Publications by authors named "Manachai Nonpassopon"

6 Publications

  • Page 1 of 1

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.
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January 2021

Predictive factors of Boston Type I Keratoprosthesis outcomes: A long-term analysis.

Ocul Surf 2020 10 21;18(4):613-619. Epub 2020 Jul 21.

University of Illinois at Chicago, Department of Ophthalmology and Visual Sciences, 1855 W Taylor St, Suite 1.145 (MC 648), Chicago, IL, 60612, USA. Electronic address:

Purpose: To study the long-term visual- and device retention-related outcomes and complications of the Boston Type I Keratoprosthesis (KPro).

Methods: Single-center, retrospective cohort study of all patients undergoing KPro implantation from February 2007 to April 2014 with at least 5 years of follow-up.

Results: 68 eyes from 65 patients underwent KPro implantation during the study period. At 5 and 10 years, the probability of maintaining or improving visual acuity (VA) was 75.0% and 66.7%, respectively, and the probability of KPro retention was 89.2% and 89.2%, respectively. Initial device retention rate at 10 years was significantly lower in those with underlying ocular surface disease (46.8% [30.6-63.2] vs 75.8% [61.0-90.7], P = 0.03), while other baseline characteristics showed no significant association. Final VA was more likely to be stable or improved in patients with fewer failed grafts (2 [1-6] vs 3 [1-6], P < 0.01), and a final VA of 20/200 or better was more likely in primary KPro eyes (44.8% [26.7-62.9] vs 19.4% [6.5-32.3], P = 0.03). Combined KPro-vitrectomy eyes were more likely to have stable or improved final VA than non-vitrectomy eyes (88.5% [76.2-100.0] vs 64.1% [49.1-79.1], P = 0.04). All complications had increasing incidence beyond 5 years; in particular, corneal melt, surgical glaucoma interventions, and endophthalmitis tended to have late presentations, with 79.0%, 78.6%, and 88.9% of these complications occurring beyond one year, respectively.

Conclusions: KPro devices show favorable long-term visual and retention outcomes in select patients. Careful long-term, multidisciplinary follow-up is warranted to address potential complications.
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October 2020

Boston Type 1 Keratoprosthesis: Updated Perspectives.

Clin Ophthalmol 2020 29;14:1189-1200. Epub 2020 Apr 29.

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.

The use of Boston type 1 keratoprosthesis (BKPro) has significantly increased worldwide. It is no longer considered a procedure of last resort but a reasonable option for patients with otherwise poor prognosis for a traditional penetrating keratoplasty. BKPro was approved by the Food and Drug Administration in 1992 for bilateral severe corneal blindness due to multiple corneal transplant failure. Over the years, indications have extended beyond recurrent immunologic rejection to include other conditions such as chemical injury and other causes of bilateral limbal stem cell deficiency, extensive corneal neovascularization, neurotrophic corneas and hypotony, among others. Numerous advances in the design of the BKPro, improvement of preoperative, intraoperative and postoperative management have resulted in favorable outcomes and a reduction in postoperative complications. Accordingly, many studies have shown that implantation of this device is highly effective in restoring vision with very good short-term outcomes. However, due to the lifetime risk of sight-threatening complications after BKPro implantation, a longer follow-up period should provide outcomes that are more realistic. In this review, the authors examined only the results of publications with an average of at least 2 years of follow-up. The overall intermediate to long-term visual outcomes and retention rate in BKPro seem to be favorable. However, autoimmune diseases and cicatrizing conditions continue to show a higher incidence of postoperative complications that require further management.
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April 2020

Management of Congenital Aniridia-Associated Keratopathy: Long-Term Outcomes from a Tertiary Referral Center.

Am J Ophthalmol 2020 02 12;210:8-18. Epub 2019 Nov 12.

Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA. Electronic address:

Purpose: To report the outcomes of medical and surgical management for congenital aniridia-associated keratopathy (AAK) over a long-term follow-up period.

Design: Retrospective, comparative case series.

Methods: Medical records of patients diagnosed with congenital aniridia were retrospectively reviewed. Age, sex, ethnicity, follow-up time, AAK stage, noncorneal abnormalities, ocular surgeries, and complications were recorded. The visual acuity equivalent (VAE), approximate Early Treatment Diabetic Retinopathy Study (appETDRS) letter score, was calculated using recorded Snellen visual acuities.

Results: A total of 92 eyes of 47 patients (31 females) with mean age of 48.0 ± 18.0 years and mean follow-up of 78.6 ± 42.2 months were included. At the initial visit, 12 eyes (13%) were classified as Stage I AAK, 33 eyes (35.9%) were Stage II, 25 eyes (27.2%) were Stage III, 17 eyes (18.5%) were Stage IV, and 5 eyes (5.4%) were Stage V. Limbal stem cell transplantation (LSCT) and Boston keratoprosthesis (KPro) were frequently performed in eyes with Stages III-V. These advanced corneal surgeries significantly improved the median (95% confidence interval [CI]) of calculated appETDRS scores from 2 (0-20) to 26 (15-41) (Snellen values, 20/20,000 to 20/300; P = 0.0004). Patients with earlier Stages (I-II) of AAK were managed medically and had stable visual acuity through their final visits (appETDRS score of 26 [20-35] to 35 [26-35]; Snellen, 20/300 to 20/200; P > 0.05). The appETDRS VAE was significantly improved from 20 (0-35) to 30 (20-55), Snellen, 20/400 to 20/250, following LSCT (P = 0.021) and from 2 (0-20) to 2 (0-41) after KPro; Snellen, 20/20,000 VAE but with improved 95% CI after follow-up (P = 0.019).

Conclusions: With proper characterization and staging of AAK, individualized medical and advanced surgical interventions preserves and improves visual acuity.
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February 2020

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.
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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.
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February 2015