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Use of recombinant tissue plasminogen activator for treatment of recalcitrant anterior uveitis: A case series

Patrick S, Hui-Tze C, Wan-Hazabbah WH, Zunaina E, Azhany Y, Liza-Sharmini AT

J Taibah Univ Med Sci, 2018 Oct;13(5):483-487.
PMID: 31435366 DOI: 10.1016/j.jtumed.2018.03.005

Management of inflammation after surgery for recalcitrant anterior uveitis is challenging. Herein, we report successful treatment using intracameral injection of recombinant tissue plasminogen activator (rtPA) in two patients with recalcitrant anterior uveitis, due to infective uveitis and Vogt-Koyanagi-Harada disease, respectively. A 40-year-old woman presented with bilateral redness and vision reduction that had persisted 2 weeks. She also had bilateral anterior uveitis, vasculitis, retinitis, and optic disc swelling. Serology was positive for Bartonella henselae and Toxoplasma gondii. She was treated using long-term systemic corticosteroids and appropriate antibiotics. Our second case; a healthy 30-year-old man with bilateral eye redness and reduced vision without pain, and associated with headache and tinnitus for 1 weeks. He showed bilateral granulomatous inflammation with vitritis, choroiditis, retinitis, and hyperemic optic disc. The patient was diagnosed with Vogt-Koyanagi-Harada disease and treated with systemic corticosteroids. Both patients developed secondary cataracts and glaucoma that necessitated surgical intervention. Persistent chronic inflammation led to the formation of a thick fibrin membrane anterior to the intraocular lens (IOL) after phacoemulsification surgery with IOL implantation. This membrane was removed surgically, and intracameral injection of rtPA (25 μg) was carried out. The persistent inflammation had resolved and visual acuity had significantly improved within 1 week of intracameral rtPA injection. There were no reported ocular or systemic side effects. Intracameral rtPA is beneficial in patients with recalcitrant anterior uveitis who have undergone intraocular surgery. In most cases, surgical intervention improves the patients' vision. Intracameral rtPA should be considered in cases of persistent inflammation of varying etiology.

Matched MeSH terms: Lenses, Intraocular
Towards Vision 2020 -Trends of Cataract Surgery in Melaka Hospital, A Malaysian Tertiary Center: 2007-2014

Thevi T, Abas AL

Kathmandu Univ Med J (KUMJ), 2021 2 18;18(70):122-132.
PMID: 33594017

Background Cataract surgery which is the only scientific method to treat cataracts has evolved from large incisions of intracapsular cataract excision to extracapsular cataract exicison and now modern day phacoemulsification. Anaesthesia too has progressed from general anaesthesia to local and topical anaesthesia. A variety of intraocular lenses are available ranging from rigid to foldable, multifocal and toric. Day care surgeries are becoming the norm these days. Objective Cataract surgery has advanced with new techniques and modalities. We studied the trends of cataract surgery and outcomes over the years. Method We performed secondary data analysis (National Eye Database) of cataract surgery patients in Hospital Melaka (2007 - 2014). Result Most patients were 60-69 years (mean 65.0 years). Primary cataract rose (p<0.05) but there was no difference in laterality and first or second eye (p>0.05). More patients presented with Hypertension and Diabetes (p<0.05). Pterygium encroaching the cornea showed a rise (p<0.05). Phacoemulsification (80.8%) showed a rise while Extracapsular Cataract Extraction (ECCE) (15.4%) declined (p<0.05). More Specialists operated and fewer combined surgeries were performed (p<0.001). Type of anaesthesia did not change (p>0.05). Operative complications reduced (p<0.001). Anterior chamber, scleral fixated and foldable intraocular lenses usage reduced (p<0.05). There was no change in pre-operative visual acuity (p>0.05) but postoperative vision showed a rise in good outcomes (p<0.05). Conclusion Melaka Hospital shows a rise in phacoemulsification and a decline in Extracapsular Cataract Extraction. More patients presented with primary cataracts. More Specialists operated and there was a reduction in intraoperative and postoperative complications. Post-operative visual outcomes showed a remarkable improvement. This improvement is in keeping with the aim of improved vision for all by 2020.

Matched MeSH terms: Lenses, Intraocular*
Fulltext The use of ultrasound in ocular biometry

Kuan BB, Lim TK

Med J Malaysia, 1984 Dec;39(4):280-4.
PMID: 6544933

Ultrasound measurement of ocular dimension is the chosen method for assessing axial length when determining dioptric power for intraocular lens. From the current results of 30 cases studied, the mean axial length ranges from 22 to 23 mm. Despite the limitation of the accuracy of the ultrasonic measurements with the 7.5 mHz transducer, the power of intraocular lens can. be determined satisfactorily in accordance with the knowledge of keratometric reading. Hence, high refractive errors could be avoided post-operatively.

Matched MeSH terms: Lenses, Intraocular
The effectiveness of sub-Tenon's infiltration of local anaesthesia for cataract surgery

Verghese I, Sivaraj R, Lai YK

Aust N Z J Ophthalmol, 1996 May;24(2):117-20.
PMID: 9199741

PURPOSE: To determine if adequate anesthesia and akinesia could be obtained using an inferonasal quadrant sub-Tenons anaesthesia for cataract surgery.
METHODS: The sub-Tenons method of local anaesthesia was used in 50 patients undergoing extracapsular cataract extraction and lens implantation. The technique following was that described by JD Stevens in his study of 50 patients. Posterior sub-Tenons space was approached through a conjunctival incision in the inferonasal quadrant and the anaesthetic solution delivered by an irrigating cannula. The patients were assessed for residual ocular movements just before surgery. Effectiveness of anaesthesia was assessed during surgery using a verbal pain rating score. Scoring was based on the concept of a visual analogue pain score chart.
RESULTS: Total akinesia was obtained in 20% patients and total anaesthesia in 24% patients. The remainder of the patients had adequate akinesia and anaesthesia to proceed with and complete the surgery.
CONCLUSION: This method provides satisfactory anaesthesia for cataract surgery.

Matched MeSH terms: Lenses, Intraocular
The Malaysian cataract surgery registry: incidence and risk factors of postoperative infectious endophthalmitis over a 7-year period

Wai YZ, Fiona Chew LM, Mohamad AS, Ang CL, Chong YY, Adnan TH, et al.

Int J Ophthalmol, 2018;11(10):1685-1690.
PMID: 30364221 DOI: 10.18240/ijo.2018.10.17

AIM: To report the incidence, risk factors and visual outcomes for postoperative endophthalmitis (POE) based on 7-year data from the Malaysian Ministry of Health Cataract Surgery Registry (MOH CSR).
METHODS: Data was collected from the web-based MOH CSR. All consecutive cataract surgery patients from 1st June 2008 to 31st December 2014 were identified. Exclusion criteria were traumatic cataract or previous ocular surgery. Demographic data, ocular co-morbidities, intraoperative details and postoperative visual acuity (VA) at final ophthalmological follow-up were noted. All eyes were taken for analysis. Subjects with POE were compared against subjects with no POE for risk factor assessment using multiple logistic regressions.
RESULTS: A total of 163 503 subjects were screened. The incidence of POE was 0.08% (131/163 503). Demographic POE risk factors included male gender (OR: 2.121, 95%CI: 1.464-3.015) and renal disease (OR: 2.867, 95%CI: 1.503-5.467). POE risk increased with secondary causes of cataract (OR: 3.562, 95%CI: 1.740-7.288), uveitis (OR: 11.663, 95%CI: 4.292-31.693) and diabetic retinopathy (OR: 1.720, 95%CI: 1.078-2.744). Intraoperative factors reducing POE were shorter surgical time (OR: 2.114, 95%CI: 1.473-3.032), topical or intracameral anaesthesia (OR: 1.823, 95%CI: 1.278-2.602), posterior chamber intraocular lens (PCIOL; OR: 4.992, 95%CI: 2.689-9.266) and foldable IOL (OR: 2.276, 95%CI: 1.498-3.457). POE risk increased with posterior capsule rupture (OR: 3.773, 95%CI: 1.915-7.432) and vitreous loss (OR: 3.907, 95%CI: 1.720-8.873). Postoperative VA of 6/12 or better was achieved in 15.27% (20/131) subjects with POE.
CONCLUSION: This study concurs with other studies regarding POE risk factors. Further strengthening of MOH CSR data collection process will enable deeper analysis and optimization of POE treatment.

Matched MeSH terms: Lenses, Intraocular
Fulltext Spontaneous repositioning of posterior chamber intraocular lens: a mere coincidence?

Wern-Yih C, Jan-Bond C, Sudha M, Norlelawati A, Shatriah I

Arq Bras Oftalmol, 2020 08;83(4):329-331.
PMID: 32756777 DOI: 10.5935/0004-2749.20200054

Despite the recent developments in modern cataract surgery and the application of a vast array of new devices and machines, late in-the-bag intraocular lens dislocation remains a devastating, albeit rare, complication. Various nonsurgical and surgical techniques have been used to manage this complication. We report a case of spontaneous repositioning in the left eye of an anteriorly subluxated in-the-bag intraocular lens. The spontaneous repositioning may have been caused by antagonistic effects related to the topical administration of brimonidine and prednisolone. The dislocation was treated without aggressive manipulation or surgical intervention.

Matched MeSH terms: Lenses, Intraocular*
Fulltext Spontaneous dislocation of intraocular lens as a late complication of uncomplicated cataract surgery: a case series

Lam HH, Visvaraja S

Clin Exp Optom, 2012 Jan;95(1):99-102.
PMID: 21954950 DOI: 10.1111/j.1444-0938.2011.00640.x

Five patients having uncomplicated phacoemulsification were implanted with CT-Asphina 603P intraocular lenses into the capsular bag. After a few months, three of the patients had haptic flexion anterior to the optic despite minimal capsular fibrosis. One patient had spontaneous dislocation of the intraocular lens into the anterior chamber with only minimal capsular fibrosis. Another patient had one haptic dislocated out of the bag. Late intraocular lens dislocation is also seen in newly designed preloaded intraocular lenses despite the absence of significant capsular fibrosis. Haptic-optic junction design and intraocular lens material play important roles in such complication. A slightly large capsulorhexis might be a deterrent for implantation of this intraocular lens.

Matched MeSH terms: Lenses, Intraocular*
Significance of intraocular lens power calculation

Singh M, Dahalan A

Br J Ophthalmol, 1987 Nov;71(11):850-3.
PMID: 3689737

A total of 94 patients underwent extracapsular cataract extraction and insertion of Sinsky style two-loop posterior chamber intraocular lenses. Forty-six eyes received a standard power IOL and 48 eyes were given a preoperatively calculated IOL. A significant difference was found in the two groups with regard to the postoperative refractive error and uncorrected visual acuity.

Matched MeSH terms: Lenses, Intraocular*
Fulltext Sequelae of neglected senile cataract

Azhany Y, Hemalatha C, Nani D, Rosediani M, Liza-Sharmini A

Malays Fam Physician, 2013;8(1):33-7.
PMID: 25606266 MyJurnal

Cataract is the most common cause of blindness in the world. An attack of phacolytic and phacomorphic glaucoma as a result of neglected cataract constitutes a medical emergency that must be addressed immediately. Ocular emergencies such as these is challenging for the surgeon with guarded or poor prognosis. We describe the presentation, management and prognosis of three cases of phacomorphic and phacolytic glaucoma. All three patients underwent aggressive management of intraocular pressure. Despite successful cataract operation with implantation of intraocular lens, there was only mild improvement of the vision. Optic nerve and pupil functions were permanently affected following the insult. Phacomorphic and phacolytic glaucoma present a very challenging problem to the surgeon with poor visual outcome. Public health education and awareness are important and health workers should encourage patients with cataract to seek early treatment for better prognosis.

Matched MeSH terms: Lenses, Intraocular
Fulltext Secondary intraocular lens implantation in University Hospital, Kuala Lumpur

Jaais F

Med J Malaysia, 1998 Sep;53(3):272-6.
PMID: 10968165

Secondary intraocular lens implantation after cataract surgery done in University Hospital between 1983 to 1993 were reviewed. Thirty three patients (37 eyes) underwent secondary intraocular lens implantation during this period. Twenty four eyes had secondary anterior chamber lens implantation while 13 had posterior chamber lens implantation. There was no case of secondary posterior scleral fixation lens implantation. Visual acuity of 6/9 or better was seen in 25 of 37 eyes (67%) in the series. Eyes seeing as good or better than before secondary implantation procedure were noted in 34 of 37 eyes (92%). Vision of 6/9 or better was seen in 9 of 13 eyes (70%) with posterior chamber implants and 16 of 24 eyes in (67%) with anterior chamber lenses. Complications including bullous keratopathy, uveitis and glaucoma were seen with anterior chamber implants of the rigid type resulting in poorer visual acuity than before the secondary procedure.

Matched MeSH terms: Lenses, Intraocular*
Refractive outcomes comparison between the Lenstar LS 900® optical biometry and immersion A-scan ultrasound

Naicker P, Sundralingam S, Peyman M, Juana A, Mohamad NF, Win MM, et al.

Int Ophthalmol, 2015 Aug;35(4):459-66.
PMID: 25024102 DOI: 10.1007/s10792-014-9970-4

To determine the accuracy of intraocular lens (IOL) calculations in eyes undergoing phacoemulsification cataract surgery with IOL implantation using immersion A-scan ultrasound (US) and Lenstar LS 900(®) biometry. In this prospective study, 200 eyes of 200 patients were randomized to undergo either Lenstar LS 900(®) or immersion A-scan US biometry to determine the IOL dioptric power prior to phacoemulsification cataract surgery. Post-operative refractive outcomes of these two groups of patients were compared. The result showed no significant difference between the target spherical equivalent (SE) and the post-operative SE value by the Lenstar LS 900(®) (p value = 0.632) or immersion A-scan US biometry (p value = 0.438) devices. The magnitude of difference between the two biometric devices were not significantly different (p value = 0.868). There was no significant difference in the predicted post-operative refractive outcome between immersion A-scan US biometry and Lenstar LS 900(®). Based on the results, the immersion A-scan US technique is as accurate as Lenstar LS 900(®) in the hands of an experienced operator.

Matched MeSH terms: Lenses, Intraocular*
Fulltext Pseudophacocoele following blunt ocular trauma

Aziz S, Asokumaran T, Intan G

Med J Malaysia, 2011 Mar;66(1):64-5.
PMID: 23765148 MyJurnal

Blunt ocular trauma may result in expulsion of the intraocular lens in a patient who has undergone cataract surgery. This case report describes a patient who presented with an extrusion of intraocular lens following blunt ocular trauma post-operatively. The authors emphasise the importance of patient counselling and protection of the operated eye after surgery.

Matched MeSH terms: Lenses, Intraocular
Fulltext Predictive factors of visual outcome of Malaysian cataract patients: a retrospective study

Thevi T, Godinho MA

Int J Ophthalmol, 2017;10(9):1452-1459.
PMID: 28944207 DOI: 10.18240/ijo.2017.09.19

AIM: To explore the associations between various characteristics of Malaysian cataract patients and their management, and their post-operative visual outcomes, to inform relevant bodies to reduce cataract-related blindness.

METHODS: We conducted a descriptive secondary data analysis of cataract surgery patients in Melaka Hospital, from 2007 to 2014 using the National Eye Database (NED). Patient-related factors (demographic features, systemic and ocular comorbidities) and management-related factors (surgical duration, type of surgery, type of lens) were analysed for their association with visual outcome (acuity).

RESULTS: Most patients were Malays (48.23%) and Chinese (38.55%) aged 60-79y (range 0-100y). Hypertension (58.61%) and diabetes (44.89%) were major systemic comorbidities. Glaucoma (6.71%) and diabetic retinopathy (10.12%) were the main ocular comorbidities. Other comorbidities were age-related macular degeneration, pterygium, corneal opacities, macula diseases, vitreous haemorrhage, retinal detachment and pseudoexfoliation (0.70%-1.60%). Preoperatively 7150 (55.03%) eyes presented with poor vision. Uncomplicated phacoemulsification performed quickly with foldable lenses gave good results.

CONCLUSION: Primary care physicians should initiate early detection to prevent late presentation of cataracts causing poor vision and should discuss the risks and benefits of cataract surgery while emphasizing the role of pre-existing comorbidities which may affect the visual outcomes. For good results, phacoemulsification should be done within 30min, without complications, using foldable posterior chamber intraocular lens.

Matched MeSH terms: Lenses, Intraocular
Fulltext Prediction error and accuracy of intraocular lens power calculation in pediatric patient comparing SRK II and Pediatric IOL Calculator

Jasman AA, Shaharuddin B, Noor RA, Ismail S, Ghani ZA, Embong Z

BMC Ophthalmol, 2010;10:20.
PMID: 20738840 DOI: 10.1186/1471-2415-10-20

Despite growing number of intraocular lens power calculation formulas, there is no evidence that these formulas have good predictive accuracy in pediatric, whose eyes are still undergoing rapid growth and refractive changes. This study is intended to compare the prediction error and the accuracy of predictability of intraocular lens power calculation in pediatric patients at 3 month post cataract surgery with primary implantation of an intraocular lens using SRK II versus Pediatric IOL Calculator for pediatric intraocular lens calculation. Pediatric IOL Calculator is a modification of SRK II using Holladay algorithm. This program attempts to predict the refraction of a pseudophakic child as he grows, using a Holladay algorithm model. This model is based on refraction measurements of pediatric aphakic eyes. Pediatric IOL Calculator uses computer software for intraocular lens calculation.

Matched MeSH terms: Lenses, Intraocular/standards*
Opacification of AcriFlex 50CSE hydrophilic acrylic intraocular lenses

Lim AK, Goh PP, Azura R, Mariam I

J Cataract Refract Surg, 2011 Apr;37(4):655-9.
PMID: 21420589 DOI: 10.1016/j.jcrs.2010.10.050

PURPOSE: To determine the prevalence of and risk factors for AcriFlex 50CSE hydrophilic acrylic intraocular lens (IOL) opacification approximately 3 years after implantation.
SETTING: Selayang Hospital, Selangor, Malaysia.
DESIGN: Cross-sectional study.
METHODS: Patients who had AcriFlex 50CSE IOL implantation in 2005 and 2006 were identified from operating logbooks and recalled via telephone and letters. Opaque IOLs were explanted and sent for scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDS).
RESULTS: The review showed that 18 patients had died and 67 had declined examination or could not be contacted, leaving 239 eyes for evaluation. The age of the patients ranged from 25 to 85 years. Of the patients, 83 (34.7%) were Malay, 127 (53.1%) Chinese, and 29 (12.1%) East Indian. The male:female ratio was 1:1. Fourteen eyes of 13 patients (5.4%) had IOL opacification; 1 had bilateral opacification. Five eyes had fine deposits, and 9 eyes had dense opaque deposits. Seven opaque IOLs required explantation. There was no correlation between age (P=.645), sex (P=.319), or race (P=.860) and IOL opacification. Pearson chi-square analysis showed a strong association between diabetes mellitus and IOL opacification (P=.019). Nine (69.2%) of the 13 patients with opacification had diabetes. Scanning electron microscopy and EDS showed calcium and phosphate deposits on the optic surface and intralenticularly near the anterior surface of the optic.
CONCLUSIONS: Results indicate that diabetes mellitus is a risk factor for AcriFlex hydrophilic acrylic IOL opacification. In some cases, opacification affected vision, necessitating explantation. The pathophysiology of this complication is unknown.
FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Matched MeSH terms: Lenses, Intraocular*
Fulltext Intraocular pressure variation following retrobulbar anaesthesia among the different sex, age and ethnic groups in Malaysia

Lee FN, Kong VY, Lee GP, Ho KH, Choon SC, Hoh HB

Med J Malaysia, 1999 Dec;54(4):438-41.
PMID: 11072460

A total of 114 patients (48 Chinese, 34 Malay and 32 Indian) undergoing extracapsular cataract extraction (ECCE) with intraocular lens implantation, were enrolled. All were given 3 ml of local anaesthetic (combination of equal amounts of lignocaine 2% and bupivacaine 0.5%) using retrobulbar technique. Intraocular pressure (IOP) was measured at different time intervals; before, immediately after and 5 minutes after injection with Honan balloon compression. Mean IOP increased by 5.0 mmHg immediately after injection (p < 0.001) and reduced to baseline level after 5 minutes of external compression. Although there were no statistical difference in terms of IOP variation between sex and age groups, Chinese patients demonstrated the highest IOP rise following retrobulbar anaesthesia. This is the first study to demonstrate the influence of race in the IOP response with Chinese subjects having the highest IOP rise.

Matched MeSH terms: Lenses, Intraocular*
Fulltext Intraocular lens implant

Sukumaran K

Med J Malaysia, 1983 Dec;38(4):272-4.
PMID: 6599981
Matched MeSH terms: Lenses, Intraocular*
Fulltext Intralenticular matchstick in a toddler: a rare presentation of penetrating ocular injury from a toy gun

Royan, Jeyarine, Teo, Khairy Shamel Sonny, Vengadasalam, Selva Raja

Journal of Biomedical and Clinical Sciences, 2018;3(1):15-18.
MyJurnal

To report on a rare case of an intralenticular foreign body which
demonstrates that use of a spring-powered airsoft gun can result in a severe
ocular injury. A 2-year-old male presented following a trauma to the left eye.
The trauma was caused by a wooden matchstick from a spring-powered airsoft
gun being shot into his eye. On examination, there was a shallow anterior
chamber with a full thickness corneal laceration, with fragmented matchstick
pieces embedded in the cornea and in the lens. The corneal foreign bodies
were removed, corneal laceration wound sutured and lensectomy done. There
were no post-operative complications, and the cornea wound healed with a
scar. A few months later, he underwent a successful secondary intraocular lens
implantation surgery with an iris claw lens. Airsoft guns are easily available to
children who are unaware of its dangers. It can cause significant ocular
morbidity despite successful surgical treatment of the injury.

Matched MeSH terms: Lenses, Intraocular
Fulltext Intracameral injection of ranibizumab caused regression of iris neovascularisation and clearance of hyphaema in a non-diabetic patient with ischaemic remnant retinal flap in a silicone filled eye

Bastion ML

BMJ Case Rep, 2010;2010.
PMID: 22242074 DOI: 10.1136/bcr.10.2009.2398

The use of 0.5 mg/0.05 ml of ranibizumab intracamerally, to induce regression of iris neovascularisation in a non-diabetic patient, is reported. A 55-year-old Malay man presented with left eye rubeosis and hyphaema secondary to ischaemic remnant retinal flap in his silicone filled pseudophakic eye. Regression of rubeosis and resolution of hyphaema was noted within 4 days of injection of intracameral ranibizumab, allowing repeat vitrectomy to be performed without much bleeding, thus facilitating removal of his intraocular lens and laser to remaining flap. One month postoperatively he remained comfortable with counting fingers vision similar to the pre-hyphaema period.

Matched MeSH terms: Lenses, Intraocular
Implantation and diabetes: analysis of 525 cases

Lim AS, Ang BC, Heng LK, Hart PM, Ngui MS, Chew P, et al.

Ann Acad Med Singap, 1989 Mar;18(2):174-7.
PMID: 2751233

This is a retrospective study of 525 posterior chamber implants in diabetics performed by A S M Lim and B C Ang of Singapore. The patients were reviewed by visiting ophthalmologists--J E Kennedy (Sydney), M Ngui (East Malaysia) and P M Hart (Belfast). This study did not show any significant difference in the complication of post-operative visual acuity between diabetics and non-diabetics. 95% obtained 6/12 vision or better when pre-existing disease was excluded. It also showed that posterior chamber implants can be inserted in eyes with maculopathy or proliferative retinopathy if laser treatment was effectively done before or after surgery.

Matched MeSH terms: Lenses, Intraocular*

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