Nimitr Ittipunkul

Predictive factors and outcomes of posterior segment intraocular foreign bodies

PurposeTo identify the predictive factors for anatomical and visual outcomes in posterior segment intraocular foreign body (IOFB) patients managed by pars plana vitrectomy (PPV).MethodsA retrospective chart review was performed for 77 patients, who had PPV for IOFBs removal between January 2001 and July 2007. Univariate and multivariate analyses were conducted to evaluate the predictive factors.ResultsThe mean age of the patients was 33.4 years. The nature of IOFBs was mainly metal, with injuries most commonly caused by an electric grass trimmer. The mean time interval between injury and IOFBs removal was 30.7 days. The mean preoperative visual acuity (VA) was 1.82 logarithm of the minimal angle of resolution (logMAR), and mean final was VA 1.10 logMAR. From multivariate analysis, good visual outcome was correlated with the corneoscleral entry site, and poor visual outcome was correlated with the presence of relative afferent pupillary defect.ConclusionsIn noncombat IOFBs, most cases were work-related. Delayed IOFBs removal was acceptable when primary wounds were repaired appropriately and extensive antibiotics administered. Even though advancement in vitreoretinal surgery can reduce the frequency of blindness, further promotion and education on eye protection during work are needed.

Changes in Central Macular Thickness following Single Session Multispot Panretinal Photocoagulation

Purpose. To determine changes in central subfield (CSF) macular thickness and best corrected visual acuity (BCVA) following single session, multispot panretinal photocoagulation (PRP). Methods. Forty eyes of 33 patients with newly diagnosed proliferative diabetic retinopathy were treated with single session, 20-millisecond, multispot PRP. Changes in central macular thickness and BCVA at 4- and 12-week follow-up were compared to baseline measurements. Results. Each eye received a mean (SD) of 2,750 (686.7) laser spots. At 4-week follow-up, there was a statistically significant 24.0 μm increase in mean CSF thickness (P = 0.001), with a 17.4 μm increase from baseline at 12-week follow-up (P = 0.002). Mean logMAR BCVA increased by 0.05 logMAR units (P = 0.03) at 4-week follow-up. At 12-week follow-up, BCVA had almost returned to normal with only an increase of 0.02 logMAR units compared to baseline (P = 0.39). Macular edema occurred in 2 eyes (5%) at 12-week follow-up. Conclusions. Macular thickening occurs following single session, 20-millisecond, multispot PRP, with a corresponding, mild change in BCVA. However, the incidence of macular edema appears to be low in these patients. Single session, 20-millisecond, multispot PRP appears to be a safe treatment for patients with proliferative diabetic retinopathy.

Predictive factors of open globe injury in patients requiring vitrectomy

BACKGROUND To determine the outcomes and predictive factors of patients with open globe injury requiring pars plana vitrectomy (PPV). METHODS The medical records of 114 patients age 10 years or older who had undergone PPV due to ocular trauma, with at least 6 months follow up, were retrospectively reviewed. RESULTS The mean age of the patients was 42 (SD14) years, with males accounting for 89% of the cases. Penetrating eye injury was the most common injury mechanism (43%) with most injuries occurring secondary to work related incidents (54%). After surgical interventions, 78% of the patients had visual improvement of one or more Snellen lines, while no light perception occurred in 10%. Anatomical attachment was achieved in 87% of eyes at the final follow up. Logistic regression analysis showed that the presence of a relative afferent pupillary defect (RAPD) was a significant predictive factor of visual outcome, while initial retinal detachment was a significant predictor of anatomical outcome. CONCLUSIONS Pupillary reaction is an important presenting ocular sign in estimating the post-vitrectomy poor visual outcome for open globe injury. Vision was restored and improved in more than half of the patients in this study; however, long-term sequelae should be monitored.

Post-injection endophthalmitis in eyes receiving vs. not receiving topical antibiotic prophylaxis in Northern Thailand

Endophthalmitis following intravitreous anti-vascular endothelial growth factor (VEGF) injection is a rare sight-threatening condition. Several Western references suggest lower rates of post-injection endophthalmitis can be achieved without topical antibiotic prophylaxis [1–3]. However, a majority of physicians in the Asia-Pacific region still prescribe antibiotic prophylaxis [4], anecdotally stating concern that differences in environmental factors (e.g., tropical climates) or patient factors in the region might cause higher risk of endophthalmitis, comparing to the Western settings, to warrant this prophylaxis, despite little scientific rationale supporting such use. To our knowledge, little is known regarding incidence of post-injection endophthalmitis without antibiotic prophylaxis in a developing countries in Asia or elsewhere. Therefore, this study determined incidence of postinjection endophthalmitis with vs. without topical antibiotic prophylaxis at a university-based practice in Northern Thailand.

Response to Comment on ‘Predictive factors and outcomes of posterior segment intraocular foreign bodies’

Response to Comment on ‘Predictive factors and outcomes of posterior segment intraocular foreign bodies’

Spontaneous Large Serous Retinal Pigment Epithelial Tear

Purpose: To report cases of spontaneous retinal pigment epithelial (RPE) tear complicating serous pigment epithelial detachment (PED). Methods: The records of 3 Asian patients with spontaneous giant RPE tear were reviewed retrospectively by including clinical presentation, angiography, optical coherence tomography, fundus autofluorescence imaging, and visual outcome. Results: Three patients (4 eyes) were included in this study, with a mean age of 48.3 (42–56) years, and a mean follow-up period of 7.75 (4–18) months. Fundus examination in all patients showed giant RPE tear associated with bullous PED. Two cases had a history of prior corticosteroid use, and 1 had no history of medication use. All 3 patients developed spontaneous resolution of subretinal fluid with no treatment. However, in patients who used corticosteroids, initial progression of the tear and subretinal fluid were observed despite ceasing medication. On subsequent follow-up, an incomplete RPE regeneration was demonstrated by fundus autofluorescence imaging, and choroidal neovascularization developed in 1 patient. Conclusion: Large PED with RPE tear is a rare manifestation. When the fovea is spared, visual prognosis is favorable. No specific treatment is required, but careful choroidal neovascularization monitoring should be performed.