Comparison of topical methylprednisolone 1% versus placebo in stevens – johnson syndrome and/or toxic epidermal necrolysis.

Objective: To study the efficacy of topical methylprednisolone compared with placebo in patients with Stevens-Johnson syndrome (SJS) and/or toxic epidermal necrolysis (TEN). Methods: Thirty-six patients were prospectively studied at Siriraj Hospital. The clinical severity score for ocular involvement was classified as mild, moderate and severe. In 12 patients with moderate severity, 1% methylprednisolone eye drop was added four times daily in one eye and 0.5% normal saline as placebo in another eye for one week. In 2 severe cases, these medications were added every 2 hours till bedtime for one week and four times daily for another week. Results: The average age of 14 patients was 50 ± 16.2 years (± SD), with female preponderance (12). Common precipitating factors were carbamazepine, nevirapine, phenytoin and dimenhydrinate. The common associated diseases were HIV. Five patients were not given systemic corticosteroid due to infection, and minimal skin involvement. The total severity score change in each group was the same at one month. In an average of 7.6 months follow up, most patients recovered normal appearance except for two eyes of the placebo group and one eye of the methylprednisolone group. The percentage of dry eye in the Schirmer test and the rose bengal score in the topical methylprednisolone eyes were not significantly less than in the control eyes. However, less tear production was statistically significant in patients with systemic corticosteroid. Conclusion: Topical corticosteroid might be used cautiously in early stages of SJS or TEN.

Quality of life assessment before and after laser in situ keratomileusis.

Objective: To assess the health-related quality of life in patients who underwent conventional laser in situ keratomileusis (LASIK). Methods: Eighty-five patients who underwent LASIK at the Excimer Unit at Siriraj Hospital were enrolled in the study. They were asked to complete a quality of life questionnaire before and after having an operation at 1, 3 and 6 months. The details of the questionnaire were published elsewhere. The questionnaire included 19 items in four categories and one independent item. Paired t-test, non parametric test and repeated measures were performed to compare pre- and post-operation results. Results: Of the total, there were 51 females (58.6%). Patients’ ages ranged from 16-50 years, with a mean age of 30.7 ± 8.7 (years ± SD). Cronbach’ alpha coefficients of the questionnaire were 0.74-0.81. In one-month (n=67), three-month (n=42) and 6-month (n=14) follow-ups, patients tended to score better on visual tasks and had a significantly better score satisfaction and emotional feeling domain. However, their score on the eye symptoms domain was worse after one month and got better after three months. In general, patients were satisfied with the results of the operation on follow-ups. Conclusion: The quality of life for patients undergoing LASIK has improved. Patients have better uncorrected vision, with more satisfaction and emotional feeling. Although they have more eye symptoms resulting from the operation, they were very satisfied with the results.

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.

Corneal sensitivity in normal Thai population.

ObjectiveTo measure corneal sensitivity in normal Thai people of different ages using the Cochet – Bonnet aesthesiometer. Methods: This prospective, cross-sectional study was conducted with three hundred normal Thai subjects (600 eyes) who were divided into six groups according to their age. Corneal sensitivity was measured by using a Cochet – Bonnet aesthesiometer at the central cornea. The mean filament length of three measurements was considered to be the corneal sensitivity threshold. Results: There were statistically significant differences in the mean corneal sensitivity of the central cornea among age groups (p < 0.0001). The mean corneal sensitivity decreased with advancing age, and was significantly reduced after the age of sixty. Conclusion: The normal value of corneal sensitivity of the central cornea in the Thai population is the same as those of previous reports from other countries. Normal corneal sensitivity significantly decreased after the age of sixty.

Tonometry after laser in situ keratomileusis treatment: a preliminary study in Thai patients.

OBJECTIVE: To evaluate the change in intraocular pressure (IOP) measurement by Goldmann applanation tonometer after Laser in Situ Keratomileusis (LASIK) for myopia and myopic astigmatism, and to assess the correlation between the changes of lOP reading and the reduction of central corneal thickness (CCT) after LASIK in Thai patients. STUDY DESIGN: Prospective correlational study. MATERIAL AND METHOD: LASIK was performed on 65 eyes of 33 patients for correction of myopia and myopic astigmatism. IOP was measured by Goldmann applanation tonometer before and 3 months after LASIK. The correlation between the change in IOP reading and the change in central corneal thickness were evaluated. RESULTS: IOP reading was significantly reduced by mean of 2.9 +/- 2.5 mmHg (p = 0.0001). The authors used Pearson analysis to study the correlation between the change in IOP and the reduction of CCT. In subgroup analysis the patients were divided by degree of myopia: group 1, myopia less than -3 diopters (D) (n = 14); group 2, myopia -3 to -6 D (n = 31); group 3, myopia greater than -6 D (n = 20)). The result showed more correlation in higher myopia group (Pearson; r = 0.158 in group 3, r = -0.098 in group 2 and r = -0.102 in group 1). CONCLUSION: Goldmann applanation tonometry underestimates the IOP in thin cornea. Variability in CCT is a potent confounder of this tonometry technique. Therefore, it has important implications for considering CCT measurement incorporated with Goldmann applanation tonometry for glaucoma diagnosis especially in myopic patients who undergo LASIK surgery.

Comparison of topical lomefloxacin 0.3 per cent versus topical ciprofloxacin 0.3 per cent for the treatment of presumed bacterial corneal ulcers.

PURPOSE: To compare the efficacy and safety of topical lomefloxacin 0.3 per cent with topical ciprofloxacin 0.3 per cent for treating mildly severe suspected bacterial corneal ulcers. METHOD: This prospective, randomized, double-masked controlled clinical trial was conducted on 41 patients (41 eyes) with suspected bacterial corneal ulcers who were randomized into 2 groups: 23 patients were in the lomefloxacin group and 18 patients in the ciprofloxacin group. All of these corneal ulcers were scraped for gram's stain, KOH preparation and microbiologic cultures before starting treatment. The clinical success rate, the time to cure, the rates of treatment failures, ocular signs and symptoms and the adverse effects of the study medication were evaluated. RESULTS: Topical lomefloxacin is equivalent clinically and statistically to topical ciprofloxacin. No statistically significant treatment differences were found between lomefloxacin (100%) and ciprofloxacin (100%) in terms of success rate. Similarly, no differences were noted in the time to cure (p > 0.05), the treatment failure, or the resolution of the clinical signs and symptoms (p > 0.05). The adverse effects of lomefloxacin were superficial punctate keratitis (26.1%) and irritation (8.7%), whereas those of ciprofloxacin were superficial punctate keratitis (22.2%), white precipitate (11.1%) and irritation (11.1%). However, no statistically significant differences of these adverse effects were found between the two groups (p > 0.05). CONCLUSION: Lomefloxacin ophthalmic solution (0.3%) is equivalent clinically and statistically to ciprofloxacin ophthalmic solution (0.3%) for the treatment of mildly severe presumed bacterial corneal ulcers without statistically significant differences in the adverse effects and discomfort.