Eye South East Asia

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

Mon, 30 Dec 2024 00:00:00 +0700

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

YII HERN ENG, WENDY YEN NEE SEE — Mon, 30 Dec 2024 00:00:00 +0700

Background

Sympathetic ophthalmia is a rare bilateral granulomatous uveitis following ocular trauma or surgery. The first line treatment of sympathetic ophthalmia is aggressive use of corticosteroid therapy. However the relapsing nature of the disease and the adverse reactions patient suffered from high dose corticosteroid therapy are where the challenges lie in managing patient with sympathetic ophthalmia.

Methods

Case report: The patient presented to us with right eye blurring of vision and redness with history of left eye scleral rupture secondary to blunt trauma one month ago. Examination revealed bilateral anterior uveitis with keratic precipitate and multifocal serous retinal detachment on fundus examination. Patient was diagnosed with right eye sympathetic ophthalmia. He was started on high dose corticosteroid therapy. However, immunomodulating agents were also initiated as patient developed steroid induced glaucoma during his treatment. Nonetheless, patient was able to achieve remission with good visual outcome after fine tuning his immunosuppressive therapy.

Conclusion

Symphathetic ophthalmia is a rare bilateral granulomatous uveitis. Hence, it is crucial to retain an index of suspicion in patient with history of ocular trauma or surgery as well as prompt immunosuppression therapy. A good visual outcome is attainable by fine tuning the balance between the control of ocular inflammation and complication of the immunosuppressive therapy.

Conflicts of Interest

We declare that there are no conflicts of interest

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

Mon, 30 Dec 2024 00:00:00 +0700

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, Mrs, Prof. , Dr., Prof. — Mon, 30 Dec 2024 00:00:00 +0700

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, Gaanchisa Vongchaiyakit — Mon, 30 Dec 2024 00:00:00 +0700

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, Guechlaing Chea — Mon, 30 Dec 2024 00:00:00 +0700

Purpose: To evaluate the incidence and significant risk factors of glaucoma after penetrating keratoplasty (PK) operation.

Methods: A retrospective study of 62 eyes of 61 patients who underwent penetrating keratoplasty from January 2020 to December 2022 in Thammasat University Hospital, Thailand, was carried out. Age, sex, preoperative diagnosis, the presence of preoperative glaucoma, recipient graft size, the status of the lenses, and additional surgery performed during keratoplasty, which may affect the postoperative intraocular pressure, were evaluated.

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 ³ 8mm, 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 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.. Patient 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 — Mon, 30 Dec 2024 00:00:00 +0700

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 disease through time is important in diagnosing and prognosticating of disease.

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. Early diagnosis and treatment of disease leads to better outcomes.

Keywords: acute primary angle closure, clinical characteristics, intraocular pressure, visual acuity

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

Luksamon Pas-arj, Sutee Ananprasert, Naruechanok Lertkusol — Mon, 30 Dec 2024 00:00:00 +0700

Objectives: To compare the efficacy and safety of intratenon injection of mitomycin-C (MMC) with

that of conventional application of soaked-sponge-applied mitomycin C 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-applied. Postoperative intraocular pressure (IOP) level was the primary outcome measure, with survival rates for IOP control, number of glaucoma medication used, complication rates, and vision serving as secondary outcomes.

Results : The 90 eyes were 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). However, there were four patients experienced no light perception vision in intratenon compared with only one patient in

soaked-sponge group. A Time to failure for postoperative IOP control was significantly different between groups. There was higher in 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.
Keywords : Trabeculectomy, Intratenon injection mitomycin-C, Soaked-sponge-applied mitomycin- C

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

Pakornkit Phrueksaudomchai, Natcha Manasilp — Mon, 30 Dec 2024 00:00:00 +0700

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. 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, comprised of 23 (27.06%) first year residency trainees, 35 (41.18%) second year residency trainees and 27 (311.76) third year residency trainees. Of these, 56 (65.88) trainees graduated from medical school in urban area, 29 (34.12%) graduated from regional area. Female trainees predominated, with the total of 52 (61.18%), with a mean age of 29 years old. Among all, 46 (54%) trainees work in urban area and 39 (46%) work in rural area. The most influencial factor 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 factor that influences the decision to apply for Ophthalmology Residency Training respectively. There were some correlations between factors such as area of doctor of medicine graduation, age and area of work, which also influenced the choosing of ophthalmology training.

Retrospective analysis of corneal ectatic disease and associated risk factors at a tertiary hospital in Thailand.

Monrada Amorntipsakul — Mon, 30 Dec 2024 00:00:00 +0700

Background: A study on the prevalence and related factors of corneal ectasia in Thammasat Eye Center. To provide public health information in 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 at Thammasat 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 diagnoses 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. Additional aspect reveals that 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.

Keywords: Corneal ectasia, Keratoconus

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)

Mon, 30 Dec 2024 00:00:00 +0700

Background: Neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) therapy require continuous follow up. Various evidences researched on root cause for low adherence to the treatment and found that disease awareness and knowledge play importance role on patient decision for treatment and follow up. This study aims to assess the effects of this web-based application on patient awareness on disease and treatment.

Methods: In this prospective study, 110 patients receiving anti-vascular endothelial growth factor (anti-VEGF) therapy for nAMD or DME for at least 3 months at Thammasat University Hospital during September 2021 to February 2022 were enrolled. They were randomized 1:1 into conventional approach and Retina Track approach. Participants were interviewed using the Patient Awareness Questionnaire at index date, and the first follow-up.

Results: In Retina Track group, there were significant increases in awareness across all aspects after knowledge acquisition and at the 3-month follow-up compared to before knowledge acquisition, including disease name (12.8% and 16.4%), and disease cause (29.0% and 34.5%). Awareness of risk factor and disease progression show significant increase of 20.0% and 21.8% at the 3-month follow-up. In the conventional approach group, significant increases were also found for all aspects after knowledge acquisition compared to before knowledge acquisition but risk factor and treatment awareness significantly decreased at the 3-month follow-up.

Conclusion: The results demonstrate that while both groups benefited from the educational intervention, the Retina Track played acritical role in both enhancing and maintaining disease awareness.