Purpose: To compare the clinical and molecular diagnoses of Herpes Simplex Keratitis (HSK). Materials and Methods: Conjunctival swabs (after fluorescein and anaesthetic wash out) and detailed questionnaire data were o...Purpose: To compare the clinical and molecular diagnoses of Herpes Simplex Keratitis (HSK). Materials and Methods: Conjunctival swabs (after fluorescein and anaesthetic wash out) and detailed questionnaire data were obtained from 146 participants. Corneal rims and conjunctival epithelial cells were infected with Herpes Simplex Virus (HSV) type 1 or HSV2 and supernatant collected. HSV1;HSV2;Varicella Zoster Virus (VZV) and Adenovirus (ADV) DNA was assessed using two real time Polymerase Chain Reaction (PCR) methods. Results: Of the 146 participants recruited, 54 were clinically diagnosed with typical epithelial lesions and 38 with atypical epithelial lesions, 17 with old inactive HSK and 37 healthy volunteers. HSV1 DNA was detected in 28 (30%) of the 92 participants with clinically suspect HSK. Patients who presented with typical epithelial lesions had a higher positive rate (46%) than those who presented with atypical type lesions (8%), when using primers against the Glycoprotein (Gp) G region of the virus. When the same samples were retested with primers against the GpB region, the positive rate for the typical and atypical cases increased to 52% and 11% respectively. Antiviral use at the time of sampling reduced the rate of PCR positivity by 20% (p < 0.05). ADV DNA was detected in 6% of the typical cases and 8% of the atypical cases. All control participants with no history of HSK were negative for HSV1 DNA. Sample quantity was confirmed by testing for housekeeping control genes, beta-actin and beta-2 macroglobulin. PCR results from in vitro control investigations of HSV1 and 2 infected corneal rims and conjunctival epithelial cells were 100% positive for infected and 100% negative for uninfected samples when assessed using both PCR methods. Conclusions: Clinical diagnosis of typical HSK is not always confirmed by PCR. Concomitant use of an antiviral reduces levels of PCR positivity. Given this and the findings that other ocular surface pathogens may mimic HSK pathology, and that choice of gene amplification region can also affect accurate detection of HSV1 by PCR, we propose the use of a multiplex assay. This would perform PCR using primers spanning a number of different regions within one gene and would also target a number of different viral genes to ensure potentially different HSV1 viral strains or other viruses do not affect the test and lead to disagreements between the clinical and molecular diagnosis of HSK. From these findings, this paper proposes a clinical supportive algorithmic guide to manage such disagreements.展开更多
AIM: To evaluate the refractive outcome of Toric Lentis Mplus intraocular lens(IOL) implant.· METHODS: This is a retrospective case series.Consecutive patients with corneal astigmatism of at least1.5 D had Toric ...AIM: To evaluate the refractive outcome of Toric Lentis Mplus intraocular lens(IOL) implant.· METHODS: This is a retrospective case series.Consecutive patients with corneal astigmatism of at least1.5 D had Toric Lentis Mplus IOL implant during cataract surgery. The exclusion criteria included irregular astigmatism on corneal topography, large scotopic pupil diameter(>6 mm), poor visual potential and significant ocular comorbidity. Postoperative manifest refraction,uncorrected distance visual acuity(UDVA), best-corrected distance visual acuity(BCVA), uncorrected intermediate visual acuity at(UIVA) 3/4 m and uncorrected near visual acuity(UNVA) were obtained.·RESULTS: There were 70 eyes from 49 patients in this study. Patients were refracted at a median of 8.9wk(range 4.0 to 15.5) from the operation date. Sixty-five percent of eyes had 6/7.5(0.10 log MAR) or better, and99% 6/12(0.30 log MAR) or better postoperative UDVA.Eighty-nine percent could read Jaeger(J) 3(0.28 log MAR)and 95% J5(0.37 log MAR) at 40 cm. The median magnitude of astigmatism decreased from 1.91 D to 0.49 D(Wilcoxon, P<0.001) after the operation. The range of the cylindrical error was reduced from 1.5-3.95 D(keratometric) preoperatively to 0.00-1.46 D(subjective refraction transposed to corneal plane) postoperatively.· CONCLUSION: Toric Lentis Mplus IOL has good predictability in reducing preexisting corneal astigmatism.展开更多
Objective. To report the outcomes following treatment of retinal tears with argon laser photocoagulation by trainee doctors as an emergency procedure. Methods. Retrospective, case note analysis of 100 consecutive pati...Objective. To report the outcomes following treatment of retinal tears with argon laser photocoagulation by trainee doctors as an emergency procedure. Methods. Retrospective, case note analysis of 100 consecutive patients treated between August 2000 and December 2002 at a tertiary referral hospital. Result. The case notes of 100 consecutive patients (41 male,59 female)-with a mean age of 57.5 years were reviewed. Out of these 90 were symptomatic. The follow-up period ranged from 1 week to 8 months. All patients had argon laser retinopexy in the Emergency department. The on-call Registrar performed the procedure on 94 patients, and Senior House Officers performed the other six. A total of 98 procedures were performed on the slit lamp and two by laser indirect ophthalmoscope. In all, 24 patients needed further treatment with either indirect laser, cryotherapy, or surgery. At the last follow-up, all the patients had anatomically attached retinas. Conclusion. A significant proportion of patients (24% ) undergoing laser retinopexy in the emergency department needed further treatment. The relative inexperience in using the indirect laser, together with its unavailability in the Emergency department, may be the contributory factors. There seems to be scope for supervised training in using the laser indirect ophthalmoscope for the trainees in the Ophthalmic Emergency department.展开更多
文摘Purpose: To compare the clinical and molecular diagnoses of Herpes Simplex Keratitis (HSK). Materials and Methods: Conjunctival swabs (after fluorescein and anaesthetic wash out) and detailed questionnaire data were obtained from 146 participants. Corneal rims and conjunctival epithelial cells were infected with Herpes Simplex Virus (HSV) type 1 or HSV2 and supernatant collected. HSV1;HSV2;Varicella Zoster Virus (VZV) and Adenovirus (ADV) DNA was assessed using two real time Polymerase Chain Reaction (PCR) methods. Results: Of the 146 participants recruited, 54 were clinically diagnosed with typical epithelial lesions and 38 with atypical epithelial lesions, 17 with old inactive HSK and 37 healthy volunteers. HSV1 DNA was detected in 28 (30%) of the 92 participants with clinically suspect HSK. Patients who presented with typical epithelial lesions had a higher positive rate (46%) than those who presented with atypical type lesions (8%), when using primers against the Glycoprotein (Gp) G region of the virus. When the same samples were retested with primers against the GpB region, the positive rate for the typical and atypical cases increased to 52% and 11% respectively. Antiviral use at the time of sampling reduced the rate of PCR positivity by 20% (p < 0.05). ADV DNA was detected in 6% of the typical cases and 8% of the atypical cases. All control participants with no history of HSK were negative for HSV1 DNA. Sample quantity was confirmed by testing for housekeeping control genes, beta-actin and beta-2 macroglobulin. PCR results from in vitro control investigations of HSV1 and 2 infected corneal rims and conjunctival epithelial cells were 100% positive for infected and 100% negative for uninfected samples when assessed using both PCR methods. Conclusions: Clinical diagnosis of typical HSK is not always confirmed by PCR. Concomitant use of an antiviral reduces levels of PCR positivity. Given this and the findings that other ocular surface pathogens may mimic HSK pathology, and that choice of gene amplification region can also affect accurate detection of HSV1 by PCR, we propose the use of a multiplex assay. This would perform PCR using primers spanning a number of different regions within one gene and would also target a number of different viral genes to ensure potentially different HSV1 viral strains or other viruses do not affect the test and lead to disagreements between the clinical and molecular diagnosis of HSK. From these findings, this paper proposes a clinical supportive algorithmic guide to manage such disagreements.
文摘AIM: To evaluate the refractive outcome of Toric Lentis Mplus intraocular lens(IOL) implant.· METHODS: This is a retrospective case series.Consecutive patients with corneal astigmatism of at least1.5 D had Toric Lentis Mplus IOL implant during cataract surgery. The exclusion criteria included irregular astigmatism on corneal topography, large scotopic pupil diameter(>6 mm), poor visual potential and significant ocular comorbidity. Postoperative manifest refraction,uncorrected distance visual acuity(UDVA), best-corrected distance visual acuity(BCVA), uncorrected intermediate visual acuity at(UIVA) 3/4 m and uncorrected near visual acuity(UNVA) were obtained.·RESULTS: There were 70 eyes from 49 patients in this study. Patients were refracted at a median of 8.9wk(range 4.0 to 15.5) from the operation date. Sixty-five percent of eyes had 6/7.5(0.10 log MAR) or better, and99% 6/12(0.30 log MAR) or better postoperative UDVA.Eighty-nine percent could read Jaeger(J) 3(0.28 log MAR)and 95% J5(0.37 log MAR) at 40 cm. The median magnitude of astigmatism decreased from 1.91 D to 0.49 D(Wilcoxon, P<0.001) after the operation. The range of the cylindrical error was reduced from 1.5-3.95 D(keratometric) preoperatively to 0.00-1.46 D(subjective refraction transposed to corneal plane) postoperatively.· CONCLUSION: Toric Lentis Mplus IOL has good predictability in reducing preexisting corneal astigmatism.
文摘Objective. To report the outcomes following treatment of retinal tears with argon laser photocoagulation by trainee doctors as an emergency procedure. Methods. Retrospective, case note analysis of 100 consecutive patients treated between August 2000 and December 2002 at a tertiary referral hospital. Result. The case notes of 100 consecutive patients (41 male,59 female)-with a mean age of 57.5 years were reviewed. Out of these 90 were symptomatic. The follow-up period ranged from 1 week to 8 months. All patients had argon laser retinopexy in the Emergency department. The on-call Registrar performed the procedure on 94 patients, and Senior House Officers performed the other six. A total of 98 procedures were performed on the slit lamp and two by laser indirect ophthalmoscope. In all, 24 patients needed further treatment with either indirect laser, cryotherapy, or surgery. At the last follow-up, all the patients had anatomically attached retinas. Conclusion. A significant proportion of patients (24% ) undergoing laser retinopexy in the emergency department needed further treatment. The relative inexperience in using the indirect laser, together with its unavailability in the Emergency department, may be the contributory factors. There seems to be scope for supervised training in using the laser indirect ophthalmoscope for the trainees in the Ophthalmic Emergency department.
