ABSTRACT
Objective: To study long-term clinical complications of Vogt-Koyanagi-Harada (VKH) disease and to compare retinal thickness using optical coherence tomography (OCT) in VKH patients with age- and gender-matched controls.Methods: Patients diagnosed with VKH for more than 6 months were identified from hospital files. Clinical presentation and clinical course were studied. OCT of the retina was performed in these patients during the most recent follow-up examination to compare with age- and gender-matched controls recruited from outpatient clinics.Results: Eighteen VKH patients (4 male, 14 female) were studied. Mean age at diagnosis was 35.1 years (SD 13.0). Mean age at last follow up was 40.8 years (SD=15.1). Median time to last follow-up was 5.2 years (interquartile range=1.7-8.1). Thirty eyes (83%) developed at least one complication, including recurrent anterior uveitis in 16 eyes (44%), glaucoma in 16 eyes (44%), cataract in 11 eyes (31%), pseudophakia in 10 eyes (28%), and aphakia in one eye (3%). Two patients were blind in one eye. Tinnitus persisted longer than 6 months in two patients. Cutaneous complications such as alopecia, vitiligo, and poliosis were present in seven patients (39%). Mean central retinal thickness was 190.1 microns (SD 61.5), comparing with 181.5 microns (SD=47.9) in controls, p=0.43. Mean retinal thickness at superior inner macula was 250.6 microns (SD=65.5), comparing with 259.0 microns (SD=66.0) in controls, p=0.15.Conclusion: Most of the VKH patients develop long-term clinical complications. The retinal thickness, measured by OCT, in VKH patients is not significantly different from that of age- and gender-matched controls.
ABSTRACT
Background: Retrobulbar anesthesia is a routine regional block for various ocular surgeries, but serious complications may occur. There have been no previous incidence reports and associating factors with these complications in Thailand. Objective: To study the incidence and factors associated with complications after retrobulbar anesthesia in Thailand. Methods: Samples were all consecutive cases undergoing retrobulbar anesthesia at King Chulalongkorn Memorial Hospital between June 2006 and May 2007. All subjects have given informed consent to participate in the study. The variables recorded included the subject baseline data, the retrobulbar block technique, and complications. Descriptive statistics and multiple logistic regression were used to analyze the data. Results: One thousand eighty eyes from 1072 patients were studied. Underlying systemic diseases were present in 48.1% of cases. Underlying ophthalmic diseases included glaucoma 3.5% and retinal diseases 3.5%. Thirty-four percent of the eyes underwent phacoemulsification and 24.1% underwent extracapsular cataract extraction. Pars plana vitrectomy was performed in 25.9% of the eyes. Other procedures included corneal surgery, strabismus correction, endoscopic cyclophotocoagulation, and evisceration. The majority of the retrobulbar block was performed by the first year residents (67.3%). All of the blocks were performed by dominant hands. Complications after retrobulbar block were seen in 4.7% (95% CI=3.5-6.0%) of the eyes. Lid swelling, chemosis, and ecchymosis were seen in 23 eyes (2.1%). Retrobulbar hemorrhage was detected in 24 eyes (2.2%). Optic nerve injection and subarachnoid injection were seen in four eyes (0.4%). Factors associated with severe complications were patient age of 60 years or more, and history of recent use of anticoagulants. Conclusion: The incidence of complications after retrobulbar block is 4.7% of the eyes. Severe complications occur more frequently in elderly patients and recent use of anticoagulants.