Eye South East Asia

A Comparative Study of Pain Intensity in Patients Receiving Cooling Botulinum Toxin (BTX) and Non-cooling BTX

Orn Tempatarachoke — Sat, 29 Jun 2024 00:00:00 +0700

Objective: To compare pain intensity in the patients who receive both cooling Botulinum toxin (BTX) injections and non-cooling BTX injections around the periocular area.

Methods: A Prospective, randomized, single-blind controlled trial study of patients who had bilateral blepharospasm or bilateral hemifacial spasm between June 2021 and October 2022. Each patient received 10 points of BTX injections around the periocular area (randomized into 5 injection points each of cooling and non-cooling BTX respectively). A visual analog scale (VAS) was used to measure the pain intensity immediately after injection at each point. Main outcome measures: pain score and complication. cooling botox: 15-18℃, non-cooling botox: room temperature 25-27℃.

Results: A cohort of 11 patients received 55 points for cooling BTX injections and 55 points for non-cooling BTX injections. The mean pain score of the cooling BTX group was 1.91 ± 1.59, while the non- cooling BTX group had a mean pain score of 1.89 ± 1.59, the difference was not statistically significant (p = 0.887). The highest pain levels in both groups were at the upper eyelids and lower (mean pain score of 2.0).

Conclusion: There was no significant difference in the pain intensity and complication between cooling BTX and non-cooling BTX injections.

Conflicts of Interest: none

Reliability and Validity of the Thai Version – The Standardized Patient Evaluation of Eye Dryness (T-SPEED)

Pakornkit Phrueksaudomchai, Jidtra Pawa — Sat, 29 Jun 2024 00:00:00 +0700

Objective: To evaluate the reliability and validity of the Thai version of The Standardized Patient Evaluation of Eye Dryness questionnaire (T-SPEED)

Design: Cross-sectional descriptive study

Methods: Consisting of four steps
1) Translation of the SPEED questionnaire from English to Thai by a team consisting of an ophthalmologist and a linguist, subsequently reverse-translated from Thai to English by a separate team.
2) Content and construct validity of the translated questionnaire were evaluated by a group of ten experts.
3) Reliability of the translated questionnaire was evaluated from responses of 290 volunteers aged between 18 and 80 years of age, via Google Forms. The period allowed for response was from the 1st August 2022-31st January 2023.
4) Data analysis and evaluation of reliability and validity using item analysis and Cronbach’s Alpha Coefficient.

Results: The indexes of item-objective congruence (IOC) with a mean of 0.93. Content Validity Index scores (CVI) with a mean of 0.98. Item-level Content Validity Index (I-CVI) scores ranged between 0.9 and 1.0 with a total scale-level Content Validity Index (S-CVI) of 0.99. Data suggests this questionnaire has credible validity in both congruence and content. In addition, the data also suggests that the questionnaire has a statistically significant reliability. The group of four questions regarding frequency and regarding severity of eye dryness had a Cronbach Alpha Coefficient value of 0.775 and 0.837 respectively, which may be interpreted as credible.

Conclusion: The Thai-translated version of the SPEED questionnaire has both credible validity and reliability and can be applied to the Thai population and may be particularly beneficial in screening and follow-up of Thai patients with dry eye disease.

Evaluation of the Relationship between Serum TSH Receptor Antibody and Dry Eye Syndrome in Graves’ Disease: A Cross-sectional Study

Pawarit Wanichsetakul, Nonthapan Narong, Peeradon Vibhatavata — Sat, 29 Jun 2024 00:00:00 +0700

Background: This study aimed to evaluate the relationship between serum TSH receptor antibody levels and dry eye syndrome in Graves' disease patients without graves’ orbitopathy.

Methods: This cross-sectional study encompassed 28 eyes of 14 individuals diagnosed with Graves’ disease. Serum TSH receptor antibodies were measured followed by dry eye parameters assessed via the OCULUS Keratograph® 5M specifically Non-Invasive Keratograph Break-Up Time, tear meniscus height, and redness score. Dry eye symptoms were assessed with OSDI score.

Results: The majority of Graves’ disease patients exhibit moderate severity of dry eye symptoms (Mean OSDI score = 25.05) and high TSH receptor antibody level (Mean TRAb level = 9.61). The TSH receptor antibody level shows a significant association primarily with the redness score (r = 0.410, p = 0.030). However, no significant correlations were observed between the TSH receptor antibody level and tear meniscus height, NIKBUT, or OSDI score.

Conclusion: In Graves’ disease patients without Graves orbitopathy, a correlation was observed between Serum TSH receptor antibody levels and the redness score. However, there was no correlation between TSH receptor antibody levels and other dry eye parameters or symptoms associated with dry eye syndrome.

Conflicts of Interest: no financial interest in any products or instruments mentioned in this study.

Effectiveness of Phacoemulsification with Goniosynechialysis in Angle Closure

Dechathon Asanathong — Sat, 29 Jun 2024 00:00:00 +0700

Objective: To study the effect of phacoemulsification with goniosynechialysis on the reduction of intraocular pressure and the medications usage in the treatment of patients with angle closure glaucoma.

Material and method: Patients who underwent phacoemulsification with goniosynechialysis between January 2019 and January 2022 were included in the study. Patient histories and records were obtained from the electronic hospital database.

Results: A total of 28 patients were included in this study, 75% being female, were enrolled in the study. The distribution of left and right eyes was equal. The average age of the patients was 59.28±8.04 years, and the mean visual acuity was Logmar 0.92±0.46. The average intraocular pressure (IOP) at baseline was 25.07±12.66 mmHg, ranging from 9 to 55 mmHg. The patients were using an average of 2.86±1.33 types of glaucoma medications. After 3 months of treatment, the average number of drops of glaucoma medications used decreased from 3.93 to 1.64 drops (P= <0.001, 95%CI [1.35,3.22]). The average intraocular pressure decreased from 25.07 mmHg to 12.75 mmHg (P= <0.001, 95%CI [7.76,16.88]), and the average number of types of glaucoma medications decreased from 2.86 to 1.53 (P= <0.001, 95%CI [0.65,2.00]).

Conclusions: Phacoemulsification with goniosynechialysis has been shown to be effective in lowering intraocular pressure in patients with angle closure glaucoma. Additionally, this procedure has the potential to decrease the number and types of glaucoma medications needed for managing the condition.

Evaluating the Correlation Between Pterygium SLIT2 Grading System and OCULUS Keratography

Sat, 29 Jun 2024 00:00:00 +0700

Background: To evaluate ocular surface parameters using the OCULUS K5 Keratograph in unilateral pterygium eyes and explore SLIT2 grading's correlation.

Method: A prospective study involved 67 participants with unilateral primary nasal pterygium. Primary objective is to compare the ocular surface parameters measured by the OCULAR K5 Keratograph in the pterygium eye and its contralateral non-pterygium eye. Our secondary objective is to find the correlation between SLIT2 grading to the ocular surface parameters measured by the OCULAR K5 Keratograph in the pterygium eye.

Results: Comparing pterygium and its contralateral non-pterygium eye, our finding reported a decreased TBUT (6.76 ± 4.87 and 8.66 ± 5.13 seconds, p = 0.001) and elevated bulbar redness (1.98 ± 0.56 and 1.42 ± 0.44, p < 0.0011). High-grade SLIT2 pterygium injection was found to be related with shorter TBUT (low grade TBUT 5.05±0.70seconds, high grade TBUT 4.44±3.38, p = 0.035). SLIT2 grading also exhibited significant correlations with bulbar redness, except for Stalker's line.

Conclusion: Pterygium eyes displayed reduced TBUT and increased bulbar redness. High-grade pterygium body injections associated with shorter TBUT. Bulbar redness showed significant differences in SLIT2 grading, excluding Stalker's line. No significant variations were observed in tear meniscus height and meibomian gland dysfunction grading.

Photo Integrated Experience Challenge (PIEC): An Innovative Active Learning Method for Teaching Ophthalmology Residents

Sat, 29 Jun 2024 00:00:00 +0700

Background: Active learning has emerged as a cornerstone in medical education, promoting superior knowledge retention and social-cognitive skills compared to traditional methods. For ophthalmology residents, developing proficiency in interpreting ophthalmic images is paramount, as over 80-90% of ocular diagnoses rely on ophthalmic images from digital slit lamp and other ophthalmic devices. In light of this, we introduce the Photo Integrated Experience Challenge (PIEC), an innovative active learning method that leverages the combined strengths of ophthalmic image recognition and personal experience sharing. This study aims to evaluate the effectiveness of PIEC, along with gathering residents feedback on its implementation.

Methods: This is a single-center, prospective study involving 29 ophthalmology residents from Department of Ophthalmology, Thammasat University, Thailand. The PIEC session consisted of 5-6 participants and lasted for 50 minutes. Initially, a first-year resident initiates the discussion by sharing their existing knowledge and observations related to a pre-assigned ophthalmic image. Subsequently, second- and third-year residents expand upon the initial insights, offering additional perspectives and integrating their personal clinical experiences with the topic. Throughout the process, the instructor helps facilitate the discussion, share expert knowledge and experience from clinical practice, and synthesize key learning points and give instant feedback at the session's conclusion. To objectively assess knowledge acquisition, 29 participating residents completed pre- and post-course self-evaluations on each covered topic. Additionally, a feedback questionnaire was employed to qualitatively evaluate student experiences and perceptions of PIEC.

Results: Mean pre- and post-course self-evaluation scores significantly increased from 52.70% to 82.60% (p<0.05), demonstrating improved knowledge acquisition. Qualitative feedback revealed PIEC fostered deeper understanding, engagement, and critical thinking. Residents reported increased confidence in communication and knowledge integration.

Conclusion: PIEC effectively enhances ophthalmology residents' knowledge, critical thinking, and communication skills, suggesting its potential as a valuable active learning tool in ophthalmology education.

Conflicts of Interest: Authors have no conflict of interest.

Multiple Cranial Nerve Involvement as the Initial Manifestation of Primary Central Nervous System Lymphoma

Muhammad Syafiq Ahmad Musthafa, Nor Higrayati Ahmad Kasah, Norlina Ramli — Sat, 29 Jun 2024 00:00:00 +0700

Background: Primary central nervous system lymphoma (PCNSL) which mostly consists of B-cell lymphomas can be described as extranodal high-grade non-Hodgkin lymphoma that is limited to the central nervous system

Case presentation: We report a case of a newly-diagnosed retroviral-positive patient who first presented with multiple cranial nerve palsy, started with left facial asymmetry for three weeks and subsequently developed symptoms involving multiple neurological foci and eye manifestations. Blood investigations revealed a markedly elevated level of lactate dehydrogenase (LDH) and cerebrospinal fluid analysis showed the presence of Oligoclonal bands. Magnetic Resonance Imaging (MRI) of the brain and orbit revealed multiple brain hyperintense T2 lesions, enlarged extraocular muscle and perineural enhancement of the optic nerve. Diagnosis of central nervous system (CNS) lymphoma was eventually confirmed by biopsy of globus pallidus that showed diffuse large B-cell lymphoma however no specific treatment was initiated due to patient succumbed to death post biopsy.

Conclusion: We report a case of a newly-diagnosed retroviral-positive patient who first presented with multiple cranial nerve palsy, started with left facial asymmetry for three weeks and subsequently developed symptoms involving multiple neurological foci and eye manifestations. Blood investigations revealed a markedly elevated level of lactate dehydrogenase (LDH) and cerebrospinal fluid analysis showed the presence of Oligoclonal bands. Magnetic Resonance Imaging (MRI) of the brain and orbit revealed multiple brain hyperintense T2 lesions, enlarged extraocular muscle and perineural enhancement of the optic nerve. Diagnosis of central nervous system (CNS) lymphoma was eventually confirmed by biopsy of globus pallidus that showed diffuse large B-cell lymphoma however no specific treatment was initiated due to patient succumbed to death post biopsy

Conflict of interest: None to declare.

Fibrin Pupillary-block Glaucoma after Uneventful Phacovitrectomy in a Patient with Proliferative Diabetic Retinopathy (PDR): A Case Report

Fahsiri Tavonvunchai, Nantinee Vilainerun, Puntanarach Gacivut — Sat, 29 Jun 2024 00:00:00 +0700

Background: Fibrin pupillary-block glaucoma is an uncommon complication after phacoemulsification or vitrectomy. Various treatment modalities relieving fibrin pupillary-block have been reported, such as intracameral recombinant tissue plasminogen activator (rTPA), argon–neodymium: YAG (Nd:YAG) laser iridotomy, Nd:YAG laser membranotomy, and medical dilation.

Objective: To report a patient with proliferative diabetic retinopathy (PDR) who developed fibrin pupillary-block glaucoma after uneventful phacovitrectomy and was successfully treated with Nd:YAG laser membranotomy.

Methods: Retrospective case report.

Results: The patient was a 59-year-old Thai male with PDR, epiretinal membrane and tractional macular edema in his left eye. Combined phacoemulsification with pars plana vitrectomy (PPV) was performed. On postoperative day 7, the patient presented with blurred vision from corneal microcystic epithelial edema associated intraocular pressure (IOP) spike due to the presence of fibrin membrane obstructing the pupil opening and was diagnosed with fibrin pupillary-block glaucoma. Nd:YAG laser membranotomy was performed and resulted in complete resolution of pupillary block.

Conclusion:Laser Nd:YAG membranotomy provides safe and effective resolution of fibrin pupillary-block glaucom.