Eye South East Asia

Comparison of Visual Outcomes and Higher Order Corneal Aberrations between SMILE and Femtosecond LASIK for Myopia Astigmatism Correction in VIETNAM

Tran Thi Kim Ngan — 2024-12-30

Introduction: To compare the visual outcomes and HOAs of small incision lenticule extraction (SMILE) and Femtosecond LASIK (FS-LASIK) for myopia correction in Southern Vietnamese.
Methods: A total of 40 patients underwent bilateral refractive procedures (40 eyes for SMILE and 40 eyes for FS-LASIK) at a tertiary international hospital in Ho Chi Minh City, Vietnam. Data were collected at three consecutive visits: pre-operative, 1 month and 6 months post-operatively. The data collected included visual outcomes (visual acuity and refraction) and higher order corneal aberrations (vertical coma, horizontal coma, spherical aberration, and total higher order corneal aberration).
Results: Data normality was tested with the Shapiro–Wilk test. The difference in visual outcomes and HOAs were compared between the two procedures with the Mann–Whitney U test. Intragroup differences at the three consecutive visits were compared using the Friedman test. A p<0.05 was considered significant. All participants achieved a corrected distance visual acuity of 20/20. The percentage of eyes achieving uncorrected visual acuity ≥ 20/20 was higher in the SMILE (95%) than in the FS-LASIK (85%, p>0.05) group at 6-months. Spherical aberration at 6 months postoperatively was significantly higher in the FS-LASIK (0.44±0.14 µm) than in the SMILE (0.34±0.14 µm) group, p=<0.01. Only two eyes (5%) in the SMILE and one eye (2.5%) in the FS-LASIK group lost one line in CDVA (p>0.05).
Conclusions: SMILE and FS-LASIK are safe and effective surgical options for myopia correction. SMILE achieves slightly greater accuracy in terms of achieving the intended refractive outcomes compared to FS-LASIK. Additionally, SMILE induces less spherical aberration compared to FS-LASIK.

Efficacy of Micropulse Trans-scleral Cyclophotocoagulation in Lowering Intra-ocular Pressure and Reducing Anti-glaucoma Medications among Cambodian Glaucoma Patients

Channdarith KITH — 2024-12-30

Objective: The micropulse trans-scleral cyclophotocoagulation has been predominantly utilized to reduce intraocular pressure (IOP) in cases of refractory glaucoma. This laser treatment has been extensively used in refractory cases with potentially poor vision, as well as across various type and severities of glaucoma. This study aims to assess the treatment outcomes of micropulse cyclophotocoagulation in Cambodian glaucoma patients.
Materials and Methods: This retrospective study included 14 patients. The review of medical records encompassed pre- and post-treatment variables such as IOP, the amount of anti-glaucoma medications used visual acuity, pain levels, and complications over 14 months. The primary outcome was categorized as success or failure, where success was defined as achieving an IOP between 6- and 21-mm Hg and a minimum 30% reduction in IOP at the final follow-up, with/without the use of medications.
Results: The mean age of patients in this study was 52.36 ± 9.98 years. The mean intraocular pressure prior to treatment was 41.00 ± 12.26 mmHg, decreasing to 21.60 ± 8.11 mmHg (41.56% reduction) at 12 weeks and 16.94 ± 5.46 mmHg (56.04% reduction) at 24 weeks (p < 0.001), with a success rate of 86%. Before treatment, the average number of anti-glaucoma drugs was 3.45 ± 0.89 (2 to 5 drugs). By weeks 12 and 24, that number had dropped to 1.85 ± 1.19 (1 to 3 drugs) and 1.46 ± 1.15 (none to 3 drugs), a drop of 2, p < 0.001. Only 3 eyes (22.43%) have complications, yet there is no apparent change in visual acuity.
Conclusions: This micropulse trans-scleral cyclophotocoagulation is an effective procedure for lowering pressure at any stage of disease and reducing anti-glaucoma medications while avoiding invasive surgeries.

Impact on Tear Film Production after Upper Lid Blepharoplasty

Thiti Wichayachiwin — 2024-12-30

Background: The global population is aging, leading to increased incidence of dermatochalasis, a condition affecting the upper eyelids due to age-related changes in levator palpebrae superioris function. Upper eyelid blepharoplasty is a common surgical intervention to correct dermatochalasis, involving excision of excess skin and fat. Despite its benefits, concerns about postoperative dry eye syndrome persist, highlighting the need for further research in this area.
Design: This prospective cohort study aimed to evaluate the impact of upper eyelid blepharoplasty on tear production and stability in patients with dermatochalasis. Ten eyes from five female patients (mean age 69.50 ± 8.26 years) were included. Tear assessments were conducted preoperatively and at 2, 6, and 12 weeks postoperatively using the Schirmer test and tear breakup time (TBUT).
Methods: Patients scheduled for upper eyelid blepharoplasty were recruited at Thammasat University Hospital. Examinations included best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure, Schirmer test, and TBUT. Exclusion criteria encompassed concurrent corneal diseases and certain pre-existing eye conditions.
Results: There were no statistically significant differences in Schirmer test measurements or TBUT between preoperative and postoperative assessments at 2, 6, and 12 weeks (p > 0.05). Mean Schirmer test values were 11.9 ± 8.99 mm preoperatively and 9.72 ± 3.55 mm at 12 weeks postoperatively. TBUT values were 9.11 ± 5.46 seconds preoperatively and 9.72 ± 3.55 seconds at 12 weeks postoperatively.
Conclusions: Upper eyelid blepharoplasty for dermatochalasis did not lead to significant changes in tear production or stability over a 12-week follow-up period. These findings suggest that careful surgical technique may preserve tear dynamics postoperatively. However, larger studies with diverse populations and longer follow-up durations are warranted to validate these results and assess potential long-term effects on ocular surface health.

The Incidence and Risk Factors of Post-penetrating Keratoplasty Glaucoma

Wimolwan Tangpagasit — 2024-12-30

Purpose: To evaluate the incidence and significant risk factors of glaucoma after penetrating keratoplasty (PK) operation.
Methods: A retrospective cohort study was carried out on 62 eyes of 61 patients who underwent penetrating keratoplasty from January 2020 to December 2022 in Thammasat University Hospital, Thailand. Age, sex, preoperative diagnosis, presence of preoperative glaucoma, presence of peripheral anterior synechiae, recipient graft size, lens status, and additional surgery performed during keratoplasty, which may affect the postoperative intraocular pressure, were evaluated for risk factors of glaucoma after penetrating keratoplasty.
Results: The overall incidence of post-penetrating keratoplasty glaucoma (PPKG) was 37.1%. The patients’ ages ranged from 20 to 95 years (with a mean of 63.53 ± 15.58 years). Twenty-nine patients (47.54%) were male. Preoperative diagnosis of inflammatory diseases such as corneal perforation (relative risk [RR] = 2.95), keratitis on graft (RR = 2.18), trauma (RR = 1.38), and infectious keratitis (RR = 1.24) were found to be risk factors for the development of glaucoma. Other significant risk factors included recipient size ε 8 mm, peripheral anterior synechiae (PAS) or shallow anterior chamber (AC), and pre-existing glaucoma (p = 0.03, 0.001, and 0.002 respectively). The average period to develop glaucoma after PK was 3.77 ± 4.81 months.
Conclusion: IOP monitoring should be started in the early postoperative period and as a routine in the follow-up period especially in patients presenting significant risk factors such as large recipient graft, pre-operative peripheral anterior synechia formation, and pre-existing glaucoma. Patients with glaucoma history should be carefully evaluated both pre- and post-operatively in PK operation.

The Clinical Characteristics of Acute Primary Angle Closure Patients in Ho Chi Minh City Eye Hospital in 2022

Bao Hong Tran — 2024-12-30

Background: Acute primary angle closure is an emergency condition that may lead to permanent damage of the optic nerve head. Updating the changes of clinical characteristics of the disease through time is important in diagnosing and prognostication.
Purpose: To describe demographic, clinical characteristics and treatment results of acute primary angle closure patients in Ho Chi Minh City Eye Hospital in 2022.
Methods: Retrospective cross-sectional study. We enrolled 780 eyes from 752 patients diagnosed with acute primary angle closure treated in Ho Chi Minh City Eye Hospital from January 1^st 2022 to December 31^st 2022. Medical records were included in this study if sufficient information was available.
Results: Most patients were from 51-70 years of age (76.7%), with female-to-male ratio being 2.6. Among the patients, 724 patients had unilateral disease and 28 patients had bilateral disease. Main chief complaints were pain (54.9%) and blurry vision (45.1%). Mean duration of disease onset was 8.7 ± 4.8 days and 74.6% of patients had no preliminary treatment. Baseline visual acuity < 6/20 was found on 87.9% of eyes; mean baseline intraocular pressure was 37.5 ± 19.6 mmHg and 60.9% of eyes had baseline intraocular pressure ≥ 35 mmHg. The most common symptoms were pain (88.3%), blurry vision (78.7%) and redness (76.3%); the most common signs were reduced pupillary reflex (96.3%), ciliary flush (83.3%) and corneal edema (79.1%). There were 95.6% of eyes with post treatment intraocular pressure < 21 mmHg and 51% of eyes had final visual acuity ≥ 2/20.
Conclusion: Acute primary angle closure is a common emergency condition. While pain, blurry vision and redness are main symptoms, the most common signs are reduced pupillary reflex, ciliary flush and corneal edema; the main chief complaints are pain and blurry vision. Early diagnosis and treatment of disease leads to better outcomes.

A Comparison of Trabeculectomy Outcomes by Intratenon Injection Mitomycin-C Versus Soaked-Sponge-Applied Mitomycin-C: One-year Follow up

Sutee Ananprasert — 2024-12-30

Objectives: To compare the efficacy and safety of mitomycin-C (MMC) injected intratenon with conventional soaked-sponge-application in trabeculectomy.
Materials and Methods: We retrospectively reviewed 90 patients with primary and secondary glaucoma diagnoses who received trabeculectomy surgery with MMC in Thammasat University Hospital, Thailand from 2018 to 2021. The MMC was administered to the subjects via either an intratenon injection or a soaked-sponge-application. Postoperative intraocular pressure (IOP) level was the primary outcome measure, with survival rates for IOP control, number of glaucoma medications used, complication rates, and vision serving as secondary outcomes.
Results: There were 90 eyes available for analysis; 36 eyes had MMC delivered via intratenon injection and 54 eyes via soaked-sponge. Mean preoperative IOP in intratenon group was 28.44 ± 12.87 mmHg and soaked sponge-applied group was 26.83 ± 6.51 mmHg, which reduced to 14.72 ± 10.08 and 11.63 ± 3.76 mmHg at final visit with P value of 0.373, respectively. Mean preoperative number of antiglaucoma medications was 3.64 ± 0.54 in intratenon group and 3.70 ± 0.54 in soaked-sponge-applied, which reduced to 0.78 ± 1.07 and 0.30 ± 0.82 with P value of 0.007, respectively. Overall, success rate (complete + qualified) was 80.6% in intratenon injection and 96.3% in soaked-sponge-applied at final visit with P value of 0.030, respectively. There was no difference between groups in postoperative complications including choroidal effusion, over filtration, hypotony, malignant glaucoma, bleb leak and blebitis (p > 0.05). The time to failure for postoperative IOP control was significantly different between groups. There was a higher survival rate of the soaked-sponge-applied group than intratenon group.
Conclusions: Both MMC delivery methods are effective in reducing IOP and the number of antiglaucoma medications. However, the sponge-applied group demonstrated superior success rates without an increased risk of complications.

Amid the Era of Globalization: What Key Factors Influencing the Selection of an Ophthalmology Residency among Trainees in Thailand?

Pakornkit Phrueksaudomchai — 2024-12-30

Purpose: To evaluate factors influencing the decision-making of current Ophthalmology residents when deciding for Ophthalmology Residency Training Program Applications in Thailand.
Setting/Venue: Online-based survey was initiated in Thailand during November 2022 to January 2023.
Method: The study is an online-based, cross-sectional study among current Ophthalmology residency trainees from 12 institutions. Focused group analysis among randomized sample of trainees and content analysis was processed for the questionnaire. ANOVA and Pearson correlation were used in the study to determine the statistical relationships among the collected data.
Results: Eighty five trainees completed the survey, comprising 23 (27.06%) first year residency trainees, 35 (41.18%) second year residency trainees and 27 (31.76%) third year residency trainees. Of these, 56 (65.88%) trainees graduated from medical school in urban areas, 29 (34.12%) graduated from rural areas. Female trainees predominated, with the total of 52 (61.18%), with a mean age of 29 years old. Of all the trainees, 46 (54%) work in urban areas and 39 (46%) work in rural areas. The most influential factors were characteristics of work that involved surgical and medical skills (mean 4.18/5), flexibility and freedom of work (mean 4.15/5) and non-emergency settings (mean 4.07/5). The area of medical school graduation was correlated with flexibility and freedom of work (R-28.0, p-value < 0.05). The age was correlated with attitude about future planning (R 22.5, p-value < 0.05) and nature of work that involved surgical and medical (R 22.2, p-value < 0.05). The area of work was correlated with original affiliation (R 29.6, p-value < 0.05) and chance of being sued (R 27.5, p-value < 0.05).
Conclusion: Nature of work that involved surgical and medical skills, flexibility and freedom in work, and non-emergency settings were the most influential factors that influenced the decision to apply for Ophthalmology Residency Training respectively. There were some correlations between factors such as the area of which they completed undergraduate medical training, age and the area of work, which also influenced the choice of ophthalmology training.

Retrospective Analysis of Corneal Ectatic Disease and Associated Risk Factors at a Tertiary Hospital in Thailand

Pakornkit Phrueksaudomchai — 2024-12-30

Background: A study on the prevalence and related factors of corneal ectasia at the Ophthalmology department at Thammasat University Hospital. To provide public health information on ways to prevent corneal ectasia and its impact on vision impairment, blindness and other aspects of quality of life.
Methods: The study is retrospective and descriptive in nature, covering a period from 1^stJanuary 2018 to 31^st December 2022 inclusive, conducted at Thammasat University Hospital.
Results: The data encompasses a total of 68 cases, with 64 (94.11%) cases attributed to keratoconus, 2 (2.94%) cases of pellucid marginal degeneration and 2 (2.94%) cases classified as unspecified corneal ectasia. The study reveals a gender distribution of 33 (48.53%) female patients to 35 (51.47%) male patients. The highest prevalence is found within the age group of 20-29 years (52.94%). Among the 68 cases, 49 individuals (72.05%) have a diagnosis of allergic conjunctivitis. 55 individuals (80.88%) have a history of eye rubbing. 23 individuals (33.82%) have documented allergic rhinitis. 18 individuals (26.47%) have a history of wearing contact lenses. 10 individuals (14.70%) have a history of obstructive sleep apnea.
Conclusion: The study provides valuable insights into the prevalence and characteristics of corneal ectatic diseases, particularly keratoconus. These insights may contribute to a better understanding of the profile of patients with corneal ectatic diseases in the specified population, facilitating improved diagnosis in terms of more prompt detection and management strategies.

Assessment of Patient Awareness on Disease and Treatment after Applying Web-based Application for Treatment Outcome Tracking in nAMD and DME Patients Treated with Anti-VEGF: A Non-drug Interventional Study (A Retina Track)

Navapol Kanchanaranya — 2024-12-30

Background: Neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) require consistent follow-up and treatment adherence, often hindered by low patient awareness. This study evaluates the Retina Track application, a web-based tool, in enhancing and sustaining patient awareness compared to conventional educational methods.
Methods: A prospective study enrolled 110 patients undergoing anti-VEGF therapy for nAMD or DME at Thammasat University Hospital from 1st September 2021 to 1st February 2022. Patients were randomized into two groups: one receiving conventional education (n = 55) and the other using Retina Track alongside conventional methods (n = 55). Patient awareness was assessed using a standardized questionnaire covering five aspects: disease name, cause, risk factors, progression, and treatment. Data were collected at baseline, post education, and at a 3-month follow-up.
Results: Both groups improved post-education, but the Retina Track group demonstrated superior long-term awareness. Disease name awareness increased by 12.8% and 16.4% (p = 0.0017) in the conventional and Retina Track groups, respectively. Awareness of disease cause improved by 38.5% in the conventional group and 34.5% in the Retina Track group (p < 0.0001). Risk factor awareness declined by 23.1% in the conventional group at 3 months but was sustained with a 20.0% increase in the Retina Track group (p = 0.0358). Disease progression awareness showed a significant 21.8% increase in the Retina Track group (p = 0.0174), while treatment awareness, though initially higher in the conventional group, declined sharply by 25.9%, in contrast with sustained awareness in the Retina Track group.
Conclusion: The Retina Track application significantly enhances and maintains patient awareness, particularly in areas where conventional methods falter over time. These findings highlight the value of technology-assisted interventions in chronic disease management and support further research into long-term clinical impacts.

Management of Bilateral Descemet’s Membrane Detachment Following Cataract Surgery: A Case Report

Pey Yih Ng — 2024-12-30

Unilateral, small peripheral Descemet’s membrane (DM) detachment (DMD) associated with cataract surgery is fairly common. However, bilateral DMD following uneventful cataract surgery is relatively rare. Conventional treatments for DMD include the injection of air, viscoelastic, or a gaseous tamponade agent. Here, we report a rare case of extensive bilateral DMD following uneventful cataract surgery and highlight a simple surgical approach that can be performed by a general ophthalmologist in treating DMD.

The Challenges in the Management of Sympathetic Ophthalmia: A Case Study

Yii Hern Eng — 2024-12-30

The article does not have an abstract.