Precautions in ophthalmic practice in a hospital with a major acute SARS outbreak: an experience from Hong Kong.

Many new infectious diseases in humans have been derived from animal sources in the past 20 years. Some are highly contagious and fatal. Vaccination may not be available and antiviral drugs are not effective enough. Infectious control is important in clinical medicine and in Ophthalmology. Severe acute respiratory syndrome (SARS), as an example, is a highly contagious respiratory disease that has recently been reported in Asia, North America, and Europe. Within a matter of weeks, the outbreak has evolved to become a global health threat and more than 30 countries have been afflicted with a novel Coronavirus strain (SARS-CoV) that is the aetiologic agent of SARS. The primary route of transmission of SARS appears involving close person-to-person contact through droplets. Ophthalmologists may be particularly susceptible to the infection as routine ophthalmic examinations like direct ophthalmoscopy and slit-lamp examination are usually performed in a setting that has close doctor-patient contact. Being the Ophthalmology Department of the only hospital in the world that has just gone through the largest outbreak of SARS, we would like to share our strategy, measures, and experiences of preventing contracting or spreading of SARS infection as an infection control model. SARS is one of the many viruses against which personnel will need protecting in an ophthalmic setting. The experiences attained and the measures established might also apply to other infectious conditions spreading by droplets such as the avian influenza with H5N1.

Immediate pars plana vitrectomy for dislocated intravitreal lens fragments during cataract surgery.

PURPOSE: To assess the outcome of patients who underwent instantaneous pars plana vitrectomy for dislocated lens fragments during cataract surgery. METHODS: The medical records of 29 patients who underwent immediate pars plana vitrectomy for dislocated lens fragments at the same sitting of phacoemulsification surgery were reviewed. Data including patients' demographics, preoperative and postoperative vision, risk factors for lens fragment dislocation, and intraoperative and postoperative complications were recorded. RESULTS: The mean follow-up period of the patients was 12.3 months (range, 3-47 months). The median preoperative visual acuity was 6/90 (range, LP to 6/15). The median final postoperative visual acuity was 6/18 (range, NLP to 6/9) and the mean improvement in vision after the operation was 4.5 lines. The commonest risk factors for dislocation of lens fragment were late detection of posterior capsule tear, splitting of anterior capsulorrhexis, and hard nucleus. After excluding nine eyes with other pre-existing ocular comorbidities, 10 (50%) eyes had a final visual acuity of 6/12 or better. Complications after surgery included three (10%) cases of retinal detachment and one (3%) patient developed epiretinal membrane. None of the patients in the study developed secondary glaucoma or cystoid macular oedema following surgery. CONCLUSION: Immediate vitrectomy in the same sitting of the cataract surgery is a surgical option in the management of dislocated intravitreal lens fragments when vitreoretinal support is available. Most patients achieve a good visual outcome with reduced risk of secondary glaucoma and cystoid macular oedema after surgery.

Modified endoscopic dacryocystorhinostomy with posterior lacrimal sac flap for nasolacrimal duct obstruction.

OBJECTIVES: To evaluate a new technique of modified endoscopic dacryocystorhinostomy involving the creation of a large posterior flap at the lacrimal sac and to compare its success rate with that of the conventional endoscopic method of excising the entire medial lacrimal sac wall as a surgical treatment for epiphora caused by nasolacrimal duct obstruction. DESIGN: Retrospective, interventional, and comparative case series. SETTING: University teaching hospital, Hong Kong. PATIENTS AND METHODS: Only adults with primary nasolacrimal duct obstruction were included. Consecutive endoscopic dacryocystorhinostomy was performed using two different techniques from July 1999 to June 2001. The new technique involved the creation of a large posterior flap at the medial lacrimal sac wall, reflecting it posteriorly, followed by removal of the remaining small anterior flap (the LSF group). Other patients had the entire medial lacrimal sac wall excised (the ELS group). MAIN OUTCOME MEASURES: Surgical success was defined by free fluorescein drainage from the conjunctival sac into the rhinostomy site at least 3 months after silicone stent removal. RESULTS: Ninety-nine procedures were performed in 99 patients. The success rate was 89.1% (41/46) in the LSF group and 71.7% (38/53) in the ELS group. The difference between the two groups was statistically significant (Chi squared test, P=0.031). CONCLUSIONS: Our new and modified technique of endonasal dacryocystorhinostomy has a greater success rate than conventional endonasal dacryocystorhinostomy. A large-scale prospective randomised controlled trial to further evaluate the efficacy and safety of this surgical technique is under way.