No abstract

Compared with manual SICS, temporal-side incision in phacoemulsification decreased corneal sensitivity in the incision site and other sites until day 15 and changes in tear film quantity and patient symptoms only on day 1.

Aim:To evaluate the predictive factors of LASIK procedure for high myopia with or without astigmatism using a combination of high-frequency femtosecond-assisted LASIK followed by an excimer laser.Methods:This study was a retrospective interventional case series study to evaluate myopic eyes undergoing high platform LASIK with FEMTO LDV Z2 intervention, followed by WaveLight®EX500 excimer laser machine. Subjects were divided into 2 groups: high myopia (SE of -6.01 to -9.00 D) and very high myopia (SE of -9.01 D or higher). Myopic eyes (Spherical Equivalent/SE) less than –13 D were included in this study. Visual Acuity (VA) was evaluated 1 day and 60 days after the procedure. Predictive factors, such as age, degree of sphere, degree of astigmatism, keratometric reading and axial length were analyzed to detect any influences affecting the final VA results.Results:A total of 316 myopia eyes underwent intervention, mean age: 25.3±3.8 years. Target treatment was achieved in 96.1% of patients with high myopia and 69.9% of patients with very high myopia. High degree of sphere and astigmatism constitutes an important factor influencing final VA.Conclusion:Modern machines provide a more promising efficacy and success of LASIK procedure in high myopia: important predictive factors were a high degree of sphere and astigmatism for achieving the optimal final outcome.

Purpose To determine current institutional practice patterns for the use of perioperative antibiotics and other measures to prevent infection after cataract surgery in Asia. Methods An online survey-based study of leading eye institutions in China, Hong Kong, India, Indonesia, Japan, Malaysia, Pakistan, Philippines, Singapore, South Korea, Taiwan, Thailand and Vietnam was conducted. The survey was administered to 26 representative key opinion leaders from prominent tertiary eye institutions that are also national academic teaching institutions in Asia. Survey responses were collated and anonymized during analysis. Results All surveyed institutions used povidone iodine for the preoperative antiseptic preparation of the eye, with notable variations in the concentration of povidone iodine used for conjunctival sac instillation. Preoperative topical antibiotics were prescribed by 61.5% and 69.2% of institutions in low-risk and high-risk cases, respectively. Regarding the use of intra-operative antibiotics, 60.0% and 66.7% of institutions administered intracameral antibiotics in low-risk and high-risk patients, respectively. Postoperative topical antibiotics use patterns were generally very similar in low-risk and high-risk patients. Over half of the institutions (52.2% and 68.0% in low-risk and high-risk patients, respectively) also indicated prolonged postoperative use of topical antibiotics (> 2 weeks). Not all surveyed institutions had established policies/protocols for perioperative antibiotic use in cataract surgery, endophthalmitis surveillance, and/or a monitoring program for emerging antimicrobial resistance. Conclusion There are variations in antimicrobial prophylaxis approaches to preoperative, intra-operative and postoperative regimens in cataract surgery in Asia. More evidence-based research is needed to support the development of detailed guidelines for perioperative antibiotic prophylaxis to reduce postoperative infections.

Aims: In this study, we aimed to investigate the intercorrelations between tear film break up time, measured non-invasively using non-invasive keratographic break-up time (NIKBUT), higher order aberrations (HOA) and quality of vision (QoV) in pseudophakic patients. Study Design: Cross-sectional. Methods: Thirty-five pseudophakic aged patients aged 50 years or older, and 35 control phakic patients aged 17 to 23 years with corrected visual acuity of 20/20 were included in this study. All subjects underwent similar examination including QoV questionnaire, aberrometry to measure HOA, and NIKBUT. HOA was measured with the OPD-Scan/ ARK 10000 corneal analyzer (Nidek CO. Ltd), expressed as Root Mean Square (RMS) HOA and NIKBUT was assessed using non-invasive TF-Scan module Keratograph 5M (K5M), equipped with modified tear film scanning function (Oculus, Wetzlar, Germany). Statistical analysis was performed to find the correlation between NIKBUT, HOA and QoV. Results: Patients in the pseudophakic group were significantly older (median age 66 vs. 20 years; P<0.01), had shorter NIKBUT (10.5 vs. 17.2; P<0.01), lower QoV score (1.63 vs. 0.68; P=0.04), and higher RMS HOA (0.5 vs. 0.26; P<0.01) compared to control group. NIKBUT was inversely correlated with RMS HOA (r = -0.19; p = 0.03) and RMS HOA was significantly correlated with QoV, even after adjustment for age and gender (r = -0.21; P0.04). NIKBUT <9.93s was correlated with lower QoV. The area under the curve was 0.81 (95% CI = 0.67 – 0.95, p = 0.012), and had 100% sensitivity and 61% specificity. Conclusion: Shorter NIKBUT was correlated with greater HOA and greater HOA was correlated with lower QoV. NIKBUT value of shorter than 9.93s could potentially predict pseudophakic patients who will likely experience visual symptoms leading to decreased QoV; thus, the use of artificial tears might be beneficial.

Purpose To illustrate the complexity in managing secondary glaucoma post-repeat penetrating keratoplasty in a developing country. Case Description A patient with a history of five repeat penetrating keratoplasties (PKPs) showed good intraocular pressure (IOP) control with trabeculectomy; however, blebitis occurred as an undesirable complication. Trabeculectomy was done rather than tube implantation due to socioeconomic factors, although it’s not an ideal treatment. After the infection subsided, we performed a bleb revision with a scleral patch graft. Intraocular pressure was high in the follow-up period after the scleral patch, therefore we decided to do tube implantation. Following glaucoma tube implant surgery, the patient had good IOP control and a clear graft after six months of follow-up. Conclusion Secondary glaucoma post repeat PKPs is challenging in both diagnosis and management. Immediate action is imperative to control IOP, prevent glaucoma progression, and minimize corneal graft damage. In addition to medical reasons, socioeconomic factors should be considered.

Introduction: Due to difficulties in attending direct patient care and to limit the spread of COVID-19, the Indonesian ministry of health encourages hospitals to establish telemedicine services. This study aimed to report the initial practice of real-time teleophthalmology during the COVID-19 pandemic in Indonesia.  Methods: This retrospective descriptive-analytical study collected data from patients who had teleophthalmology consultations within 3 months (April 27 – July 27, 2020). All consecutive patients were included in this study, except those with incomplete records. Patients’ demographics, the main reason for the consultation, working diagnosis, prescribed medication, management plan, and satisfaction survey were collected for the analysis.  Result: There were 251 video consultations from 206 patients with 4 patients (1.9%) excluded due to incomplete medical records. There were 52 (25.7%) new patients. The median consultations were 2 (1-8) each day. The median age was 43.5 (from <1 year to 95 years). The main reasons for consultation were dry eye-related symptoms and red eye. The three most common primary working diagnoses were dry eye syndrome, conjunctivitis, and stye. Medication was prescribed for 149 patients (73.8 %) and 43 patients (21.3 %) were advised to have immediate direct consultation. The satisfaction survey revealed a 21.3% response rate, of which 41.9% and 58.1% felt very satisfied and satisfied respectively. Conclusion: Real-time teleophthalmology consultation seemed to be well-accepted by our population in spite of its early adoption with a high satisfactory rate.

Introduction and Objective: Boston keratoprosthesis (Boston KPro) is an artificial cornea (collar button design) for a severely damaged cornea that is not suitable for penetrating keratoplasty (PKP). One main advantage of Boston KPro type I is there is no need to perform tarsoraphy. There were no previous studies investigating the clinical outcome of Boston KPro implantation in Indonesia, therefore we aimed to investigate the visual outcomes, device retention, and complications following Boston KPro type 1 keratoprosthesis. Case Presentation: This study was a case series of 11 patients conducted at Jakarta Eye Center with 18 months follow up period. The inclusion criteria were patients with severe corneal diseases that are not amenable for PKP. We found that VA baseline were LP (±72.72%) and HM (27.27%) (mean VA baseline=2.51±0.14 logMAR or equal to HM – LP VA) which significantly improved to 1.09 ± 0.69 logMAR (equal to 6/60 Snellen, ±36.3% were near normal vision based on WHO criteria), p=0.007. Two cases (±16.7%) were still HM because of implant explantation with corneal melting. There were 80.5% retention rates at final follow-up and other complications were retroprosthetic membrane formation (26.7%), elevated IOP (13.9%), and sterile corneal stromal necrosis (17.8%).There was no endophtalmitis found in this study. Conclusion: Boston K-Pro type 1 is a recommended option for patients with multiple corneal graft failure. It provides promising visual outcome with good retention rates. The number of Boston K-Pro type 1 implantations should be increased to counterbalance the corneal blindness burden in Indonesia.