Publications by authors named "Passara Jongkhajornpong"

20 Publications

  • Page 1 of 1

Contact Lens Use Patterns, Behavior and Knowledge Among University Students in Thailand.

Clin Ophthalmol 2021 23;15:1249-1258. Epub 2021 Mar 23.

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

Purpose: Little is known about contact lens (CL) use in young generation. This study aimed to investigate the patterns, behavior and knowledge of CL wear and care in Thai university students.

Methods: A cross-sectional study using online questionnaires was conducted during July 2019 to February 2020 in two Rajabhat universities, Bangkok, Thailand. Participant characteristics, CL information, knowledge and behaviors were collected. Factors associated with poor behaviors and CL-related corneal ulcers were analyzed using logistic regression.

Results: Of 493 students participating in the survey, 336 students (66.78%) were current CL users and completed the questionnaires. Mean age was 19.2 ± 1.4 years with female predominance (80.36%). All students wore soft CL with a major replacement schedule of monthly disposable (90.18%). Good CL wear and care behaviors were found in 190 students (56.55%). The most common poor CL behavior and poor CL knowledge were CL overuse (44.64%) and sleeping with lenses (31.85%), respectively. There were no correlations between behaviors and knowledge (r = 0.03). Purchasing lens from internet, wearing experience over one year, and long wear duration (> 12 hours) were significantly associated with poor CL behavior. Male gender and swimming with lens were significantly associated with history of corneal ulcers.

Conclusion: The study pointed out a low compliance of CL wear and care in Thai university students. Good CL practices, awareness of CL-related complications and purchasing place should be carefully informed and regularly stressed to minimize preventable visual damage in young population.
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http://dx.doi.org/10.2147/OPTH.S304735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005268PMC
March 2021

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

Comparison of Anterior Segment Parameters and Axial Length Using Two Scheimpflug Devices with Integrated Optical Biometers.

Clin Ophthalmol 2020 23;14:3487-3494. Epub 2020 Oct 23.

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

Purpose: To assess the repeatability of anterior segment parameters and axial length (AL) using Pentacam AXL and Galilei G6 and the agreement between both devices.

Materials And Methods: Eighty-four eyes of 84 participants were measured prospectively with two devices. Outcome measurements included corneal curvatures, anterior chamber depth (ACD), AL, pupil size, and white-to-white distance (WTW). Intra-device repeatability was assessed using intraclass correlation coefficient (ICC), within-subject standard deviation (Sw), test-re-test repeatability (TRT=2.77 Sw), and coefficient of variation (CoV). Agreement between two devices was analyzed using Bland-Altman plots.

Results: For each device, the Sw of corneal curvatures, ACD, and AL were lower than 0.25 D, 0.04 mm, and 0.04 mm, respectively. The ICC was higher than 0.90 in all parameters measured by Pentacam AXL, whereas three parameters measured by Galilei G6 (steep meridian at anterior and posterior cornea, and pupil size) were lower than 0.90. Comparing to Galilei G6, Pentacam AXL led to significantly lower mean anterior cornea curvatures (Km) with the mean difference (95% level of agreement; LoA) of -0.12 D (-0.36, 0.12, <0.001). For ACD, there was no significant difference between the two devices. Pentacam AXL led to significantly lower AL, pupil size, and WTW, with the mean differences (95% LoA) of -0.04 mm (-0.35, 0.27), -0.18 mm (-0.71, 0.35), and -0.35 mm (-0.61, -0.10), respectively.

Conclusion: We found good repeatability of corneal curvature, ACD, and AL in both devices. Most parameters obtained from Pentacam AXL were statistically significantly different from those obtained from Galilei G6, except for steep meridians and ACD.
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http://dx.doi.org/10.2147/OPTH.S278701DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590999PMC
October 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.
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http://dx.doi.org/10.7717/peerj.8555DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036273PMC
February 2020

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.
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http://dx.doi.org/10.1186/s13601-019-0300-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873726PMC
November 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.
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http://dx.doi.org/10.1097/ICO.0000000000002025DOI Listing
December 2019

The Repurposed Drug Disulfiram Inhibits Urease and Aldehyde Dehydrogenase and Prevents Growth of the Oomycete .

Antimicrob Agents Chemother 2019 08 25;63(8). Epub 2019 Jul 25.

School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.

is an oomycete microorganism that causes a life-threatening infectious disease, called pythiosis, in humans and animals. The disease has been increasingly reported worldwide. Conventional antifungal drugs are ineffective against Treatment of pythiosis requires the extensive removal of infected tissue (i.e., eye and leg), but inadequate surgery and recurrent infection often occur. A more effective treatment is needed for pythiosis patients. Drug repurposing is a promising strategy for the identification of a U.S. Food and Drug Administration-approved drug for the control of Disulfiram has been approved to treat alcoholism, but it exhibits antimicrobial activity against various pathogens. In this study, we explored whether disulfiram possesses an anti- activity. A total of 27  strains, isolated from various hosts and geographic areas, were susceptible to disulfiram in a dose-dependent manner. The MIC range of disulfiram against (8 to 32 mg/liter) was in line with that of other pathogens. Proteogenomic analysis indicated that several potential targets of disulfiram (i.e., aldehyde dehydrogenase and urease) were present in By homology modeling and molecular docking, disulfiram can bind the putative aldehyde dehydrogenase and urease of at low energies (i.e., -6.1 and -4.0 Kcal/mol, respectively). Disulfiram diminished the biochemical activities of these enzymes. In conclusion, disulfiram can inhibit the growth of many pathogenic microorganisms, including The drug can bind and inactivate multiple proteins of , which may contribute to its broad antimicrobial property. Drug repurposing of disulfiram could be a new treatment option for pythiosis.
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http://dx.doi.org/10.1128/AAC.00609-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6658754PMC
August 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.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0214076PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426210PMC
December 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.
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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:

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

Successful Subcutaneous Allergen-Specific Immunotherapy in Refractory Atopic Keratoconjunctivitis: A Case Report.

Case Rep Ophthalmol 2017 Sep-Dec;8(3):562-567. Epub 2017 Dec 14.

Division of Allergy, Immunology, and Rheumatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Purpose: We report a case of refractory atopic keratoconjunctivitis (AKC) which was successfully treated with subcutaneous immunotherapy (SCIT).

Case Report: A 22-year-old woman presented with severe allergic conjunctivitis for one and a half year. She failed to respond to conventional topical anti-allergic medications, topical corticosteroid, as well as topical cyclosporine A. Therefore, oral corticosteroids had to be prescribed to control the exacerbation for 1 year. Due to refractory AKC and to avoid long-term corticosteroid use, we referred her to an allergy clinic for considering the role of SCIT. Allergology investigations showed positive skin prick test and strongly elevated serum-specific IgE to (Der f) and (Der p). She received a conventional protocol of SCIT using Der f and Der p allergen extracts.

Results: The patient's ocular signs and symptoms were dramatically improved 2 months after the initiation of SCIT, and oral corticosteroids could be discontinued within 3 months of the treatment. She was maintained with mast cell stabilizers and preservative-free tears without any episodes of exacerbation.

Conclusions: SCIT may contribute to successful outcomes in controlling symptoms and preventing exacerbation in AKC patient. It should be considered as an alternative or even a primary treatment for patients with refractory AKC. However, the optimal SCIT protocol must be discussed with an allergist on an individual basis for the best outcome.
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http://dx.doi.org/10.1159/000485174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803704PMC
December 2017

Topical ganciclovir treatment post-Descemet's stripping automated endothelial keratoplasty for patients with bullous keratopathy induced by cytomegalovirus.

Br J Ophthalmol 2018 09 23;102(9):1293-1297. Epub 2018 Jan 23.

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

Background/aims: To investigate the efficacy of topical ganciclovir (GCV) for preventing disease recurrence and improving the surgical outcome post-Descemet's stripping automated endothelial keratoplasty (DSAEK) in patients with cytomegalovirus (CMV) endotheliitis.

Methods: This prospective, non-comparative case series study involved six eyes of six patients with endothelial decompensation due to CMV endotheliitis who underwent DSAEK, followed by a continuous, four to six times daily, topical administration of 0.5% GCV. Patient demographics, clinical history, and preoperative and postoperative examination (including any recurrence of CMV endotheliitis post-DSAEK), best corrected visual acuity (BCVA), intraocular pressure (IOP), graft survival rate and endothelial cell density (ECD) were examined.

Results: No recurrence of CMV endotheliitis was detected post-DSAEK. The mean follow-up period was 40 months (range, 12-60 months). The mean preoperative BCVA was 1.52±0.68 LogMAR (range, 0.52-2.40 LogMAR), yet it had significantly improved to 0.15±0.16 LogMAR (range: -0.08 to 0.30 LogMAR) by 1 year postoperative (P<0.01). In all patients, IOP was well controlled (10-20 mm Hg) postsurgery. The mean preoperative donor ECD was 2692±177 cells/mm, and the mean postoperative ECD was 1974, 1771 and 1174 cells/mm for the ECD loss of 26%, 33% and 54% at 6, 12 and 36 months, respectively. No adverse effects were observed associated with the long-term topical administration of GCV.

Conclusion: The continuous topical application of 0.5% GCV was found to be effective for preventing the recurrence of CMV endotheliitis, and it provided the optimal mid-term clinical outcomes post-DSAEK in patients with CMV endotheliitis.

Trial Registration Number: UMIN000026746.
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http://dx.doi.org/10.1136/bjophthalmol-2017-311145DOI Listing
September 2018

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

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.
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http://dx.doi.org/10.1038/srep38143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5133461PMC
December 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.
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http://dx.doi.org/10.1097/OPX.0000000000000835DOI Listing
June 2016

Elevated expression of ABCB5 in ocular surface squamous neoplasia.

Sci Rep 2016 Feb 4;6:20541. Epub 2016 Feb 4.

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

ATP-binding cassette subfamily B member 5 (ABCB5) is a new member of the ATP-binding cassette superfamily and has been reported as a novel marker for limbal stem cell (LSC), which is essential for corneal homeostasis. ABCB5 expression has also been discovered in the subpopulation of several cancer cells containing the cancer stem cell (CSC). However, the pathogenetic relationship between LSC and CSC and ABCB5 in the ocular surface squamous neoplasm (OSSN) is still entirely unknown. To improve understanding of the role of ABCB5 in OSSN, we performed immunohistochemistry for ABCB5 in nine OSSN case series. While expression of ABCB5 is restricted to the basal epithelial cell layer in the normal limbus, elevated expressions of ABCB5 were clearly observed in all OSSN, and there was some breadth in the range of intensity of ABCB5 expression. Interestingly, the elevated expression patterns of ABCB5 in OSSN could be classified in three categories: perivascular, marginal and diffuse patterns. Our findings demonstrated for the first time that the expression of ABCB5 was upregulated in OSSN and that elevated expression of ABCB5 may be involved in the pathogenesis of OSSN.
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http://dx.doi.org/10.1038/srep20541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4740799PMC
February 2016

Phenotypic Investigation of Regenerated Epithelial Cells After Gonococcal Corneal Perforation: A Clinical, Histological, and Immunohistochemical Study.

Cornea 2015 Nov;34(11):1508-12

*Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan; †Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and ‡Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Purpose: To determine the characteristics of regenerated epithelial cells after severe gonococcal infection after corneal perforation.

Methods: Pathological tissue was obtained from the cornea at the time of surgery. Hematoxylin and eosin staining and immunohistochemical analysis were performed for cytoskeletal keratins (K12, K13, and K15), basement membrane and junctional markers (laminin 5, ZO-1 and Desmoplakin), and proliferative and mesenchymal markers (Ki67, α-SMA, and vimentin).

Results: A 42-year-old patient with severe gonococcal keratoconjunctivitis rapidly progressed to corneal perforation during administration of intensive topical and systemic antibiotics. After conservative treatment, the perforation healed and 5- × 3-mm corneal ectasia occurred with localized iris attachment. Complete closure of the cornea was confirmed by a negative Seidel test. After lamellar keratoplasty to improve corneal integrity and to prevent secondary glaucoma, the pathological tissue revealed a poorly organized epithelial layer at the regenerated ectatic area. The regenerated epithelial cells clearly expressed K12, ZO-1, and Desmoplakin with underlying laminin 5 (+) basement membrane. K15 and Ki67 expressions were observed predominantly at the limbal area but not in the regenerated area. α-SMA and vimentin were sporadically expressed in the underlying connective tissue.

Conclusions: We speculate that the process of epithelial wound healing at the site of corneal perforation was responsible for migration of the surrounding epithelial cells. Although the regenerated cells expressed several cytokeratins and junctional markers, they remained disorganized and fragile.
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http://dx.doi.org/10.1097/ICO.0000000000000551DOI Listing
November 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.
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http://dx.doi.org/10.1038/hgv.2015.47DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4785563PMC
April 2016

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