Can supervise: YES
Gunasekaran, P, Hodge, C, Rose, K & Fraser, CL 2019, 'Persistent visual disturbances after concussion.', Australian journal of general practice, vol. 48, no. 8, pp. 531-536.View/Download from: UTS OPUS
BACKGROUND:Ocular dysfunction, including eye movement defects, has been documented in up to 69% of patients with concussion. However, standard sports-related concussion assessment protocols do not typically include any clinical examination of the ocular system. OBJECTIVE:The aim of this article is to inform general practitioners (GPs) about ocular defects associated with concussion, identify test procedures and highlight the important role of GPs within the concussion paradigm. DISCUSSION:Ocular dysfunction that commonly occurs with concussion includes abnormalities of accommodation, convergence, saccades and smooth pursuits. This may cause blurred vision, double vision, ocular pain and difficulty with close work. Symptoms can severely affect daily work, school or play activities. Patients complaining of extended ocular symptoms following concussion should be referred to an ophthalmologist for a complete ocular assessment.
Gunasekaran, P, Hodge, C, Pearce, A, King, D & Fraser, C 2019, 'A review of concussion diagnosis and management in Australian professional sporting codes', PHYSICIAN AND SPORTSMEDICINE.View/Download from: Publisher's site
Ling, MLH, Wells, M, Petsoglou, C, Luo, K, Georges, P, Devasahayam, R, Hodge, C, Treloggen, J, Sutton, G & Zhu, M 2019, 'Factors Affecting Corneal Organ Culture Contamination: A 6-year Study at the New South Wales Tissue Bank.', Cornea, vol. 38, no. 7, pp. 829-835.View/Download from: UTS OPUS or Publisher's site
PURPOSE:To report the rate of microbial contamination and analyze possible risk factors for contamination of banked corneas stored using the organ culture method. METHODS:Data from the New South Wales Tissue Banks incorporating the Lions NSW Eye Bank, between September 1, 2011, and November 30, 2017, were reviewed retrospectively. All corneas collected during this period and stored in organ culture storage media were tested for microbial contamination. The influence of potential factors on the rate of contamination was analyzed using the χ test and logistic regression using generalized estimating equations. RESULTS:A total of 4410 corneas were included in this study, of which 110 were medium culture positive, representing a microbial contamination rate of 2.5%. The main contaminants were Candida species followed by Staphylococcus species. Corneal tissue collected in summer and autumn had a significantly higher contamination rate (P = 0.006). All other factors studied were not shown to have a statistically significant association with contamination after accounting for within-pair correlation and confounders. CONCLUSIONS:A relatively low contamination rate of 2.5% observed in our study reflects the stringent laboratory protocols, strict donor selection criteria, and high level of experience among staff at the Lions NSW Eye Bank. Our study demonstrated that the season of collection had a strong association with the rate of organ culture contamination. Because Candida species contributed the largest percentage of contamination, specific measures to reduce and eliminate fungal proliferation should be considered by eye banks particularly in warm seasons.
Agarwal, S, Thornell, E, Hodge, C, Sutton, G & Hughes, P 2018, 'Visual outcomes and higher order aberrations following LASIK on eyes with low myopia and astigmatism', Open Ophthalmology Journal, vol. 12, pp. 84-93.View/Download from: UTS OPUS or Publisher's site
© 2018 Agarwal et al. Background: Laser-Assisted in situ Keratomileusis (LASIK) can induce corneal aberrations that can impact vision and patient satisfaction. Recent developments in laser technologies have helped minimise these aberrations. Objective: To assess the quality of vision and change in Higher-Order Aberrations (HOAs) following wavefront-optimized LASIK in low-myopic astigmatic patients. Methods: LASIK was performed on a total of 76 eyes in patients with myopia <4.0 D and cylinder <2.0 D using the WaveLight® EX500 excimer and FS200 femtosecond laser platform. Visual acuity, contrast sensitivity and HOAs were measured at 1 and 3 months postoperatively and compared to preoperative values. Subjective quality of vision was assessed pre-and postoperatively using a VF14 questionnaire. Results: Mean postoperative Spherical Equivalent (SE) was-0.09 ± 0.26 µm with 95% of patients within ± 0.5 D of attempted SE. Postoperative uncorrected distance visual acuity was 20/20 or better for 96% of patients. Contrast sensitivity increased against horizontal and vertical gratings at all spatial frequencies except for vertical gratings at 18 cycles/degree. Spherical aberration and total HOA increased by 0.085 µm and 0.13 µm respectively. The mean VF14 score increased from 89.2 ± 16.7% to 99 ± 1.4% postoperatively. Conclusion: LASIK performed using the WaveLight® EX500 excimer and WaveLight® FS200 laser platform provided improved contrast sensitivity and visual acuity with minimal introduction of HOAs, making it a suitable platform for low myopic astigmatic patients.
Chen, Z, You, J, Liu, X, Cooper, S, Hodge, C, Sutton, G, Crook, JM & Wallace, GG 2018, 'Biomaterials for corneal bioengineering.', Biomedical materials (Bristol, England), vol. 13, no. 3.View/Download from: UTS OPUS or Publisher's site
Corneal transplantation is an important surgical treatment for many common corneal diseases. However, a worldwide shortage of tissue from suitable corneal donors has meant that many people are not able to receive sight-restoring operations. In addition, rejection is a major cause of corneal transplant failure. Bioengineering corneal tissue has recently gained widespread attention. In order to facilitate corneal regeneration, a range of materials is currently being investigated. The ideal substrate requires sufficient tectonic durability, biocompatibility with cultured cellular elements, transparency, and perhaps biodegradability and clinical compliance. This review considers the anatomy and function of the native cornea as a precursor to evaluating a variety of biomaterials for corneal regeneration including key characteristics for optimal material form and function. The integration of appropriate cells with the most appropriate biomaterials is also discussed. Taken together, the information provided offers insight into the requirements for fabricating synthetic and semisynthetic corneas for in vitro modeling of tissue development and disease, pharmaceutical screening, and in vivo application for regenerative medicine.
Lawless, M & Hodge, C 2018, 'Ocular emergencies Prompt action can improve outcomes', Medicine Today, vol. 19, no. 5, pp. 40-49.
© 2018 College of Family Physicians of Canada. All rights reserved. Ocular emergencies include physical and chemical trauma to the eye and conditions such as retinal detachment and vascular events. For patients who present to a GP with an ocular emergency, organising referral to the available ophthalmic services is paramount, but basic investigation and in some cases treatment can be of benefit.
Levitz, L, Reich, J & Hodge, C 2018, 'Posterior capsular complication rates with femtosecond laser-assisted cataract surgery: a consecutive comparative cohort and literature review.', Clinical ophthalmology (Auckland, N.Z.), vol. 12, pp. 1701-1706.View/Download from: UTS OPUS or Publisher's site
The aim of the study was to determine whether femtosecond-assisted laser cataract surgery (FLACS) reduces the posterior capsular complication (PCC) rate compared to manual cataract surgery when performed by an experienced surgeon.We reviewed 2,021 consecutive FLACS procedures between 1 June 2012 and 30 August 2017. All cases of posterior capsular rupture (PCR) with or without vitreous prolapse or zonular dialysis (ZD) that prevented an in-the-bag placement of the intraocular lens were included. Risk factors were noted and outcomes documented.Six eyes of 2,021 (0.3%) who underwent FLACS had either a PCR or ZD. One eye (0.25%) of 403 eyes that had manual cataract surgery had a PCR. There was no significant difference in outcomes. Risk factors included advanced age, dense nuclei, pseudoexfoliation and small pupil. Only a single case in the FLACS series may have been directly attributed to the FLACS procedure.This study provides evidence that there is no significant difference in the PCC rate between FLACS and manual cataract surgery in the hand of an experienced surgeon who performs >350 cases annually. This low rate of complications may be achieved by less experienced surgeons adopting FLACS.
Roberts, TV, Hodge, C, Sutton, G & Lawless, M 2018, 'Comparison of Hill-radial basis function, Barrett Universal and current third generation formulas for the calculation of intraocular lens power during cataract surgery', Clinical and Experimental Ophthalmology, vol. 46, no. 3, pp. 240-246.View/Download from: UTS OPUS or Publisher's site
© 2017 Royal Australian and New Zealand College of Ophthalmologists. Importance: This study represents a novel comparison of recently introduced intraocular lens power calculation formulas. Background: To compare current new generation formulas for calculating the intraocular lens power for a standard cohort of patients undergoing cataract and lens replacement surgery in a private group practice in Australia. Design: Retrospective case series comparison. Participants: Postoperative results from 400 consecutive patients undergoing implantation of an SN60WF intraocular lens post cataract removal by 12 surgeons were used. Methods: Refractive outcomes were compared with expected targets to determine the predicted refractive outcomes using the Hill-radial basis function, Barrett Universal II and readily available third or fourth generation intraocular lens power calculation formulas. Main Outcome Measure: Mean absolute predicted error. Results: The mean absolute predicted difference ranged from 0.30 to 0.34 D. There was no overall significant difference in the predicted difference or variance between formulas. All formulas achieved greater than 78.3% of eyes within ±0.5 D of intended refraction. The Hill-radial basis function and Barrett formulas provided the lowest mean numerical error compared with existing formulas in short and long eyes, respectively. The Barrett Universal II formula had the lowest percentage of refractive surprises ( > 1 D from predicted error) across all axial lengths. Conclusions and Relevance: Acceptable outcomes can be achieved with optical biometry, consistent surgical technique and use of current intraocular lens power calculation formulas. The Barrett Universal II formula may provide the lowest risk of refractive surprise compared with other intraocular lens power calculation formulas.
You, J, Corley, SM, Wen, L, Hodge, C, Höllhumer, R, Madigan, MC, Wilkins, MR & Sutton, G 2018, 'RNA-Seq analysis and comparison of corneal epithelium in keratoconus and myopia patients.', Scientific Reports, vol. 8, no. 1, pp. 389-389.View/Download from: UTS OPUS or Publisher's site
Keratoconus is a common degenerative corneal disease that can lead to significant visual morbidity, and both genetic and environmental factors have been implicated in its pathogenesis. We compared the transcriptome of keratoconus and control epithelium using RNA-Seq. Epithelial tissues were obtained prior to surgery from keratoconus and myopia control patients, undergoing collagen cross-linking and photorefractive keratectomy, respectively. We identified major differences in keratoconus linked to cell-cell communication, cell signalling and cellular metabolism. The genes associated with the Hedgehog, Wnt and Notch1 signaling pathways were down-regulated in keratoconus. We also identified plasmolipin and Notch1 as being significantly reduced in keratoconus for both gene and protein expression (p < 0.05). Plasmolipin is a novel protein identified in human corneal epithelium, and has been demonstrated to have a key role in epithelial cell differentiation in other tissues. This study shows altered gene and protein expression of these three proteins in keratoconus, and further studies are clearly warranted to confirm the functional role of these proteins in the pathogenesis of keratoconus.
You, J, Munoz-Erazo, L, Wen, L, Hodge, C, Madigan, MC & Sutton, G 2018, 'In-Vitro Effects of Secreted Frizzled-Related Protein 1 (SFRP1) On Human Corneal Epithelial Cells.', Current eye research, vol. 43, no. 4, pp. 455-459.View/Download from: UTS OPUS or Publisher's site
PURPOSE:Limbal corneal epithelial cells (LCECs) are responsible for corneal epithelial cell regeneration. However, corneal central epithelial cells (CCECs) are also suggested to display potential for self-renewal. Additionally, a better understanding of molecules that regulate corneal epithelial cell regeneration is important for studying conditions affecting the cornea, for example, keratoconus. Given our previous findings of reduced levels of secreted frizzled-related protein 1 (SFRP1) in tears from keratoconus patients compared to controls, we investigated the effects of SFRP1 on the proliferation and survival of cultured central and limbal human corneal epithelial cells. MATERIAL AND METHODS:Limbal and central corneal explants were established from postmortem human corneas, and cultured in CnT-PR, an epithelial-specific tissue culture media. Subcultured cells from explants were immunostained for the cytokeratins CK3, 12, 19, and the proliferative/oligopotent markers Ki67 and p63. BrdU flow cytometry, Alamar Blue and LDH assays were used to assess effects of SFRP1 treatment on central and LCECs. RESULTS:Primary limbal and central corneal epithelial cells were successfully cultured in vitro to confluence (P6 and P4, respectively). They all expressed varying levels of cytokeratins CK3, CK12 and CK19, and Ki67 and p63. Additionally, they showed significantly increased metabolic activity after SFRP1 treatment (p < 0.05), with a maximum response at 1 μg/mL of SPRF1. No difference in proliferation was detected in SFRP1 treated LCECs; however, a reduction in cell death was noted (p < 0.05). CONCLUSION:Similar to the LCECs, primary human CCECs can be cultured in vitro, and expressed epithelial markers. SFRP1 demonstrated an improvement on the metabolic activity of both CCECs and LCECs, which in LCECs could be resulted from reduced cell death. This may have implications in degenerative corneal disorders, such as keratoconus.
Hodge, C, Sutton, G, Devasahayam, R, Georges, P, Treloggen, J, Cooper, S & Petsoglou, C 2017, 'The use of donor scleral patch in ophthalmic surgery.', Cell and Tissue Banking, vol. 18, no. 1, pp. 119-128.View/Download from: UTS OPUS or Publisher's site
Scleral tissue has been in use in ophthalmology for many years although indications for use have varied. We retrospectively reviewed scleral transplant tissue requests over a 12 month period at a local eye bank and confirmed a small but significant demand for the use of scleral tissue. Iatrogenic surgical complications are the primary indication for use. Our understanding of the indications and outcomes of scleral graft procedures is derived from case reports and small cohort series. We reviewed the current literature on existing indications for its use and discuss the relative outcomes. To our knowledge this represents the first review of scleral transplant indications and further summarises usage rates in the Lions NSW Eye Bank which may provide practical information for those surgeons who use scleral tissue and Eye Banks who supply it.
Lawless, M, Levitz, L & Hodge, C 2017, 'Reviewing the visual benefits of femtosecond laser-assisted cataract surgery: Can we improve our outcomes?', Indian Journal of Ophthalmology, vol. 65, no. 12, pp. 1314-1322.View/Download from: UTS OPUS or Publisher's site
Femtosecond laser-assisted cataract surgery (FLACS) was introduced in 2009 and has increasingly been incorporated into surgical practice. The automation of three key aspects of cataract surgery was expected to deliver a significant improvement in both refractive and safety outcomes. The published literature has not yet shown consistent refractive improvement above conventional techniques. The purpose of this paper is to review current FLACS refractive outcomes and explore factors that may have contributed to the current findings and whether future improvements are possible.
Martin, AI, Devasahayam, R, Hodge, C, Cooper, S & Sutton, GL 2017, 'Analysis of the learning curve for pre-cut corneal specimens in preparation for lamellar transplantation: a prospective, single-centre, consecutive case series prepared at the Lions New South Wales Eye Bank.', Clinical and Experimental Ophthalmology, vol. 45, no. 7, pp. 689-694.View/Download from: UTS OPUS or Publisher's site
This study is the first paper to establish a learning curve by a single technician.Preparation of pre-cut corneal endothelial grafts commenced at Lions New South Wales Eye Bank in December 2014. The primary objective of this study was to review the safety and reliability of the preparation method during the first year of production.This is a hospital-based, prospective case series.There were 234 consecutive donor corneal lenticules.Donor lenticules were prepared by a single operator using a linear cutting microkeratome. Immediately prior to cutting, central corneal thickness values were recorded. Measurements of the corneal bed were taken immediately following lenticule preparation. Outcomes were separated by blade sizes, and intended thickness was compared to actual thickness for each setting. Early specimens were compared to later ones to assess for a learning curve within the technique.The main parameter measured is the mean difference from intended lamellar cut thickness.The mean final cut thickness was 122.36 ± 20.35 μm, and the mean difference from intended cut was 30.17 ± 37.45 μm. No significant difference was found between results achieved with early specimens versus those achieved with later specimens (P = 0.425).Thin, reproducible endothelial grafts can routinely be produced by trained technicians at their respective eye banks without significant concerns for an extended learning curve. This service can reduce perioperative surgical complexity, required surgical paraphernalia and theatre times. The consistent preparation of single-pass, ultrathin pre-cut corneas may have additional advantages for surgeons seeking to introduce lamellar techniques.
Tong, JY, Viswanathan, D, Hodge, C, Sutton, G, Chan, C & Males, JJ 2017, 'Corneal collagen crosslinking for post-lasik ectasia: An australian study', Asia-Pacific Journal of Ophthalmology, vol. 6, no. 3, pp. 228-232.View/Download from: Publisher's site
© 2017 by Asia Pacific Academy of Ophthalmology. Purpose: Post laser-Assisted in situ keratomileusis (LASIK) ectasia is a rare and unpredictable complication after LASIK. Corneal collagen crosslinking (CXL) has emerged as a promising technique to address this complication. Our study evaluates the long-Term efficacy of CXLfor post-LASIK ectasia in an Australian setting.Design: Retrospective review of post-LASIK ectasia patients referred to and treated at 3 corneal refractive surgery institutions in Sydney, Australia. Methods: Eleven patients (14 eyes; mean age, 39.7 ± 12.6 years) underwent epithelium-off CXL with follow-up ranging from 12-78 months. Best spectacle-corrected visual acuity (BSCVA), simulated keratometry, corneal topography indices, and higher-order aberrations (HOAs) [mean ± standard error of the mean (SEM)] were measured with a rotating Scheimpflug camera (Pentacam, Oculus). Comparisons between baseline measurements and postoperative outcomes were performed using paired t test analysis. Results: At last follow-up, BSCVAimproved significantly by 0.2 ± 0.06 logMAR(P = 0.01), and 12 of 14 eyes showed no keratometric deterioration. Of the corneal topography indices, index of height asymmetry showed a trend toward a significant improvement (P = 0.05). There was no progression of corneal HOAs. Central corneal thickness was not significantly altered (P = 0.6). No major postoperative complications were observed. Conclusions: In the Australian setting, CXLhas proven effective at stabilizing the progression of post-LASIK ectasia, inducing corneal regularity, and improving visual acuity.
Chan, C, Lawless, M, Sutton, G, Versace, P & Hodge, C 2016, 'Small incision lenticule extraction (SMILE) in 2015', Clinical and Experimental Optometry, vol. 99, no. 3, pp. 204-212.View/Download from: Publisher's site
© 2016 Optometry Australia. Small incision lenticule extraction (SMILE) represents a recent addition to the refractive surgeon's range of procedures. Although there remains a number of similarities to existing techniques in terms of patient selection and treatment parameters, consideration is required to optimise patient outcomes and satisfaction. Here, we review the selection criteria, contraindications, indications and existing published safety and efficacy outcomes.
Devasahayam, R, Georges, P, Hodge, C, Treloggen, J, Cooper, S, Petsoglou, C, Sutton, G & Zhu, M 2016, 'Implementation of Organ Culture storage of donor corneas: a 3 year study of its impact on the corneal transplant wait list at the Lions New South Wales Eye Bank', Cell and Tissue Banking, vol. 17, pp. 377-385.View/Download from: Publisher's site
© 2016 Springer Science+Business Media Dordrecht Organ Culture corneal storage offers an extended storage time and increased donor pool and tissue assessment opportunities. In September 2011, the Lions New South Wales Eye Bank (LNSWEB) moved from hypothermic storage to Organ Culture corneal storage. This study evaluates the impact of implementation of Organ Culture on donor eye retrieval and the corneal transplant waiting list over a 3 year period in NSW, Australia. Retrospective review of the LNSWEB data from September 2011 to August 2014. Tissue collection, waiting list and tissue utilization data were recorded. The data from September 2008 to August 2011 for Optisol-GS storage was used for comparison. The annual donor and cornea collection rate increased 35 % and 44 % respectively with Organ Culture compared to Optisol-GS storage. The utilization rate of corneal tissue increased from 73.4 % with hypothermic storage to 77.2 % with Organ Culture storage. The transplant wait list decreased by 77.3 % from September 2011 to August 2014 and correlated with the increased rate of corneal transplantation (r = −0.9381, p < 0.0001). No other factors impacting the wait list changed over this period. Corneas not used from either storage method were due to unacceptable endothelial cell density/viability. The contamination rate of corneas stored in Organ Culture medium was low at 1.74 %. The Organ Culture storage method increases the corneal donor pool available to Eye banks. The practical benefits of the extended storage time and increased donor assessment opportunities have directly led to an increase in corneal utilization rate and a significant decrease in recipient wait list time.
Modern cataract surgery is relatively routine, yet the decision to proceed to surgery may be complex. GPs can recognise potential problems and help to guide patients' postoperative expectations as they are faced with options for improving their vision and gaining independence from prescription glasses.
Hughes, PH & Hodge, C 2016, 'Laser refractive surgery: A guide for GPs', Medicine Today, vol. 17, no. 10, pp. 59-62.
Laser refractive surgery is now an established option for patients seeking independence from glasses. With excellent patient satisfaction and millions of procedures previously performed worldwide, refractive surgery is considered to be among the most successful elective procedures;1 yet achieving an optimal outcome after surgery remains a concern. This is discussed below with reference to the GP as an important source of guidance.
Lauschke, JL, Lawless, M, Sutton, G, Roberts, TV & Hodge, C 2016, 'Assessment of corneal curvature using verion optical imaging system: a comparative study', CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY, vol. 44, no. 5, pp. 369-376.View/Download from: Publisher's site
Roberts, TV, Lawless, M, Sutton, G & Hodge, C 2016, 'Update and clinical utility of the LenSx femtosecond laser in cataract surgery', Clinical Ophthalmology, vol. 10, pp. 2021-2029.View/Download from: Publisher's site
ï¿½ 2016 Roberts et al. The introduction of femtosecond lasers to cataract surgery has been the major disruptive technology introduced into ophthalmic surgery in the last decade. Femtosecond laser cataract surgery (FLACS) integrates high-resolution anterior segment imaging with a femtosecond laser allowing key steps of cataract surgery to be performed with computer-guided laser accuracy, precision, and reproducibility. Since the introduction of FLACS, there have been significant advances in laser software and hardware as well as surgeon experience, with over 250 articles published in the peer-reviewed literature. This review examines the published evidence relating to the LenSx platform and discusses surgical techniques, indications, safety, and clinical results.
Hodge, C, Chan, C, Zantos, S, Kokkinakis, J, Stapleton, F & Sutton, G 2015, 'Therapeutic treatment of keratoconus: a survey of local optometric practice criteria', CLINICAL AND EXPERIMENTAL OPTOMETRY, vol. 98, no. 4, pp. 312-318.View/Download from: Publisher's site
Levitz, L, Reich, J, Roberts, K & Hodge, C 2015, 'Evaluation of toric intraocular lenses in patients with low degrees of astigmatism', Asia-Pacific Journal of Ophthalmology, vol. 4, no. 5, pp. 245-249.View/Download from: Publisher's site
© 2015 Asia Pacific Academy of Ophthalmology. Purpose: This study aimed to describe the efficacy of toric intraocular lenses (IOLs) in patients with low degrees of corneal astigmatism. Design: Retrospective case series was undertaken. Methods: Patients with low amounts of corneal astigmatism who were treated with either a toric monofocal lens (SN6AT2 Toric, n = 76) or a toric multifocal lens (SND1T2 +3.00, n = 44) were reviewed. Eyes were evaluated preoperatively and 3 months postoperatively. Refraction and visual outcomes were monitored. Results: Patients (69.7%) in the monofocal toric group obtained refractive cylinder less than 0.25 diopters (D) compared with 70.5% of the multifocal toric group. Both toric groups showed a statistically significant reduction in refractive cylinder after surgery (P = 0.001). Monofocal (66.7%) and multifocal (68.2%) toric patients achieved uncorrected distance visual acuity of 20/20 or better. Conclusions: This represents the first article to investigate the use of low-power toric IOLs in patients with less than 1.25 D of corneal cylinder. Before the development of low-power toric IOLs, patients with low to moderate amounts of astigmatism required concurrent intraoperative adjustments or additional forms of treatment to benefit from cataract and IOL surgery. Evidence suggests that the toric T2 IOL now removes this barrier, providing consistent, accurate refractive and astigmatic results, and enables these patients to achieve excellent outcomes with a single treatment across IOL platforms. Larger studies will help to consolidate our results.
Roberts, TV, Lawless, M, Sutton, G & Hodge, C 2015, 'Anterior capsule integrity after femtosecond laser-assisted cataract surgery', Journal of Cataract and Refractive Surgery, vol. 41, no. 5, pp. 1109-1110.View/Download from: Publisher's site
You, J, Wen, L, Roufas, A, Hodge, C, Sutton, G & Madigan, MC 2015, 'Expression of HGF and c-met proteins in human keratoconus corneas', Journal of Ophthalmology, vol. 2015.View/Download from: Publisher's site
© 2015 Jingjing You et al. Keratoconus (KC) is a progressive degenerative inflammatory-related disease of the human cornea leading to decreased visual function. The pathogenesis of KC remains to be understood. Recent genetic studies indicate that gene variants of an inflammation-related molecule, hepatocyte growth factor (HGF), are associated with an increased susceptibility for developing KC. However HGF protein expression in KC has not been explored. In this initial study, we investigated late-stage KC and control corneas for the expression of HGF and its receptor mesenchymal-epithelial transition factor (c-Met/Met). KC buttons (8 mm diameter) (n = 10) and whole control corneas (n = 6) were fixed in 10% formalin or 2% paraformaldehyde, paraffin embedded and sectioned. Sections were immunolabelled with HGF and c-Met antibodies, visualised using immunofluorescence, and examined with scanning laser confocal microscopy. Semiquantitative grading was used to compare HGF and c-Met immunostaining in KC and control corneas. Overall, KC corneas showed increased HGF and c-Met immunostaining compared to controls. KC corneal epithelium displayed heterogeneous moderate-to-strong immunoreactivity for HGF and c-Met, particularly in the basal epithelium adjacent to the cone area. Taken together with the recent genetic studies, our results further support a possible role for HGF/c-Met in the pathogenesis of KC.
Chen, S, Hodge, C, Sutton, G & Versace, P 2014, 'Lacquer cracks developing after phakic intraocular lens implantation', Journal of Refractive Surgery, vol. 30, no. 9, pp. 646-648.View/Download from: Publisher's site
PURPOSE: To describe a case of lacquer cracks developing after phakic intraocular lens implantation.METHODS: Case report.RESULTS: A 46-year-old woman diagnosed as having extreme myopia and corrected distance visual acuity of 20/40 presented with decreased vision and a central scotoma less than 24 hours following phakic intraocular lens implantation. Dilated examination revealed the presence of a macular hemorrhage and possible lacquer crack formation. Documented preoperative imaging showed an absence of lacquer cracks in the eye that was operated on. The patient was treated with intravitreal bevacizumab. At 4 weeks postoperatively, imaging confirmed an almost complete resolution of the hemorrhagic pigment epithelial detachment with evidence of lacquer cracks. Uncorrected visual acuity was 20/50 and the patient was asymptomatic.CONCLUSIONS: This is the first reported case of macular crack formation immediately following phakic intraocular lens implantation. Possible contributing factors are discussed. © SLACK Incorporated.
Hodge, C, Chan, C & Sutton, G 2014, 'Investigation of keratoconus in an Australian refractive population', Clinical and Experimental Ophthalmology, vol. 42, no. 8, pp. 796-798.View/Download from: Publisher's site
Martin, AI, Hodge, C, Lawless, M, Roberts, T, Hughes, P & Sutton, G 2014, 'Femtosecond laser cataract surgery: challenging cases', CURRENT OPINION IN OPHTHALMOLOGY, vol. 25, no. 1, pp. 71-80.View/Download from: Publisher's site
Martin, AI, Hughes, P & Hodge, C 2014, 'First report of femtosecond laser cataract surgery in a nanophthalmic eye', Clinical and Experimental Ophthalmology, vol. 42, no. 5, pp. 501-502.View/Download from: Publisher's site
Roberts, TV, Lawless, M, Chan, CC, Jacobs, M, Ng, D, Bali, SJ, Hodge, C & Sutton, G 2014, 'Femtosecond laser cataract surgery: Response', Clinical and Experimental Ophthalmology, vol. 42, no. 3, pp. 290-291.View/Download from: Publisher's site
Roberts, TV, Lawless, M, Sutton, G & Hodge, C 2014, 'Hydrodissection techniques during femtosecond laser-assisted cataract surgery', Journal of Cataract and Refractive Surgery, vol. 40, no. 4, pp. 692-693.View/Download from: Publisher's site
Hodge, C, Chan, C, Bali, SJ & Sutton, G 2013, 'A review of corneal melting following kerato-refractive surgery', CLINICAL AND EXPERIMENTAL OPTOMETRY, vol. 96, no. 1, pp. 14-19.View/Download from: Publisher's site
Roberts, TV, Lawless, M & Hodge, C 2013, 'Laser-assisted cataract surgery following insertion of a pupil expander for management of complex cataract and small irregular pupil', Journal of Cataract and Refractive Surgery, vol. 39, no. 12, pp. 1921-1924.View/Download from: Publisher's site
We report a case in which laser-assisted cataract surgery was performed safely and successfully following manual division of posterior synechiae and mechanical dilation of the pupil with a Malyugin ring in a patient with an irregular, small stuck-down pupil. Financial Disclosure Dr. Lawless is a member of the medical advisory board of Alcon Lensx. No author has a financial or proprietary interest in any material or method mentioned. © 2013 ASCRS and ESCRS.
Roberts, TV, Lawless, M, Bali, SJ, Hodge, C & Sutton, G 2013, 'Surgical outcomes and safety of femtosecond laser cataract surgery: A prospective study of 1500 consecutive cases', Ophthalmology, vol. 120, no. 2, pp. 227-233.View/Download from: Publisher's site
Objective: To report the surgical outcomes and safety of femtosecond (FS) laser cataract surgery (LCS) with greater surgeon experience, modified techniques, and improved technology. Design: Prospective, interventional case series. Participants: Fifteen hundred consecutive eyes undergoing FS laser cataract and refractive lens exchange surgery in a single group private practice. Intervention: Femtosecond LCS. Methods: All eyes undergoing LCS between April 2011 and March 2012 were included in the study. Cases underwent anterior capsulotomy, lens fragmentation, and corneal incisions with the Alcon/LenSx FS laser (Alcon/LenSx, Aliso Viejo, CA). The procedure was completed by phacoemulsification and insertion of an intraocular lens. The cases were divided into 2 groups: Group 1, initial experience consisting of the first 200 cases; and group 2, the subsequent 1300 cases performed by the same surgeons. Main Outcome Measures: Intraoperative complication rates and comparison between groups. Results: Both groups were comparable for baseline demographic parameters. Anterior capsule tears occurred in 4% and 0.31% of eyes, posterior capsule tears in 3.5% and 0.31% of eyes, and posterior lens dislocation in 2% and 0% of eyes in groups 1 group 2, respectively (P<0.001 for all comparisons). Number of docking attempts per case (1.5 vs 1.05), incidence of post-laser pupillary constriction (9.5% vs 1.23%), and anterior capsular tags (10.5% vs 1.61%) were significantly lower in group 2 (P<0.001 for all comparisons). Conclusions: In the authors' experience, the surgical outcomes and safety of LCS improved significantly with greater surgeon experience, development of modified techniques, and improved technology. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. © 2013 American Academy of Ophthalmology.
Roberts, TV, Lawless, M, Chan, CCK, Jacobs, M, Ng, D, Bali, SJ, Hodge, C & Sutton, G 2013, 'Femtosecond laser cataract surgery: Technology and clinical practice', Clinical and Experimental Ophthalmology, vol. 41, no. 2, pp. 180-186.View/Download from: Publisher's site
The recent introduction of femtosecond lasers to cataract surgery has generated much interest among ophthalmologists around the world. Laser cataract surgery integrates high-resolution anterior segment imaging systems with a femtosecond laser, allowing key steps of the procedure, including the primary and side-port corneal incisions, the anterior capsulotomy and fragmentation of the lens nucleus, to be performed with computer-guided laser precision. There is emerging evidence of reduced phacoemulsification time, better wound architecture and a more stable refractive result with femtosecond cataract surgery, as well as reports documenting an initial learning curve. This article will review the current state of technology and discuss our clinical experience. © 2012 Royal Australian and New Zealand College of Ophthalmologists.
PURPOSE OF REVIEW: The introduction of the femtosecond laser to the field of cataract surgery offers many potential benefits. The femtosecond laser is able to perform three important steps in cataract surgery: capsulotomy, lens fragmentation and corneal incisions. Although evidence in support of its efficacy is accumulating, there is a surgical learning curve that needs to be addressed. This review outlines key issues to consider when contemplating the transition to laser cataract surgery in clinical practice. RECENT FINDINGS: Laser cataract surgery has been shown to be associated with an initial learning curve. Femtosecond lasers produce a more accurate and precise anterior capsulotomy, improve intraocular lens centration and reduce intraocular lens tilt. Visual and refractive outcomes, although in a limited number of studies, have been shown to be at least as good as those of conventional phacoemulsification. The impact of reduced phacoemulsification energy on the corneal endothelium is still being investigated. SUMMARY: The automation of key steps by the use of femtosecond lasers in cataract surgery has several potential advantages. Emerging literature supports the transition from conventional phacoemulsification to the laser cataract surgery. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Tenen, A, Roberts, K, Sack, J & Hodge, C 2013, 'Assessment of midperipheral anterior chamber depth in patient with posterior chamber phakic intraocular lens', Journal of Cataract and Refractive Surgery, vol. 39, no. 10, pp. 1611-1614.View/Download from: Publisher's site
We describe a patient who required surgical explantation of a phakic intraocular lens (pIOL) as a result of mechanical angle closure despite the absence of standard preoperative risk factors. An assessment of the patient's records suggested peripheral anterior chamber depth (ACD) values considerably shallower than the central ACD measurement. Subsequently, the midperipheral values of all patients having pIOL implantation at our practice were reviewed to provide potential baseline measurements for comparison against the values of the explanted pIOL eyes. Assessment of midperipheral anterior chamber anatomy may be advantageous in the evaluation of patients for pIOL surgery. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. © 2013 ASCRS and ESCRS.
You, J, Hodge, C, Wen, L, McAvoy, JW, Madigan, MC & Sutton, G 2013, 'Tear levels of SFRP1 are significantly reduced in keratoconus patients', Molecular Vision, vol. 19, pp. 509-515.
Purpose: To measure secreted frizzled-related protein 1 (SFRP1) levels in human tears and to investigate tear SFRP1 as a potential biomarker for keratoconus (KC). Methods: Tears were collected from control (n=33) and KC patients (n=33) using micropipette tubes. Total tear protein was measured using a FluoroProfile Protein Quantification kit. An in-house enzyme-linked immunosorbent assay (ELISA) was developed to measure SFRP1 in control and KC tears. Statistical analyses of age, gender, the association of SFRP1, and total tear protein with KC were conducted. Results: Tear SFRP1 was significantly decreased in KC, compared to age-matched controls (3.41 ng/μl±3.12 versus 5.55 ng/μl±5.62, respectively; p=0.039). Conversely, total tear protein was significantly increased in KC, compared to age-matched controls (12.38 μg/μl±4.76 versus 9.40 μg/μl±3.88, respectively; p=0.038). The ratio of SFRP1/total tear protein was also found to be significantly decreased in the KC group (p=0.007). No significant association between tear SFRP1 and total tear protein was detected. Conclusions: Tear SFRP1 was significantly decreased in age-matched KC versus control patients, and may be further reduced in moderate KC. Tear-SFRP1 levels alone do not provide an obvious biomarker for KC; however, our results provide further evidence that tear-protein profiles are altered in KC, and suggest the involvement of SFRPs in the pathogenesis of KC. © 2013 Molecular Vision.
Bali, SJ, Hodge, C, Chen, S & Sutton, G 2012, 'Femtosecond laser assisted cataract surgery in phacovitrectomy', Graefe's Archive for Clinical and Experimental Ophthalmology, vol. 250, no. 10, pp. 1549-1551.View/Download from: Publisher's site
Bali, SJ, Hodge, C, Lawless, M, Roberts, TV & Sutton, G 2012, 'Early experience with the femtosecond laser for cataract surgery', Ophthalmology, vol. 119, no. 5, pp. 891-899.View/Download from: Publisher's site
Objective: To describe the intraoperative complications and to evaluate the learning curve with femtosecond laser cataract surgery. Design: Prospective, consecutive cohort study. Participants: The first 200 eyes undergoing femtosecond laser cataract surgery and refractive lens exchange in a single center. Methods: The initial 200 eyes undergoing cataract surgery between April 2011 and June 2011 by 6 surgeons were included in the study. The cases underwent anterior capsulotomy, lens fragmentation, and corneal incisions with the femtosecond laser. The procedure was completed by phacoemulsification and insertion of an intraocular lens. Data were collected about patient demographics, preoperative investigations and intraoperative complications. The cases were divided into 4 groups - group 1 included the first 50 cases, group 2 included cases 51 through 100, group 3 included cases 101 through 150, and group 4 included cases 151 through 200 - and were analyzed. Main Outcome Measures: Intraoperative complication rates. Results: The mean age of patients included was 69.2±9.8 years. Of the 200 eyes, 74.5% underwent a complete procedure of laser capsulotomy, lens fragmentation, and corneal incisions. Five eyes had suction breaks during the laser procedure that led to the remainder of the laser procedure being aborted. Twenty-one (10.5%) eyes showed the presence of small anterior capsular tags. The number of eyes with free-floating capsulotomies was 35 (17.5%). The other complications during the study were anterior radial tears (n = 8; 4%), posterior capsular ruptures (n = 7; 3.5%), and dropped nucleus (n = 4; 2%). A significant difference was noted among the sequential groups with respect to the number of docking attempts (P<0.001), miosis after the laser procedure (P<0.001), and free-floating capsulotomies (P<0.001), suggesting an improving learning curve. The surgeons with prior experience with femtosecond lasers had fewer complications in the first 100 cases (P<0.001). ...
Hodge, C, Bali, SJ, Lawless, M, Chan, C, Roberts, T, Ng, D, Chen, S, Hughes, P & Sutton, G 2012, 'Femtosecond cataract surgery: A review of current literature and the experience from an initial installation', Saudi Journal of Ophthalmology, vol. 26, no. 1, pp. 73-78.View/Download from: Publisher's site
Cataract surgery remains the most widely performed intraocular procedure throughout the world. Safety and accuracy of the procedure are paramount and techniques should remain under constant review. Recently, the introduction of the femtosecond laser to assist cataract surgery has provided ophthalmologists with an exciting tool that may further improve outcomes. We review the existing literature and discuss the installation and initial experience of a femtosecond laser into our practice. © 2012 Saudi Ophthalmological Society, King Saud University.
Lawless, M, Bali, SJ, Hodge, C, Roberts, TV, Chan, C & Sutton, G 2012, 'Outcomes of femtosecond laser cataract surgery with a diffractive multifocal intraocular lens', Journal of Refractive Surgery, vol. 28, no. 12, pp. 859-864.View/Download from: Publisher's site
PURPOSE: To report the visual and refractive outcomes in an initial series of eyes undergoing femtosecond laser cataract surgery with implantation of a diffractive multifocal intraocular lens (IOL). METHODS: The first 61 consecutive eyes undergoing femtosecond laser cataract surgery and ReSTOR (Alcon Laboratories Inc) +3.00-diopter (D) add IOL implantation between May and July 2011 were enrolled in the study (LCS group). The control group consisted of a retrospective consecutive cohort of 29 eyes that underwent manual phacoemulsification cataract surgery and ReSTOR +3.00-D add IOL implantation (MCS group) between December 2010 and April 2011. Visual and refractive parameters were collected pre- and postoperatively at 1 and 3 months. RESULTS: Mean postoperative spherical equivalent refraction was -0.01±0.35 D and -0.06±0.30 D in the LCS and MCS groups, respectively (P=.492). Mean absolute refractive prediction error (PE) was 0.26±0.25 D for the LCS group and 0.23±0.16 D for the MCS group (P=.489). Mean arithmetic refractive PE was 0.06±0.44 D and -0.02±0.30 D for the LCS and MCS groups, respectively (P=.388). No significant difference was noted in mean postoperative uncorrected distance visual acuity or uncorrected near visual acuity between groups. No eyes in either group had surgical complications or loss of corrected distance visual acuity in the follow-up period. CONCLUSIONS: Mean spherical equivalent refraction and visual acuity of our initial group of patients undergoing laser cataract surgery are comparable to the manual phacoemulsification cohort for the AcrySof ReSTOR +3.00-D add IOL. Copyright © SLACK Incorporated.
Tenen, A & Hodge, C 2012, 'Acute-onset cataract as the initial presentation of diabetes mellitus', JOURNAL OF CATARACT AND REFRACTIVE SURGERY, vol. 38, no. 10, pp. 1861-1863.View/Download from: Publisher's site
You, J, Hodge, C, Wen, L, McAvoy, JW, Madigan, MC & Sutton, G 2012, 'Using soybean trypsin inhibitor as an external loading control for Western blot analysis of tear proteins: Application to corneal disease', Experimental Eye Research, vol. 99, no. 1, pp. 55-62.View/Download from: Publisher's site
Hodge, C, Lawless, M & Sutton, G 2011, 'Keratectasia following LASIK in a patient with uncomplicated PRK in the fellow eye', Journal of Cataract and Refractive Surgery, vol. 37, no. 3, pp. 603-607.View/Download from: Publisher's site
We present a case of unilateral keratectasia in a laser refractive surgery patient. Laser in situ keratomileusis (LASIK) was performed in the first eye, but because of difficulty lifting the femtosecond-created cap in the second eye, photorefractive keratectomy was performed in that eye. Neither eye had risk factors for keratectasia; both had identical low scores on the Randleman risk factor score. Although femtosecond laser caps were created in both eyes, ectasia developed in only the LASIK eye, in which the cap was lifted. We believe this is the first case of this complication reported in the literature. It highlights our incomplete knowledge of the risk factors for keratectasia following LASIK and suggests that unlifted flaps do not undergo the same biomechanical weakening as flaps that are lifted. © 2011 ASCRS and ESCRS.
Hodge, C, Sutton, G, Lawless, M & Rogers, C 2011, 'Photorefractive keratectomy with mitomycin-C after corneal transplantation for keratoconus', Journal of Cataract and Refractive Surgery, vol. 37, no. 10, pp. 1884-1894.View/Download from: Publisher's site
Purpose: To evaluate the efficacy of photorefractive keratectomy (PRK) for residual refractive error after penetrating keratoplasty (PKP) for keratoconus. Setting: Private ophthalmic clinic. Design: Case series. Method: Consecutive patients who had PRK augmented with topical mitomycin-C (MMC) after PKP for keratoconus were retrospectively reviewed. Patients were divided into a a low cylinder group (refractive cylinder ≤6.00 D) and a high cylinder group (refractive cylinder >6.00 D). Visual acuity, refraction, and keratometry were analyzed preoperatively and 1, 3, 6, and 12 months postoperatively. Results: The study comprised 47 eyes (41 patients). The spherical equivalent (SE) decreased from -4.24 D ± 3.23 (SD) preoperatively to -0.71 ± 1.03 D 12 months postoperatively in the low cylinder group and from -4.19 ± 3.54 D to -2.45 ± 3.42 D, respectively, in the high cylinder group. The refractive cylinder decreased from -4.27 ± 1.4 D to -1.71 ± 1.55 D, respectively, in the low cylinder group and from -7.78 ± 1.21 D to -4.6 ± 2.54 D, respectively, in the high cylinder group. By the last follow-up, 8.3% of patients had lost 2 lines of corrected distance visual acuity. There were no cases of corneal haze greater than 2+ or of graft rejection. Conclusions: Penetrating keratoplasty with adjunctive MMC decreased several refractive variables in patients with previous PKP. These results compare well with those in the published literature and suggest PRK is as effective as, and probably safer than, laser in situ keratomileusis in treating refractive error in these cases. Financial Disclosure: No author has financial or proprietary interests in any material or method mentioned. © 2011 ASCRS and ESCRS.
Roberts, TV, Sutton, G, Lawless, MA, Jindal-Bali, S & Hodge, C 2011, 'Capsular block syndrome associated with femtosecond laser-assisted cataract surgery', Journal of Cataract and Refractive Surgery, vol. 37, no. 11, pp. 2068-2070.View/Download from: Publisher's site
We report intraoperative capsular block syndrome occuring during the first 50 femtosecond laser-assisted cataract surgeries performed in our facility. Two patients had uneventful combined laser fragmentation, capsulotomy, and corneal incision procedures. In both cases, following transfer to the operating room and manual removal of the laser-cut capsulotomy, posterior capsule rupture was noted during hydrodissection, resulting in posterior dislocation of the lens. Pars plana vitrectomy, removal of the crystalline lens, and sulcus implantation of an intraocular lens were performed in both patients with good visual outcomes. Femtosecond laser-assisted cataract surgery changes the intraoperative environment with the generation of intracapsular gas and laser-induced changes in the cortex. With awareness of the changed intraocular environment following laser lens fragmentation and capsulotomy and a modification of the surgical technique, no additional cases of intraoperative CBS have been seen in more than 600 laser-assisted cataract surgery procedures performed to date at our facility. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes. © 2011 ASCRS and ESCRS.
Saad, A, Hodge, C, Lawless, M & Gatinel, D 2011, 'Retrospective testing of a new method for detecting ectasia-susceptible corneas', Journal of Cataract and Refractive Surgery, vol. 37, no. 10, pp. 1907-1908.View/Download from: Publisher's site
Chan, CCK, Hodge, C & Sutton, G 2010, 'External analysis of the Randleman Ectasia Risk Factor Score System: a review of 36 cases of post LASIK ectasia', CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY, vol. 38, no. 4, pp. 335-340.View/Download from: Publisher's site
Roberts, TV, Hodge, C, Graham, SL, Burlutsky, G & Mitchell, P 2009, 'Prevalence of nocturnal oxygen desaturation and self-reported sleep-disordered breathing in glaucoma', Journal of Glaucoma, vol. 18, no. 2, pp. 114-118.View/Download from: Publisher's site
PURPOSE: To evaluate the prevalence of nocturnal oxygen desaturation and sleep-disordered breathing symptoms within a glaucoma population. PATIENTS AND METHODS: One hundred and twelve subjects (glaucoma=52, control=60) aged between 45 and 80 years were recruited for the study. Clinical assessment included overnight ambulatory pulse oximetry monitoring and administration of a self-reported sleep-disordered breathing questionnaire. RESULTS: There were no differences in age, sex, body mass index, or prevalence of systemic hypertension between the groups. The mean oxygen desaturation index of the glaucoma group (8.6) did not differ significantly from that of the control group (9.6) (P=0.715). The prevalence of moderate to severe respiratory dysfunction (oxygen desaturation index >20) in the glaucoma group (17%) was similar to that in the control group (12%) (P=0.463). The severity of sleep-disordered breathing symptoms was similar between the groups (P=0.157). CONCLUSIONS: No statistically significant association was found between glaucoma and either nocturnal oxygen desaturation or sleep-disordered breathing. Although this study cannot exclude the possibility of either impaired optic nerve head autoregulation or hypoxic damage occurring secondary to sleep apnea syndrome, the findings do not support the routine use of pulse oximetry in the workup of individuals with glaucoma. © 2009 Lippincott Williams & Wilkins, Inc.
Hodge, C & Lawless, M 2008, 'Ocular emergencies', AUSTRALIAN FAMILY PHYSICIAN, vol. 37, no. 7, pp. 506-509.
Sutton, G & Hodge, C 2008, 'Accuracy and precision of LASIK flap thickness using the intralase femtosecond laser in 1000 consecutive cases', Journal of Refractive Surgery, vol. 24, no. 8, pp. 802-806.
PURPOSE: To report the safety and flap thickness predictability of LASIK using the IntraLase femtosecond laser. METHOD: A retrospective analysis of 1000 consecutive LASIK cases was performed to assess the rate of intraand postoperative complications and loss of best spectacle-corrected visual acuity (BSCVA). A subset of 260 eyes was prospectively analyzed to assess flap thickness predictability using subtraction ultrasound on the day of surgery. RESULTS: No serious intra- or postoperative complications were noted. Three (0.3%) patients had epithelial defects that required a bandage contact lens. Four (0.4%) patients had slipped caps on day 1 that required repositioning. Two (0.2%) patients developed grade I diffuse lamellar keratitis. No patient developed epithelial ingrowth >1 mm from the flap edge, transient light sensitivity, or infection. No patient lost ≥2 lines of BSCVA at 6 months postoperatively. With an attempted flap thickness of 105 μm with the 15-KHz laser, the mean flap thickness was 116.79±10.75 μm (range: 95 to 148 μm) (n=119). In the 30-KHz group (n=141), the target corneal flap thickness was 115 μm, with a mean flap thickness of 114.02±9.82 μm (range: 93 to 163 μm). Overall 87.3% of eyes were within ±20 μm of the intended result. Ninety-eight percent of caps created with the 30-KHz laser were within ±20 μm compared to 74.8% in the 15-KHz group. CONCLUSIONS: LASIK surgery with the IntraLase femtosecond laser is safe and flap thickness is predictable.
Sutton, G, Hodge, C & Mcghee, CNJ 2008, 'Rapid visual recovery after penetrating keratoplasty for keratoconus', Clinical and Experimental Ophthalmology, vol. 36, no. 8, pp. 725-730.View/Download from: Publisher's site
Purpose: To ascertain the level and speed of visual recovery after penetrating keratoplasty for keratoconus. Method: A retrospective review was performed of 100 consecutive cases of penetrating keratoplasty for keratoconus, performed between 1999 and 2005. Review assessed visual function and the speed at which patients achieved a functional best corrected visual acuity (BCVA) of ≥6/12 either with glasses or phoropter. Analysis of visual, refractive and keratometric results were made on 76 eyes that had reached 6 months after suture removal. Intraoperative and postoperative complications including graft rejections were recorded. Results: Post keratoplasty, 43.4%, 78.9% and 96.1% of patients achieved a BCVA of 6/12 or better by 1, 3 and 6months, respectively. The mean time to achieve a BCVA of 6/12 was 9.6weeks. Only 5.3% of patients required a rigid gas permeable contact lens. Overall 42.4% of patients had unaided visual acuity of 6/12 or better at 12months. The mean refractive cylinder and standard deviation was 2.78±1.6D, and the mean spherical equivalent was -1.12±2.9D. There were no significant intraoperative complications, and although 3.9% of eyes had at least one graft rejection episode there were no graft failures. Conclusion: Penetrating keratoplasty is an effective method for treating advanced keratoconus. By 3 months almost all patients are able to achieve a BCVA of 6/12 or better with progressive improvement over time. This technique allows almost half of patients to achieve an unaided vision of 6/12 or better with sutures in situ. © Journal compilation © 2008 Royal Australian and New Zealand College of Ophthalmologists.
Chan, CCK, Hodge, C & Lawless, M 2006, 'Calculation of intraocular lens power after corneal refractive surgery', Clinical and Experimental Ophthalmology, vol. 34, no. 7, pp. 640-644.View/Download from: Publisher's site
Purpose: Underestimation of required intraocular lens (IOL) power with resultant hyperopia is common in post-corneal refractive surgery eyes. A number of methods to minimize error have been proposed but most studies have been small and theoretical. Methods: We retrospectively reviewed 34 eyes that had undergone routine phacoemulsification and IOL implantation after photorefractive keratectomy or laser in situ keratomileusis. Sixteen eyes were included in the final analysis. Using known pre-and postoperative data, four methods were used to obtain keratometric values combined with three common IOL formulae (Holladay 2, SRK/T and Hoffer Q) and Koch's published Double-K nomogram. The Double-K method was also used in conjunction with the Holladay 2 formula. Target refractions were calculated and then compared to actual postoperative results. Results: The Clinical History method at the spectacle plane produced the lowest mean K-values. Shammas adjustment formula combined with the Holladay 2 and Hoffer Q produced results closest to emmetropia. The Double-K methods produced the least number of hyperopic results. Overall, all methods would have resulted in unacceptably high rates of hyperopia and deviation from target refraction. Conclusions: No method produces acceptably consistent results because modern IOL formulae were designed for presurgical eyes. Accuracy will only be improved when new IOL formulae based on the anatomy of postrefractive eyes become available. Shammas adjustment formula and regression formulae are viable alternatives especially when there is a lack of preoperative data. The Double-K methods are best suited to avoiding a hyperopic surprise. © 2006 The Authors; Journal compilation © 2006 Royal Australian and New Zealand College of Ophthalmologists.
Kim, P, Briganti, EM, Sutton, GL, Lawless, MA, Rogers, CM & Hodge, C 2005, 'Laser in situ keratomileusis for refractive error after cataract surgery', JOURNAL OF CATARACT AND REFRACTIVE SURGERY, vol. 31, no. 5, pp. 979-986.View/Download from: Publisher's site
Lawless, M & Hodge, C 2005, 'Laser vision correction: Where are we in 2005?', Medicine Today, vol. 6, no. 7.
* Patients seek refractive surgery in order to function better, rather than for cosmetic reasons. * Laser vision correction works well as an alternative to glasses or contact lenses. * The most common laser vision correction procedure is LASIK (laser in situ keratomileusis). * Not everyone is suitable for laser vision correction; the decision to proceed is an individual choice with advice from the ophthalmologist. * Lens surgery is a better choice than laser refractive surgery in some patients.
In the 5 years since the first wavefront-based LASIK treatment on normal eyes, the ophthalmology profession has had to confront a new language based on astronomy, optics and mathematics. Over this time wavefront technology has been used for diagnosis and treatment, and its application has made the profession define what is meant by good vision, and determine whether, with psychophysical and psychometric tests, it is possible understand how an individual perceives the world. The clinical application of wavefront technology has forced ophthalmologists and vision scientists with an engineering bias to talk to those with a biological bias, and to appreciate that if you try and change the corneal shape, its biological, anatomical and optical properties exist within a complex external eye environment. This perspective article demonstrates that wavefront analysis is a useful diagnostic tool, and that wavefront-based corneal refractive surgery is an improvement over conventional techniques. Its use by an ophthalmologist is a clinical decision specific to an individual patient.
Hodge, C & Dunlop, A 2004, 'Unilateral red eye eye series-16', Australian Family Physician, vol. 33, no. 6, pp. 443-444.
Hodge, C & Friedrich, J 2004, 'Pupil disorder. Eye series--19.', Australian family physician, vol. 33, no. 9, pp. 729-730.
Hodge, C & Lawless, M 2004, 'Corneal graft case study eye series - 15', Australian Family Physician, vol. 33, no. 5, pp. 345-346.
A young patient has returned from their ophthalmologist having been diagnosed with keratoconus. It was explained that if eye glasses or contact lenses become insufficient in correcting their vision, a corneal transplant may be necessary. The patient is concerned about this possible development.
Hodge, C & Lawless, M 2004, 'Presbyopia case study', Australian Family Physician, vol. 33, no. 10, pp. 841-842.
Hodge, C & Ng, D 2004, 'Eye series: Dry eyes, menopause and hormone therapy', Australian Family Physician, vol. 33, no. 11, pp. 931-932.
Hodge, C & Ng, D 2004, 'Improved reading vision. Eye series--12.', Australian family physician, vol. 33, no. 1-2, pp. 53-54.
Hodge, C & Ng, D 2004, 'Itchy eyes case study: Eye series - 17', Australian Family Physician, vol. 33, no. 7, pp. 531-532.
Hodge, C & Roberts, T 2004, 'Obesity case study', Australian Family Physician, vol. 33, no. 4, pp. 257-258.
Hodge, C & Roberts, T 2004, 'Pregnancy and ocular complications', Australian Family Physician, vol. 33, no. 12, pp. 1023-1024.
Hodge, C & Roberts, T 2004, 'Vision loss. The patient with developmental disability. Eye series-18.', Australian family physician, vol. 33, no. 8, pp. 635-636.
Hodge, C & Friedrich, J 2003, 'Diabetes case study. Eye series 6.', Australian family physician, vol. 32, no. 7, pp. 537-538.
Hodge, C & Friedrich, J 2003, 'Test your knowledge. Chronic red eye.', Australian family physician, vol. 32, no. 5, pp. 353-354.
A 62 year old woman has come to the practice complaining of an irritable, red eye (Figure 1). This has occurred intermittently over a number of years. The condition tends to resolve over a week or so with the help of a series of lid bathes and hot compresses. For mild to moderate episodes she has previously been prescribed Predsol steroid eye drops for which she has responded quickly. The patient feels that the episodes are increasing and the eye is remaining 'gritty' for longer. Vision in the right eye has become poorer than the left eye.
Hodge, C & Martin, F 2003, 'Sudden onset double vision. Eye series--11.', Australian family physician, vol. 32, no. 12, pp. 1016-1017.
Hodge, C & Martin, PA 2003, 'Test your knowledge. Droopy eyelid. Eye series. 2.', Australian family physician, vol. 32, no. 3, pp. 159-160.
Hodge, C & McKay, D 2003, 'Increasing visual disturbances. Eye series 5.', Australian family physician, vol. 32, no. 6, pp. 459-460.
Hodge, C & Roberts, T 2003, 'Flashes and floaters. Eye series--9.', Australian family physician, vol. 32, no. 10, pp. 851-852.
Hodge, C & Roberts, T 2003, 'Glaucoma. Eye series. 7.', Australian family physician, vol. 32, no. 8, pp. 643-644.
Hodge, C & Sutton, G 2003, 'Dry eyes. Eye series. 3.', Australian family physician, vol. 32, no. 4, pp. 265-266.
During her regular check-up a 68 year old woman patient mentions, as an aside, that the recent hot weather has left her eyes with a 'dry, gritty feeling'. The feeling is more noticeable toward the end of the day and on further questioning has gradually become more prominent over the past few years.
Hodge, C, Molloy, A & Rogers, C 2003, 'Sterile corneal infiltrates. Contact lens case study--eye series 8.', Australian family physician, vol. 32, no. 9, pp. 748-749.
Hodge, C, Roberts, TV & McKay, D 2003, 'Test your knowledge. Sudden right eye shadow. Eye series 1.', Australian family physician, vol. 32, no. 1-2, pp. 53-54.
Lawless, MA, Hodge, C, Rogers, CM & Sutton, GL 2003, 'Laser in situ Keratomileusis with Alcon CustomCornea', Journal of Refractive Surgery, vol. 19, no. 6.
PURPOSE: To report the 3-month results of our first cases of laser in situ keratomileusis (LASIK) with Alcon's CustomCornea. METHODS: Wavefront analysis was performed using the LADARWave aberrometer and ablation was performed with the LADARVision4000 system. Thirty-one eyes of 17 patients were analyzed prospectively, at 1 and 3 months after CustomCornea surgery. Psychophysical tests were performed, including high and low contrast acuity, and contrast sensitivity under scotopic and photopic conditions. In addition, psychometric testing was performed using a subjective vision questionnaire. RESULTS: Mean spherical equivalent refraction improved from a baseline -3.05 ± 1.92 D to +0.02 ± 0.28 D at 3 months (28 eyes). At 3 months, 46.4% (13 eyes) had uncorrected visual acuity of 20/16, 92.7% (26 eyes) had 20/20, and 100% (28 eyes) had 20/25 uncorrected visual acuity. Three months after CustomCornea surgery, there was a statistically significant improvement in contrast sensitivity under both scotopic and photopic conditions, and a statistically significant increase in third and fourth order aberrations. There was a statistically significant improvement in visual quality as measured by the subjective vision index, increasing from a preoperative mean 66.62 to 87.63 at 3 months after surgery. CONCLUSIONS: CustomCornea was an improvement over conventional LASIK as measured by most psychophysical and psychometric parameters. The relationship between higher order aberrations and other psychophysical and psychometric measurements needs more analysis.
Lundström, M, Dickman, M, Henry, Y, Manning, S, Rosen, P, Tassignon, MJ, Young, D, Stenevi, U, Hodge, C, Lawless, M, Roberts, TV, Sutton, G, Ingels, W, Mertens, EL, Netukova, M, Stodulka, P, Herbst, T, Holland, D, Filkon, T, Nagy, ZZ, Mastropasqua, L, Vecchiarino, L, Ligabue, E, Gualdi, L, Gualdi, M, Perone, G, Incarbone, F, Bellucci, R, Cargnoni, M, Nuijts, RMMA, van den Biggelaar, FJHM, Guëll, JL, Ayoğlu, B, Göker, S, Asena, BS, Barlett, J, Daya, S, Espinosa-Lagana, M, Stevens, JD & Sunga, C 2017, 'Femtosecond laser–assisted cataract surgeries reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery: Baseline characteristics, surgical procedure, and outcomes', Journal of Cataract and Refractive Surgery, pp. 1549-1556.View/Download from: Publisher's site
© 2017 ASCRS and ESCRS Purpose To describe a large cohort of femtosecond laser–assisted cataract surgeries in terms of baseline characteristics and the related outcomes. Setting Eighteen cataract surgery clinics in 9 European countries and Australia. Design Prospective multicenter case series. Methods Data on consecutive eyes having femtosecond laser–assisted cataract surgery in the participating clinics were entered in the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). A trained registry manager in each clinic was responsible for valid reporting to the EUREQUO. Demographics, preoperative corrected distance visual acuity (CDVA), risk factors, type of surgery, type of intraocular lens, visual outcomes, refractive outcomes, and complications were reported. Results Complete data were available for 3379 cases. The mean age was 64.4 years ± 10.9 (SD) and 57.8% (95% confidence interval [CI], 56.1-59.5) of the patients were women. A surgical complication was reported in 2.9% of all cases (95% CI, 2.4-3.5). The mean postoperative CDVA was 0.04 ± 0.15. logarithm of the minimum angle of resolution. A biometry prediction error (spherical equivalent) was within ±0.5 diopter in 71.8% (95% CI, 70.3-73.3) of all surgeries. Postoperative complications were reported in 3.3% (95% CI, 2.7-4.0). Patients with good preoperative CDVA had the best visual and refractive outcomes; patients with poor preoperative visual acuity had poorer outcomes. Conclusions The visual and refractive outcomes of femtosecond laser–assisted cataract surgery were favorable compared with manual phacoemulsification. The outcomes were highly influenced by the preoperative visual acuity, but all preoperative CDVA groups had acceptable outcomes.