Outcome of porous implants: incidence of complications, management, and morbidity.

OBJECTIVE: To determine the incidence of complications and the outcome associated with the use of three kinds of ocular porous implants. MATERIAL AND METHOD: Retrospective review of 133 consecutive case series. All patients undergoing orbital implantation either primary or secondary implantation of 49 coral hydroxyapatite, 43 human bone hydroxyapatite and 39 bovine bone hydroxyapatite from September 1995 to September 2007 were included. Charts were reviewed for preoperative diagnoses, type and size of implant, use of a wrapping material, and complications. Patients were followed for signs of inflammation, infection, extrusion, or other complications. RESULTS: There are more exposures of human bone hydroxyapatite (8.16%) and bovine bone hydroxyapatite (7.69%) than coralline hydroxyapatite implants (2.22%). Spontaneous healing of exposures occurred in 25% (2 of 8) of cases. Covering exposures with patch grafts underneath vascularized conjunctival flaps was the most successful method of surgical repair in 2 cases (25%). Chronic infection of the 2 exposed human bone hydroxyapatite leading to the removal of the 2 implants (1.5%). Conjunctival granulomas and late exposure developed in 2 and 3 patients after peg coupling respectively. There were no cases of implant migration or prolonged inflammation related to the covering material. CONCLUSION: Careful selection of surgical technique, implant type and size may help reduce the risk of severe complications.

Glaucoma care and clinical profile in Priest Hospital, Thailand.

OBJECTIVE: To assess the prevalence, mechanism and status of glaucoma, and to investigate the magnitude of visual impairment from glaucoma and its relating factors in Buddhist priest and novices. MATERIAL AND METHOD: Cross-sectional study of 190 patients treated in Glaucoma service, Priest hospital was performed. One hundred thirty seven patients with glaucoma and suspected glaucoma had comprehensive ophthalmic examination included interview on medical and ocular history, visual acuity, applanation tonometry, gonioscopy, optic disc, visual field evaluation, and retinal nerve fiber layer thickness measurement (Stratus Optical Coherence Tomography; Stratus OCT). RESULTS: Glaucoma was diagnosed in 106 (77%) patients (181 eyes); 31 patients (23%) were glaucoma suspects. Open angle glaucoma (OAG) was found in 53 (50%) cases and classified into 36 (33%) primary open angle glaucoma and 17 (16%) normal tension glaucoma (NTG). Five (4.6%) patients had pseudoexfoliative glaucoma, 24 (23%) had primary angle-closure glaucoma (PACG), 10 (9.4%) had angle-closure glaucoma secondary to other causes (SACG), seven (6.6%) had secondary open angle glaucoma and seven (6.6%) were diagnosed of juvenile glaucoma. Among 31 glaucoma suspects, 18 cases were diagnosed based on disc appearance, eight based on intraocular pressure (IOP), two based on visual field and three cases had primary angle closure (PAC). The prevalence of glaucoma increased with age, with the highest prevalence (33%) in the age range 71 to 80 years. The Glaucoma service of Priest hospital diagnosed glaucoma in 53% of the priest. Rate of glaucoma was higher in priest from rural area than those from Bangkok and urban area. The mean baseline IOP was 26.5 +/- 14.7 mmHg. The mean treated IOP was 14.5 +/- 7.9 mmHg. The average mean deviation (MD) was -14.45 +/- 11.11. OCT showed average RNFL thickness of 70.8 +/- 35.6 microm. Glaucoma medications was received by 72% of the priest, 18% had laser treatment, and 22 % had glaucoma surgery. At diagnosis, two patients were blind according to WHO criteria, 29 (28%) patients were unilaterally blind, and seven (6.5%) had low vision. After treatment, 31 (29%) patients had unilateral blindness and none had bilateral blindness. The main associated diseases were hypertension, dyslipidemia, and diabetes. Transportation and financial condition were the major barriers in receiving eye care. CONCLUSIONS: OAG comprised 50% of all glaucoma, 23% of PACG, and 16% of all subtypes of secondary glaucoma. The prevalence of glaucoma in priest rose significantly with age. In the treated glaucoma patients, 47% retained good visual outcome. Delayed diagnosis was a major factor for unsatisfactory outcome as 28% of patients had monocular blindness at diagnosis and 53% were previously unaware of their disease.

Eye health in the priests and novices in central Bangkok.

BACKGROUND: Early detection and proper management of eye diseases in priests and novices is cost effective, and minimize serious ocular damage and permanent loss of vision. Therefore, the Department of Ophthalmology, Priest Hospital set-up an eye examination project for the priests and novices who came for physical examination. The laboratory test was part of the Sustained and Holistic Healthcare Program for Priests and Novices as Commemoration of His Majesty the King's 60 Years of Accession to the Throne. OBJECTIVE: To evaluate eye health status and screening for refractive error in priests and novices and to provide free spectacles and eye health education to fulfill the criteria of voluntary Buddhist eye health workers. MATERIAL AND METHOD: Between February and June 2006, the Department of Ophthalmology, Priest Hospital conducted eye examination for the priests and novices in 28 temples in central Bangkok. The priest and novices with refractive error and abnormal eye examination received appointment for repeated refraction and complete eye examination in Priest Hospital. RESULTS: Six hundred forty nine priests and novices had complete eye examination. Normal visual acuity (Snellen VA 20/20) was found in 355 (54.69%) cases. The most common eye diseases were refractive error with 294 cases (45.30%), cataract with 41 cases (6.32%), glaucoma with 10 cases (1.54%) and vitreoretinal diseases, which included diabetic retinopathy, age related macular degeneration and branch retinal venous occlusion with eight cases (1.23%). Three novices had amblyopia (0.46%). CONCLUSION: Most of the priests and novices in central Bangkok had good eye health. Half of the eye problems were refractive errors. Since most of other eye diseases reported in priests were associated with aging and systemic diseases as hypertension, diabetes, and ischemic heart disease, regular ophthalmic examination should be provided in this risk group. Eye health education should be provided for sustainable eye health development as voluntary eye health workers in Buddhism.

Eye health of priests and novices in rural area.

BACKGROUND: Early detection and treatment of eye diseases is important to minimize visual morbidity and permanent visual loss in general and priests' population. OBJECTIVE: To evaluate eye health status, visual acuity and eye diseases of the priests and novices, to estimate the prevalence and causes of visual impairment, and to provide eye health education. MATERIAL AND METHOD: Between May 2006 and March 2007, the priests and novices in selected village (stratified population cluster random sampling) of 22 provinces in The First National Survey of Blindness and Visual Impairment Program in Thailand (TVIP) had their visual acuity (VA) and intraocular pressure (IOP) measured and eye examined by ophthalmic nurses. An ophthalmologist examined the anterior and posterior segment and took fundus pictures. RESULTS: Two hundred sixty eight priests and novices were examined. Their age ranged between 12 and 88 years with a mean of 48.5 years. Most priests and novices had normal vision (20/20-20/40 - 67.54%). No priest and novices had bilateral blindness. Almost half (48.13%) had eyeglasses and 2.24% had bilateral low vision. Unilateral low vision and unilateral blindness were 3.73% and 3.36%. One eye blindness and one eye low vision was only 0.37%. Refractive error was the leading cause of visual impairment (22.39%), followed by cataract (17.54%), glaucoma (5.97%), vitreo-retinal diseases (1.49%), and glaucoma suspected (occludable angle and ocular hypertension) (3.35%). Fifty five priests (20.52%) were referred for further investigation and treatment. CONCLUSION: Because the mean age of the priests and novices in this survey was only 48.5 years, the prevalence of visual impairment was low. Most of the cases were avoidable or preventable. The implementation of an effective screening program and access to eye treatment with standard of care remains a priority for the priests in rural areas. For sustainable development, eye health education must be promoted.