Publications by authors named "Varintorn Chuckpaiwong"

13 Publications

  • Page 1 of 1

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

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

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

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

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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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0123729PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4390196PMC
March 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.
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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.
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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.
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http://dx.doi.org/10.1155/2013/521315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3745890PMC
March 2014

Pythium insidiosum keratitis in contact lens wear: a case report.

Cornea 2009 Dec;28(10):1173-7

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

Purpose: The purpose of this study was to report a case of contact lens-related Pythium insidiosum corneal ulcer.

Methods: The authors conducted an interventional case report. We report the clinical presentations, histopathologic findings, and treatments of a patient with P. insidiosum keratitis associated with contact lens wear.

Results: A 22-year-old Thai woman presented to our clinic with a nonresponsive, progressive corneal ulcer of the left eye. Slit lamp examination showed a large central ulcer measuring 5.4 x 5.2 mm with underlying dense stromal infiltrates surrounded by subepithelial and superficial stromal opacity in a reticular pattern along with radial perineural-like infiltrates. Histopathologic examination revealed broad, branched, thin-walled nonparallel hyaline hyphae with rare septates consistent with P. insidiosum. The corneal culture confirmed the diagnosis. The infection recurred after multiple therapeutic penetrating keratoplasties. Enucleation was eventually performed to eradicate the infection. No definite report of contact lens-related P. insidiosum keratitis existed in the literature.

Conclusion: Pythium keratitis may present with central ulcer and radial keratoneuritis similar to acanthamoeba keratitis. Contact lens wear can be a risk factor for this infection. Increasing awareness, early diagnosis, and intervention may improve the prognosis.
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http://dx.doi.org/10.1097/ICO.0b013e318199fa41DOI Listing
December 2009

A serum- and feeder-free technique of culturing human corneal epithelial stem cells on amniotic membrane.

Mol Vis 2009 Jun 30;15:1294-302. Epub 2009 Jun 30.

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

Purpose: To describe a simple technique of cultivating human corneal epithelial stem cells using an Epilife culture medium under serum- and feeder-free conditions.

Methods: Cadaveric donor limbal corneal epithelial cells were cultured on denuded amniotic membranes using an explant technique that was free of serum and feeder cells in the Epilife medium containing a growth supplement of defined composition. These cells were assessed by phase contrast microscope. The expressions of the proposed corneal epithelial stem cell markers (p63, ATP-binding cassette member 2 (ABCG2), and cytokeratin 15 and 19) and differentiation markers (cytokeratin 3, 12, connexin 43, and p75) were analyzed using reverse transcription polymerase chain reaction (RT-PCR) and immunocytochemical staining.

Results: Successful cultures were obtained, resulting in a monolayer to double layer cell sheets with a cobblestone-like morphology. RT-PCR and immunocytochemistry disclosed an expression of both putative limbal stem cell (LSC) markers and differentiation-associated markers in the cultured cells. Most of the cultured corneal epithelial cells that were immunopositive for putative LSC markers were smaller, more uniform, and closer to the limbal explant than cells positively stained with differentiation-associated markers.

Conclusions: A serum- and feeder-free culture system using Epilife medium may grow human corneal epithelial equivalents, minimizing the risk of contamination during culture. The technique may also be useful for the clinical application of limbal stem cell culture.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704912PMC
June 2009

Pathologic findings in postmortem corneas after successful laser in situ keratomileusis.

Cornea 2005 Jan;24(1):92-102

Emory Eye Center, Emory University, Atlanta, GA 30322, USA.

Purpose: To examine the histologic and ultrastructural features of human corneas after successful laser in situ keratomileusis (LASIK).

Methods: Corneas from 48 eyes of 25 postmortem patients were processed for histology and transmission electron microscopy (TEM). The 25 patients had LASIK between 3 months and 7 years prior to death. Evaluation of all 5 layers of the cornea and the LASIK flap interface region was done using routine histology, periodic acid-Schiff (PAS)-stained specimens, toluidine blue-stained thick sections, and TEM.

Results: In patients for whom visual acuity was known, the first postoperative day uncorrected visual acuity was 20/15 to 20/30. In patients for whom clinical records were available, the postoperative corneal topography was normal and clinical examination showed a semicircular ring of haze at the wound margin of the LASIK flap. Histologically, the LASIK flap measured, on average, 142.7 microm (range, 100-200). A spectrum of abnormal histopathologic and ultrastructural findings was present in all corneas. Findings at the flap surface included elongated basal epithelial cells, epithelial hyperplasia, thickening and undulations of the epithelial basement membrane (EBM), and undulations of Bowman's layer. Findings in or adjacent to the wound included collagen lamellar disarray; activated keratocytes; quiescent keratocytes with small vacuoles; epithelial ingrowth; eosinophilic deposits; PAS-positive, electron-dense granular material interspersed with randomly ordered collagen fibrils; increased spacing between collagen fibrils; and widely spaced banded collagen. There was no observable correlation between postoperative intervals and the severity or type of pathologic change except for the accumulation the electron-dense granular material.

Conclusions: Permanent pathologic changes were present in all post-LASIK corneas. These changes were most prevalent in the lamellar interface wound. These changes along with other pathologic alterations in post-LASIK corneas may change the functionality of the cornea after LASIK.
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http://dx.doi.org/10.1097/01.ico.0000142110.37166.71DOI Listing
January 2005

Effect of laser in situ keratomileusis on the corneal endothelium.

J Refract Surg 2003 Mar-Apr;19(2 Suppl):S237-40

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

Purpose: To assess the effects of laser in situ keratomileusis (LASIK) on the corneal endothelium.

Methods: In a prospective study, preoperative and 12-month postoperative specular microscopy of the central corneal endothelium and corneal thickness assessment was done in 180 eyes of 105 patients (mean age 31.96 +/- 8.88 years; range 16 to 55 yr) who had LASIK to correct myopia. The central endothelium was analyzed for several parameters including cell density, coefficient of variation, and corneal thickness. Preoperative and postoperative data were compared.

Results: The mean preoperative endothelial cell density was 2,547.37 +/- 282.00 cells/mm2, mean coefficient of variation of cell size was 58.33 +/- 11.50%, and mean central corneal thickness was 558.90 +/- 28.42 microm. There was not a statistically significant change in mean endothelial cell density (2,508.24 +/- 289.57 cells/mm2) or mean coefficient of variation (58.61 +/- 9.89%) at 1 year after surgery (P >.05 ). Average endothelial cell loss was 1.54% at 1 year after surgery. Mean central corneal thickness at 12 months postoperatively was 493.24 +/- 52.55 microm (P<.01).

Conclusion: LASIK did not appear to alter corneal endothelial cell density at 12 months postoperatively.
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May 2003