Ophthalmologists discussed the management of vitreous floaters, fungal infection and myopic retinopathy during a free paper session at the recently held 5th ASEAN Ophthalmology Society Virtual Congress (AOS 2022).
Laser Floater Treatment
Although common, vitreous floaters can be more than a nuisance as they may lead to vision impairment. According to Dr. Chester Pataray from the Philippines, current management options are: observation (a conservative approach that is deemed unsatisfactory); vitrectomy (a surgical approach that may be too aggressive or risky); and YAG laser vitreolysis (which could be the best choice with the potential of being effective and safe).
To confirm this, he assessed the efficacy and safety of YAG laser vitreolysis for symptomatic floaters in a tertiary hospital via a prospective, interventional, participant-blinded and outcome assessor-blinded randomized controlled study. In this study, the participants were randomly assigned to either the YAG laser (n=18) or sham group (n=18).
Ten-point visual disturbance scores at baseline and day 30 showed a significant reduction for the YAG laser group (p = 0.0001) and no difference for the sham laser group (p = 1). Meanwhile, the comparative analysis showed significant differences between the two groups, reported Dr. Pataray.
“The subjective grading of improvement at day 30 using a 5-level qualitative improvement scale, and objective grading of improvement at day 30 using the 5-level floater disparity scale, both show significant improvement and even complete resolution in the YAG laser group, while no improvement of symptoms and no success of treatment was noted among the sham group. No inflammation or intraocular pressure increase was observed,” he added.
With these results, Dr. Pataray concluded that the Nd:YAG laser vitreolysis is an effective and safe treatment for symptomatic floaters.
From Soil to Eye
The soil is a haven for germs and sometimes they can get into the eye without our realization. Dr. Tanavadee Rattanaphong from Thailand shared an interesting case of ocular manifestation of disseminated sporotrichosis.
A 62-year-old woman under long-term immunosuppressants experienced blurred vision in both eyes for one week before she presented at the clinic. She had an infected wound at her left index finger (due to an injury sustained while gardening), multiple inflammatory skin nodules on her face and throughout her body, as well as fever upon presentation. The initial diagnosis made was bilateral granulomatous panuveitis and possibly endogenous endophthalmitis.
Systemic work for the source of infection was performed and an aqueous specimen was sent for PCR fungus and mycobacterium tuberculosis detection, which came back negative. Fungal infection was then suspected and the pus from the patient’s left index finger and face was sent for a fungus culture test, which revealed the fungus as Sporothrix spp. With this, the final diagnosis was made as disseminated sporotrichosis with bilateral endogenous endophthalmitis.
After nine weeks of systemic antifungal treatment and nine doses of intravitreal antifungal treatment, the patient’s anterior chamber was found to be quiet, and corneal lesions were inactive and regressing.
“Sporotrichosis, also known as ‘rose gardener’s disease,’ is caused by a dimorphic fungus called Sporothrix. The most common presentation is granulomatous conjunctivitis and the first choice of treatment is oral itraconazole 100mg/day for ≥90 days,” Dr. Rattanaphong highlighted.
She noted that in such cases, performing a dilated fundus examination is important and the clinician should think of infection in the differential diagnosis. “There’s a variety of presentations in endogenous endophthalmitis and different pathogens that can cause it. Clinical suspicion is important for early detection and prompt treatment to reduce morbidity and mortality. The mainstay of treatment in endogenous endophthalmitis is systemic medication, and adjunctive intravitreal injection is helpful in most cases,” she said.
Myopic Retinopathy in Vietnam
Myopia is an increasing problem in Vietnam and high myopia can have dire consequences if not properly managed. Dr. Hai Yen Pham from Vietnam investigated the prevalence and related factors of myopic retinopathy through a prospective, cross-sectional study of 168 eyes of 88 participants with unilateral/bilateral high myopia from January to August 2020 in Vietnam. Examination methods used included slit-lamp and fundoscopy, B ultrasound, IOL Master, as well as the optic nerve and macular optical coherence tomography.
Participants ranged from 12 to 47 years of age. “The concern in regard to this group is not so much that myopia has already caused widespread vision impairment, but that the growing rates of myopia and high myopia will increase the risk of future vision impairment,” she said.
The study showed that myopic Vietnamese people have similar rates of peripapillary, macular and peripheral degenerations as other countries. “According to our findings, we found peripapillary atrophy in 70.2% of eyes. Central retinal lesions, at 66.1%, were lower than what was reported in Singapore (85.7%) and higher than in China (43%). Meanwhile, peripapillary changes are common in patients with high myopia. Screening for peripheral retinal lesions plays a crucial role in preventing sight-threatening complications such as retinal break or detachment. The prevalence of peripheral retinal changes in this study (43.5%), as well as the percentage of white without pressure (WWOP; 31%) and lattice degeneration (LD; 12.2%), were similar to those reported in China.”
She noted that the level and duration of myopia and increased axial length (AL) were related to peripapillary changes. “Increasing age, level of myopia, longer duration of myopia and increased AL are associated with increased risk of central retinopathy. Meanwhile, peripheral retinal lesions were associated with levels of myopia and AL. No relation between myopic peripheral retinal lesion and age, age of onset and period of myopia was found. Therefore, highly myopic patients of any age must have the peripheral retina examined thoroughly to rule out the presence of pathology.
“Retinal complications were common among high myopic Vietnamese patients. The risk of increased rates of vision loss from myopic retinopathy appears real for Vietnam as myopia and high myopia demographics shift from younger to older people in the coming years. The degenerative features of myopia suggest that targeted public healthcare in preventing or delaying myopia onset and slowing myopia progression are needed to address this issue,” she concluded.
Editor’s Note: The 5th AOS Congress was held virtually on March 26-27, 2022. Reporting for this story took place during the event.
