Eye South East Asia

Atypical Presentation of Conjunctival Kaposi Sarcoma: A Case Report

Wimolwan Tangpagasit — 2023-12-28

Background: Kaposi sarcoma is an antiproliferative spindle-cell tumor derived from vascular endothelium and immune cells infected with human herpes virus type 8 (HHV-8). It is one of the most common ocular malignancies in patients with human immunodeficiency virus (HIV) infection but is also found in immunocompetent patients.

Case presentation: A 55-year-old male patient with a 1-month history of painless maroon-colored nodular mass, surrounded by telangiectatic vessels at the lower palpebral conjunctiva. His serologic test was positive for HIV infection. After performing an excisional biopsy, the histopathological report confirmed the diagnosis of a nodular stage of Kaposi sarcoma.

Conclusion: Although ocular Kaposi sarcoma is extremely rare, especially when manifest as the initial manifestation of occult HIV infection. Recognizing the correct diagnosis is valuable. The advantage of evaluating for HIV infection is early identification and comprehensive highly active antiretroviral therapy (HAART) to prevent further morbidity and mortality sequelae.

Pseudophakic pupillary block after posterior chamber intraocular lens (PC-IOL)

Sutee Ananprasert — 2023-12-28

Purpose: To report a case with pseudophakic pupillary block after lens removal with posterior chamber intraocular lens (PC-IOL), which is rarely found. And the benefits of anterior segment imaging (UBM) in helping diagnosis

Method: A Case report

Result: A 30-year-old Thai female presented with sudden right eye pain for 2 weeks. She had undergone uncomplicated cataract surgery on her right side for 6 years. The initial intraocular pressure (IOP) was 60 mmHg. The slit-lamp examination on the right eye revealed diffused marked corneal edema with un-uniformly shallow anterior chamber (AC) and non-reactive corectopia. The diagnosis was pseudophakic pupillary block with 360-degree posterior synechiae accommodated by anterior segment ultrasound biomicroscope (UBM). The symptoms disappeared after doing a laser peripheral iridotomy. Four weeks after laser treatment, the IOP was well controlled with only medical treatment.

Conclusion: The diagnosis of angle closure in the pseudophakic eye was challenging because it is infrequent. However, with meticulous clinical examination and assistance of anterior segment ultrasound biomicroscope (UBM) could facilitate the diagnosis and guide the suitable treatment.

Conflicts of Interest: None.

Endogenous endophthalmitis: A 5-year Retrospective Study at Thammasat Hospital

Theinchai Pasurakul — 2023-12-28

Purpose: To study clinical features, risk factors, microbiological characteristics, and visual outcomes in patient with endogenous endophthalmitis

Design: Retrospective, observational case series study

Methods: Review of medical records of 16 patients 18 eyes with endogenous endophthalmitis between 2017 -2022 at Thammasat Hospital which had completed in medical record more than 12 months. The initial visual acuity, underlying disease, method of treatment, method of culture etc. had been recorded. From the results of this study, we compared the treatment outcomes between intravenous antibiotics, pars plana vitrectomy, and a combined method. Endophthalmitis from other causes had been ruled out from the study.

Results: 18 eyes of 16 patients who were diagnosed with endogenous endophthalmitis. Mean(±SD) age was 52.75 (±18.58) years. Mean(±SD) onset was 5.43(±7.44) days. Seventy-five percent of patients had udnerlying disease. The most common risk factor was diabetes mellitus and the most common primary site of infection is the urinary tract. Causative organisms were identified in 87.5% of patients. The most common organism was Streptococcus agalactiae (43.75%). The final visual outcomes were no light perception in 29.41%.

Conclusion: Endogenous endophthalmitis is the cause of severe visual loss. Risk factor of endogenous endophthalmitis comes from various causes but diabetes mellitus is still the most common risk factor. Primary vitrectomy with intravitreal antibiotics may be the better option for treatment than intravitreal antibiotics alone.

The clinical characteristics of pediatric strabismus in Ho Chi Minh city Eye Hospital in 2020

Bao Hong Tran — 2023-12-28

Background: Pediatric strabismus is a common disorder that may lead to a severe decrease in visual quality. Updating the changes in disease characteristics through time is important for the diagnosis and prognostication of pediatric strabismus.

Methods: Retrospective cross-sectional study. Medical records of 1,101 patients with the diagnosis of pediatric strabismus from January 1st, 2020 to December 31st, 2020 were enrolled in this study. The medical records are included if suffcient information is available.

Results: We included 1,101 medical records in 2020. The prevalence of exotropia, esotropia and vertical strabismus were, in order, 68.4%, 29.3% and 2.3%. The prevalence of alternating strabismus and monocular strabismus were, in order, 74.8% and 25.2%. The prevalence of intermittent strabismus and manifest strabismus were, in order, 65.9% and 34.1%. Refractive errors exist in 87.3% of patients. Visual acuity could be recorded in 51.5% of patients, in which 31.8% of patients had a severe decrease of visual acuity (< 2/20). Amblyopia was recorded in 34% of patients, with 68.2% of whom from esotropia. Correcting refractive errors was the main treatment procedure (60.7%).

Conclusion: Pediatric strabismus may affect the children’s visual acuity deeply and therefore affect their quality of life. Early diagnosis of the disease takes the decisive role in preventing patients from amblyopia. As a large number of patients have refractive errors, early screening of the patient’s refraction is also mandatory.

Conficts of interest: The authors declare no confict of interest.

The comparison of pain perception between polypropylene and chromic catgut suture in Müller muscle’s conjunctival resection with externalization of suture knots; a randomized controlled trial

Duangmontree Rojdamrongratana — 2023-12-28

Objective: Muller’s muscle conjunctival resection (MMCR) is a posterior approach surgical technique to correct blepharoptosis. The purpose of this study was to compare the patient-reported pain scores and surgical outcomes between polypropylene sutures and chromic catgut sutures.

Methods: A prospective randomized comparative clinical trial enrolled subjects from one tertiary eye center. Patients undergoing unilateral MMCR were randomized to receive either a polypropylene suture or a chromic catgut suture. Upper eyelid margin-to-reflex distance was measured and recorded before and after surgery. Then, pain scores were quantified using the pain visual analog scale: measured during surgery, one day after surgery, and when the sutures removed. The results were analyzed using an unpaired t-test.

Results: The study enrolled twenty-two unilateral cases. Seventeen (77%) of the subjects were female. The mean patient age was 45 years (45.18). The mean margin-to-reflex distance was 1.84 mm preoperatively, which increased to 2.96 and 3.09 mm one month postoperatively in the polypropylene and the catgut suture groups, respectively (P-value <0.0001). Results demonstrated significant pain scores difference between the two sutures during sutures removal. There were no suture-related complications.

Conclusion: Patients receiving polypropylene sutures reported significantly more pain during suture removal than those receiving catgut sutures. However, the surgical outcomes were not different.

Conflicts of interest: No conflict of interest is reported.

Hyper reflective foci on spectral domain optical coherence tomography as a biomarker for predict recurrent rate and visual prognosis in diabetes macular edema.

Theinchai Pasurakul — 2023-12-28

Purpose: To investigate the correlation between the hyperreflective retinal foci and recurrent rate in diabetes patient after treatment with anti-VEGF

Methods: Review of medical records of 82 patients 101 eyes with diabetes macular edema between 2021 -2023 at Thammasat Hospital which had completed in medical record more than 24 month. We design study to compared recurrent and non recurrent macular edema group. Demographic data, such as age, gender, details of the underlying disease (HbA1c), including biomarkers such as Disorganization of retinal inner layer(DRIL), Hyper reflective retinal foci(HRF), Subretinal fluid(SRF), Intraretinal fluid(IRF) from OCT were collected at baseline.

Results : Hyperreflective retinal foci was notably more abundant in the recurrence group, exhibiting statistically significant disparities (P-value: 0.013). Furthermore, a substantial discrepancy emerged concerning HBA1C levels, with values of 7.5 ± 1.4 in the non-recurrence group and 8.9 ± 2.3 in the recurrence group (P-value: 0.044). Upon a 24-month evaluation, the visual acuity (log MAR) measured at 0.363 ± 0.482 in the non-recurrence group and 0.527 ± 0.206 in the recurrence group, manifesting a notable difference (P-value: 0.033). Hyperreflective retinal foci in the outer retina were markedly more prevalent in the recurrence group compared to the alternative group (P-value: 0.026). Furthermore, the mean count of anti-VEGF injections stood at 10.54 ± 2.58 in the non-recurrence group and 17.82 ± 1.93 in the recurrence group, displaying a statistically significant divergence (P-value: 0.041).

Conclusions : HRF in the outer retina displayed a favorable impact on visual prognosis and a tendency towards recurrence in cases of diabetic macular edema. Furthermore, Hemoglobin A1C emerged as a noteworthy risk factor deserving attention to attain optimal treatment outcomes.

The Effectiveness of single procedure of Slit-lamp Needling Revision with low dose Mitomycin-C (0.1 mg/ml) as an alternative to surgical revision for bleb Failure at Preah Ang Duong Hospital in Cambodia

Kossama CHUKMOL — 2023-12-28

Background: Bleb needling revision with Mitomycin-C has been known as a common procedure performed after failed trabeculectomy around the world. Numerous studies show a high success rate of slit-lamp needling revision with high dose Mitomycin-C. To our best knowledge, there are currently no known studies showing the efficacy of single needling procedures with low dose Mitomycin-C for bleb revision. The authors conducted a study to investigate the efficacy and safety of this procedure.

Objectives: This study aims to investigate the efficacy and safety of a single procedure of slit-lamp needling revision with low dose Mitomycin C (0.1 mg/ml) in bleb failure in Cambodian eyes.

Methods: It’s a prospective and non-comparative study involving 32 eyes of 32 uncontrolled glaucoma patients after trabeculectomy. All procedures were performed at Preah Ang Duong Hospital from March 2021 to March 2022. Bleb needling was performed on slit-lamp using a 26-gauge needle to open the flap, and 0.1 ml of 0.1 mg/ml MMC was injected 2 millimeters posteriorly to the superior scleral flap side to the sub-tenon space. The outcome measurements are described as rate of success , intraocular pressure, number of antiglaucoma medications, bleb morphology changes and complications at three time points (one month, three months, and six months).

Results: In our study, we found 3.12 % of complete success and 96.88% of qualified success at the end-point. A significant reduction of IOP (from 24.12 +/- 4.52 mmHg to 11.93 +/- 1.24 mmHg, p < 0.001) and number of anti-glaucoma medications (2.96 +/- 0.64 to 1.53 +/- 0.62) was also demonstrated. There’s no statistically significant change in bleb morphology, however diffused blebs were found. No serious complications were found during the study.

Conclusion: Slit-lamp needling revision with low dose Mitomycin-C appears to be efficacious and safe for restoring bleb function in glaucomatous eyes with bleb failures.

Detection of Covid-19 with Ocular signs, Symptoms, and Rapid Test Standard Q on the Conjunctiva and Tear Film

Thanakrit sorasit — 2023-12-28

Background: Coronavirus infection (Covid-19) is a recent pandemic outbreak, characterized by transmission through body secretions. Research indicates the presence of the infection in the Oropharynx2, encompassing the nasopharynx, establishing a connection to the tear duct pathway (nasolacrimal system). Several studies have reported the presence of the infection in the tears and conjunctival tissues3. The objective of this study is to determine the detection of Covid-19 from conjunctival secretions and lacrimal ducts using standard rapid antigen tests. Additionally, the study aims to explore ocular manifestations in individuals diagnosed with Covid-19 using RT-PCR.

Setting: THABO CROWN PRINCE HOSPITAL

Study design: Prospective cohort study

Methodology: Data were collected from 414 patients at risk of contracting Covid-19. A total of 414 patients exhibiting respiratory symptoms indicative of coronavirus disease (Covid-19) received a diagnosis of SARS-CoV-2 through RT-PCR in the PCR group. Subsequently, these subjects underwent evaluation via standard rapid antigen test using conjunctival secretions. Additionally, an ophthalmologist conducted examinations using a handheld slit-lamp microscope.

Results: The sample group consisted of 414 individuals that exhibit symptoms of entry and susceptibility to Covid-19. Among them, nasal swab RT-PCR, which was considered the gold standard, was performed on 212 people, constituting an incidence rate of 51.21% (95% CI: 46.39-56.02%). The occurrence of Covid-19 in lacrimal secretion was observed in 10 cases (2.42%), with 7 cases (3.30%) identifed in the nasal swab RT-PCR positive subgroup. Upon statistical analysis, no statistically signifcant difference was discerned (p-value= 0.290). The sensitivity for the intraocular diagnostic test was determined to be 3.30% (95% CI: 1.58-5.02%). Notably, this study revealed no transmission between medical personnel and patients, and there were no reported fatalities.

Conclusion: Within the high-risk group, respiratory symptoms associated with coronavirus (Covid-19) infection can manifest through tears. The diagnosis of Covid-19 was established through both positive and negative results in nasal swabs RT-PCR tests. Consequently, the intraocular Antigen Test Kit (ATK) is deemed inappropriate as a diagnostic tool. Nonetheless, it serves a valuable role in affrming the potential for pathogen contamination in the tear region. Thus, caution is warranted when medical personnel are required to make contact with the patient’s conjunctiva and tears.