Frosted-branch angiitis

OBJECTIVE: To report a case of frosted-branch angiitis. METHOD: This is a case report of frosted-branch angiitis seen at the University of the Philippines-Philippine General Hospital. RESULTS: A 42 year-old male presented with progressive blurring of vision of the left eye. Indirect funduscopy showed dilated retinal veins with perivascular sheathing, giving the appearance of frosted-branches of a tree. CONCLUSION: Frosted-branch angiitis is a rare form of retinal vasculitis with various etiologies. Despite the severe retinal appearance, the prognosis is usually good, with rapid recovery of visual acuity after prompt steroid treatment.

Multicenter survey of badminton-related eye injuries

Objective: To determine the patient profile and risk factors for badminton-related eye injuries in Metro Manila. Methods: We conducted a cross-sectional survey of badminton-related eye injuries in Metro Manila. A survey form was sent to 13 ophthalmologists who were asked to report on patients treated for badminton-related eye injuries from July 1 to December 1, 2004. The following data were collected: patient age, gender, and sports experience; details of eye injury; use of protective eyewear; and visual outcomes. Logistic regression analysis was performed to predict sight-threatening injuries. Results: The average patient age was 34.7 +/- 6.2 years (range 18 to 46). There were more males than females (1.55:1). All patients sustained eye injury while playing doubles. None of the patients were wearing protective eyewear at the time of injury. Blunt trauma due to shuttlecock impact was the cause of injury in 74 % of cases. The most common ocular findings were iridocyclitis (n = 11), secondary glaucoma (n = 6), and hyphema (n = 5). Twenty-nine sight-threatening conditions were reported. Six (26 %) patients developed chronic ocular sequelae. Conclusion: Sight-threatening injuries can occur in individuals playing badminton. While vision loss is uncommon, treatment outcomes are generally good. Since all injuries were sustained without the use of protective eyewear, ophthalmologists have a responsibility to promote its use when playing badminton.

Comparison of preoperative anti-infective preparations for extracapsular lens extraction

Objective: To investigate the effect of three preoperative anti-infective regimens on the sterility of anterior-chamber aspirates (ACA) in eyes undergoing extracapsular cataract extraction (ECCE). Methods: Ninety eyes scheduled to undergo ECCE were randomly assigned to receive one of the following preoperative anti-infective regimens: Group 1 (Control) - no additional preoperative preparation; Group 2 (Eye drop) - neomycin/ polymixin B/gramicidin eye drops applied 3 times daily for 3 days prior to surgery; and Group 3 (Lid scrub) - neomycin/polymixin B/ bacitracin ointment lid scrub applied 3 times prior to surgery. ACAs were obtained from all eyes at the conclusion of surgery and cultured. The patients were followed up for 3 months after the surgery. Results: Positive cultures developed from ACAs in 5 (16.6 percent) of 30 eyes from Group 1, in 0 of 30 from Group 2, and in 3 (10 percent) of 30 from Group 3. No eye developed endophthalmitis. Compared with the control group, preoperative neomycin/polymixin B/gramicidin eye drops significantly reduced the ACA contamination rate (p= 0.03). Conclusion: Preoperative neomycin/polymixin B/bacitracin eyedrops can improve the sterility of the anterior chamber during ECCE.

Preseptal and orbital cellulitis at the Philippine General Hospital

OBJECTIVE: To describe the clinical features, causative agents, management practices, and outcomes of preseptal and orbital cellulitis at a tertiary-care center in a developing country. METHODS: This is a retrospective case series of preseptal and orbital cellulitis seen at the Orbit Clinic of the Philippine General Hospital from January 1990 to December 1995. The medical records were reviewed and the following data obtained: age, gender, manner of disease presentation, causative agent, medical interventions, and outcomes. RESULTS: Fifty-six patients with preseptal cellulitis and 35 with orbital cellulitis were identified. Among the patients with preseptal cellulitis, the mean age at presentation was 12.6 +/- 17.0 years. No gender predilection was observed. The most common presenting signs were lid swelling (all patients), eye redness (34 %), fever (29%), and eye discharge (27 %). Bilateral involvement occurred in 9 patients. Among those with orbital cellulitis, 25 were classified as orbital cellulitis, 5 as orbital abscess, and 5 as cavernous sinus thrombosis. There were slightly more females than males (1.3:1). The mean age at presentation was 17.1 +/- 18.6 years. The most common symptoms were lid swelling (94 %), ophthalmoplegia (89 %), chemosis (77%), proptosis (71%), and decreased vision (51%). Both conditions were associated with antecedent infectious conditions such as skin and lid infection, sinusitis, dental abscess, respiratory-tract infection, and trauma. Staphylococcus was the most common organism isolated. The most common initial antibiotics used were beta-lactamase-resistant penicillins. Other antibiotics were added based on clinical response and microbial studies. Orbital cellulitis was associated with sight threatening complications such as glaucoma, retinal vascular occlusion, exposure keratitis, and optic-nerve compression. CONCLUSIONS: The etiology of preseptal and orbital cellulitis in this series differs from that in developed countries. Preseptal and orbital cellulitis should be distinguished early so that proper management can be instituted. Orbital cellulitis is associated with greater mortality and morbidity. CT scan and microbial studies are invaluable for appropriate diagnosis and management of orbital cellulitis.

Patterns of uveitis in a Philippine eye clinic

OBJECTIVE: To describe the distribution and clinical characteristics of endogenous uveitis among patients in a Philippine eye clinic. METHODS: The demographic and clinical data of 103 uveitis patients consulting at the Asian Eye Institute over an 18-month period were analyzed and compared with a previous report. RESULTS: The mean age at consultation was 43 +/- 17 years (range 5 to 83). The maleto-female ratio was 1:1.3. The racial distribution consisted of Malay (77 %), Chinese (22%), and Indian (1%). Forty-one patients (40%) presented with anterior uveitis, 15 (15%) with intermediate uveitis, 19 (18 %) with posterior uveitis, and 28 (27%) with panuveitis. The most frequent diagnoses were idiopathic anterior uveitis (24 %), pars planitis (14 %), multifocal choroiditis and panuveitis (9 %), Vogt-Koyanagi-Harada syndrome (9 %), and Behcets disease (8%). Long-term systemic therapy was needed for control of uveitis in 66 (64%) patients. Twenty patients (20 %) developed sight-threatening ocular complications. Twelve patients (12%) with panuveitis became bilaterally blind. CONCLUSIONS: The patterns of uveitis in the Philippines have markedly changed over the past 2 decades. Significant rates of ocular complications and blindness were found in this series, particularly among patients with panuveitis. These patients should be treated aggressively with corticosteroids and long-term immunosuppressive therapy.

The cost-effectiveness of management of Filipino patients with chronic primary glaucoma in a tertiary charity hospital setting

Chronic primary glaucoma affects sight very quietly - until such time that the progression of the disease is considerably advanced. The search for the ideal therapeutic approach to the disease can only provide, at best, for the arrest of the damage to the optic nerve head by bringing down the intraocular pressure to a level low enough to elude harm. Patients afflicted with the disease are bound to a therapy of a lifetime. This has implications of understated proportions in the economic scenario of a developing country. This study is conceived to determine the cost-effectiveness of chronic primary glaucoma management. A cross-sectional study design is employed to answer this objective. Medical records of 290 study eyes of 148 patients with chronic primary glaucoma (aged 14 - 88 years) are evaluated for cost-effectiveness of therapy. Results have shown that on one hand, medical therapy has a mean annual cost of PhP 5,830.00 + 278.00. On the other hand, surgical therapy has a one-time mean annual cost of PhP 8,100.00 + 359.00.Comparing cost-effectiveness using analysis of covariance (ANCOVA), one finds that filtering surgery is at least twice more cost effective than medical management (p0.001). Surgical complications, however, may hamper the effectiveness of filtering surgery. The study recommends that young patients with advanced disease and with higher IOP at the time of consult could be served more efficiently with a filter, whereas elderly patients approaching their life expectancy who can comply with the demands of effective medical management may not benefit much from it.

Tersons syndrome as a prognosticating factor in aneurysmal subarachnoid hemorrhage

This is a descriptive study of Tersons syndrome among patients with aneurysmal subarachnoid hemorrhage at the Philippine General Hospital. The incidence of Tersons syndrome was 13.4 percent. There were no statistically significant differences in outcomes among patients with and without Tersons syndrome. (Author)