Chorioretinal biopsy in an immunocompromised patient with subretinal mass.

A 59-year-old woman with autoimmune diseases presented with rapidly decreased vision in the left eye. Clinical examination and investigations were inconclusive. Pars plana vitrectomy and chorioretinal biopsy were performed. The histopathologic examination revealed acute branching, septate hyphae morphologically consistent with Aspergillus spp. The infection responded to systemic and intravitreous voriconazole. The subretinal mass gradually subsided but eventually the eye became blind. Chorioretinal biopsy is a valuable diagnostic procedure which, in some cases, may be the only way to provide a definite diagnosis and specific treatment of patients with progressive chorioretinal lesions of unknown etiology. In the presented case, although the vision cannot be recovered, we can avoid unnecessary enucleation and prevent the spread of infection that may threaten patient’s life.

Efficacy of amniotic membrane patching for acute chemical and thermal ocular burns.

OBJECTIVE: To study the efficacy of amniotic membrane patching (AMP) for acute chemical and thermal ocular burns and compare the results with a control group. MATERIAL AND METHOD: Fifteen patients (21 eyes) with acute ocular burn severity grading of II to IV were retrospectively reviewed. Thirteen eyes were treated with preserved AMP while eight eyes were treated with conventional treatment. Outcomes and complications were evaluated and compared between eyes in the AMP group and the control group with the same severity of burn. RESULTS: In the AMP group, the mean age was 36.9 +/- 11.7 years (range, 20-58). The mean follow-up time was 8.0 +/- 6.8 months (range, 1-20). Complete epithelialization was achieved in 69.2% (9/13 eyes) in total, 100% (5/5 eyes), 100% (3/3 eyes) and 20% (1/5 eyes) in grade II, III and IV respectively. Mean epithelial healing time in the AMP group was 10.4 +/- 5.8 days (range, 4-20). Comparison of grade 2 and 3 burns showed that the AMP group in which patching was performed within 5 days resulted in faster epithelial healing, less corneal haze and limbal deficiency than in the group in which patching was performed after 5 days, and the control group (mean epithelial defect 7.0 +/- 2.0, 19.5 +/- 0.7, 9.9 +/- 10.8 days respectively). CONCLUSION: Adjunctive treatment of ocular burns with AMP promoted rapid epithelial healing and reduced corneal complication. Surgery performed in the early stage tended to yield a better outcome.

Vogt-Koyanagi-Harada disease in Thai patients.

OBJECTIVES: To study the demographic, clinical manifestations, treatment and visual outcome of Vogt-Koyanagi-Harada disease (VKH) in a group of Thai patients. DESIGN: Retrospective case series. MATERIAL AND METHOD: Patients with VKH disease in Pramongkutklao Hospital from January 1998 to December 2002 were identified. Demographic data, clinical manifestations, treatment, and outcome were analyzed. RESULTS: Among the 33 patients, there were 12 males and 21 females with a mean age of onset of 35 +/- 13.4 year-old (range 17-67). Serous retinal detachment was detected in 48%. Transient hearing loss, vitiligo, poliosis and alopecia occurred in 18%, 24%, 15% and 33% respectively. Forty two percent of the patients were treated with systemic corticosteroids alone and 58% with a combination of steroids and immunosuppressive drugs. At the end of the follow-up, visual acuity (VA) improved in 55%, remained unchanged in 36% and worsened in 9% of the eyes. Final VA of equal or better than 20/40 was obtained in 76%. The mean follow-up time was 21.6 +/- 14.9 months (range 2-64). CONCLUSION: Demographic data, clinical manifestations, and treatment outcome of this group of Thai patients are comparable with studies from other countries.

Corneal lattice dystrophy, a concealed ophthalmic problem in Thailand.

One single family of corneal lattice dystrophy was examined and interviewed to elucidate the variety of clinical manifestations, factors associated with visual impairment, and the impact on the patient's quality of life. Forty-three out of 88 family members (48.9%) were affected. The inheritance pattern was autosomal dominant. Corneal haze grading from 1 to 4 was 5.3 per cent, 26.3 per cent, 43.4 per cent, and 25 per cent respectively. Surface irregularity grading from 1 to 4 was 18.4 per cent, 39.5 per cent, 32.9 per cent, and 9.2 per cent respectively. Forty-five per cent of the patients had VA < or = 20/200. Corneal haziness, irregularity, corneal erosion and disease duration were significantly related to visual impairment (p < 0.05). This disturbed the patient's activities such as reading (79.1%), working (62.8%) and daily life (69.8%). Corneal lattice dystrophy within the same family may present with different manifestations depending on the severity and duration of the disease and might be misdiagnosed. Inadequate knowledge among patients was susceptible to the high prevalence of the disease leading to impaired quality of life.