Publications by authors named "Kaevalin Lekhanont"

43 Publications

Predisposing Factors, Clinical Presentations, and Outcomes of Contact Lens-Related Pythium Keratitis.

Cornea 2021 Jan 18. Epub 2021 Jan 18.

Departments of Ophthalmology; and Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Purpose: To describe predisposing factors, clinical presentations, and treatment outcomes of contact lens (CL)-related Pythium keratitis.

Methods: This was an 11-year retrospective study of CL-related Pythium keratitis conducted from 2009 to 2019. Six eyes of 6 patients were identified. Demographics, predisposing factors, CL history, clinical presentation, diagnostic tests, treatments, and outcomes were reviewed.

Results: Mean age of the patients was 34 years (SD 16.3 years) with equal proportion between male and female patients. Five of 6 patients (83.3%) used soft CL, whereas 1 patient used rigid gas permeable lens. All patients had a history of water contamination (tap water and water from river and sea). Mean duration from the onset was 7.8 days (range 4-14 days). Mean size of the corneal lesion was 3.33 mm (SD 1.31 mm) in width. The typical feature of tentacle-like lesions radiating in a reticular pattern was observed in all patients. Feathery edge (1 eye), satellite lesions (2 eyes), and radial keratoneuritis (2 eyes) were also found. Every patient received therapeutic penetrating keratoplasty because of failed medical treatments. One patient subsequently underwent enucleation. Globe salvage was achieved in 5 patients (83.33%).

Conclusions: Awareness of the history of water contamination, recognition of specific clinical features of Pythium keratitis, and performing surgical treatment are key for achieving globe salvage in patients with CL-related Pythium keratitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ICO.0000000000002651DOI Listing
January 2021

Association of HLA polymorphisms and acetaminophen-related Steven-Johnson syndrome with severe ocular complications in Thai population.

Br J Ophthalmol 2020 Nov 23. Epub 2020 Nov 23.

Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Background/aims: To investigate the association of genetic polymorphisms of human leucocyte antigens (HLA) class I and II genes with acetaminophen-related Steven-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) who developed severe ocular complications (SOC) in the Thai population.

Methods: A prospective case-control study including 20 unrelated Thai acetaminophen-related SJS/TEN patients with SOC and 60 Thai healthy volunteers, recruited at three university hospitals in Bangkok, Thailand, from September 2014 to August 2019. HLA genes were analysed using PCR amplification followed by hybridisation with sequence-specific oligonucleotide (SSO) probes with bead-based typing kits. The carrier and gene frequencies of individual HLA alleles in patients were compared with those in control volunteers based on dominant assumption using Fisher's exact test.

Results: Among HLA class I polymorphisms, HLA-A*33:03, HLA-B*44:03 and HLA-C*07:01 were significantly associated with acetaminophen-related SJS/TEN and SOC with high ORs (95% CI, corrected p value; Pc) in carrier frequency of 5.4 (1.8 to 16.3, Pc=0.0274), 9.0 (95% CI 2.7 to 30.4, Pc=0.0034), and 9.3 (2.8 to 30.2, Pc=0.0022), respectively. There were no significant HLA class II associations with the disease after corrected for a total number of alleles tested.

Conclusion: HLA-B*44:03 was strongly associated with acetaminophen-related SJS/TEN patients who developed SOC in Thai population. In addition, we also found moderate to strong associations with HLA-A*33:03 and HLA-C*07:01 suggesting their potential roles in the pathogenesis of SOC in acetaminophen-related SJS/TEN.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjophthalmol-2020-317315DOI Listing
November 2020

Mycobacterium haemophilum scleritis: two case reports and review of literature.

BMC Ophthalmol 2020 Sep 23;20(1):378. Epub 2020 Sep 23.

Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Rd., Rajathevi, Bangkok, 10400, Thailand.

Background: Mycobacterium haemophilum is a rare and emerging nontuberculous mycobacteria (NTM). It normally causes localized or disseminated systemic diseases, particularly skin infections and arthritis in severely immunocompromised patients. There have been 5 cases of M. haemophilum ocular infections reported in the literature. Only 1 case presented with scleritis with keratitis. Here, we reported 2 cases of M. haemophilum scleritis. One of them was immunocompetent host and had keratitis with radial keratoneuritis as a presenting sign.

Case Presentation: Case 1: A 52-year-old Thai female with rheumatoid arthritis presented with scleritis. Conjunctival scraping was carried out and the culture result was positive for M. haemophilum. Despite receiving systemic and topical antibiotics, her clinical symptoms and signs worsened. Surgical debridement was performed. After surgery, the lesion was significantly improved and finally turned to conjunctival scarring. Case 2: A 32-year old healthy Thai male without underlying disease presented with nodular scleritis and keratouveitis with multiple radial keratoneuritis. Surgical debridement of the scleral nodule was performed. Initial microbiological investigations were negative. Herpes ocular infections was suspected. Topical antibiotics, oral acyclovir, low-dose topical steroids and systemic steroids were started. The scleral inflammation subsided but later the keratitis relapsed, requiring corneal biopsy. Histopathology of the specimen revealed acid-fast bacteria and M. haemophilum was identified by polymerase chain reaction (PCR) and sequencing. The diagnosis of Mycobacterial keratitis was made. Although using the combination of systemic and topical antibiotics, his clinical status progressively deteriorated. Multiple therapeutic penetrating keratoplasties were required to eradicate the infection. No recurrence was found during the 1-year follow-up in both cases.

Conclusions: M. haemophilum can cause scleritis and keratitis, even in immunocompenent host. Radial keraoneuritis is first described in M. haemophilum keratitis. NTM keratitis should be considered in the differential diagnosis of patients with radial keratoneuritis. Increased awareness and early diagnosis using appropriate culture conditions and molecular techniques are important for the proper treatment of this infection. Prompt surgical intervention appears to be vital for successful management of M. haemophilum scleritis and keratitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12886-020-01649-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513486PMC
September 2020

Recent update in diagnosis and treatment of human pythiosis.

PeerJ 2020 20;8:e8555. Epub 2020 Feb 20.

Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Human pythiosis is an infectious condition with high morbidity and mortality. The causative agent is the oomycete microorganism . The pathogen inhabits ubiquitously in a wet environment, and direct exposure to the pathogen initiates the infection. Most patients with pythiosis require surgical removal of the affected organ, and many patients die from the disease. Awareness of pythiosis among healthcare personnel is increasing. In this review, we summarized and updated information on the diagnosis and treatment of human pythiosis. Vascular and ocular pythiosis are common clinical manifestations. Recognition of the typical clinical features of pythiosis is essential for early diagnosis. The definitive diagnosis of the disease requires laboratory testing, such as microbiological, serological, molecular, and proteomic assays. In vascular pythiosis, surgical intervention to achieve the organism-free margin of the affected tissue, in combination with the use of antifungal drugs and immunotherapy, remains the recommended treatment. Ocular pythiosis is a serious condition and earliest therapeutic penetrating keratoplasty with wide surgical margin is the mainstay treatment. Thorough clinical assessment is essential in all patients to evaluate the treatment response and detect an early sign of the disease recurrence. In conclusion, early diagnosis and proper management are the keys to an optimal outcome of the patients with pythiosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7717/peerj.8555DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036273PMC
February 2020

Prominent corneal nerves, conjunctival neuromas, and dry eye in a patient without MEN2B.

Can J Ophthalmol 2019 12 1;54(6):e313-e317. Epub 2019 Apr 1.

Rutnin Eye Hospital, Bangkok, Thailand.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcjo.2019.02.008DOI Listing
December 2019

Association of SNPs in cold medicine-related Stevens-Johnson syndrome in Thailand.

Clin Transl Allergy 2019 22;9:61. Epub 2019 Nov 22.

3Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Hirokoji, Kawaramachi, Kamigyoku, Kyoto, 602-0841 Japan.

Purpose: Our meta-analysis of several ethnic groups (Japanese, Korean, Indian, Brazilian) revealed a significant genome-wide association between cold medicine-related SJS/TEN (CM-SJS/TEN) with severe ocular complications (SOC) and SNPs, suggesting that might be a potential marker for susceptibility to CM-SJS/TEN with SOC. In this study, we examined the association between CM-SJS/TEN with SOC and the SNPs in the Thai population.

Methods: 57 CM-SJS/TEN with SOC and 171 control samples were collected at Chulalongkorn University and Mahidol University. Genomic DNA samples were genotyped for the SNPs at Kyoto Prefectural University of Medicine in Japan using the TaqMan SNP genotyping assay.

Results: The four SNPs previously reported to be associated with CM-SJS/TEN with SOC in the Japanese were examined in the Thai samples. Although the number of Thai cases (n = 57) was small, a significant association between CM-SJS/TEN with SOC and SNPs which included rs4917014 (T vs G, OR = 2.9, p = 0.0012, Pc = 0.0049), rs4917129 (T vs C, OR = 2.8, p = 0.0026, Pc = 0.010) and rs10276619 (G vs A, OR = 1.8, p = 0.012, Pc = 0.048) was identified.

Conclusion: In addition to the Japanese, Korean and Indian populations, Thai cases with CM-SJS/TEN and SOC were significantly associated with SNPs. With our previous report of the critical role of in mucocutaneous inflammation, these results suggest that is important in the pathogenesis of CM-SJS/TEN with SOC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13601-019-0300-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873726PMC
November 2019

Association between the levels of prostaglandin E2 in tears and severity of dry eye.

Int J Ophthalmol 2019 18;12(7):1127-1133. Epub 2019 Jul 18.

Clinical Epidemiology and Biostatistics Unit, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.

Aim: To investigate the relationship between the levels of prostaglandin E2 (PGE2) in tears and dry eye disease severity based on both clinical symptoms and signs.

Methods: Tear samples were collected from 36 non-Sjögren syndrome dry eye patients (10 males and 26 females, mean age 50.11±11.17y). All participants completed the Ocular Surface Disease Index (OSDI) questionnaire and underwent a detailed ophthalmic examination including, tear film breakup time (TBUT), ocular surface fluorescein staining, Schirmer I test, and meibomian gland assessment. The level of PGE2 in tears was measured using enzyme-linked immunosorbent assay (ELISA). The independent associations between tear PGE2 levels and other variables including demographics, OSDI scores, TBUT, Schirmer scores, ocular surface staining scores, and stage of meibomian gland dysfunction (MGD) were evaluated using linear regression analysis.

Results: The mean PGE2 level in tears of dry eye patients was 537.85±234.02 pg/mL. The tear PGE2 levels significantly positively correlated with OSDI scores (=0.608, <0.001), however, they did not significantly associate with TBUT (=0.153, =0.373), Schirmer scores (=-0.098, =0.570), ocular surface staining scores (=0.282, =0.095), and stage of MGD (=-0.107, =0.535). Male sex was significantly negatively correlated with tear PGE2 levels.

Conclusion: The levels of PGE2 in tears are positively correlated with dry eye symptoms. However, no significant association was found between tear PGE2 levels and the results of other common dry eye diagnostic tests.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18240/ijo.2019.07.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6629794PMC
July 2019

Evaluating Dry Eye and Meibomian Gland Dysfunction With Meibography in Patients With Stevens-Johnson Syndrome.

Cornea 2019 Dec;38(12):1489-1494

Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Purpose: To investigate ocular surface and meibomian gland characteristics using infrared meibography in patients with Stevens-Johnson syndrome (SJS).

Methods: This is a single-center, prospective, noncontrolled, observational study. Thirty-two Thai patients (64 eyes) with SJS for 1 year or longer (1-44 years) were enrolled in the study. All participants underwent a comprehensive ophthalmic examination including slit-lamp biomicroscopy, tear meniscus height, fluorescein tear breakup time, ocular surface fluorescein staining, eyelid morphology, Schirmer 1 test, meibomian gland expressibility, and upper and lower eyelid meibography using a noncontact infrared meibograph mounted on a slit-lamp biomicroscope.

Results: The mean age was 42.2 ± 17.7 years (range, 4-68 years). Twenty-nine patients (90.6%) had a history of severe ocular complications in the acute stage of the disease. Medications were the most common cause of SJS (93.8%). Meibum quality could not be assessed in 23 patients (71.9%) due to no glands expressible. Partial or complete loss of the meibomian glands in either the upper or lower eyelid was found in all patients. The degree of meibomian gland dropout significantly correlated with tear breakup time (P < 0.001), meibum quality (P < 0.001), meibum expressibility (P < 0.001), ocular surface staining (P < 0.001), and presence of long-term ocular sequelae including symblepharon (P = 0.027) and limbal stem cell deficiency (P = 0.003).

Conclusions: SJS is associated with obstructive meibomian gland dysfunction. The severity of meibomian gland dropout has a relationship with abnormal dry eye tests, subjective meibomian gland evaluation, and other ocular sequelae of SJS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ICO.0000000000002025DOI Listing
December 2019

Predicting factors and prediction model for discriminating between fungal infection and bacterial infection in severe microbial keratitis.

PLoS One 2019 20;14(3):e0214076. Epub 2019 Mar 20.

Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

A retrospective medical record review including 344 patients who were admitted with severe microbial keratitis at Ramathibodi Hospital, Bangkok, Thailand, from January 2010 to December 2016 was conducted. Causative organisms were identified in 136 patients based on positive culture results, pathological reports and confocal microscopy findings. Eighty-six eyes (63.24%) were bacterial keratitis, while 50 eyes (36.76%) were fungal keratitis. Demographics, clinical history, and clinical findings from slit-lamp examinations were collected. We found statistically significant differences between fungal and bacterial infections in terms of age, occupation, contact lens use, underlying ocular surface diseases, previous ocular surgery, referral status, and duration since onset (p < 0.05). For clinical features, depth of lesions, feathery edge, satellite lesions and presence of endothelial plaque were significantly higher in fungal infection compared to bacterial infection with odds ratios of 2.97 (95%CI 1.43-6.15), 3.92 (95%CI 1.62-9.45), 6.27 (95%CI 2.26-17.41) and 8.00 (95%CI 3.45-18.59), respectively. After multivariate analysis of all factors, there were 7 factors including occupation, history of trauma, duration since onset, depth of lesion, satellite lesions, endothelial plaque and stromal melting that showed statistical significance at p < 0.05. We constructed the prediction model based on these 7 identified factors. The model demonstrated a favorable receiver operating characteristic curve (ROC = 0.79, 95%CI 0.72-0.86) with correct classification, sensitivity and specificity of 81.48%, 70% and 88.24%, respectively at the optimal cut-off point. In conclusion, we propose potential prediction factors and prediction model as an adjunctive tool for clinicians to rapidly differentiate fungal infection from bacterial infection in severe microbial keratitis patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0214076PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426210PMC
December 2019

Epithelial analysis of simple limbal epithelial transplantation in limbal stem cell deficiency by in vivo confocal microscopy and impression cytology.

Cell Tissue Bank 2019 Mar 24;20(1):95-108. Epub 2019 Jan 24.

Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Simple limbal epithelial transplantation (SLET) is a relatively new treatment for severe limbal stem cell deficiency. Outcomes of treatment are typically determined based on clinical manifestations. In this prospective-multicenter study, we aimed to analyze the epithelial phenotypes of the corneas after SLET using IVCM and IC, and correlated them with clinical findings. Ten eyes of nine patients, who underwent SLET (five autologous SLET and five living-related SLET) were recruited. A set of examinations included slit-lamp biomicroscopy, corneal in vivo confocal microscopy (IVCM), and impression cytology (IC) was performed in all eyes at least twice (≥ 3-month interval) postoperatively. Then, a correlation between findings of the three examinations was analyzed. There were seven eyes with clinical success (no central neovascularization) showed pure corneal epithelial phenotype or mixed corneal-conjunctival phenotypes (mostly cornea) in either IVCM or IC. Three eyes with clinical failure, presented with peripheral and central neovascularization, showed total or predominant conjunctival phenotype in IVCM and sole conjunctival phenotype in IC. From a total of 22 sets of examinations, there was a high correlation between clinical manifestation vs. IC (κ = 0.844, observed agreement = 81.82%) and a substantial correlation between clinical manifestation vs. IVCM (κ = 0.727, observed agreement = 76.19%) and between IVCM versus IC (κ = 0.729, observed agreement = 76.19%). In conclusion, IVCM and IC facilitate determination of epithelial phenotype of the cornea after SLET. There was a substantial to high correlation between IVCM, IC and clinical presentations. Findings observed by IVCM and IC may allow early detection of epithelial alterations in eyes underwent SLET before clinical recognition.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10561-018-09746-3DOI Listing
March 2019

Association between HLA-B*44:03-HLA-C*07:01 haplotype and cold medicine-related Stevens-Johnson syndrome with severe ocular complications in Thailand.

Br J Ophthalmol 2018 09 29;102(9):1303-1307. Epub 2018 Apr 29.

Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan

Background: Polymorphisms in human leucocyte antigen (HLA) class I genes have been found to be associated with cold medicine (CM)-related Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) with severe ocular complications (SOC). Because ethnic differences in genetic predisposition to SJS/TEN among different populations have been proposed, we focused on Thai patients and investigated the association between HLA class I genotypes and CM-SJS/TEN with SOC.

Methods: This multicentre case-control study was conducted between September 2014 and August 2017. Seventy-one Thai patients with SJS/TEN with SOC and 159 healthy Thai controls were enrolled. HLA typing was performed. Genetic relationships were analysed using Fisher's exact test.

Results: Of 71 patients with SJS/TEN with SOC (28 male, 43 female), 49 (69%) had a history of taking cold medications prior to SJS/TEN onset. The mean age of onset was 26.7±17.1 years (range, 2-77 years). HLA-B*44:03 (OR, 7.2, p=5.5×10, pc=1.1×10) and HLA-C*07:01 (OR, 6.1, p=7.1×10, pc=1.1×10) showed significant positive associations with Thai patients with CM-SJS/TEN with SOC. Additionally, 17 of 49 patients with CM-SJS/TEN with SOC (34.7%) significantly harboured the HLA-B*44:03 and HLA-C*07:01 haplotype compared with only 11 of 159 healthy controls (6.9%) (OR=7.1, p=5.5×10).

Conclusions: HLA-B*44:03-HLA-C*07:01 haplotype is a potential risk factor for CM-SJS/TEN with SOC in the Thai population. This study supports that HLA-B*44:03 might be a common marker for CM-SJS/TEN with SOC in Eurasia populations, including European, Indian, Japanese and Thai.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjophthalmol-2017-311823DOI Listing
September 2018

Epithelial basement membrane dystrophy after femtosecond laser-assisted laser in situ keratomileusis.

Can J Ophthalmol 2018 04 28;53(2):e44-e46. Epub 2017 Sep 28.

Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcjo.2017.08.004DOI Listing
April 2018

TFOS DEWS II Epidemiology Report.

Ocul Surf 2017 07 20;15(3):334-365. Epub 2017 Jul 20.

Centre for Contact Lens Research, School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada.

The subcommittee reviewed the prevalence, incidence, risk factors, natural history, morbidity and questionnaires reported in epidemiological studies of dry eye disease (DED). A meta-analysis of published prevalence data estimated the impact of age and sex. Global mapping of prevalence was undertaken. The prevalence of DED ranged from 5 to 50%. The prevalence of signs was higher and more variable than symptoms. There were limited prevalence studies in youth and in populations south of the equator. The meta-analysis confirmed that prevalence increases with age, however signs showed a greater increase per decade than symptoms. Women have a higher prevalence of DED than men, although differences become significant only with age. Risk factors were categorized as modifiable/non-modifiable, and as consistent, probable or inconclusive. Asian ethnicity was a mostly consistent risk factor. The economic burden and impact of DED on vision, quality of life, work productivity, psychological and physical impact of pain, are considerable, particularly costs due to reduced work productivity. Questionnaires used to evaluate DED vary in their utility. Future research should establish the prevalence of disease of varying severity, the incidence in different populations and potential risk factors such as youth and digital device usage. Geospatial mapping might elucidate the impact of climate, environment and socioeconomic factors. Given the limited study of the natural history of treated and untreated DED, this remains an important area for future research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtos.2017.05.003DOI Listing
July 2017

Factors Contributing to Long-Term Severe Visual Impairment in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.

J Ophthalmol 2017 26;2017:2087578. Epub 2017 Mar 26.

Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

. To study the correlation between demographics and clinical variables and long-term severe visual impairment in patients with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). . A retrospective chart review of SJS/TEN patients between 2004 and 2014 was conducted. Demographics, causative agents, ocular manifestations, and visual outcomes were collected. The data were analyzed using a multivariate logistic regression model. . Of the 89 patients including SJS (65, 73.03%), TEN (15, 16.85%), and SJS-TEN overlap (9, 10.11%), 55 were female. The mean age was 41.58 ± 19.17 years. The most common identified agents were medications. Among these groups, antibiotics were the most prevalent (47.19%). Three patients (3.7%) had unknown etiology. Antibiotics and nonpharmaceutical triggers were significantly associated with long-term severe visual impairment (odds ratio 4.32; = 0.015 and 7.20; = 0.037, resp.). There was a significant negative relationship between HIV infection and long-term severe visual impairment ( = 0.021). Among all chronic ocular complications, only corneal neovascularization significantly correlated with severe visual impairment ( = 0.001). . SJS/TEN patients caused by nonpharmaceutical triggers or antibiotics have an increased risk of developing long-term severe visual impairment from corneal neovascularization. HIV infection might be a protective factor against long-term poor visual outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2017/2087578DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385247PMC
March 2017

Outcomes of descemet stripping automated endothelial keratoplasty using imported donor corneas.

BMC Ophthalmol 2017 Apr 5;17(1):41. Epub 2017 Apr 5.

Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Rama VI Rd., Rajathevi, Bangkok, 10400, Thailand.

Background: The lack of development of local donor tissue acquisition in several regions of the world has resulted in the necessity of performing keratoplasty with imported donor corneas. The greatest concern about the use of donor corneas supplied by foreign eye banks is the effect of the increased donor death-to-operation time which inevitably occurs during the tissue recovery, tissue processing, and tissue transfer between the countries. The purpose of this study was to report the outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) using imported donor corneas.

Methods: This retrospective, non-comparative case series investigated the outcomes of the 102 consecutive DSAEK procedures using imported donor corneas performed at a single university-based hospital between August 2006-2014. The main outcome measures were postoperative best-corrected visual acuity (BCVA), endothelial cell density (ECD), and complications.

Results: The mean death-to-operation time was 9.52 ± 1.48 days (range, 8-13). The mean preoperative ECD was 2761 ± 285 cells/mm. Fuchs' endothelial dystrophy was the predominant indication for grafting. The mean follow-up duration was 65.3 months. Ninety-three eyes had improved vision postoperatively (91.18%). BCVA unchanged in 3 eyes due to preexisting macular scar and advanced glaucoma. Primary graft failure occurred in 6 eyes (5.88%). Of the 93 eyes with improved BCVA, 100% had their best corrected vision within the first 1 year. The mean ECD at 6, 12, 24, 36, and 60 months after surgery was 1762 ± 294 cells/mm, 1681 ± 284 cells/mm, 1579 ± 209 cells/mm, 1389 ± 273 cells/mm, and 1251 ± 264 cells/mm respectively. The mean ECD loss at 6 months, 1 year, 2 years, 3 years, and 5 years after surgery was 36.2%, 39.1%, 42.8%, 49.7%, and 54.7% respectively. The most common complication was graft detachment/dislocation (10.78%). There were no cases of any postoperative infection.

Conclusions: DSAEK with imported donor corneas provides rapid and good visual rehabilitation. The percentages of endothelial cell loss were comparable to those achieved in Western series using domestic corneas in which fresher tissues were available for transplantation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12886-017-0436-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5382393PMC
April 2017

Modified Surgical Techniques for Managing Intraoperative Floppy Iris Syndrome.

Case Rep Ophthalmol Med 2016 23;2016:1289834. Epub 2016 Nov 23.

Department of Ophthalmology, Mettapracharak (Wat Rai Khing) Hospital, Nakhon Pathom, Thailand.

To report a modified surgical strategy in the management of intraoperative floppy iris syndrome-associated iris prolapse. Prolapsed iris is left as is and a new corneal incision near the original wound but at a different site is created. Depending on the location of the original incision and the surgeon's preference, this additional incision can be used as a new port for phacoemulsification tip or can be the new site for the iris to securely prolapse, allowing for the surgery to proceed safely. We present 2 cases of iris prolapse and inadequate pupil dilation in patients with IFIS. Along with our modified technique, additional iris retractors were placed to increase the workspace for the phacoemulsification tip. The cataract surgery was performed successfully without further complications in both cases. This surgical technique could be an adjunct to allow the surgeons to expand the armamentarium for the management of IFIS-associated iris prolapse.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2016/1289834DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5141300PMC
November 2016

Undiluted Serum Eye Drops for the Treatment of Persistent Corneal Epitheilal Defects.

Sci Rep 2016 12 2;6:38143. Epub 2016 Dec 2.

Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Several studies found that 50-100% serum eye drops provided greater benefits without inducing detrimental effects on the corneal epithelial healing. This study assessed the efficacy of undiluted serum eye drops for the treatment of persistent corneal epithelial defects (PED). A total of 109 eyes received 100% serum eye drops for PED were recruited into this study. The data were compared with an historical control group of 79 eyes with PED who received conventional treatments from 2006-2011 at the same institution. Main outcome measures were complete healing of PED and incidence of adverse events. No significant difference in demographics between the 2 groups was noted. The success rate of the treatment and control groups were 87.16% (95% CI 0.79-0.93) and 69.62% (95% CI 0.59-0.80) (P = 0.001), respectively. The median time to complete epithelialization was 14 days (95% CI 12-21) in the treatment group and 28 days (95% CI 21-59) in the control group (P = 0.001). Serum treatment, primary diagnosis of non-limbal stem cell deficiency etiology, and prior contact lens wear significantly correlated with the corneal re-epithelialization. There were no serious side effects encountered during the study period. In conclusion, undiluted serum therapy is effective and safe for treating PED.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/srep38143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5133461PMC
December 2016

Pattern of Uveitis in a Tertiary Ophthalmology Center in Thailand.

Ocul Immunol Inflamm 2017 7;25(sup1):S94-S99. Epub 2016 Sep 7.

b Section for Epidemiology and Biostatistics , Faculty of Medicine, Ramathibodi Hospital, Mahidol University , Bangkok , Thailand.

Purpose: To study the etiology and pattern of uveitis in a tertiary ophthalmology center in Thailand.

Methods: A cross-sectional study was conducted on uveitis patients presenting to a uveitis clinic at Ramathibodi Hospital, Thailand, between February 2014 and January 2015.

Results: A total of 758 uveitis patients were enrolled into this study. The most common identified cause was herpetic uveitis (17.2%), followed by Vogt-Koyanagi-Harada disease (13.5%), cytomegalovirus uveitis (12.7%), and HLA-B27/spondyloarthropathy-associated uveitis (12.4%).

Conclusions: Herpetic uveitis was the commonest form of infectious uveitis, whereas Vogt-Koyanagi-Harada disease was most frequently seen as the non-infectious cause of uveitis in Thailand.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2016.1215475DOI Listing
July 2018

Brown-McLean syndrome: the role of iridodonesis.

Clin Ophthalmol 2016 15;10:671-7. Epub 2016 Apr 15.

Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Purpose: The aim of this study was to report a case series of Brown-McLean syndrome (BMS).

Methods: The charts of 28 patients with BMS at Ramathibodi and Rutnin Hospital from 1981 to 2015 were reviewed.

Results: BMS is a rare condition with corneal edema involving the peripheral cornea with orange-brown pigment deposition underlying the edematous area. The edema typically starts inferiorly and advances circumferentially to superior cornea. Central cornea remains clear in most patients. We report 28 patients with BMS that occurred either spontaneously or after various intraocular procedures. Ultrasound biomicroscopy was performed to demonstrate the iridocorneal relationship.

Conclusion: Iridocorneal relationship from the ultrasound biomicroscopy study in four patients did not support previous hypothesis about the role of iridodonesis impact on corneal endothelium. Patients with BMS can rarely progress to corneal decompensation; however, they should be periodically monitored and made aware of early clinical signs of their complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/OPTH.S96507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4841410PMC
May 2016

Boston Type 1 Keratoprosthesis for Gelatinous Drop-Like Corneal Dystrophy.

Optom Vis Sci 2016 06;93(6):640-6

*MD †MD, PhD Department of Ophthalmology, Ramathibodi Hospital, Mahodol University, Bangkok, Thailand (KL, PJ, PC); and Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan (PJ, TI, SK).

Purpose: To report the outcomes of Boston type 1 keratoprosthesis in the management of advanced gelatinous drop-like corneal dystrophy (GDLD).

Methods: A retrospective, noncomparative, interventional case series was conducted at Ramathibodi Hospital, Bangkok, Thailand. Four eyes of three siblings with molecularly and histologically confirmed GDLD from a Thai family underwent an uneventful Boston type 1 keratoprosthesis implantation for visual rehabilitation. Clinical data were obtained from a review of the medical records. Visual acuity, device retention, and postoperative complications were the main outcome measures. The follow-up ranged from 8 to 96 months.

Results: One eye received keratoprosthesis surgery as a primary penetrating procedure. The other three eyes had the surgery as a secondary procedure after graft failure. Best-corrected visual acuity was favorably improved from counting fingers to 20/25 in two eyes, from hand movement to 20/20 in one eye, and from hand movement to counting fingers at 2 feet in one eye caused by severe amblyopia. The improved vision was maintained for 8 months to 6.2 years after surgery. Postoperative complications included disease recurrence in the donor graft (N = 3), manageable retroprosthetic membrane (N = 3), intraocular pressure elevation responded to antiglaucoma drugs (N = 2), and Pseudomonas keratitis with severe corneal melting requiring device removal (N = 1). All of our patients failed to have a comfortably well-fitting contact lens after surgery.

Conclusions: Boston type 1 keratoprosthesis could be considered as a reasonable option in the management of advanced GDLD. However, patients remain at risk for sight-threatening postoperative complications as long as the keratoprosthesis is retained. The use of Boston keratoprosthesis implantation needed to be individualized on a case-by-case basis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/OPX.0000000000000835DOI Listing
June 2016

Agreement between clinical history method, Orbscan IIz, and Pentacam in estimating corneal power after myopic excimer laser surgery.

PLoS One 2015 8;10(4):e0123729. Epub 2015 Apr 8.

Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

The purpose of this study was to investigate the agreement between the clinical history method (CHM), Orbscan IIz, and Pentacam in estimating corneal power after myopic excimer laser surgery. Fifty five patients who had myopic LASIK/PRK were recruited into this study. One eye of each patient was randomly selected by a computer-generated process. At 6 months after surgery, postoperative corneal power was calculated from the CHM, Orbscan IIz total optical power at the 3.0 and 4.0 mm zones, and Pentacam equivalent keratometric readings (EKRs) at 3.0, 4.0, and 4.5 mm. Statistical analyses included multilevel models, Pearson's correlation test, and Bland-Altman plots. The Orbscan IIz 3.0-mm and 4.0 mm total optical power, and Pentacam 3.0-mm, 4.0-mm, and 4.5-mm EKR values had strong linear positive correlations with the CHM values (r = 0.90-0.94, P = <0.001, for all comparisons, Pearson's correlation). However, only Pentacam 3.0-mm EKR was not statistically different from CHM (P = 0.17, multilevel models). The mean 3.0- and 4.0-mm total optical powers of the Orbscan IIz were significantly flatter than the values derived from CHM, while the average EKRs of the Pentacam at 4.0 and 4.5 mm were significantly steeper. The mean Orbscan IIz 3.0-mm total optical power was the lowest keratometric reading compared to the other 5 values. Large 95% LoA was observed between each of these values, particularly EKRs, and those obtained with the CHM. The width of the 95% LoA was narrowest for Orbscan IIz 3.0-mm total optical power. In conclusion, the keratometric values extracted from these 3 methods were disparate, either because of a statistically significant difference in the mean values or moderate agreement between them. Therefore, they are not considered equivalent and cannot be used interchangeably.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0123729PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4390196PMC
March 2016

Treatment with intrastromal and intracameral voriconazole in 2 eyes with Lasiodiplodia theobromae keratitis: case reports.

Medicine (Baltimore) 2015 Feb;94(6):e541

From the Department of Ophthalmology (KL, MN, NN); and Department of Pathology (PS), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

To report the clinical presentation and the role of intrastromal and intracameral voriconazole injection in the management of rare cases of fungal keratitis caused by Lasiodiplodia theobromae.Two eyes of 2 patients with Lasiodiplodia keratitis unresponsive to topical and oral antifungal medications were included in this study. Diagnosis of Lasiodiplodia keratitis was confirmed by microbiological analysis, including culture-based (case 1 and 2) and DNA sequencing techniques (case 2 only).The first patient presented with multiple satellite lesions and one of these infiltrates spread deeply into the cornea, forming a stromal abscess. Another patient had a large full-thickness corneal infiltrates with several fungal balls in the anterior chamber, requiring a limbus-to-limbus therapeutic penetrating keratoplasty. Despite aggressive topical therapy, the stromal abscess continued to worsen in the first case and recurrent keratitis was observed postoperatively in the second case. Voriconazole 50 μg/0.1 mL was administered intracamerally and intrastromally around the fungal abscess as adjuncts to topical antimycotics in the first case. The second patient who needed therapeutic keratoplasty was treated with an intracameral injection of 50 μg/0.1 mL voriconazole at the end of surgery. Postoperatively, 100 μg/0.1 mL voriconazole was also injected intracamerally after the recurrence of infection was noted in the graft. Reinjections were given 48 hours apart in both cases. After the injections, all corneal and anterior chamber lesions were reduced in size and density and completely resolved within 4 weeks.Intrastromal and intracameral voriconazole injections may offer safe and effective treatment options for L theobromae keratitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MD.0000000000000541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602755PMC
February 2015

Novel TACSTD2 mutation in gelatinous drop-like corneal dystrophy.

Hum Genome Var 2015 26;2:15047. Epub 2015 Nov 26.

Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine , Kyoto, Japan.

We identified a novel mutation in the tumor-associated calcium signal transducer 2 (TACSTD2) gene in a consanguineous Thai family with gelatinous drop-like corneal dystrophy (GDLD). All affected family members presented with an intense amyloid substance deposited on the cornea, which required surgical management. Genetic analysis of these individuals revealed a homozygous mutation c.79delC, in the TACSTD2 gene. Both parents of these individuals were unaffected and showed heterozygous mutations in the TACSTD2 gene. The mutation produced a truncated protein sequence that might be the cause of GDLD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/hgv.2015.47DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4785563PMC
April 2016

Medium-term outcomes of boston type 1 keratoprosthesis implantation in Bangkok, Thailand.

Cornea 2014 Dec;33(12):1312-9

*Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and †Clinical Epidemiology and Biostatistics Unit, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Purpose: The aim of this study was to investigate the medium-term outcomes after Boston type 1 keratoprosthesis surgery in patients with poor prognosis for standard keratoplasty.

Methods: A prospective study of a case series was conducted at a university-based referral center from 2006 to 2013. Forty-two eyes of 40 patients with a minimum follow-up of 4 years were recruited. The main outcome measures included best spectacle-corrected visual acuity (BSCVA), keratoprosthesis retention, and complications.

Results: The mean follow-up was 64.9 ± 15.2 months (range, 48-88 months). At 1 week, 90.5% had an improvement in BSCVA by ≥2 lines compared with that in preoperative BSCVA. The best-ever vision was reached by the end of 6 months. Nevertheless, 39.5% (15/38) could not maintain the improved vision. The major etiology of visual deterioration after initial gains was glaucoma (60%). The initial keratoprosthesis retention rate was 80.9%, corresponding to a failure rate of 4 per 100 eye-years or 0.04/eye-year. Autoimmune diagnosis was the independent risk factor for keratoprosthesis failure (hazard ratio, 5.68; 95% confidence interval, 1.41-22.85; P = 0.014). The common postoperative complications were glaucoma, retroprosthetic membrane, corneal melting, infectious keratitis, and endophthalmitis.

Conclusions: Boston type 1 keratoprosthesis is an alternative for patients who are not candidates for corneal transplants. However, there was a trend toward visual loss over time most commonly because of progressive glaucoma. Therefore, appropriate patient selection, lifelong follow-up, and early aggressive treatment of complications are recommended.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ICO.0000000000000265DOI Listing
December 2014

Effects of sodium hyaluronate on wavefront aberrations in dry eye patients.

Optom Vis Sci 2014 Jan;91(1):39-46

*MD Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Purpose: To investigate the effects of a single instillation of hypotonic 0.18% sodium hyaluronate artificial tears on wavefront aberrations in dry eye patients.

Methods: Fifty patients with dry eye were recruited into this single-center, prospective, double-masked, randomized controlled trial. Patients were randomly assigned to receive one drop of preservative-free, hypotonic 0.18% sodium hyaluronate (treatment) in one eye and one drop of sterile 0.9% sodium chloride solution (control) in the other eye. Ocular aberrations evaluated by a Hartmann-Shack aberrometer and severity of dry eye symptoms graded by a questionnaire (at baseline, 1, 10, 30, 60, and 120 minutes after instillation) were the main outcome measures.

Results: After a single instillation of one drop of the allocated eye drops, there were no statistically significant differences between the treatment and control groups in total higher-order aberrations, coma, and spherical aberrations during the study period (p = 0.40, 0.57, and 0.16, respectively). Although a statistically significant (p = 0.04) decrease from baseline in spherical aberrations was noted in the treatment group at 1 minute following instillation, it gradually increased back to baseline values at later time points. A statistically significant diminishment of dry eye symptoms compared with the placebo was reported at all time points by the treatment group (p < 0.001).

Conclusions: A single instillation of hypotonic 0.18% sodium hyaluronate eye drops is safe and effective in alleviating subjective dry eye symptoms; however, it does not appear to affect higher-order aberrations in moderate to severe dry eye patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/OPX.0000000000000101DOI Listing
January 2014

Topical 100% serum eye drops for treating corneal epithelial defect after ocular surgery.

Biomed Res Int 2013 30;2013:521315. Epub 2013 Jul 30.

Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Rama VI Road, Rajathevi, Bangkok 10400, Thailand.

The purpose of this study was to investigate the efficacy and safety of topical 100% serum eye drops for corneal epithelial defect after ocular surgery. A total of 181 patients who received topical 100% serum therapy for the treatment of corneal epithelial defect following several different types of ocular surgery were recruited into this study. Each patient already failed conventional medical therapy before being prescribed 100% serum eye drops. Slit-lamp biomicroscopic examination with fluorescein staining was performed at baseline and all follow-up visits. The main outcome measures were the rate of complete healing of the corneal epithelial defect and incidence of adverse events. One hundred and seventy-eight eyes (98.34%) received autologous serum eye drops, and 3 (1.66%) received allogeneic serum eye drops. The overall success rate of treating persistent postoperative epithelial defect using 100% serum eye drops was 93.92% (95% CI 0.88-0.98). The median time to complete corneal epithelialization was 4 days (95% CI 4-5). Adverse reactions were observed in 3 patients (1.66%), including sticky sensation with minimal eye discomfort and asymptomatic trace corneal subepithelial infiltration. No serious complications were reported. In conclusion, 100% serum eye drops are effective, safe, and tolerable for treating postoperative corneal epithelial defect following ocular surgeries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2013/521315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3745890PMC
March 2014

Anterior chamber contamination during phacoemulsification after povidone-iodine application.

J Med Assoc Thai 2012 May;95(5):689-92

Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Objective: To determine the rate of anterior chamber contamination during phacoemulsification after applying 5% povidone-iodine prior to surgery.

Material And Method: One hundred eyes from 100 patients having phacoemulsification cataract surgery by a single surgeon at Ramathibodi Hospital between October 2010 and March 2011 were included in the present study. Povidone-iodine 5% solution eye drops were used in all patients at least three minutes before the operation. Anterior chamber fluid was aspirated at the end of the procedure for culture in chocolate agar

Results: Anterior chamber fluid cultures were positive in three eyes (Pseudomanas oryzihabitans in 1 eye, Klebsiella pneumoni in 1 eye, and yeast in 1 eye). These three patients had no exaggerated or prolonged postoperative intraocular inflammation compared to others. No patients in the present study developed endophthalmitis.

Conclusion: Povidone-iodine 5% solution eye drops before operation may control microbial contamination during phacoemulsification.
View Article and Find Full Text PDF

Download full-text PDF

Source
May 2012

Randomized controlled trial of subconjunctival bevacizumab injection in impending recurrent pterygium: a pilot study.

Cornea 2012 Feb;31(2):155-61

Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Purpose: To investigate the efficacy and safety of subconjunctival bevacizumab injection for the treatment of impending recurrent pterygium.

Methods: A prospective, randomized, single-masked, controlled trial was conducted in 80 patients with impending recurrent pterygium. Patients were randomized into 4 groups using random tables: 20 patients served as a control and treatment groups received a single intralesional injection of 1.25 mg (20 patients, group 1), 2.5 mg (20 patients, group 2), or 3.75 mg (20 patients, group 3) of bevacizumab. Topical 0.1% fluorometholone and ocular lubricant were administered 4 times daily for 1 month in all groups. Severity of impending recurrent pterygium graded by photographic assessment (at baseline, 3 days, 1 week, and 2, 4, 8, and 12 weeks after treatment) and true recurrence were the main outcome measures.

Results: At 3 days, the conjunctival injection significantly decreased in all treatment groups (P < 0.01). A significant decrease in the conjunctival injection was still observed until 2 and 4 weeks in only groups 2 and 3, respectively (P < 0.05). The conjunctival hyperemia appeared to increase back to baseline at later time points. No significant difference in the mean severity score among the groups was observed. True recurrence was found in 62 patients with no statistically significant difference among the groups. No serious ocular or systemic adverse events were seen.

Conclusions: A single subconjunctival bevacizumab injection seems to only partially and transiently decrease conjunctival vascularization in impending recurrent pterygium in a dose-dependent manner. This treatment does not cause regression or reduce the recurrent rate of impending recurrent pterygium.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ICO.0b013e3182151e0eDOI Listing
February 2012

A randomized controlled trial of intralesional bevacizumab injection on primary pterygium: preliminary results.

Cornea 2011 Nov;30(11):1213-8

Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Purpose: To evaluate the efficacy and safety of intralesional injection of bevacizumab on primary pterygium treatment.

Methods: In this randomized controlled trial, each primary pterygium patient was randomized to receive either an intralesional injection of bevacizumab 2 mg (1 mg/0.04 mL) or a combination of topical antihistamine (antazoline HCl 0.05%) and vasoconstrictor (tetrahydrozoline HCl 0.04%) as a control. The main outcome measurements were symptoms and signs (including eye irritation, epiphora, redness, amount of discharge, inflammation and elevation of pterygium, and percentage of corneal pterygium area).

Results: A total of 74 pterygium eyes in 66 patients were randomized and allocated into a treatment group (N = 34) and a control group (N = 40). In the treatment group, there was a statistically significant reduction of symptoms (including irritation, photophobia, epiphora, redness, discharge, and blurred vision) and signs (inflammation and corneal pterygium area) compared with the baseline, up to at least 6 months. Between the treatment and control groups, no significant differences were found for all visits with respect to the (1) symptoms, (2) signs, and (3) percentage of corneal pterygium.

Conclusions: Intralesional bevacizumab may have a therapeutic effect on symptoms and signs of primary pterygium for at least 6 months (ie, the follow-up period), with no serious ocular or systemic adverse effects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ICO.0b013e31821c9b44DOI Listing
November 2011

Effects of intracameral triamcinolone and gentamicin injections following cataract surgery.

J Med Assoc Thai 2011 Jul;94(7):819-25

Department of Ophthalmology, Ramathibodi Hospital, Faculty ofMedicine, Mahidol University, Bangkok, Thailand.

Objective: Evaluate the anti-inflammatory efficacy of intracameral triamcinolone acetonide and gentamicin injections compared with topical dexamethasone and tobramycin combination eye drops in cataract surgery patients.

Material And Method: The present prospective study enrolled 60 patients scheduled to receive phacoemulsification surgery. After surgery, patients were randomized to receive either single intracameral injections of triamcinolone acetonide and gentamicin followed by topical tobramycin eye drops four times daily for one week (IC TA group, n=30), or topical dexamethasone-tobramycin combination eyedrops four times daily until no inflammation was seen (Topical group, n=30). Postoperative evaluations included grading of anterior chamber cells, log MAR best-corrected visual acuity (BCVA), intraocular pressure (IOP) and adverse effects.

Results: There was no significant difference between the treatment groups in anterior chamber cells at one day and one week after surgery (p = 0.50 and 0.328, respectively). However the anterior chamber cells were significantly less in the IC TA group than in the Topical group, one month postoperatively (p = 0.006). No significant between-group difference in mean BCVA or IOP was noted at any time point (p > 0.05). No adverse effects or endophthalmitis were observed.

Conclusion: Intracameral injections of triamcinolone acetonide and gentamicin appear to be a promising treatment option for the control of post-operative inflammation following cataract surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
July 2011