Thuss Sanguansak

Infectious endophthalmitis: review of 420 cases

Background To characterize the causative pathogens and the visual outcomes among patients with endophthalmitis at a large referral center in northeastern Thailand. Methods All cases of infectious endophthalmitis treated between 1983 and 2007 were reviewed retrospectively. The patient data – including age, sex, history of ocular injuries, previous treatment and duration of the symptoms – were recorded. The ocular examination included affected side, anterior chamber reaction, vitreous haze, and presence of intraocular foreign bodies. Smears and cultures were prepared from anterior chamber paracentesis and/or vitreous tapping. Intraocular antibiotics were administered at the time of anterior chamber paracentesis and/or vitreous tapping. Vitrectomy and/or lensectomy were performed when indicated. Initial visual acuity before treatment and the final best-corrected vision were compared. Results A total of 420 cases of endophthalmitis were reviewed: 181 cases (43.1%) had ocular trauma before the infection; 135 (32.2%) developed endophthalmitis after intraocular surgery; and, 122 (29.1%) had a positive culture. Bacteria were isolated in 114 cases (93.4%) and fungi were noted in eight (6.6%). The common causative bacterium was Staphylococcus epidermidis. Combined vitrectomy and intraocular antibiotics were performed in 189 cases (45.0%), whereas 69 cases (16.4%) were treated with intraocular antibiotics alone. Conclusion Most of the reviewed cases were associated with trauma and intraocular surgery. The most frequently encountered bacterium causing infectious endophthalmitis was S. epidermidis. Most cases were treated with combined vitrectomy and intraocular antibiotics. The final visual outcomes seem to vary according to the type of endophthalmitis.

Air vs Perfluoropropane Gas in Pneumatic Retinopexy: A Randomized Noninferiority Trial

OBJECTIVE To evaluate whether air is as effective as perfluoropropane gas in treating rhegmatogenous retinal detachment by pneumatic retinopexy. METHODS In a double-blind, randomized, clinically controlled noninferiority trial, eligible patients were randomized into 2 treatment groups by using block randomization and treated by pneumatic retinopexy using filtered air or perfluoropropane gas. MAIN OUTCOME MEASURES Retinal reattachment rate and final visual recovery. RESULTS One hundred twenty-six patients were recruited. Half (63 patients) were assigned to receive filtered air during pneumatic retinopexy and half received perfluoropropane gas. The single-procedure reattachment rate was higher for the perfluoropropane gas group (73.0%[46 patients]) than for the air group (60.3% [38]), but the difference was not statistically significant (risk difference, -12.7%; 95% confidence interval, -29.0% to 3.6%). The final reattachment rate after additional pneumatic retinopexy and/or surgical procedures was 92.1% (58) in the air group and 96.8% (61) in the perfluoropropane gas group. This result showed an equivalent effect on the final reattachment rate (risk difference, -4.7%; 95% confidence interval, -12.7% to 3.2%). Final visual acuity did not differ significantly between groups. CONCLUSION Pneumatic retinopexy using filtered air is associated with a nonsignificantly lower initial reattachment rate than using perfluoropropane gas but results in an equivalent final reattachment rate and final visual recovery. APPLICATION TO CLINICAL PRACTICE Air is an acceptable alternative to perfluoropropane gas when treating rhegmatogenous retinal detachment by pneumatic retinopexy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00120445.

The effect of glasses on visual function following cataract surgery in a cataract camp

Aim: To investigate visual and functional impact of glasses following cataract surgery in a high-volume cataract camp as measured by the World Health Organization Prevention of Blindness Visual Function Questionnaire (WHO/PBD-VFQ-20). Method: Subjects were administered the WHO/PBD-VFQ three times: (1) preoperatively; (2) 3 months postoperatively, before glasses; and (3) 6 months postoperatively, after 3 months with glasses. Patients were given prescription glasses or +2.50 readers at the 3-month follow-up. Results: 315 patients enrolled in the study; 113 patients had complete WHO/PBD-VFQ and visual acuity data from all three administrations. The mean preoperative visual acuity in the surgical eye was 20/327. Following cataract surgery but before glasses, visual acuity improved to 20/57. Total WHO/PBD-VFQ and subscale scores improved significantly at the 3-month point. With glasses, visual acuity improved to 20/43. Total WHO/PBD-VFQ scores did not change following glasses, although the overall and near vision subscales did improve significantly. Glasses were worn once per week or less in 56% of patients. Conclusion: Postoperative glasses result in modest improvements in visual acuity. Total WHO/PBD-VFQ scores did not change significantly following glasses, but the overall and near vision subscales did improve. The net beneficial effect of glasses was small relative to cataract surgery itself.

The Impact of Preprinted Prescription Forms on Medication Prescribing Errors in an Ophthalmology Clinic in Northeast Thailand: A Non-Randomised Interventional Study

Objectives To understand the incidence and types of medication prescribing errors in a low resource setting ophthalmology clinic and to determine the impact of a preprinted prescription based on the hospital formulary (FormularyScript) on medication prescribing errors. Design Non-randomised interventional study. Setting Ophthalmology clinic in a teaching hospital in northeast Thailand. Participants 4349 handwritten prescriptions collected from October 2009 to December 2009, and 4146 FormularyScripts collected from February 2010 to May 2010. Primary and secondary outcome measures All prescriptions from the handwritten and FormularyScript groups were analysed for medication error rates by types (legibility, ambiguous, incomplete, abbreviation and accuracy) and subtypes (drug name, strength, which eye, route and dispensed amount). Results Comparison of error rates in the two groups showed a 10-fold reduction in the overall error rate using FormularyScript (32.9%–3.5%, p<0.001). FormularyScripts were associated with statistically significant (p<0.001) decreases in the following error types: legibility (16.1%–0.1%), incomplete (16.1%–0.1%) and abbreviation (3.1%–0.3%). There was no statistically significant change in accuracy errors (0.8%–0.6%, p=0.21). Ambiguous errors increased with FormularyScripts (0.6%–2.5%, p<0.001), likely due to the introduction of new ways to make errors. Decreases were seen in all legibility, abbreviation and accuracy error subtypes, and four out of six incomplete error subtypes. There were statistically significant increases in both ambiguous error subtypes: which eye (0.3%–2.5%, p<0.001) and drug name (0.3%–0.6%, p=0.03). Conclusions In our study population, outpatient medication prescribing errors were common and primarily due to legibility and incomplete error types. A preprinted prescription form has the potential to decrease medication prescribing errors related to legibility, incomplete prescribing information and use of unacceptable abbreviations without changing the overall rate of accuracy errors. However, new error types can occur.

Blood culture bottles are superior to conventional media for vitreous culture.

To compare blood culture bottles and conventional media for the vitreous culture in patients with clinically suspected infectious endophthalmitis.

Comparing smartphone camera adapters in imaging post-operative cataract patients.

Introduction The goal of this study is to compare image quality and clinical confidence for managing post-operative cataract patients based on anterior segment smartphone images obtained in real-world settings using four types of adapters: (a) macro lens (ML), (b) ML with augmented light-emitting diode (LED) illumination (ML-LED), (c) no adapter (NA) and (d) slit lamp (SL) adapter. Methods Anterior segment images were obtained from 190 eyes after cataract surgery using an eight-megapixel iPhone 6 smartphone camera with four adapters: ML, ML-LED, NA, and SL. Smartphone images were subjectively rated by ophthalmologists as acceptable or not acceptable for: (a) image quality for evaluating the anterior segment structures and (b) reader confidence in clinically managing post-operative patients based on smartphone images. Results NA, ML-LED, and SL had the highest scores for image quality with 100%, 93.7%, and 86.3% judged as acceptable, respectively. NA, SL, and ML-LED were also rated highest in clinical confidence with 100%, 98%, and 93.2% having acceptable levels, respectively. ML was judged lowest in both image quality (61.1% acceptable) and clinical confidence (37.4% acceptable). Discussion This study represents the first effort to compare different smartphone camera adapters’ ability to image the anterior segment of the eye in a real-world setting. Our study shows that ML-LED, NA, and SL adapters were acceptable for visualizing anterior segment structures to physician readers in 86–100% of cases. When coupled with visual acuity, intro-ocular pressure and history, these images can result in acceptable clinical confidence in 93–100% of cases.

Laser-Induced Choroidal Neovascularizations: Clinical Study of 3 Cases

Background: We report 3 patients with laser-induced choroidal neovascularization (CNV). Method: Retrospective, observational case series. Medical charts and photographs were reviewed. Results: Two patients with central serous chorioretinopathy who developed iatrogenic CNV after focal laser photocoagulation were treated with intravitreal ranibizumab injections. One patient with CNV secondary to thermal laser photocoagulation for diabetic macular edema was treated with photodynamic therapy (PDT). Visual improvement has been demonstrated in the patients treated with intravitreal ranibizumab injections, and their successful visual outcome was stable for more than 2 years. Stable visual acuity was also observed in the patient treated with PDT, no visual improvement was observed possibly due to the macular scar and macular ischemia. No systemic or ocular complications were detected among the 3 cases. Conclusion: To prevent a laser-induced CNV, it is critical to avoid heavy small-spot laser burns and repeated application. Patients should be monitored carefully for CNV after laser treatment. In our cases, PDT and intravitreal ranibizumab injections were effective for the treatment of laser-induced CNV.

Macular sensitivity after half-dose verteporfin photodynamic therapy in central serous chorioretinopathy

Objective To study the macular sensitivity after half-dose verteporfin photodynamic therapy in patients with resolved central serous chorioretinopathy using the automated static perimeter. Methods Prospective consecutive case study of 24 patients with resolved central serous chorioretinopathy was performed. The macular sensitivity was measured using a conventional automated static perimeter with the Swedish interactive threshold algorithm 10-2 and foveal threshold. Best corrected visual acuity, intraocular pressure, fundus examination, macular thickness, and volume were also examined. The mean macular sensitivities of the affected eyes and their normal fellow eyes were calculated and compared. P<0.05 was considered statistically significant. Results The mean macular sensitivities of the affected eyes were lower than the normal fellow eyes with a statistically significant difference in all areas of the study (P<0.05). Best corrected visual acuity improved significantly from pretreatment (0.26±0.3 logMAR) to posttreatment (0.075±0.15 logMAR, P<0.05). Macular thicknesses in affected eyes were 230.66±67.34 μm and in the normal eyes were 238.33±92.26 μm (P=0.68). Macular volumes in affected eyes were 8.77±0.49 and in the normal eyes were 8.70±0.50 (P=0.60). These findings were not statistically significant. Conclusion Eyes with resolved central serous chorioretinopathy after half-dose verteporfin photodynamic therapy had lower macular sensitivity than normal fellow eyes. These findings agreed well with the previous microperimetric studies. The conventional automated static perimeter can also be used when a microperimeter is not available.

Effects of Ranibizumab on Exudative Disciform Scars

BACKGROUND AND OBJECTIVE To evaluate the effect of intravitreal ranibizumab in patients with leaking disciform scars. PATIENTS AND METHODS In this retrospective case series, 31 eyes received one or two ranibizumab injections for treatment of choroidal neovascularization. Visual acuity, central retinal thickness, and macular volume were measured prior to injection and at 1-month follow-up. RESULTS After one injection (n = 31), mean optical coherence tomography (OCT) central foveal thickness decreased from 317 to 242 microm (P = .00016). Mean OCT macular volume decreased from 7.89 to 6.80 mm3 (P = .00019). After two injections (n = 12), mean OCT central foveal thickness decreased from 310 to 248 microm following the second injection (P = .04). Mean OCT macular volume decreased from 7.80 to 6.43 mm3 at 1-month follow-up after a second injection (P = .006). There was no significant change in visual acuity after injections. CONCLUSION In the short-term, ranibizumab decreases the leakage associated with choroidal neovascularization in chronic macular degeneration.

Multimedia Appendix Correction: Two-Way Social Media Messaging in Post-Operative Cataract Surgical Patients:A Prospective Interventional Study (Preprint)

[This corrects the article DOI: 10.2196/jmir.8330.].