Ngamjit Kasetsuwan

Incidence and pattern of dry eye after cataract surgery.

Purpose To evaluate the incidence and severity pattern of dry eye after phacoemulsification. Setting King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Design Prospective descriptive study. Methods Samples were collected from ninety-two uncomplicated cataract patients who were 18 years old or older. Dry eye incidence and pattern were analyzed at days 0, 7, 30 and 90 after phacoemulsification using (1) Ocular Surface Disease Index (OSDI) questionnaire, (2) tear break up time (TBUT), (3) Oxford ocular surface staining system, and (4) Schirmer I test without anesthesia. Results Seven days after phacoemulsification, the incidence of dry eye was 9.8% (95% confidence interval; 3.6–16.0%). The severity of dry eye peaked seven days post-phacoemulsification and was measured by OSDI questionnaire and all three clinical tests. Within thirty days and 3 months post-surgery, both the symptoms and signs showed rapid and gradual improvements, respectively. However, dry eye post-phacoemulsification was not significantly associated with sex and systemic hypertension (P = 0.26, 0.17 and 0.73, respectively). Conclusions The incidence of dry eye after phacoemulsification was 9.8%. Symptoms and signs of dry eye occurred as early as seven days post-phacoemulsification and the severity pattern improved over time. We recommend that ophthalmologists should evaluate patients both before and after phacoemulsification to prevent further damage to the ocular surface and able to manage the patient promptly and effectively so the patient will not have a poor quality of life and vision due to dry eye syndrome.

Lagenidium sp. ocular infection mimicking ocular pythiosis.

ABSTRACT This is a report of a Lagenidium sp. in a Thai patient who was diagnosed with severe keratitis that was unresponsive to antibacterial and antifungal drugs. Examination of a corneal biopsy specimen confirmed the presence of aseptate hyphae. The internal transcribed spacer DNA sequence of the strain isolated showed 97% identity with Lagenidium giganteum and other Lagenidium species.

Prevention of Recurrent Pterygium with Topical Bevacizumab 0.05% Eye Drops: A Randomized Controlled Trial.

PURPOSE We assessed the efficacy and tolerability of topical bevacizumab 0.05% when used as an adjunctive therapy after excision of primary pterygia. METHODS This randomized double-masked study included 22 patients (22 eyes) with primary pterygia who underwent pterygium surgery with the use of the bare sclera technique. After pterygium excision, 22 patients were randomized to receive the topical bevacizumab 0.05% (12 eyes) or the placebo (10 eyes) with the use of the block of four randomization method. Topical bevacizumab and placebo were applied in the respective groups 4 times daily for 3 months. Follow-up evaluations for recurrence by slit-lamp photography were conducted once monthly. Ocular and systemic adverse events were assessed every 2 weeks during the 3 months of treatment. The slit-lamp photographs were masked and analyzed. The primary and secondary outcomes were the differences in the pterygial recurrence rates between the groups and adverse events at 3 months, respectively. Corneal recurrence was defined as recurrent fibrovascular tissue invading the cornea; conjunctival recurrence was defined as either recurrent vessels or fibrous tissue in the excised area without corneal invasion. FINDINGS All 22 patients completed follow-up at 3 months after the start of the trial medications. After 3 months of treatment, 1 patient (8.33%) and 3 patients (30.00%) from the bevacizumab and placebo groups, respectively, had a corneal recurrence. No significant (P = 0.293) differences were found between the groups as determined by Fishers exact test. However, conjunctival and corneal recurrences were found in 4 (33.33%) and 9 (90.00%) patients, respectively, in the bevacizumab and placebo groups, a difference that reached significance (P = 0.01). No significant adverse events developed. IMPLICATIONS Topical bevacizumab, as an adjunctive treatment after pterygium excision, was well tolerated. The trend for recurrence was lower in the topical bevacizumab group. ClinicalTrials.gov identifier: NCT01311960.

The efficacy and safety of 0.5% Levofloxacin versus fortified Cefazolin and Amikacin ophthalmic solution for the treatment of suspected and culture-proven cases of infectious bacterial keratitis: a comparative study

Background: Bacterial keratitis is a major devastating ocular condition that quickly deteriorates the patient’s vision. Vigorous and prompt treatment of bacterial keratitis with broad-spectrum antibiotic eye-drops is preferred. Objective: Evaluate the efficacy and safety of 0.5% Levofloxacin for the treatment of suspected and cultureproven cases of infectious bacterial keratitis in comparison to fortified Cefazolin and Amikacin ophthalmic solution. Materials and methods: Seventy-one eyes from 69 patients suspected of having infectious bacterial keratitis were enrolled in the study. The patients were randomized into two arms, 0.5% Levofloxacin eye drops (34 eyes) or fortified Cefazolin and Amikacin (37 eyes). Sixty-eight eyes were included in the efficacy analysis. During treatment, on days 2, 7, 14, and 21, the patient’s symptoms and signs were scored from grade 0-3 (absent to severe). Results: At the end of the treatment, 61 out of 71 eyes completely healed. The resolution of the keratitis was not significantly different between both groups. There were no significant differences in the mean time-duration for the ulcer to heal or for the symptoms and clinical signs to disappear between the two groups. No serious adverse events or side effects from the disease were found. The patients compliance was 80% based on the self-reported diaries. Conclusion: The efficacy and safety of 0.5% topical Levofloxacin was comparable to fortified Cefazolin and Amikacin for the treatment of mild-to-moderate bacterial keratitis. Topical Levofloxacin is far superior because of its availability and patient compliance when used as monotherapy for the treatment of infectious bacterial keratitis.

Comparison of performances of femtosecond laser and microkeratome for thin-flap laser in situ keratomileusis

To compare the clinical outcomes of femtosecond laser (FS) and microkeratome (MK) for thin‐flap in situ keratomileusis (LASIK).

Concomitant herpes simplex virus and cytomegalovirus endotheliitis in immunocompetent patient.

A case of an immunocompetent 51-year-old healthy man with chronic recurrent disciform corneal oedema and hypertensive anterior uveitis in the right eye for 2 years was unresponsive to topical corticosteroid and systemic acyclovir. Diagnostic anterior chamber tapping was performed and viral DNA PCR was positive for both cytomegalovirus and herpes simplex virus. The patient was treated with both oral valganciclovir for 3 months and long-term oral acyclovir. His condition improved significantly after the treatment; intraocular pressure and anterior chamber inflammation were controlled and the remaining keratic precipitates in the cornea started to clear up.

Recurrent rates and risk factors associated with recurrent painful bullous keratopathy after primary phototherapeutic keratectomy

Objective To assess the recurrent rate, mean survival time, and risk factors associated with recurrent painful bullous keratopathy (BK) after primary treatment with phototherapeutic keratectomy. Methods Medical records from 72 patients (72 eyes) who had phototherapeutic keratectomy for painful BK were evaluated. Data for sex, age, duration of BK, associated ocular and systemic diseases (hypertension, diabetes mellitus, ischemic heart disease, asthma, dyslipidemia, and rheumatoid arthritis), frequency and degree of pain (grade 1–3), visual acuity, corneal thickness, intraocular pressure, and laser setting were extracted and analyzed. Results The mean age of the patients was 64.2±11.4 years. The mean preoperative duration of BK was 15.0±11.0 months. Most patients had pseudophakic BK (69.40%). Majority of the cases had grade 3 degree of pain (48.60%). Glaucoma and hypertension were markedly found among these patients (51.40% and 19.40%, respectively). Preoperative mean intraocular pressure and corneal thickness were 13.70±4.95 mmHg and 734.1±83.80 µm, respectively. The mean laser diameter and depth were 8.36±1.22 mm and 38.89±8.81 µm, respectively. Systemic disease was significantly associated with the risk for developing recurrent painful BK (P=0.022, hazard ratio [HR] 1.673, 95% confidence interval [CI] 1.08–2.58). The overall recurrent rate was 51%. The average duration time of recurrent painful BK was 17.3±12.9 months (range 1–50 months). The median survival time before recurrence was 29.0±6.6 months. Conclusion Systemic disease was found to be the only risk factor significantly associated with the development of recurrent painful BK. Low recurrent rate and long mean survival time showed that phototherapeutic keratectomy was effective in relieving recurrent painful BK and can be used as an alternative procedure for patients waiting for corneal transplantation.

Effectiveness of voriconazole and corneal cross-linking on Phialophora verrucosa keratitis: a case report

BackgroundWe report a rare case of Phialophora verrucosa fungal keratitis, which required various types of treatment according to the intractable natural history of the disease.Case presentationA 51-year-old Thai man with poorly controlled diabetes received a bamboo branch injury and developed a perforated corneal lesion on his left eye. A pathological study from therapeutic penetrating keratoplasty showed fungal hyphae. This was later identified as Phialophora verrucosa by polymerase chain reaction. This organism was aggressive and recalcitrant because it relapsed with two corneal grafts and was resistant to amphotericin B, natamycin, and itraconazole. However, we found that the efficacy of voriconazole was promising for treating Phialophora verrucosa. We also used corneal cross-linking to establish corneal integrity after the infection was under control.ConclusionsBecause of the chronic nature of Phialophora verrucosa, a patient’s first visit may occur many years after trauma, and sometimes clinical presentation might not appear to indicate fungal infection. Therefore, a high index of suspicion is needed in this situation. Voriconazole showed good results in our case. Instead of using a more invasive keratoplasty, we used corneal cross-linking to strengthen the corneal biomechanics. To the best of our knowledge, this is the first case showing the benefit of corneal cross-linking to improve corneal biomechanics in resolved Phialophora verrucosa keratitis.

Effectiveness of a participatory eye care program in reducing eye strain among staff computer users in Thailand

Background The increased usage of computers results in a variety of health problems, particularly eye strain, which is the most common workplace complaint today. Objectives This study aimed to evaluate the effectiveness of a participatory eye care (PEC) program by comparing eye care knowledge, attitude, and practice (KAP), as well as eye strain symptoms in staff computer users at Sukhothai Thammathirat Open University, Thailand. Methods A participatory approach was held by organizing a meeting of 26 stakeholders to get opinions for developing the PEC program. The developed PEC program consisted of 3-hour training course on eye strain, rest breaks for 30 seconds every 30 minutes of computer use, and 15-minute rest break (in the morning and the afternoon) with integrated eye–neck exercises. Then, a quasi-experiment was conducted to evaluate the effectiveness of the PEC program. A total of 35 staff computer users enrolled in each of intervention and control groups for 8 weeks. Chi-square test and repeated measures analysis of variance were used for comparison of eye strain symptoms and the KAP scores. Results The intervention was associated with reduction in percentage of eye strain. Significant differences were found between the intervention and the control groups at follow-up 1 (χ2=18.529, p-value <0.001) and follow-up 2 (χ2=18.651, p-value <0.001). The PEC program likely increased the beneficial effect on KAP scores between the groups and between times (p<0.05). Conclusion The findings currently provide evidence to support a practical program developed through a participatory approach, which both researchers and computer users could apply to reduce eye strain.

Descemet's scroll in syphilitic interstitial keratitis: a case report with anterior segment evaluation and a literature review.

Purpose To present a case of syphilitic interstitial keratitis with Descemet’s scrolls, as well as its characteristic findings in an anterior segment investigation in relation to the histopathologic findings from a literature review. Case presentation A case report of a 64-year-old woman with syphilitic infection presented with band keratopathy and retrocorneal scrolls. Slit-lamp photography, confocal microscopy, anterior segment optical coherence tomography (AS-OCT), and ultrasound biomicroscopy were performed. Four previous reports were reviewed to describe the pathogenesis, natural history, and histopathologic and immunohistologic findings of the Descemet’s scroll. Results The spectacle-corrected visual acuity was 20/50 and 20/30 in the right and left eyes, respectively. The scrolls appeared as a translucent web extending from Descemet’s membrane into the anterior chamber. Confocal microscopy showed decreased endothelial cell density, pleomorphism, polymegathism, and hyperreflective fibrocellular rods with central hollow. The AS-OCT and ultrasound biomicroscopy showed rod-shaped retrocorneal scrolls. The corneal thickness was 494 microns, as measured by AS-OCT. The corneal lesion remained stable during the 6-year follow-up period without the need for keratoplasty, while the previous literature reported spontaneous and postoperative corneal decompensation. Conclusion We present a case of syphilitic interstitial keratitis with rare Descemet’s scrolls featuring relatively good visual acuity. Although we did not obtain the corneal tissue for examination, the anterior segment investigation provides insight into the underlying histopathology and natural disease history. The central hollow and cellular component seen during confocal microscopy might correspond to the amorphous core and the abnormal endothelial cells in the histopathologic findings. Failure to detect the corneal endothelium due to stromal opacity in these cases is possible, however, compromised endothelium may present.