Screening for chloroquine maculopathy in populations with uncertain reliability in outcomes of automatic visual field testing.

Purpose: The purpose of this study was to compare screening methods for the early detection of maculopathy in patients treated with chloroquine (CQ) or hydroxychloroquine (HCQ) and to identify the risk factors for the development of toxic maculopathy. Methods: We performed a prospective study of all 217 patients taking CQ and/or HCQ and seen in our center between July 2011 and December 2013. All subjects underwent a complete ocular examination, as well as spectral domain optical coherence tomography (SD‑OCT), fundus autofluorescence (FAF), and 10‑2 Humphrey visual field (10‑2 HVF). Results: The median age of patients was 51 years, median CQ/HCQ duration was 40 months, and median cumulative dose was 180 g. The prevalence of at least two abnormal tests was 7.4% (16/217). SD‑OCT had the highest sensitivity, specificity, predictive values and accuracy while 10‑2 HVF showed in 30% of nonreliable results and had the lowest specificity and positive predictive value. In multivariate analysis, an age of older than 60 years (P = 0.002), CQ duration of more than 5 years (P < 0.001), and CQ dose more than 3 mg/kg/day (P = 0.005) were associated with toxicity. Conclusions: In patients with unreliable outcomes of 10‑2 HVF testing, SD‑OCT in combination with FAF might represent a suitable alternative screening tool for toxic maculopathy.

Clinical features and etiology of retinal vasculitis in Northern Thailand.

Purpose: To report on the clinical features and etiology of patients with retinal vasculitis (RV). Materials and Methods: We reviewed medical records of 47 patients (75 affected eyes) diagnosed with RV. Clinical presentations, ocular complications, associated systemic diseases, and treatment regimens were registered. Results: Etiology of RV included infectious causes in 10/47, (21%) while an association with systemic and/or ocular non‑infectious disorders was noted in 22/47 (47%). Eales’ disease and Behcet’s disease represented the most common clinical entities in non‑infectious group while tuberculosis‑associated RV was diagnosed in 6/10 (60%) among those with infectious disorders. RV was bilateral in 28/47 (60%) patients. Retinal veins were most commonly affected (72%, 34/47). Involvement of arteries was present in 12/47 (25%) and was associated with viral infections and Behcet’s disease. Ocular complications developed in 60/75 (80%) eyes. The most common complications were elevated intraocular pressure and/or glaucoma (33/75, 44%). Retinal detachment, vitreous hemorrhage, and cystoid macular edema developed in similar percentages (15%). Conclusions: RV in Thailand manifested mostly in male patients, was typically bilateral and involved mostly veins. Involvement of arteries was observed in patients with viral infections and Behcet’s disease. Tuberculosis was the most common infectious cause.

An outbreak of acute postoperative endophthalmitis after cataract surgery.

BACKGROUND: Endophthalmitis is one of the most serious complications of ophthalmic surgery, which includes postoperative cataract extraction. Outbreak of acute postoperative endophthalmitis after cataract surgery has been reported in Thailand and other countries. OBJECTIVE: To describe an outbreak of acute postoperative endophthalmitis after cataract surgery that was referred to Chiang Mai University Hospital during March 2006. MATERIAL AND METHOD: Observational case series were made from the records of inpatients and outpatients, who had been referred for treatment of acute postoperative endophthalmitis after cataract surgery at a district hospital in northern Thailand. The surgery was conducted on two consecutive days by volunteer ophthalmologists of a non-profit foundation from Bangkok. RESULTS: In this outbreak, the authors recorded 31 endophthalmitis cases, with 33 eyes (bilateral 2 cases). Of the 33 endophthalmitis eyes, 32 occurred following extracapsular cataract extraction with intraocular lens and one after the secondary intraocular lens implant. Microbiological investigations in the hospital were done with aqueous tapping, vitreous tapping, and vitreous from pars plana vitrectomy. Gram-positive cocci were detected from vitreous tapping in four eyes. Thirty-two cases were managed with intravitreous antibiotics, one with subconjunctival antibiotic only, and all eyes were treated with fortified topical antibiotics. Fifteen eyes underwent pars plana vitrectomy Assessment of visual acuity (VA) before and after treatment showed improvement in 75.8% (25/33), decrease of VA in 9.1% (3/33), while visual acuity remained stable in 15.2% (5/33). CONCLUSION: In high-volume cataract surgery, an outbreak of endophthalmitis is always possible. Prompt and appropriate treatment can improve the visual outcome.

Choroidal detachment after topical prostaglandin analogs: case report.

OBJECTIVE: To report three cases of delayed choroidal detachment after treatment with topical prostaglandin analogs. MATERIAL AND METHOD: Intervention three case reports. Four eyes of three patients with chronic angle closure glaucoma developed choroidal detachment after using topical prostaglandin analogs. RESULTS: Three patients with chronic angle closure glaucoma developed chroidal detachment in one week, three weeks and two years after using travoprost, bimatoprost and latanoprost respectively. All of them resolved after discontinuation of these medications. All of the eyes that developed chroidal detachment were pseudophakic. CONCLUSION: Travoprost, bimatoprost and latanoprost may lead to choroidal detachment and hypotony. Pseudophakic patients may be at high risk of the development of chroidal detachment. Topical prostaglandin analogs should be used cautiously in these patients.

Detection of cytomegalovirus in vitreous, aqueous and conjunctiva by polymerase chain reaction (PCR).

OBJECTIVE: To evaluate the diagnostic value of polymerase chain reaction (PCR) performed on vitreous, aqueous and conjunctiva for the detection of cytomegalovirus in AIDS patients with a clinical diagnosis of cytomegalovirus retinitis. MATERIAL AND METHOD: PCR-based assay was used to detect cytomegalovirus DNA in vitreous, aqueous and conjunctival samples from 24 patients with the acquired immunodeficiency syndrome (AIDS) who had untreated clinically diagnosed cytomegalovirus retinitis and from 15 immunocompetent patients, including 11 with retinal detachment, 2 with macular hole and 2 with vitreous hemorrhage. RESULTS: Cytomegalovirus DNA was detected in 16, 9 and 3 of 24 vitreous, aqueous and conjunctival samples, respectively, from patients with AIDS, untreated clinically diagnosis of cytomegalovirus retinitis; and in one patient out of 15 vitreous, aqueous and conjunctival samples from immunocompetent patients with vitreoretinal diseases. CONCLUSION: The use of PCR in the detection of cytomegalovirus in vitreous, aqueous and conjunctival samples had an equal specificity of 93% and had sensitivity of 67, 37 and 12%, respectively.