (TT) facial wash or petroleum jelly at home on specified intervals daily. DC posttreatment was recorded, and digital photographs of the eyelids were taken at the end of treatment.@*Results@#Thirteen patients were included in the study; 5 in the TTO and 8 petroleum jelly. In the TTO group, 3 patients had decrease in DC and 2 an increase, but all patients reported decrease in the severity and frequency of ocular symptoms. In the petroleum jelly group, 5 patients had decrease in DC after 6 weeks, while the remaining 3 had opposite results. All reported a general improvement in their symptoms. No adverse reactions were observed in either treatment groups.@*Conclusion@#Lid scrub with petroleum jelly caused a significant reduction (p<0.05) in Demodex counts compared to lid scrub with tea tree oil and tea tree facial wash. Petroleum jelly may have some effect in the eradication of Demodex mites in cases of Demodex-induced blepharitis. Although lid scrub with petroleum jelly and tea tree oil and tea tree facial wash both produced a decrease in Demodex counts and a decrease in the frequency and severity of ocular symptoms after 6 weeks of treatment, the presence of some conflicting results suggests that further studies with more patients should be initiated.

Demodex sp. infestation in anterior blepharitis, meibomian-gland dysfunction, and mixed blepharitis

Objective@#This study determined the incidence and density of Demodex species on the eyelashes of subjects with normal eyelids, anterior blepharitis (AB), meibomian-gland dysfunction (MGD), and mixed blepharitis (MB).@*Methods@#Consecutive patients diagnosed with AB, MGD, and MB were recruited, along with 50 normal individuals who served as controls. All underwent a standard eye exam. Data on demographics and ocular symptomatology were gathered. Digital photographs of the lid margins were taken. Lash sampling was done using the modified Coston procedure for epilating lashes. The collected lashes were checked for Demodex based on morphology and motility, and the total number of Demodex identified were tabulated for each eye. Patients with AB and MB had eyelid bacterial culture. Data were subjected to statistical analyses. @*Results@#A total of 167 patients with mean age of 53.7 years were included: 40% with MGD, 12% with AB, 19% with MB, and 30% normal. The overall incidence of Demodex infestation was 73%; 85% for MGD, 95% for AB, 97% for MB, and 34% for control group. The mean density count (MDC) was 13.63 for MB, 8.95 for AB, 4.08 for MGD, and 0.98 for the normal group. The incidence and density of Demodex infestation increased with age. Symptoms of irritation correlated with high MDC (>9 mites) (p <0.04). Asymptomatic patients had low MDC (0 to 2 mites) (p < 0.01). Sixty-eight percent of patients with cylindrical dandruff (p <0.001) and 36.1% with plugged meibomian glands (p < 0.001) had high MDC, while 82.7% with no eyelash findings had low MDC (p < 0.001). @*Conclusion@#The incidence and density of Demodex infestation was highest among patients with AB and MGD. Lid irritation and presence of cylindrical dandruff were indicative of high density count. These should alert the clinician to treat concomitant Demodex infestation of the eyelashes.

Alport syndrome

Objective@#To present a case of Alport syndrome, its pathogenesis, etiology, clinical manifestation, diagnosis, and management.@*Methods@#This is a case report.@*Results@#A 22-year-old male presented with blurring of vision associated with bilateral anterior and posterior lenticonus. The patient had a history of blurring of vision on both eyes, occasional right lower-quadrant pain on urination, frothy urine, and bilateral hearing loss. Family medical history showed one brother who died at 15 years of heart disease, and another brother at 17 from chronic kidney disease. Slitlamp examination showed a conspicuous oil droplet reflex seen through retroillumination. Anterior and posterior bulging of the lens was noted, highly suggestive of anterior and posterior lenticonus. On indirect ophthalmoscopy, no perimacular dot-and-fleck retinopathy was seen. Further systemic workup revealed elevated serum levels of blood urea nitrogen (BUN) and creatinine, and marked proteinuria and hematuria. Ultrasound of the kidneys revealed bilateral renal parenchymal disease. Pure tone audiometry confirmed bilateral moderate sensorineural hearing loss. @*Conclusions@#There should be a high index of suspicion for Alport syndrome in any patient presenting with anterior and posterior lenticonus. A thorough history-taking and physical examination, including slitlamp examination through a dilated pupil, are necessary to fully support its diagnosis. There is no specifically defined treatment for Alport’s syndrome; management should be individualized and approached in a multidisciplinary fashion. Lenticonus can be treated by phacoemulsification with careful capsulorrhexis.

A survey of eye-related complaints among call-center agents in Metro Manila

@#Objective This study determined the most common eye-related complaints among call-center agents in Metro Manila. Methods A survey was conducted among agents employed in a call center in Metro Manila. The questionnaire used categorical scales to measure the prevalence, frequency, diurnal occurrence, duration, and intrusiveness of common eyerelated symptoms. The eye-related symptoms were: dryness, redness, eye strain, blurring of vision, doubling of vision, headaches, eye pain, watery eyes, slow focusing from near to distance or vice versa. Descriptive statistics, measures of frequencies and percentages were derived for demographic characteristics. Cramer's V coefficient was calculated to detect relationship between variables, and p values <0.05 were considered significant. Results Two hundred seventy-seven (277) respondents with a mean age of 24.56 ± 4.14 and consisting of 130 (47%) males and 147 (53%) females participated in the study. The top three eye-related complaints were eye strain or tiredness (68%), headache (66%), and blurring of vision (53%). The symptoms lasted less than an hour, except for headaches that persisted for 1 to 2 hours and had the highest mean severity of 2.31 ± 1.24. The duration of computer use was strongly correlated with the severity of the eye complaints, except for blurring of vision. The duration of employment was also strongly correlated with all the symptoms except for doubling of vision. Conclusion Ocular symptoms were prevalent among call-center agents. The severity of the symptoms was correlated with the duration of computer use and employment as a call-center agent.