ABSTRACT
A 22-year-old Thai man from the Northeast region presented with acute eye swelling, itching, and discharge on his left eye. He was suspected of having gnathostomiasis and treated with albendazole and prednisolone for 3 weeks. Nine months later, he was treated with high-dose oral prednisolone for the preliminary and differential diagnoses with thyroid-associated orbitopathy and lymphoma. He had been administered prednisolone intermittently over a few years. Then he developed a painless movable mass at the left upper eyelid and recurrent pseudotumor oculi was suspected. The surgical removal of the mass was performed. A white pseudosegmented worm revealed a definite diagnosis of ocular sparganosis by a plerocercoid larva. Molecular diagnosis of the causative species was made based on the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene. Proper technique of extraction and amplification of short fragments DNA from formalin-fixed paraffin-embedded tissue successfully identified parasite species. The result from the sequencing of the PCR-amplified cox1 fragments in this study showed 99.0% sequence homology to Spirometra ranarum. This is the first report of S. ranarum in Thailand.
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.
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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.
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Background: There are a limited number of reports on the epidemiology of malignant tumors of the eye and ocular adnexa in Thailand. Objective: To study the relative frequency and patient characteristics of various malignant tumors of the eye and ocular adnexa. Methods: Data from the medical records of the patients diagnosed with malignant tumors of the eye and ocular adnexa during 2000 to 2005, including the patients’ gender, age of presentation, and clinical presentation were collected. Histopathology results were classified by the anatomical location: eyelid, conjunctiva, orbit, lacrimal gland, and intraocular tissue. Pathology slides were reviewed. Results: Ninety patient data were studied. The most common presentation was mass (44.6%), followed by proptosis (10.8%), and ulcer (9.6%). Most of the tumors were in male. The most common site was the conjunctiva (35.6%), followed by the eyelid (27.8%), the lacrimal gland (14.4%), the eyeball (10%), and the orbit (8.9%). Conjunctival squamous cell neoplasia (84.4%) was the most common conjunctival malignancy. The average age was 56.4 years. Basal cell carcinoma (64%) was the most common eyelid malignancy. The mean age of presentation was 67.4 years. Lymphoma was a major malignancy of the lacrimal gland (84.6%) and the orbit (62.5%). Retinoblastoma was the most common intraocular malignancy with a mean age of 24 months. There was only one case of corneal malignancy, which was corneal intraepithelial neoplasia. Conclusion: The conjunctiva was the most common location of malignancy of the eye and ocular adnexa. The demographic data help ophthalmologists and epidemiologists to monitor trends of malignancy of the eye and ocular adnexa in this geographic region and provide comparison with other populations.
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Background: Uveal malignant melanoma is not common among Asians and is rare in young people. Extensive necrosis of a tumor without prior treatment has scarcely been reported. Objective: To study the histopathology findings of a large uveal mass in a young female. Method: Review of clinical history, physical examination, ultrasonography, radiography, and histopathology were performed. Results: A 14-year-old Thai female with a past history of trauma presented with visual loss in her left eye. Total lens opacity was found. During the lens aspiration procedure, a dark ciliochoroidal mass was detected. A large uveal melanoma was suspected. The enucleated eye consisted of an extensively necrotic ciliochoroidal malignant melanoma with only tiny foci of the epithelioid cells at the tumor base. There was no extrascleral extension. A systemic work-up did not show extraocular involvement. Conclusion: We report a rare case of a large, necrotic type, uveal melanoma in a teenage Thai female.