Eye South East Asia

Herpetic Acute Retinal Necrosis (ARN) Complicated by Panophthalmitis - A Rare Ocular Presentation: A Case Report

Fri, 27 Jun 2025 00:00:00 +0700

Purpose: To describe an atypical manifestation of panophthalmitis resulting from human herpes simplex virus 2 (HSV-2) infection.
Methods: A case report
Results: A 39-year-old Cambodian man presented with severe orbital inflammation, pain, restriction of eye movement, granulomatous panuveitis and poor view of retina in his right eye, suggesting panophthalmitis. Prompt diagnostic vitrectomy confirmed herpetic acute retinal necrosis (ARN) caused by HSV-2 infection. Treatment with intravenous acyclovir and corticosteroids resulted in improved inflammation and visual acuity (VA), increasing from counting fingers to 5/200 within two weeks. However, rhegmatogenous retinal detachment subsequently developed with unfavorable visual outcome.
Conclusions: Panophthalmitis is an unusual presentation of herpetic acute retinal necrosis. This report contributes to a better understanding of the various presentations of ARN and emphasizes the importance of early recognition and proactive management to prevent long-term visual impairment.

Purtscher-like Retinopathy an Unusual Complication of Retrobulbar Anesthesia after Cataract Surgery

Parinya Srihatrai, Hataiphat Tamnakpo — Fri, 27 Jun 2025 00:00:00 +0700

Purtscher and Purtscher-like retinopathy are exceptionally rare conditions characterized by a distinctive pattern of ischemic retinal fundus findings, typically following traumatic or non-traumatic events, respectively, and resulting in sudden and severe visual impairment. We report the case of a 77-year-old male patient who experienced acute visual loss following retrobulbar anesthesia administered for routine cataract surgery. This case highlights a rare instance of Purtscher-like retinopathy as a complication of retrobulbar anesthesia which is a commonly used technique in ophthalmic surgery that provides effective akinesia and anesthesia. Although the peribulbar technique is often favored for its lower risk of optic nerve injury and intradural injection, it has also been associated with complications, including central retinal artery occlusion and Purtscher-like retinopathy.¹

Treatment Outcome of Proliferative Diabetic Retinopathy Management in Thailand: A Retrospective Study (Today Study)

Fri, 27 Jun 2025 00:00:00 +0700

Introduction: The study aimed to assess real-world treatment outcomes of proliferative diabetic retinopathy (PDR) in terms of visual acuity (VA) change after pan-retinal photocoagulation (PRP) with adjunct treatments and clinical burden in Thailand.
Methods: Multi-center retrospective medical review of the patients with PDR who received the first PRP from 1 June 2016 to 30 June 2019 with at least 1-year follow-up data.
Result: 359 patients were included. Mean change in ETDRS letters VA declined at year 1 (-2.44, 95% confidence interval [CI] -4.54 to -0.34, p = 0.023), year 2 (-3.52, 95%CI –6.85 to -0.18, p = 0.039) and year 3 (-7.38, 95%CI -13.77 to -0.99, p = 0.024). Of all 359 patients, 162 patients (45.13%) had PRP monotherapy, 164 patients (45.68%) had adjunctive anti-vascular endothelial growth factor treatments and a few had other adjunctive treatments. The median number of visits to complete PRP is 3, with a total of 8 visits within one year.
Conclusion: This study demonstrates real-world outcomes of a decline in VA following PRP in patients with PDR in Thailand. Due to the nature of retrospective study and lack of confounding control in this study, the results should be interpreted with caution. Adjunctive treatments were common in patients with PDR.
Conflicts of interest: This study was sponsored by Novartis (Thailand) Ltd.

Comparison of Re-vitrectomy Rates in TAP and INJECT versus Pars Plana Vitrectomy for Acute Endophthalmitis: A Retrospective Comparative Study

Fri, 27 Jun 2025 00:00:00 +0700

Background: Acute endophthalmitis is a severe complication of ocular surgery requiring prompt treatment to prevent vision loss. The optimal initial treatment—vitreous tapping with intravitreal injection (TAP) versus pars plana vitrectomy (PPV)—remains debated. Advances in vitrectomy techniques challenge conclusions from the Endophthalmitis Vitrectomy Study (EVS), prompting this study to compare re-vitrectomy rates and outcomes between TAP and PPV.
Methods: This retrospective study analyzed 34 patients diagnosed with acute endophthalmitis at a tertiary care center. Patients were divided into TAP (Group 1, n = 10) and PPV (Group 2, n = 24) groups. Demographic data, clinical presentations, microbial culture results, and outcomes—including visual acuity (VA) improvement and re-vitrectomy rates—were compared using statistical analyses. A subgroup analysis focused on patients with presenting VA ≥ hand motion.
Results: Group 1 (TAP) had a significantly higher re-vitrectomy rate (50% vs. 16.7%, p = 0.044) despite comparable VA improvement between groups (50% vs. 45.8%, p = 0.618). In the subgroup with VA ≥ hand motion, re-vitrectomy rates were higher in Group 1 (44.4% vs. 9.5%, p = 0.028), while VA improvement was similar (62.5% vs. 52.4%, p = 0.62). Positive microbial cultures were exclusive to Group 2 (29.1%).
Conclusion: TAP and PPV yield comparable VA improvement, but PPV significantly reduces the need for re-vitrectomy, highlighting the advantages of modern surgical techniques. Further research is needed to refine treatment protocols.

Comparing Efficacy of Combined Intense Pulsed Light Therapy and Low-level Light Therapy Versus Intense Pulsed Light for the Treatment of Dry Eye Disease: A Retrospective Study

Fri, 27 Jun 2025 00:00:00 +0700

Introduction: Dry eye disease is a prevalent condition that impacts millions of individuals globally, with meibomian gland dysfunction (MGD) being a significant contributor to the development of this condition. In recent years, intense pulsed light (IPL) and low-level light therapy (LLLT) have emerged as promising treatments for MGD-related dry eye disease. Several studies have reported that a combined therapy of IPL with LLLT is effective in treating MGD patients. However, to date, there is a lack of research comparing the efficacy of IPL alone versus IPL in combination with LLLT in the treatment of dry eye patients.
Purpose: To compare the efficacy of Intense Pulsed Light therapy combined with Low-Level Light therapy Versus Intense Pulsed Light for the treatment of dry eye disease
Study design: Retrospective single-center clinical study
Materials and Methods: Patients presenting with a dry eye disease (DED) with MGD and having received treatment with IPL or IPL with LLLT at Thammasat University Hospital between February 2023 and November 2023 were included. The single IPL session and combined IPL and LLLT session was performed once weekly over 3 weeks. The end point was the mean difference of DEQ-5 score between baseline (0-14 days before the first session of the treatment) and 2 weeks after the last session. Data collection was done retrospectively. Statistical analysis was done using STATA 16.0.
Results: 51 patients were included (25 patients from IPL group, 26 patients from IPL with LLLT group). DEQ-5 score significantly decreased after the single IPL treatment and the combined IPL with LLLT treatment (P < 0.001). Patients in the combined IPL with LLLT group showed significant improvement in DEQ-5 score compared with the single IPL group (-10.2 ± 3.1 vs -7.8 ± 2.1, P < 0.05). There was no adverse effect reported in both groups.
Conclusions: Both IPL and IPL with LLLT were safe and effective in improving ocular discomfort symptoms in MGD-related dry eye disease. However, the combined IPL with LLLT determined a greater improvement in symptoms.

Characteristics of Open Globe Injury in a Tertiary Hospital of Thailand and Predictive Factors for Visual Outcomes.

Kritrath Panittaveekul, Kittichai Akrapipatkul , Supangpa Chuengtanacharoenlert — Fri, 27 Jun 2025 00:00:00 +0700

Background: Eye injuries are among the leading causes of visual impairment globally. This study investigated the characteristics of patients with open globe injuries and identified factors that may influence poor visual outcomes.
Methods: Retrospective review of 96 patients with open globe injury (OGI) between 2018 and 2023, presenting at Thammasat University Hospital. Demographic data and prognostic factors that influence the final visual outcome were examined. Statistical analysis was conducted using univariate and multiple logistic regression analysis.
Results: Of 96 patients, 85.4% were male, and the mean age was 44.64 ± 19.52 years. The outdoors was the leading place of open globe injury (OGI) (38.5%), followed by the workplace (31.3%). Construction was the most common culprit activity (37.5%). High-velocity metallic objects were the most common cause (42.7%). Penetrating injury is the most common type of injury (51.0%), followed by globe rupture (31.3%) and IOFB (17.7%). In a univariate analysis, factors that statistically affected visual outcome are older age, poor initial VA (2.12 ± 0.41 logMAR), globe rupture as a type of open globe injury, positive RAPD, present of retinal detachment, vitreous hemorrhage, eyelid laceration, and Low Ocular Trauma Score (OTS). In multivariate logistic regression analysis, poor initial VA, presence of retinal detachment, and Low OTS were found to be statistically significant.
Conclusion: In this retrospective study, the majority of patients with open globe injury were male. The mean age of the patients was 44.6 ± 19.5 years. The most important factors influencing final visual outcome were poor initial VA, presence of retinal detachment, and low OTS. This can be used to inform patient prognosis and identify strategies to prevent OGI.
Conflicts of Interest: This study has no conflicts of interest.