Correcting Corneal Astigmatism with Corneal Arcuate Incisions during Femtosecond Laser Assisted Cataract Surgery.

BACKGROUND: Astigmatic management is an important step to achieve the best visual quality after refractive cataract surgery. Nowadays, along with progress in cataract surgery, the femtosecond laser can produce the arcuate incisions high precisely that help the astigmatic correction. In Vietnam, it has not yet any study about this issue, so we perform this study. AIM: To assess the efficacy and safety of arcuate corneal incisions in treatment corneal astigmatism during femtosecond laser-assisted cataract surgery. METHODS: In this clinical interventional study, forty-five cases with cataract and corneal astigmatism (> 0.50D) were treated with corneal arcuate incisions and femtosecond-laser assisted cataract surgery in Vietnam National Institute of Ophthalmology, from January 2017 to May 2018. The uncorrected and corrected distance visual acuity, refraction spherical equivalent, corneal astigmatism were measured (using an OPD-Scan III topographer) before, 1 week and 3 months after surgery. Some features of arcuate corneal incisions (quantity, depth, length and morphology), spectacle independence at a distance and complications were recorded. RESULTS: The rate of postoperative spherical refraction equivalent was within ± 0.50D and ± 1.0D at 3 months (in 95.6% and 100% of the eyes respectively). Mean length of arcuate corneal incisions was 53.78o ± 17.683o (range: 20o to 85o). The average of preoperative corneal astigmatism was 1.65 ± 0.83D, decreased to 0.59 ± 0.549D in the third month after surgery. Surgical induced astigmatism was 1.05 ± 0.449D and lower than preoperative corneal astigmatism (1.65 ± 0.83D), thereby this indicated undercorrection. However, the rate of spectacle independence was 82.3%, and no complications were recorded. CONCLUSION: Correcting of corneal astigmatism in femtosecond laser-assisted cataract surgery combined with the formation of the arcuate incisions is a new and modern method for high safety and efficacy.

Tissue-Cultured Human Cord Lining Epithelial Cells in Treatment of Persistent Corneal Epithelial Defect.

BACKGROUND: Persistent corneal epithelial defect (PED) is a consequence of many ocular surface disorders. Although many therapies have been suggested, the treatment of this disease have faced a lot of difficulties up to now. The transplatation of cultivated amniotic epithelial cells sheets is the new promised method for PED. Cord lining epithelial cells (CLECs) are epithelial cells of amniotic membrane of umbilical cord, so these cultivated cells sheet may be good for treating PED. AIM: To evaluate the efficacy of the transplantation of cultivated CLECs sheets in treatment of PED and analyze some influential factors of this therapy. METHODS: A prospective interventional case series with transplantation of tissue-cultured human CLECs in 37 PED eyes in Vietnam National Institute of Ophthalmology. RESULTS: Thirty four of 37 eyes were healed with the cells transplantation and 22 eyes of them healed within a week postoperatively. There were normal corneal scars and normal corneal epithelial cell (by impression cytology detection) on transplantation site in all 31 successful cases. The other successful eyes were done lamellar keratoplasty (respectively in 1 month, 3 months, 6 months and 27 months postoperatively) to investigate the histopathology of the CLECs transplant site. The histopathological images showed normal corneal scar and there was no appearance of CLECs in transplant site. CONCLUSION: tissue-cultured human CLECs transplantation is a quite safe and effective treatment for persistent corneal epithelial defect. The CLECs may help the epithelial healing at early stage but do not exist at transplant site for a long time.

Outcomes of Small Incision Lenticule Extraction for Myopic Astigmatic Treatment.

BACKGROUND: Some studies have shown that there is a certain rotation of the eye in the sitting and lying position of the patient. The Visumax system used for the Refractive Lenticule Extraction-Small Incision Lenticule Extraction (ReLEx SMILE) surgery lacks the rotation of eye control function. So, is the ReLEx SMILE surgery for patients with astigmatism safe and effective? AIM: To evaluate the outcomes of the ReLEx SMILE surgery in cases with myopic astigmatism. METHODS: The case series included 120 eyes with myopic astigmatism undergoing ReLEx SMILE surgery from January 2018 to November 2018. The distribution of patients for two subgroups based on the power of astigmatism, low astigmatic group (≤ 1.50D) and high astigmatic group (> 1.50D). All patients were measured UDVA, CDVA, refractive sphere, astigmatism and sphere equivalent before and after surgery one week, one month and three months carefully. The astigmatic correction was evaluated by the vectorial analysis Alpins. RESULTS: The mean efficacy index of the low and high astigmatic group was 1.035 and 1.082 (respectively); the mean safety index was 1.113 and 1.215 (respectively). 93% of eyes in the low astigmatic group had an angle of error (AE) within ± 15 degrees and 100% in high astigmatic group. There was an undercorrection in astigmatic treatment. No complications during and after surgery were recorded. CONCLUSION: ReLEx SMILE surgery for the myopic astigmatic treatment was safe and effective.

Assessing the Status of Filtering Blebs at 5 Year Post- Trabeculectomy.

BACKGROUND: Glaucoma is a common cause of blindness in the world as well as in Vietnam. It is treated by many different methods but trabeculectomy is still the most popular and highly effective surgical method to treat this condition. AIM: To analyze the status of 5 years filtering blebs following trabeculectomy and to explore multiple factors associated with filtering blebs. METHODS: This is a retrospective, cross-sectional descriptive study. Eyes had been performed trabeculectomy for 5 years were included in these results. The filtering blebs were assessed using slit lamp and OCT. the OCT captured bleb area to evaluate fluid subconjunctival spaces, thickness and height of bleb and to evaluate the related factors. RESULTS: A group of 106 primary glaucoma eyes of 97 patients (88 patients with 1 eye, 9 patients 2 eyes) had been performed trabeculectomy for 5 years were taken OCT anterior image. The proportion of female patients is 1.5 times that of male patients. IOP was controlled with or without topical medication in all eyes. The filtering bleb had a high echo reflection, which accounted for 42.5%, the average echo reflection was 38.6%, the low echo reflection response of 18.9%. 66% of the eyes had the aqueous space under the conjunctiva, 65.1% have the aqueous space under sclera flap, the average height of the bleb on OCT was 0.4 mm ± 0.3 mm. Young patients often have a higher rate of bleb fibrosis and loss of function than older patients. CONCLUSION: OCT is capable of assessing the function of bleb. After 5 years of trabeculectomy, on the OCT image, most cases of blebs are maintaining drainage function.

Ocular Biometrics of Vietnamese Young Adults with Myopia.

BACKGROUND: Myopia is most prevalent type of refraction error. In some Asian countries, the prevalence of myopia can be 80 - 90% in the population aged 17 - 18. AIM: To analyze the correlation between ocular biometric indices and refraction status in Vietnamese young myopes. METHODS: A prospective cross - section study was conducted in young myopes. Data on axial length, central cornea thickness, corneal topography & anterior chamber depth and spherical equivalent were collected. Independent Sample T Test and ANOVA test were used to compare between groups. The correlations between ocular biometry and myopic spherical equivalent refraction were examined by Pearson Correlation with the level of significance p < 0.05. RESULTS: Totally, 418 eyes from 209 patients were recruited. The average axial length, central cornea thickness, cornea refraction & anterior chamber depth were 25.68 ± 1.09 mm, 539.78 ± 32.665 µm, 43.16 ± 1.369 D, 3.30 ± 0.243 mm, respectively. The correlation between axial length and spherical equivalent refraction (SER) was high (r = - 0.742, p < 0.0001) while those between central cornea thickness and cornea refraction were negligible (r = - 0.107, p = 0.029; r = -0.123, p = 0.012; respectively). There was no correlation between anterior chamber depth and spherical equivalent refraction (r = 0.019, p = 0.697). CONCLUSION: Among ocular biometric indices, axial length was significantly correlated with spherical equivalent of young adult patients.

Penetrating Keratoplasty for Keratoconus in Vietnamese Patients.

BACKGROUND: Keratoconus is an ectatic corneal disorder that can impair the visual acuity. Up to now, penetrating keratoplasty (PK) remains the most common surgical procedure to treat severe keratoconus. In Vietnam, most keratoconus patients come to visit doctor at severe stage and were treated by PK, so we conduct this study. AIM: To evaluate the results of PK for keratoconus in Vietnamese patients. METHODS: This was a retrospective study of 31 eyes with keratoconus who underwent PK in VNIO from January 2005 to December 2014. RESULTS: The average visual acuity was 0.86 ± 0.37 logMAR (20/145). In the group of patients without amblyopia, best spectacle-corrected visual acuity of 20/60 or better was recorded in 75.9% of eyes and 93.1% of eyes achieved a best corrected visual acuity with hard contact lenses of 20/40 or better. Mean postoperative corneal power was 43.8 ± 4.5D. Mean corneal astigmatism was 5.9 ± 2.7D. 94.6% of grafts remained clear. Posterior subcapsular cataract developed in 22.6% of eyes. Graft rejection was recognized in 12.9% of eyes. CONCLUSION: PK is an effective procedure with high rate of graft survival for keratoconus patients. However, patients should be aware of the necessary of optical correction to gain the best VA after surgery.

Dry Eyes Status on Des Scale and Related Factors in Outpatients at Vietnam National Institute of Ophthalmology.

BACKGROUND: Dry eye (DE) can effect on quality of life by pain, inability to perform certain activities that require prolonged attention (driving, reading,…) and productivity at work and finally effect to Q0L associated with DE. OSDI is scale questionnaire is created team to measure the quality of life related to ocular surface disease. AIM: To describe the dry eye disease according to OSDI scale and related factors of this disease. METHODS: A cross-sectional descriptive study was carried out on outpatients (≥ 16-year-old) who were examined and diagnosed with dry eyes at Vietnam National Institute Of Ophthalmology from April to July 2018. Data was collected using the OSDI questionnaire. RESULTS: The average age of participants was 44.6 years; 80.9% of patients were female; 39.9% were identified having mild dry eye. The related factors have been identified that associated with severe dry eye, including age OR = 1.03 (95% CI: 1.01-1.05, p = 0.005), binocular good vision OR = 0.11 (95% CI: 0.05-0.23; p < 0.0001), medical history OR = 17.09 (95% CI: 2.24-130.25; p < 0.0001), chronic conjunctivitis OR = 0.36 (95% CI: 0.14-0.91; p = 0.027), refractive errors OR = 0.14 (95% CI: 0.04-0.48; p < 0.0001), Sjogren's syndrome OR = 31.13 (95% CI: 7.08-136.76; p < 0.0001). CONCLUSION: Several related factors have been identified associated with severe dry eye, including: age, binocular good vision, medical history, chronic conjunctivitis, refractive errors, Sjogren's syndrome.

Evaluation of Anterior Chamber Depth and Anterior Chamber Angle Changing After Phacoemulsification in the Primary Angle Close Suspect Eyes.

BACKGROUND: Phacoemulsification surgery has the ability to deeply alter the segment anterior morphology, especially in eye with shallow anterior chamber (AC), narrow anterior chamber angle (ACA). However, the changes of anterior chamber depth (ACD) and ACA on the close angle suspect eyes after phacoemulsification have not been mentioned in many studies. So, we conduct this research. AIM: To evaluate the alteration in the ACA and ACD after phacoemulsification in the close angle suspect eyes. METHODS: Interventional study with no control group. Subjects were the primary angle closure suspect (PACS) eyes, that were operated by phacoemulsification with intraocular lens (IOL) at Glaucoma Department of VNIO from December 2017 to October 2018. RESULTS: 29 PACS eyes with cataract were operated by phacoemulsification with intraocular lens. After 3 months of monitoring, the average ACD augmented from 2.082 ± 0.244 to 3.673 ± 0.222 mm. AOD500 increase from 0.183 ± 0.088 to 0.388 ± 0.132 µm, AOD750 increased from 0.278 ± 0.105 to 0.576 ± 0.149 µm. The TISA500 enlarged from 0.068 ± 0.033 to 0.140 ± 0.052 mm2, TISA750 enlarged from 0.125 ± 0.052 to 0.256 ± 0.089 mm2 at the third month (p < 0.01). CONCLUSION: Phacoemulsification surgery increases the ACD and enlarged the angle in the PACS eyes.

Evaluation of Phacoemulsification Cataract Surgery Outcomes After Penetrating Keratoplasty.

BACKGROUND: Cataract is one of the reasons which causes impaired visual acuity (VA) of the eyes after penetrating keratoplasy (PK), which can be treated by cataract surgery after PK or triple procedure. Cataract surgery after PK has advantages that parameters of the eyes such as axial length, anterior chamber depth (ACD) as well as corneal curvature are stabilized after removing all sutures postoperatively, and intraocular lens (IOL) power can be calculated correctly. Therefore, postoperative VA will be improved significantly. In Vietnam, there have not been any study about cataract surgery after PK, therefore we conduct this research. AIM: To evaluate the outcomes of phacoemulsification cataract surgery following primary PK. METHODS: Non-randomized controlled intervention study. Ninteen eyes (19 patients) that underwent phacoemulsification plus IOL insertion after initial PK in Cornea department, Vietnam National Institute of Ophthalmology, from December 2013 to September 2014. RESULTS: All patients presented with reduced VA, including 17 eyes (89.9%) with VA ≤ 20/200, mean astigmatism was 7.9 ± 1.0 D. Clear corneal grafts in 16 eyes while corneal opacity was seen in 3 eyes. All eyes with cataract were diagnosed from grade 2. After cataract surgery, improved VA > 20/200 was achieved in 72.22% of cases. There was a markable reduce of postoperative astigmatism with 1.8 ± 0.8 D (p < 0.05). However, the immunologic graft reaction was presented in one eye, and two edematous corneas also reported after cataract surgery. After treatment, there was one cornea achieved its clarity. CONCLUSION: Phacoemulsification cataract surgery following initial PK showed good outcomes with improved postoperative VA, reduced astigmatism, and the ultimate graft survival rate was high.

Clinical and Microbiological Features of Pediatric Endopthalmitis After Open Globe Injury in the North of VietNam.

BACKGROUND: Pediatric endophthalmitis after open-globe injury had its clinical features, microbiological profile different from those in aldults. In Viet Nam, there was no report on the clinical and microbiological characteristics of pediatric posttraumatic endophthalmitis. Therefore, we conduct this study. AIM: To describe clinical features, ultrasound results, gram stain and culture results of endophthalmitis in pediatric open globe injuries. METHODS: Prospective non-controlled study. Case series of 30 eyes presenting with post-traumatic endophthalmitis between 2015 and 2016 were reviewed. RESULTS: Mean age was 8.03 ± 3.99 years. Metallic and organic etiologies were the most common causes for injuries (n = 11). 27 cases had penetrating corneal trauma. Dense opaque vitreous was seen in 25 eyes. Retinal necrosis < 1 quadrant and chorioretinal abscess > 1 quadrant were the most common fundus lesions. Dense vitreous opacity on ultrasound was most common (n = 28). Gram stain bacteria positivity was 93.3%, gram-positive was isolated in 63.3%. Vitreous samples were more often positive than aqueous (P = 0,002). CONCLUSION: Posttraumatic endophthalmitis in children is more common in boys aged 6-10 years and most often caused by injury with metallic and organic matters. Culture results were very low. Vitreous samples were more often positive than aqueous. Gram-positive bacteria were the most common causative organism.

Distribution of rotavirus G and P genotypes approximately two years following the introduction of rotavirus vaccines in South Korea.

Genotyping of human rotaviruses was performed on 299 (40.1%) rotavirus-positive samples obtained from 745 children with acute diarrhea in three provinces in South Korea between March 2008 and February 2010, approximately 2 years following the introduction of the RotaTeq (September 2007) and Rotarix (July 2008). The most prevalent G genotypes were G1 (51.5%), followed by G3 (24.0%), G4 (15.4%), G9 (6.4%), and G2 (4.7%). The predominant types of P genotypes were P[8] (72.6%), followed by P[6] (19.1%) and P[4] (6.0%). The phylogenetic analyses of the VP7 genes of G9 strains revealed they were highly identical and belonged in lineage III. This study highlights the consistency of the predominant G1 genotype and slightly higher predominance of the identical G9 strains over the G2 genotype.