Emmy Li - Academia.edu (original) (raw)

Papers by Emmy Li

Research paper thumbnail of In vivo measurements of macular and nerve fibre layer thickness in retinal arterial occlusion

Eye, 2007

To investigate the structure-function relationship in patients with retinal arterial occlusion by... more To investigate the structure-function relationship in patients with retinal arterial occlusion by measuring the macular and the peripapillary retinal nerve fibre layer (RNFL) thickness and the visual sensitivity. This is an observational case series with three patients with central retinal arterial occlusion (CRAO) and two patients with branch retinal arterial occlusion (BRAO). The macular/peripapillary RNFL thickness and the visual field were measured with Stratus optical coherence tomography (OCT) and Humphrey visual field analyzer, respectively, at least 1 year after the diagnosis of CRAO or BRAO. The macular thickness, in particular the inner retinal layer, and the peripapillary RNFL thickness were reduced in patients with retinal arterial occlusion. The decrease in the macular and the peripapillary RNFL thickness corresponded to the sites of retinal arterial occlusion with diffuse and segmental thinning found in CRAO and BRAO, respectively. Visual field defects were found in the corresponding locations of macular and RNFL thinning, and closely correlated with the degree of the structural damage. Structural damages in terms of reduction in the macular and peripapillary RNFL thickness were evident in patients with retinal arterial occlusion. A close structure-function correlation was found and a worse functional outcome is associated with a more extensive thinning of the macula and RNFL. OCT measurements of the macular/peripapillary RNFL thickness provide useful indicators to reflect the severity of the disease in retinal arterial occlusion and serve as a new paradigm to study and monitor the disease longitudinally.

Research paper thumbnail of Reply: To PMID 25448990

American Journal of Ophthalmology

Research paper thumbnail of Change in Tear Film Lipid Layer Thickness, Corneal Thickness, Volume and Topography after Superficial Cauterization for Conjunctivochalasis

Scientific Reports, 2015

We evaluated the change in tear film lipid layer thickness, corneal thickness, volume and topogra... more We evaluated the change in tear film lipid layer thickness, corneal thickness, volume and topography after superficial cauterization of symptomatic conjunctivochalasis. Bilateral superficial conjunctival cauterization was performed in 36 eyes of 18 patients with symptomatic conjunctivochalasis. The mean age of patients (12 males, 6 females) was 68.6 ± 10.9 years (range: 44-83 years). Preoperatively, 28 eyes (77.8%) had grade 1 conjunctivochalasis, and 8 eyes (22.2%) had grade 2 conjunctivochalasis. At 1 month postoperatively, the severity of conjunctivochalasis decreased significantly (p < 0.001) and 29 eyes (80.6%) had grade 0 conjunctivochalasis whereas 7 eyes (19.4%) had grade 1 conjunctivochalasis. The mean Ocular Surface Disease Index score decreased from 31.5 ± 15.2 preoperatively to 21.5 ± 14.2 at the end of 1 month postoperatively (p = 0.001). There was a statistically significant increase in mean tear film lipid layer thickness 1 month after the surgery (49.6 ± 16.1 nm vs 62.6 ± 21.6 nm; p < 0.001). The central corneal thickness, thinnest corneal thickness and corneal volume decreased significantly postoperatively (p < 0.001). Our study showed that superficial conjunctival cauterization is an effective technique for management of conjunctivochalasis in the short term. An increase in tear film lipid layer thickness along with a decrease in corneal thickness and volume were observed after surgical correction of conjunctivochalasis.

Research paper thumbnail of Safety and efficacy of adjunctive intranasal mitomycin C and triamcinolone in endonasal endoscopic dacryocystorhinostomy

International Ophthalmology, 2015

One of the common causes of failure in dacryocystorhinostomy for nasolacrimal duct obstruction (N... more One of the common causes of failure in dacryocystorhinostomy for nasolacrimal duct obstruction (NLDO) is mucosal scarring and fibrosis around the ostium. Steroid and mitomycin C (MMC) can potentially reduce scarring by their action on the inflammatory and proliferative phase of wound healing, respectively. The purpose of this study is to evaluate the safety and efficacy of combined usage of adjunctive MMC and intranasal triamcinolone (TA) in endonasal endoscopic dacryocystorhinostomy (EE-DCR). This is a retrospective interventional case series. All patients underwent mechanical EE-DCR in two regional hospitals in Hong Kong from January 2005 to December 2006 were included. All received intraoperative MMC application for 5 min and gelfoam soaked with TA onto the ostium. Main outcome measures include the anatomical and functional success rate at follow-up at least 6 months after operation. Other outcomes include complications occurred during and after operation. A total of 73 EE-DCR were performed in 69 patients. Three patients had simultaneous bilateral DCR; one had sequential DCRs for both sides. At the last follow-up, anatomical success was achieved in 68 cases (93 %) and both anatomical with functional success in 67 cases (92 %). No major complication was observed. Minor complications included asymptomatic mucosal adhesion between the nasal septum and lateral nasal wall in one patient and moderate secondary hemorrhage in another. EE-DCR with adjunctive MMC and TA is a safe and successful procedure for the treatment of NLDO.

Research paper thumbnail of Adenoviral Keratoconjunctivitis

Survey of Ophthalmology, 2015

Viral conjunctivitis caused by adenovirus is the most common infectious conjunctivitis. Adenoviru... more Viral conjunctivitis caused by adenovirus is the most common infectious conjunctivitis. Adenoviruses are highly contagious pathogens. The modes of transmission are mainly through hand to eye contact, ocular secretions, respiratory droplets, and contact with ophthalmic care providers and their medical instruments. The most frequent manifestation of ocular adenoviral infection is epidemic keratoconjunctivitis, followed by pharyngoconjunctival fever. Epidemic keratoconjunctivitis is also the most severe form and presents with watery discharge, hyperemia, cheosis, and ipsilateral lymphadenopathy. Pharyngoconjunctival fever is characterized by abrupt onset of high fever, pharyngitis, bilateral conjunctivitis, and periauricular lymph node enlargement. Isolated follicular conjunctivitis without corneal or systemic involvement also occurs. The rate of clinical accuracy in diagnosing viral conjunctivitis is less than 50%. Rapid diagnostic tests now being used decrease unnecessary antibiotic use. Treatment for viral conjunctivitis is mostly supportive. The majority of cases are self-limited, and no treatment is necessary in uncomplicated cases.

Research paper thumbnail of Lymphoproliferative Disease of the Orbit

Asia-Pacific Journal of Ophthalmology, 2015

Lymphoproliferative diseases of the orbit account for majority of orbital tumors. The pathologies... more Lymphoproliferative diseases of the orbit account for majority of orbital tumors. The pathologies range from reactive lymphoid hyperplasia to specific IgG4-related inflammation to malignant lymphomas. This review summarizes current concepts regarding pathology, clinical presentation, diagnosis, staging, and treatment strategies of major orbital lymphoproliferative diseases based on updated and relevant bibliography.

Research paper thumbnail of Twelve-Year Outcomes of Pterygium Excision with Conjunctival Autograft versus Intraoperative Mitomycin C in Double-Head Pterygium Surgery

Journal of ophthalmology, 2015

Purpose. The study aims to compare the long-term outcome of conjunctival autograft (CAU) and mito... more Purpose. The study aims to compare the long-term outcome of conjunctival autograft (CAU) and mitomycin C (MMC) in double-head pterygium surgery. Methods. This is a follow-up study of a comparative interventional trial. Thirty-nine eyes of the 36 patients with double-head pterygium excision in the original study 12 years ago were recruited for clinical assessment. Seven out of the 36 patients were lost. In the original study, each eye with double-head pterygium was randomized to have pterygium excision with CAU on one "head" (temporal or nasal) and MMC on the other "head." All patients were invited for clinical assessment for conjunctival bed status and the presence of pterygium recurrence in the current study. Results. There was no significant difference between the size, morphology, and type of pterygium among the two treatment groups. The recurrence rate of CAU group and MMC group 12 years after excision was 6.3% and 28.1%, respectively (P = 0.020). Among eyes ...

Research paper thumbnail of Agreement among 3 Methods to Measure Corneal Thickness: Ultrasound Pachymetry, Orbscan II, and Visante Anterior Segment Optical Coherence Tomography

To assess the agreement of central and paracentral corneal thickness measurements between ultraso... more To assess the agreement of central and paracentral corneal thickness measurements between ultrasound pachymetry (USP), Orbscan II, and Visante anterior segment optical coherence tomography (ASOCT). Observational cross-sectional study. Seventy eyes of 70 subjects. Each subject underwent Orbscan II (using an acoustic equivalent correction factor of 0.89), ASOCT, and USP examination. Bland-Altman plots were used to evaluate agreement between instruments. Central and paracentral corneal thickness measurements by the 3 methods and agreement, as evaluated by 95% limits of agreement (LOA). The mean measurements of average central corneal thickness by USP, Orbscan II, and ASOCT were 553.5+/-30.26 microm, 553.22+/-25.47 microm, and 538.79+/-26.22 microm, respectively. There was high correlation between instruments: USP with ASOCT (r = 0.936, P<0.001), USP with Orbscan II (r = 0.900, P<0.001) for central corneal thickness measurements, and Orbscan II with ASOCT for average paracentral 2- to 5-mm measurements (r = 0.947, P<0.001). The mean differences (and upper/lower LOA) for central corneal thickness measurements were 0.31+/-13.34 microm (26.44/-25.83) between USP and Orbscan II, 14.74+/-10.84 microm (36.0/-6.51) between USP and ASOCT, and 14.44+/-9.14 microm (32.36/-3.48) between Orbscan II and ASOCT. The average mean difference (and upper/lower LOA) between Orbscan II and ASOCT for paracentral 2- to 5-mm corneal thickness measurements was 10.35+/-8.67 microm (27.35/-6.65). Anterior segment optical coherence tomography underestimated corneal thickness compared with that measured with USP. Anterior segment optical coherence tomography had better agreement with the gold standard USP, as compared with Orbscan II. However, important discrepancies among instruments exist. Clinicians should be aware that corneal thickness measurements are influenced by the method of measurement and that, although highly correlated, these instruments should not be used interchangeably for the assessment of corneal thickness.

Research paper thumbnail of Cataract surgery outcomes in adult patients with Down's syndrome

The British journal of ophthalmology, 2014

To describe the outcomes of cataract surgery in adult patients with Down's syndrome at a tert... more To describe the outcomes of cataract surgery in adult patients with Down's syndrome at a tertiary eye hospital in Hong Kong. Retrospective case-file analysis was performed to identify patients with Downs's syndrome who underwent cataract surgery between January 2002 and December 2012. Morphology of cataract, associated ocular features and surgical and visual outcomes were analysed. Cataract surgery was performed in 33 eyes of 20 patients (12 males, 8 females, mean age 42.9±10.6 years) over a 10-year period. Nine patients (9/20, 45.0%) had bilateral cataracts at the time of diagnosis. White cataracts were noted in 12 eyes of 10 patients (12/33, 36.3%) at the time of presentation. Associated ocular problems included myopic maculopathy (18 eyes, 54.5%), keratoconus (12 eyes, 36.3%), nystagmus (2 eyes, 6.0%), corneal scar (2 eyes, 6.0%) and glaucoma (2 eyes, 6.0%). Five eyes (15.1%) underwent extracapsular cataract extraction whereas a phacoemulsification was performed in 28 (84...

Research paper thumbnail of Descemet stripping endothelial keratoplasty in a patient with keratoglobus and chronic hydrops secondary to a spontaneous descemet membrane tear

Case reports in ophthalmological medicine, 2013

Purpose. To report the use of Descemet stripping endothelial keratoplasty (DSEK) in a patient wit... more Purpose. To report the use of Descemet stripping endothelial keratoplasty (DSEK) in a patient with keratoglobus and chronic hydrops. Case Report. We describe a case of a 28-year-old man with bilateral keratoglobus and chronic hydrops in the right eye secondary to spontaneous Descemet membrane tear. The patient presented with finger counting (CF) vision, itching, foreign body sensation, and severe photophobia in the right eye. Peripheral corneal thinning with central corneal protrusion and Descemet membrane tear spanning from 4 to 7 o'clock was noted on slit lamp examination. The right eye cornea was 15 mm in the horizontal diameter. After a 5.5-month loss to follow-up, the patient presented with discomfort, photophobia, decreasing vision, and tearing in the right eye. Vision was 20/60 with pinhole. 360-degree peripheral corneal ectasia with mild neovascularization and hydrops was present. Over the next few months, the patient complained of photophobia and intermittent eye pain. ...

Research paper thumbnail of Descemet stripping endothelial keratoplasty: effect of the surgical procedure on corneal optics

American journal of ophthalmology, 2008

To determine the changes in corneal optical performance after posterior lamellar corneal transpla... more To determine the changes in corneal optical performance after posterior lamellar corneal transplantation. Retrospective case series. The anterior segment in four eyes of four patients who underwent Descemet stripping endothelial keratoplasty (DSEK) with cataract extraction and intraocular lens (IOL) implantation were imaged with the Visante anterior segment optical coherence tomography [OCT] (Carl Zeiss Meditec, Dublin, California, USA). The curvature of the posterior surface of the donor graft was compared with that of the host cornea, and corneal thickness was measured. All eyes had a hyperopic refractive error after surgery. The posterior corneal curvature after surgery was more than that before surgery. Average preoperative keratometry was 43.4 diopters (D), and after surgery, it was 42.8 D using keratometry. However, when the postsurgical corneal power was calculated using the Gaussian optics method, the average value was 40.8 D. The addition of a donor corneal graft to the pos...

Research paper thumbnail of Agreement among 3 methods to measure corneal thickness: ultrasound pachymetry, Orbscan II, and Visante anterior segment optical coherence tomography

Ophthalmology, 2007

To assess the agreement of central and paracentral corneal thickness measurements between ultraso... more To assess the agreement of central and paracentral corneal thickness measurements between ultrasound pachymetry (USP), Orbscan II, and Visante anterior segment optical coherence tomography (ASOCT). Observational cross-sectional study. Seventy eyes of 70 subjects. Each subject underwent Orbscan II (using an acoustic equivalent correction factor of 0.89), ASOCT, and USP examination. Bland-Altman plots were used to evaluate agreement between instruments. Central and paracentral corneal thickness measurements by the 3 methods and agreement, as evaluated by 95% limits of agreement (LOA). The mean measurements of average central corneal thickness by USP, Orbscan II, and ASOCT were 553.5+/-30.26 microm, 553.22+/-25.47 microm, and 538.79+/-26.22 microm, respectively. There was high correlation between instruments: USP with ASOCT (r = 0.936, P<0.001), USP with Orbscan II (r = 0.900, P<0.001) for central corneal thickness measurements, and Orbscan II with ASOCT for average paracentral 2...

Research paper thumbnail of Comparison of Outcomes of Primary Anterior Chamber Versus Secondary Scleral-Fixated Intraocular Lens Implantation in Complicated Cataract Surgeries

American Journal of Ophthalmology, 2015

To compare the outcome of primary anterior chamber vs secondary scleral-fixated intraocular lens ... more To compare the outcome of primary anterior chamber vs secondary scleral-fixated intraocular lens (IOL) implantation in complicated cataract surgeries. Retrospective, comparative study. A consecutive series of complicated cataract surgeries with primary anterior chamber (ACIOL) or secondary scleral-fixated IOL implantation from January 1, 2004 to December 31, 2009 was analyzed. Main outcome measures included the postoperative best-corrected visual acuity (BCVA) and postoperative complications. There were 89 eyes in the primary ACIOL group and 74 eyes in the secondary scleral-fixated IOL group. The mean follow-up duration was 64.1 ± 36.7 months. The mean postoperative logarithm of minimal angle of resolution (logMAR) BCVA at 1 year was 0.32 ± 0.54 and 0.34 ± 0.21 in the primary ACIOL group and the secondary scleral-fixated IOL group, respectively (P = .734). The mean latest logMAR BCVA was 0.68 ± 0.54 and 0.61 ± 0.47 in the primary ACIOL group and the secondary scleral-fixated IOL group, respectively (P = .336). The primary ACIOL group had more early postoperative complications (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). No difference in late postoperative complications was observed between the 2 groups (P = .100). Regression analysis showed that primary ACIOL and secondary scleral-fixated IOL implantation had similar latest postoperative logMAR BCVA (P = .927), while the presence of late complications was associated with a worse final visual outcome (P = .000). This study shows that there are no long-term differences in the visual outcomes and complication profiles after primary ACIOL or secondary scleral-fixated IOL implantation in a complicated cataract operation when capsular support is inadequate.

Research paper thumbnail of Orthokeratology-Associated Infectious Keratitis in a Tertiary Care Eye Hospital in Hong Kong

American Journal of Ophthalmology, 2014

To analyze cases of orthokeratology-associated infectious keratitis managed in a tertiary care ey... more To analyze cases of orthokeratology-associated infectious keratitis managed in a tertiary care eye hospital in Hong Kong between 2003 and 2013. Retrospective study. Case records of patients with infectious keratitis attributable to orthokeratology contact lenses were analyzed. Data analyzed included clinical features, microbiological evaluation, and treatment outcomes. A total of 23 patients were included (16 female, 7 male, mean age: 15.0 ± 4.2 years; range: 9-23 years). All patients were using overnight orthokeratology for an average of 2.7 ± 2.8 years (range: 3 months - 10 years) before the onset of infection. Clinical features included corneal infiltrate (n = 14, 60.9%) and corneal perineuritis (n = 12, 52.2%). Fifteen eyes (65.2%) had a positive microbiological culture obtained from corneal scrapings. The most commonly isolated organism was Pseudomonas aeruginosa (n = 6), followed by coagulase-negative Staphylococcus (n = 5) and Acanthamoeba (n = 3). Five cases of Pseudomonas aeruginosa and 5 cases of Acanthamoeba were identified from contact lenses or contact lens solution. The mean duration from disease onset to remission was 31.9 ± 34.9 days (range: 6-131 days). All patients responded to medical treatment, and no emergency surgical intervention was needed. The best-corrected logMAR visual acuity improved significantly from 0.62 ± 0.51 (20/83 Snellen) to 0.15 ± 0.20 (20/28 Snellen) (Wilcoxon signed rank test, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Orthokeratology-associated infectious keratitis continues to be a serious problem, especially in regions with high prevalence of myopia. Early clinical and microbiological diagnosis and intensive treatment can improve final visual outcomes.

Research paper thumbnail of Reply re: "Balloon dacryoplasty in internal ostium stenosis after endoscopic dacryocystorhinostomy

Ophthalmic plastic and reconstructive surgery

Research paper thumbnail of Application of anterior segment optical coherence tomography to identify eyes with posterior polar cataract at high risk for posterior capsule rupture

Journal of Cataract & Refractive Surgery, 2014

properly cited.

Research paper thumbnail of Prevalence of Blindness and Outcomes of Cataract Surgery in Hainan Province in South China

Ophthalmology, 2013

Objective: To define the prevalence of blindness and visual impairment (VI) in people in rural Ha... more Objective: To define the prevalence of blindness and visual impairment (VI) in people in rural Hainan using the rapid assessment of avoidable blindness (RAAB) and to report the outcomes of cataract surgery among the residents.

Research paper thumbnail of Inferonasal Prolapsed Orbital Fat

Ophthalmic Plastic and Reconstructive Surgery, 2013

Prolapsed orbital fat is a common entity in the literature and is mostly located in the superotem... more Prolapsed orbital fat is a common entity in the literature and is mostly located in the superotemporal quadrant. It can be confused with other conjunctival tumors. The authors describe a 56-year-old woman with a rare inferonasal prolapsed orbital fat. Excision of the lesion was performed without recurrence at 6 months.

Research paper thumbnail of Balloon Dacryoplasty in Internal Ostium Stenosis After Endoscopic Dacryocystorhinostomy

Ophthalmic Plastic and Reconstructive Surgery, 2014

To determine the effectiveness of balloon dacryoplasty in the treatment of internal ostium stenos... more To determine the effectiveness of balloon dacryoplasty in the treatment of internal ostium stenosis after endoscopic dacryocystorhinostomy (EnDCR). A retrospective, noncomparative interventional case series of patients who underwent balloon dacryoplasty for post-EnDCR internal ostium stenosis were included. A balloon catheter was used in all procedures, with bicanalicular silicone intubation. Patient records were reviewed and data analyzed. Anatomical success was defined by functional endoscopic dye test, and functional success was defined as a subjective improvement in symptoms at last follow up. Nineteen lacrimal systems of 18 consecutive patients were studied between July 2007 and September 2012. At a mean follow up of 20 months (range, 3-53 months), anatomical success rate was 84% (16/19 systems), whereas functional success was 74% (14/19 systems). No major complication was observed. Balloon dacryoplasty is a minimally invasive procedure in the treatment of post-EnDCR internal ostium stenosis. It is a simple, safe procedure and can provide symptomatic relief to some of these patients. It can be considered as a treatment option for patients demonstrated with internal ostium stenosis after EnDCR.

Research paper thumbnail of Barriers for Poor Cataract Surgery Uptake among Patients with Operable Cataract in a Program of Outreach Screening and Low-cost Surgery in Rural China

Ophthalmic Epidemiology, 2014

To identify the reasons for poor uptake of cataract surgery in a program of outreach screening an... more To identify the reasons for poor uptake of cataract surgery in a program of outreach screening and low-cost surgery in Pucheng County, a rural area in northwestern China. Detailed interviews with a semi-structured questionnaire were conducted by telephone or face-to-face for participants who had been advised to attend a low-cost cataract surgery program but did not schedule the surgery within 3 months after the initial screening. Among 432 eligible subjects, 355 (82.2%) were interviewed (mean age 70.6 ± 6.6 years, 73.8% female). A total of 138 subjects (38.9%) were interviewed by phone and 217 (61.1%) were interviewed face-to-face. Lack of family support (n = 106, 29.9%) and failure to understand the need for surgery (n = 96, 27.0%) were the two main reasons for not undergoing cataract surgery. Other factors included fear of surgery (n = 62, 17.5%), lack of faith in doctors (n = 36, 10.1%), financial constraints (n = 25, 7.0%) and lack of transportation (n = 4, 1.1%). The principal barriers to low-cost cataract surgery uptake in rural China included lack of family support and failure to understand the need for surgery. Education targeting entire families to eliminate these barriers and development of community support systems at the family level are required to achieve greater uptake of low-cost cataract surgery programs in rural China.

Research paper thumbnail of In vivo measurements of macular and nerve fibre layer thickness in retinal arterial occlusion

Eye, 2007

To investigate the structure-function relationship in patients with retinal arterial occlusion by... more To investigate the structure-function relationship in patients with retinal arterial occlusion by measuring the macular and the peripapillary retinal nerve fibre layer (RNFL) thickness and the visual sensitivity. This is an observational case series with three patients with central retinal arterial occlusion (CRAO) and two patients with branch retinal arterial occlusion (BRAO). The macular/peripapillary RNFL thickness and the visual field were measured with Stratus optical coherence tomography (OCT) and Humphrey visual field analyzer, respectively, at least 1 year after the diagnosis of CRAO or BRAO. The macular thickness, in particular the inner retinal layer, and the peripapillary RNFL thickness were reduced in patients with retinal arterial occlusion. The decrease in the macular and the peripapillary RNFL thickness corresponded to the sites of retinal arterial occlusion with diffuse and segmental thinning found in CRAO and BRAO, respectively. Visual field defects were found in the corresponding locations of macular and RNFL thinning, and closely correlated with the degree of the structural damage. Structural damages in terms of reduction in the macular and peripapillary RNFL thickness were evident in patients with retinal arterial occlusion. A close structure-function correlation was found and a worse functional outcome is associated with a more extensive thinning of the macula and RNFL. OCT measurements of the macular/peripapillary RNFL thickness provide useful indicators to reflect the severity of the disease in retinal arterial occlusion and serve as a new paradigm to study and monitor the disease longitudinally.

Research paper thumbnail of Reply: To PMID 25448990

American Journal of Ophthalmology

Research paper thumbnail of Change in Tear Film Lipid Layer Thickness, Corneal Thickness, Volume and Topography after Superficial Cauterization for Conjunctivochalasis

Scientific Reports, 2015

We evaluated the change in tear film lipid layer thickness, corneal thickness, volume and topogra... more We evaluated the change in tear film lipid layer thickness, corneal thickness, volume and topography after superficial cauterization of symptomatic conjunctivochalasis. Bilateral superficial conjunctival cauterization was performed in 36 eyes of 18 patients with symptomatic conjunctivochalasis. The mean age of patients (12 males, 6 females) was 68.6 ± 10.9 years (range: 44-83 years). Preoperatively, 28 eyes (77.8%) had grade 1 conjunctivochalasis, and 8 eyes (22.2%) had grade 2 conjunctivochalasis. At 1 month postoperatively, the severity of conjunctivochalasis decreased significantly (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and 29 eyes (80.6%) had grade 0 conjunctivochalasis whereas 7 eyes (19.4%) had grade 1 conjunctivochalasis. The mean Ocular Surface Disease Index score decreased from 31.5 ± 15.2 preoperatively to 21.5 ± 14.2 at the end of 1 month postoperatively (p = 0.001). There was a statistically significant increase in mean tear film lipid layer thickness 1 month after the surgery (49.6 ± 16.1 nm vs 62.6 ± 21.6 nm; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The central corneal thickness, thinnest corneal thickness and corneal volume decreased significantly postoperatively (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Our study showed that superficial conjunctival cauterization is an effective technique for management of conjunctivochalasis in the short term. An increase in tear film lipid layer thickness along with a decrease in corneal thickness and volume were observed after surgical correction of conjunctivochalasis.

Research paper thumbnail of Safety and efficacy of adjunctive intranasal mitomycin C and triamcinolone in endonasal endoscopic dacryocystorhinostomy

International Ophthalmology, 2015

One of the common causes of failure in dacryocystorhinostomy for nasolacrimal duct obstruction (N... more One of the common causes of failure in dacryocystorhinostomy for nasolacrimal duct obstruction (NLDO) is mucosal scarring and fibrosis around the ostium. Steroid and mitomycin C (MMC) can potentially reduce scarring by their action on the inflammatory and proliferative phase of wound healing, respectively. The purpose of this study is to evaluate the safety and efficacy of combined usage of adjunctive MMC and intranasal triamcinolone (TA) in endonasal endoscopic dacryocystorhinostomy (EE-DCR). This is a retrospective interventional case series. All patients underwent mechanical EE-DCR in two regional hospitals in Hong Kong from January 2005 to December 2006 were included. All received intraoperative MMC application for 5 min and gelfoam soaked with TA onto the ostium. Main outcome measures include the anatomical and functional success rate at follow-up at least 6 months after operation. Other outcomes include complications occurred during and after operation. A total of 73 EE-DCR were performed in 69 patients. Three patients had simultaneous bilateral DCR; one had sequential DCRs for both sides. At the last follow-up, anatomical success was achieved in 68 cases (93 %) and both anatomical with functional success in 67 cases (92 %). No major complication was observed. Minor complications included asymptomatic mucosal adhesion between the nasal septum and lateral nasal wall in one patient and moderate secondary hemorrhage in another. EE-DCR with adjunctive MMC and TA is a safe and successful procedure for the treatment of NLDO.

Research paper thumbnail of Adenoviral Keratoconjunctivitis

Survey of Ophthalmology, 2015

Viral conjunctivitis caused by adenovirus is the most common infectious conjunctivitis. Adenoviru... more Viral conjunctivitis caused by adenovirus is the most common infectious conjunctivitis. Adenoviruses are highly contagious pathogens. The modes of transmission are mainly through hand to eye contact, ocular secretions, respiratory droplets, and contact with ophthalmic care providers and their medical instruments. The most frequent manifestation of ocular adenoviral infection is epidemic keratoconjunctivitis, followed by pharyngoconjunctival fever. Epidemic keratoconjunctivitis is also the most severe form and presents with watery discharge, hyperemia, cheosis, and ipsilateral lymphadenopathy. Pharyngoconjunctival fever is characterized by abrupt onset of high fever, pharyngitis, bilateral conjunctivitis, and periauricular lymph node enlargement. Isolated follicular conjunctivitis without corneal or systemic involvement also occurs. The rate of clinical accuracy in diagnosing viral conjunctivitis is less than 50%. Rapid diagnostic tests now being used decrease unnecessary antibiotic use. Treatment for viral conjunctivitis is mostly supportive. The majority of cases are self-limited, and no treatment is necessary in uncomplicated cases.

Research paper thumbnail of Lymphoproliferative Disease of the Orbit

Asia-Pacific Journal of Ophthalmology, 2015

Lymphoproliferative diseases of the orbit account for majority of orbital tumors. The pathologies... more Lymphoproliferative diseases of the orbit account for majority of orbital tumors. The pathologies range from reactive lymphoid hyperplasia to specific IgG4-related inflammation to malignant lymphomas. This review summarizes current concepts regarding pathology, clinical presentation, diagnosis, staging, and treatment strategies of major orbital lymphoproliferative diseases based on updated and relevant bibliography.

Research paper thumbnail of Twelve-Year Outcomes of Pterygium Excision with Conjunctival Autograft versus Intraoperative Mitomycin C in Double-Head Pterygium Surgery

Journal of ophthalmology, 2015

Purpose. The study aims to compare the long-term outcome of conjunctival autograft (CAU) and mito... more Purpose. The study aims to compare the long-term outcome of conjunctival autograft (CAU) and mitomycin C (MMC) in double-head pterygium surgery. Methods. This is a follow-up study of a comparative interventional trial. Thirty-nine eyes of the 36 patients with double-head pterygium excision in the original study 12 years ago were recruited for clinical assessment. Seven out of the 36 patients were lost. In the original study, each eye with double-head pterygium was randomized to have pterygium excision with CAU on one "head" (temporal or nasal) and MMC on the other "head." All patients were invited for clinical assessment for conjunctival bed status and the presence of pterygium recurrence in the current study. Results. There was no significant difference between the size, morphology, and type of pterygium among the two treatment groups. The recurrence rate of CAU group and MMC group 12 years after excision was 6.3% and 28.1%, respectively (P = 0.020). Among eyes ...

Research paper thumbnail of Agreement among 3 Methods to Measure Corneal Thickness: Ultrasound Pachymetry, Orbscan II, and Visante Anterior Segment Optical Coherence Tomography

To assess the agreement of central and paracentral corneal thickness measurements between ultraso... more To assess the agreement of central and paracentral corneal thickness measurements between ultrasound pachymetry (USP), Orbscan II, and Visante anterior segment optical coherence tomography (ASOCT). Observational cross-sectional study. Seventy eyes of 70 subjects. Each subject underwent Orbscan II (using an acoustic equivalent correction factor of 0.89), ASOCT, and USP examination. Bland-Altman plots were used to evaluate agreement between instruments. Central and paracentral corneal thickness measurements by the 3 methods and agreement, as evaluated by 95% limits of agreement (LOA). The mean measurements of average central corneal thickness by USP, Orbscan II, and ASOCT were 553.5+/-30.26 microm, 553.22+/-25.47 microm, and 538.79+/-26.22 microm, respectively. There was high correlation between instruments: USP with ASOCT (r = 0.936, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), USP with Orbscan II (r = 0.900, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) for central corneal thickness measurements, and Orbscan II with ASOCT for average paracentral 2- to 5-mm measurements (r = 0.947, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The mean differences (and upper/lower LOA) for central corneal thickness measurements were 0.31+/-13.34 microm (26.44/-25.83) between USP and Orbscan II, 14.74+/-10.84 microm (36.0/-6.51) between USP and ASOCT, and 14.44+/-9.14 microm (32.36/-3.48) between Orbscan II and ASOCT. The average mean difference (and upper/lower LOA) between Orbscan II and ASOCT for paracentral 2- to 5-mm corneal thickness measurements was 10.35+/-8.67 microm (27.35/-6.65). Anterior segment optical coherence tomography underestimated corneal thickness compared with that measured with USP. Anterior segment optical coherence tomography had better agreement with the gold standard USP, as compared with Orbscan II. However, important discrepancies among instruments exist. Clinicians should be aware that corneal thickness measurements are influenced by the method of measurement and that, although highly correlated, these instruments should not be used interchangeably for the assessment of corneal thickness.

Research paper thumbnail of Cataract surgery outcomes in adult patients with Down's syndrome

The British journal of ophthalmology, 2014

To describe the outcomes of cataract surgery in adult patients with Down's syndrome at a tert... more To describe the outcomes of cataract surgery in adult patients with Down's syndrome at a tertiary eye hospital in Hong Kong. Retrospective case-file analysis was performed to identify patients with Downs's syndrome who underwent cataract surgery between January 2002 and December 2012. Morphology of cataract, associated ocular features and surgical and visual outcomes were analysed. Cataract surgery was performed in 33 eyes of 20 patients (12 males, 8 females, mean age 42.9±10.6 years) over a 10-year period. Nine patients (9/20, 45.0%) had bilateral cataracts at the time of diagnosis. White cataracts were noted in 12 eyes of 10 patients (12/33, 36.3%) at the time of presentation. Associated ocular problems included myopic maculopathy (18 eyes, 54.5%), keratoconus (12 eyes, 36.3%), nystagmus (2 eyes, 6.0%), corneal scar (2 eyes, 6.0%) and glaucoma (2 eyes, 6.0%). Five eyes (15.1%) underwent extracapsular cataract extraction whereas a phacoemulsification was performed in 28 (84...

Research paper thumbnail of Descemet stripping endothelial keratoplasty in a patient with keratoglobus and chronic hydrops secondary to a spontaneous descemet membrane tear

Case reports in ophthalmological medicine, 2013

Purpose. To report the use of Descemet stripping endothelial keratoplasty (DSEK) in a patient wit... more Purpose. To report the use of Descemet stripping endothelial keratoplasty (DSEK) in a patient with keratoglobus and chronic hydrops. Case Report. We describe a case of a 28-year-old man with bilateral keratoglobus and chronic hydrops in the right eye secondary to spontaneous Descemet membrane tear. The patient presented with finger counting (CF) vision, itching, foreign body sensation, and severe photophobia in the right eye. Peripheral corneal thinning with central corneal protrusion and Descemet membrane tear spanning from 4 to 7 o'clock was noted on slit lamp examination. The right eye cornea was 15 mm in the horizontal diameter. After a 5.5-month loss to follow-up, the patient presented with discomfort, photophobia, decreasing vision, and tearing in the right eye. Vision was 20/60 with pinhole. 360-degree peripheral corneal ectasia with mild neovascularization and hydrops was present. Over the next few months, the patient complained of photophobia and intermittent eye pain. ...

Research paper thumbnail of Descemet stripping endothelial keratoplasty: effect of the surgical procedure on corneal optics

American journal of ophthalmology, 2008

To determine the changes in corneal optical performance after posterior lamellar corneal transpla... more To determine the changes in corneal optical performance after posterior lamellar corneal transplantation. Retrospective case series. The anterior segment in four eyes of four patients who underwent Descemet stripping endothelial keratoplasty (DSEK) with cataract extraction and intraocular lens (IOL) implantation were imaged with the Visante anterior segment optical coherence tomography [OCT] (Carl Zeiss Meditec, Dublin, California, USA). The curvature of the posterior surface of the donor graft was compared with that of the host cornea, and corneal thickness was measured. All eyes had a hyperopic refractive error after surgery. The posterior corneal curvature after surgery was more than that before surgery. Average preoperative keratometry was 43.4 diopters (D), and after surgery, it was 42.8 D using keratometry. However, when the postsurgical corneal power was calculated using the Gaussian optics method, the average value was 40.8 D. The addition of a donor corneal graft to the pos...

Research paper thumbnail of Agreement among 3 methods to measure corneal thickness: ultrasound pachymetry, Orbscan II, and Visante anterior segment optical coherence tomography

Ophthalmology, 2007

To assess the agreement of central and paracentral corneal thickness measurements between ultraso... more To assess the agreement of central and paracentral corneal thickness measurements between ultrasound pachymetry (USP), Orbscan II, and Visante anterior segment optical coherence tomography (ASOCT). Observational cross-sectional study. Seventy eyes of 70 subjects. Each subject underwent Orbscan II (using an acoustic equivalent correction factor of 0.89), ASOCT, and USP examination. Bland-Altman plots were used to evaluate agreement between instruments. Central and paracentral corneal thickness measurements by the 3 methods and agreement, as evaluated by 95% limits of agreement (LOA). The mean measurements of average central corneal thickness by USP, Orbscan II, and ASOCT were 553.5+/-30.26 microm, 553.22+/-25.47 microm, and 538.79+/-26.22 microm, respectively. There was high correlation between instruments: USP with ASOCT (r = 0.936, P<0.001), USP with Orbscan II (r = 0.900, P<0.001) for central corneal thickness measurements, and Orbscan II with ASOCT for average paracentral 2...

Research paper thumbnail of Comparison of Outcomes of Primary Anterior Chamber Versus Secondary Scleral-Fixated Intraocular Lens Implantation in Complicated Cataract Surgeries

American Journal of Ophthalmology, 2015

To compare the outcome of primary anterior chamber vs secondary scleral-fixated intraocular lens ... more To compare the outcome of primary anterior chamber vs secondary scleral-fixated intraocular lens (IOL) implantation in complicated cataract surgeries. Retrospective, comparative study. A consecutive series of complicated cataract surgeries with primary anterior chamber (ACIOL) or secondary scleral-fixated IOL implantation from January 1, 2004 to December 31, 2009 was analyzed. Main outcome measures included the postoperative best-corrected visual acuity (BCVA) and postoperative complications. There were 89 eyes in the primary ACIOL group and 74 eyes in the secondary scleral-fixated IOL group. The mean follow-up duration was 64.1 ± 36.7 months. The mean postoperative logarithm of minimal angle of resolution (logMAR) BCVA at 1 year was 0.32 ± 0.54 and 0.34 ± 0.21 in the primary ACIOL group and the secondary scleral-fixated IOL group, respectively (P = .734). The mean latest logMAR BCVA was 0.68 ± 0.54 and 0.61 ± 0.47 in the primary ACIOL group and the secondary scleral-fixated IOL group, respectively (P = .336). The primary ACIOL group had more early postoperative complications (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). No difference in late postoperative complications was observed between the 2 groups (P = .100). Regression analysis showed that primary ACIOL and secondary scleral-fixated IOL implantation had similar latest postoperative logMAR BCVA (P = .927), while the presence of late complications was associated with a worse final visual outcome (P = .000). This study shows that there are no long-term differences in the visual outcomes and complication profiles after primary ACIOL or secondary scleral-fixated IOL implantation in a complicated cataract operation when capsular support is inadequate.

Research paper thumbnail of Orthokeratology-Associated Infectious Keratitis in a Tertiary Care Eye Hospital in Hong Kong

American Journal of Ophthalmology, 2014

To analyze cases of orthokeratology-associated infectious keratitis managed in a tertiary care ey... more To analyze cases of orthokeratology-associated infectious keratitis managed in a tertiary care eye hospital in Hong Kong between 2003 and 2013. Retrospective study. Case records of patients with infectious keratitis attributable to orthokeratology contact lenses were analyzed. Data analyzed included clinical features, microbiological evaluation, and treatment outcomes. A total of 23 patients were included (16 female, 7 male, mean age: 15.0 ± 4.2 years; range: 9-23 years). All patients were using overnight orthokeratology for an average of 2.7 ± 2.8 years (range: 3 months - 10 years) before the onset of infection. Clinical features included corneal infiltrate (n = 14, 60.9%) and corneal perineuritis (n = 12, 52.2%). Fifteen eyes (65.2%) had a positive microbiological culture obtained from corneal scrapings. The most commonly isolated organism was Pseudomonas aeruginosa (n = 6), followed by coagulase-negative Staphylococcus (n = 5) and Acanthamoeba (n = 3). Five cases of Pseudomonas aeruginosa and 5 cases of Acanthamoeba were identified from contact lenses or contact lens solution. The mean duration from disease onset to remission was 31.9 ± 34.9 days (range: 6-131 days). All patients responded to medical treatment, and no emergency surgical intervention was needed. The best-corrected logMAR visual acuity improved significantly from 0.62 ± 0.51 (20/83 Snellen) to 0.15 ± 0.20 (20/28 Snellen) (Wilcoxon signed rank test, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Orthokeratology-associated infectious keratitis continues to be a serious problem, especially in regions with high prevalence of myopia. Early clinical and microbiological diagnosis and intensive treatment can improve final visual outcomes.

Research paper thumbnail of Reply re: "Balloon dacryoplasty in internal ostium stenosis after endoscopic dacryocystorhinostomy

Ophthalmic plastic and reconstructive surgery

Research paper thumbnail of Application of anterior segment optical coherence tomography to identify eyes with posterior polar cataract at high risk for posterior capsule rupture

Journal of Cataract & Refractive Surgery, 2014

properly cited.

Research paper thumbnail of Prevalence of Blindness and Outcomes of Cataract Surgery in Hainan Province in South China

Ophthalmology, 2013

Objective: To define the prevalence of blindness and visual impairment (VI) in people in rural Ha... more Objective: To define the prevalence of blindness and visual impairment (VI) in people in rural Hainan using the rapid assessment of avoidable blindness (RAAB) and to report the outcomes of cataract surgery among the residents.

Research paper thumbnail of Inferonasal Prolapsed Orbital Fat

Ophthalmic Plastic and Reconstructive Surgery, 2013

Prolapsed orbital fat is a common entity in the literature and is mostly located in the superotem... more Prolapsed orbital fat is a common entity in the literature and is mostly located in the superotemporal quadrant. It can be confused with other conjunctival tumors. The authors describe a 56-year-old woman with a rare inferonasal prolapsed orbital fat. Excision of the lesion was performed without recurrence at 6 months.

Research paper thumbnail of Balloon Dacryoplasty in Internal Ostium Stenosis After Endoscopic Dacryocystorhinostomy

Ophthalmic Plastic and Reconstructive Surgery, 2014

To determine the effectiveness of balloon dacryoplasty in the treatment of internal ostium stenos... more To determine the effectiveness of balloon dacryoplasty in the treatment of internal ostium stenosis after endoscopic dacryocystorhinostomy (EnDCR). A retrospective, noncomparative interventional case series of patients who underwent balloon dacryoplasty for post-EnDCR internal ostium stenosis were included. A balloon catheter was used in all procedures, with bicanalicular silicone intubation. Patient records were reviewed and data analyzed. Anatomical success was defined by functional endoscopic dye test, and functional success was defined as a subjective improvement in symptoms at last follow up. Nineteen lacrimal systems of 18 consecutive patients were studied between July 2007 and September 2012. At a mean follow up of 20 months (range, 3-53 months), anatomical success rate was 84% (16/19 systems), whereas functional success was 74% (14/19 systems). No major complication was observed. Balloon dacryoplasty is a minimally invasive procedure in the treatment of post-EnDCR internal ostium stenosis. It is a simple, safe procedure and can provide symptomatic relief to some of these patients. It can be considered as a treatment option for patients demonstrated with internal ostium stenosis after EnDCR.

Research paper thumbnail of Barriers for Poor Cataract Surgery Uptake among Patients with Operable Cataract in a Program of Outreach Screening and Low-cost Surgery in Rural China

Ophthalmic Epidemiology, 2014

To identify the reasons for poor uptake of cataract surgery in a program of outreach screening an... more To identify the reasons for poor uptake of cataract surgery in a program of outreach screening and low-cost surgery in Pucheng County, a rural area in northwestern China. Detailed interviews with a semi-structured questionnaire were conducted by telephone or face-to-face for participants who had been advised to attend a low-cost cataract surgery program but did not schedule the surgery within 3 months after the initial screening. Among 432 eligible subjects, 355 (82.2%) were interviewed (mean age 70.6 ± 6.6 years, 73.8% female). A total of 138 subjects (38.9%) were interviewed by phone and 217 (61.1%) were interviewed face-to-face. Lack of family support (n = 106, 29.9%) and failure to understand the need for surgery (n = 96, 27.0%) were the two main reasons for not undergoing cataract surgery. Other factors included fear of surgery (n = 62, 17.5%), lack of faith in doctors (n = 36, 10.1%), financial constraints (n = 25, 7.0%) and lack of transportation (n = 4, 1.1%). The principal barriers to low-cost cataract surgery uptake in rural China included lack of family support and failure to understand the need for surgery. Education targeting entire families to eliminate these barriers and development of community support systems at the family level are required to achieve greater uptake of low-cost cataract surgery programs in rural China.