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2. Peroral endoscopic myotomy versus pneumatic dilation in treatment-naive patients with achalasia: 5-year follow-up of a randomised controlled trial

Author

Kuipers, T., Ponds, F. A., Fockens, P., Bastiaansen, B. A. J., Lei, A., Oude Nijhuis, R. A. B., Neuhaus, H., Beyna, T., Kandler, J., Frieling, T., Chiu, P. W. Y., Wu, J. C. Y., Wong, V. W. Y., Costamagna, Guido, Familiari, Pietro, Kahrilas, P. J., Pandolfino, J. E., Smout, A. J. P. M., Bredenoord, A. J., Costamagna G. (ORCID:0000-0002-8100-2731), Familiari P. (ORCID:0000-0002-5181-2928), Kuipers, T., Ponds, F. A., Fockens, P., Bastiaansen, B. A. J., Lei, A., Oude Nijhuis, R. A. B., Neuhaus, H., Beyna, T., Kandler, J., Frieling, T., Chiu, P. W. Y., Wu, J. C. Y., Wong, V. W. Y., Costamagna, Guido, Familiari, Pietro, Kahrilas, P. J., Pandolfino, J. E., Smout, A. J. P. M., Bredenoord, A. J., Costamagna G. (ORCID:0000-0002-8100-2731), and Familiari P. (ORCID:0000-0002-5181-2928)

Abstract

Background: 2-year follow-up data from our randomised controlled trial showed that peroral endoscopic myotomy is associated with a significantly higher efficacy than pneumatic dilation as initial treatment of therapy-naive patients with achalasia. Here we report therapeutic success rates in patients treated with peroral endoscopic myotomy compared with pneumatic dilation at the 5-year follow-up. Methods: We did a multicentre, randomised controlled trial in six hospitals in the Netherlands, Germany, Italy, Hong Kong, and the USA. Adults aged 18–80 years with newly diagnosed symptomatic achalasia (based on an Eckardt score >3) were eligible for inclusion. Patients were randomly assigned (1:1) to peroral endoscopic myotomy or pneumatic dilation using web-based randomisation with a random block size of 8 and stratification according to site. Randomisation concealment for treatment type was double blind until official study enrolment. Treatment was unmasked because of the different technical approach of each procedure. Patients in the pneumatic dilation group were dilated with a single series of 30–35 mm balloons. The need for subsequent dilations in the pneumatic dilation group, and the need for dilation after initial treatment in the peroral endoscopic myotomy group, was considered treatment failure. The primary outcome was therapeutic success (Eckardt score ≤3 in the absence of severe treatment-related complications and no need for retreatment). Analysis of the primary outcome was by modified intention to treat, including all patients randomly assigned to a group, excluding those patients who did not receive treatment or were lost to follow-up. Safety was assessed in all included patients. This study is registered at the Dutch Trial Registry, NTR3593, and is completed. Findings: Between Sept 21, 2012, and July 20, 2015, 182 patients were assessed for eligibility, 133 of whom were included in the study and randomly assigned to peroral endoscopic myotomy (n=67) or pn

Published
2022

7. Effect of Peroral Endoscopic Myotomy vs Pneumatic Dilation on Symptom Severity and Treatment Outcomes among Treatment-Naive Patients with Achalasia: A Randomized Clinical Trial

Author

Ponds, F. A., Fockens, P., Lei, A., Neuhaus, H., Beyna, T., Kandler, J., Frieling, T., Chiu, P. W. Y., Wu, J. C. Y., Wong, V. W. Y., Costamagna, Guido, Familiari, Pietro, Kahrilas, P. J., Pandolfino, J. E., Smout, A. J. P. M., Bredenoord, A. J., Costamagna G. (ORCID:0000-0002-8100-2731), Familiari P. (ORCID:0000-0002-5181-2928), Ponds, F. A., Fockens, P., Lei, A., Neuhaus, H., Beyna, T., Kandler, J., Frieling, T., Chiu, P. W. Y., Wu, J. C. Y., Wong, V. W. Y., Costamagna, Guido, Familiari, Pietro, Kahrilas, P. J., Pandolfino, J. E., Smout, A. J. P. M., Bredenoord, A. J., Costamagna G. (ORCID:0000-0002-8100-2731), and Familiari P. (ORCID:0000-0002-5181-2928)

Abstract

Importance: Case series suggest favorable results of peroral endoscopic myotomy (POEM) for treatment of patients with achalasia. Data comparing POEM with pneumatic dilation, the standard treatment for patients with achalasia, are lacking. Objective: To compare the effects of POEM vs pneumatic dilation as initial treatment of treatment-naive patients with achalasia. Design, Setting, and Participants: This randomized multicenter clinical trial was conducted at 6 hospitals in the Netherlands, Germany, Italy, Hong Kong, and the United States. Adult patients with newly diagnosed achalasia and an Eckardt score greater than 3 who had not undergone previous treatment were included. The study was conducted between September 2012 and July 2015, the duration of follow-up was 2 years after the initial treatment, and the final date of follow-up was November 22, 2017. Interventions: Randomization to receive POEM (n = 67) or pneumatic dilation with a 30-mm and a 35-mm balloon (n = 66), with stratification according to hospital. Main Outcomes and Measures: The primary outcome was treatment success (defined as an Eckardt score ≤3 and the absence of severe complications or re-treatment) at the 2-year follow-up. A total of 14 secondary end points were examined among patients without treatment failure, including integrated relaxation pressure of the lower esophageal sphincter via high-resolution manometry, barium column height on timed barium esophagogram, and presence of reflux esophagitis. Results: Of the 133 randomized patients, 130 (mean age, 48.6 years; 73 [56%] men) underwent treatment (64 in the POEM group and 66 in the pneumatic dilation group) and 126 (95%) completed the study. The primary outcome of treatment success occurred in 58 of 63 patients (92%) in the POEM group vs 34 of 63 (54%) in the pneumatic dilation group, a difference of 38% ([95% CI, 22%-52%]; P <.001). Of the 14 prespecified secondary end points, no significant difference between groups was demonstrated in

Published
2019

14. Perilimbal conjunctival pigmentation in Chinese patients with vernal keratoconjunctivitis.

Author

Luk, F. O. J., Wong, V. W. Y., Rao, S. K., and Lam, D. S. C.

Subjects
*KERATOCONJUNCTIVITIS, *PIGMENTATION disorders, *CORNEA diseases, *ORTHOPTICS, *CONJUNCTIVITIS
Abstract

PurposeTo document the disease spectrum and evaluate the presence of perilimbal conjunctival pigmentation in Chinese patients with vernal keratoconjunctivitis (VKC).MethodA case–control study was conducted between November 2004 and July 2005. Patients aged 18 or younger with VKC and age-matched children attending our eye clinic for refractive or orthoptic problems were recruited and compared. Detailed slit-lamp examination was performed noting in particular the presence of perilimbal conjunctival pigmentation, the severity of papillary reaction, and corneal complications of VKC.ResultsA total of 19 patients and 23 controls were evaluated. The presence of bilateral large tarsal or limbal papillae and epithelial defect were significantly associated with symptoms severity (Fisher's exact test, P=0.015 and P=0.035 respectively). All VKC patients were found to have perilimbal conjunctival pigmentation in at least one eye. There was a significant correlation in the colour and density of pigments between the two eyes (Sperman's ρ=0.93, P<0.001). None of the controls was found to have such perilimbal conjunctival pigmentation (Fisher's exact test, P<0.001).ConclusionThe presence of perilimbal conjunctival pigmentation appears to be a consistent clinical finding in Chinese patients with VKC and may be a useful diagnostic sign for patients with subtle signs or symptoms.Eye (2008) 22, 1011–1014; doi:10.1038/sj.eye.6702816; published online 27 April 2007 [ABSTRACT FROM AUTHOR]

Published
2008
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15. A prospective study on trypan blue capsule staining under air vs under viscoelastic.

Author

Wong, V. W. Y., Lai, T. Y. Y., Lee, G. K. Y., Lam, P. T. H., and Lam, D. S. C.

Subjects
*PHACOEMULSIFICATION, *CATARACT surgery, *ULTRASONICS in ophthalmology, *TRYPAN blue, *VISCOELASTIC materials, *VISUAL acuity
Abstract

Aim: To compare the safety and effectiveness of trypan blue capsule staining under air vs under viscoelastic. Methods: A total of 52 consecutive patients planned for phacoemulsification of white mature cataract were randomly assigned to trypan blue staining under air or under viscoelastic. Perioperative changes in best-corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell density (ECD) were compared between the two groups. The differences in operating and phacoemulsification times, staining pattern, and complications between the two groups were also recorded. Results: Phacoemulsification of white mature cataract was performed in 50 (96%) eyes. The median preoperative BCVA was hand movement. No significant differences in the baseline characteristics were found between the two groups. At 3 months after phacoemulsification, the median BCVA improved to 0.8. The mean CCT returned to preoperative level by 1 month postoperatively and the mean ECD loss was 11.9% 3 months postoperatively. No significant differences in median BCVA, mean phacoemulsification and operation times, mean CCT, and mean ECD were found between the two groups. Conclusions: Trypan blue staining of the anterior lens capsule under air or under viscoelastic were similarly effective and safe methods for the phacoemulsification of white mature cataract. [ABSTRACT FROM AUTHOR]

Published
2006
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16. Acute Staphylococcus aureus wound infection after temporal clear corneal phacoemulsification.

Author

Wong, V. W. Y., Lai, T. Y. Y., Lam, P. T. H., and Lam, D. S. C.

Subjects
*STAPHYLOCOCCUS aureus, *STAPHYLOCOCCUS aureus infections, *CORNEA diseases, *PHACOEMULSIFICATION, *CATARACT surgery
Abstract

The article reports on a wound infection, which is the acute staphylococcus aureus, that occurred two days after temporal clear corneal phacoemulsification. Wound infection is a rare complication after cataract extraction and most of the time, wound infection occurs four days after the phacoemulsification.

Published
2006
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19. Idiopathic macular hole surgery in Chinese patients: a randomised study to compare indocyanine green-assisted internal limiting membrane peeling with no internal limiting membrane peeling.

Author

Kwok AK, Lai TY, and Wong VW

Subjects
Adolescent, Coloring Agents administration & dosage, Epiretinal Membrane surgery, Hong Kong, Humans, Logistic Models, Multivariate Analysis, Postoperative Complications, Prospective Studies, Retina pathology, Retina surgery, Retinal Detachment etiology, Treatment Outcome, Vision, Ocular, Indocyanine Green administration & dosage, Retinal Perforations surgery, Vitrectomy methods
Abstract

Objective: To compare the anatomical and visual outcomes of primary idiopathic macular hole surgery using indocyanine green-assisted internal limiting membrane peeling versus no internal limiting membrane peeling., Design: Prospective randomised controlled clinical trial., Setting: University teaching hospital, Hong Kong., Patients: Fifty-one eyes of 49 Chinese patients with primary idiopathic macular hole were studied., Interventions: Patients were randomised to undergo pars plana vitrectomy with indocyanine green-assisted internal limiting membrane peeling (26 eyes) or surgery without internal limiting membrane peeling (25 eyes). Perfluorocarbon gas was used in all cases as internal tamponade., Main Outcome Measures: Primary macular hole closure rate and best-corrected visual acuity., Results: The mean follow-up duration was 12 months (range, 6-23 months). Respectively to the indocyanine green-assisted internal limiting membrane peeling group and non-internal limiting membrane peeling group, the primary anatomical closure rate was 92.3% and 32.0% (P<0.001), whereas improvement in best-corrected visual acuity was 3.7 and 1.5 lines (P=0.002). More eyes in the first group (84.6%) had improvement of 2 or more lines of best-corrected visual acuity after surgery than in the second group (32.0%) [P<0.001]. Multivariate logistic regression showed indocyanine green-assisted internal limiting membrane peeling was the only significant predictor for primary closure of the macular hole (adjusted odds ratio=30.8)., Conclusion: Indocyanine green-assisted internal limiting membrane peeling in idiopathic macular hole surgery results in significantly better anatomical and visual outcomes compared with non-internal limiting membrane peeling in Chinese patients.

Published
2005

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