Nonmydriatic digital retinal images for determining diabetic retinopathy.

OBJECTIVE: To evaluate the efficacy of nonmydriatic digital retinal images for determining diabetic retinopathy. MATERIAL AND METHOD: Single field 45-degree digital retinal images of 225 eyes from 142 diabetic patients were obtained with a nonmydriatic camera. The images were diagnosed and graded by a general ophthalmologist. These results were compared with clinical diagnosis obtained by retinal specialists, after examination by using biomicroscope with plus lens and indirect ophthalmoscope of the patients. International clinical diabetic retinopathy disease severity scale was used for grading diabetic retinopathy in all cases. RESULTS: Presence of diabetic retinopathy was detected in 70 eyes (31.1%). The sensitivity and specificity for determining diabetic retinopathy was 68.57% (95%CI 57.00-78.20) and 92.25% (95%CI 87.00-95.50), respectively. The positive predictive value and negative predictive value was 80.00% (95%CI 68.20-88.20) and 86.67% (95%CI 80.60-91.00). Overall accuracy was 84.89%. CONCLUSION: Single field 45-degree nonmydriatic digital retinal images were limited by fair sensitivity for determining diabetic retinopathy although overall accuracy from the present study was relatively high. Upcountry, this tool might facilitate increased access of diabetic patients for eye evaluation but cannot replace standard eye examination.

Pseudophakic retinal detachment with ruptured posterior lens capsule.

The relationship between retinal detachment and posterior lens capsule rupture in pseudophakic patients was studied. Records of patients with pseudophakic retinal detachment who were admitted to Siriraj Hospital from 1992 to 2004 were reviewed. The patients were divided into 2 main groups: 1) The study group (pseudophakic retinal detachment) 79 eyes (78 cases) which was subdivided into group 1a) pseudophakic retinal detachment with intact posterior lens capsule (50 eyes), and group 1b) pseudophakic retinal detachment with ruptured posterior lens capsule (29 eyes); 2) The control group 99 eyes (90 cases) which was subdivided into group 2a) pseudophakic patients with intact posterior lens capsule (83 eyes), and group 2b) pseudophakic patients with ruptured posterior lens capsule (16 eyes). The relationship between pseudophakic retinal detachment and posterior lens capsule rupture was analyzed by Chi-square test, and risk factors were analyzed by multiple logistic regression. Retinal detachment in pseudophakic patients was found more often in males more than in females, and the average age was 57.9 +/- 11.8 years, the retinal detachment was related to posterior lens capsule rupture (p = 0.003). Patients with pseudophakic retinal detachment with a ruptured posterior lens capsule had a risk 5.7 times greater than pseudophakic patients with an intact posterior lens capsule (adjusted Odds ratio = 5.716, 95% CI = 2.118-15.427). The present study showed that posterior lens capsule rupture increased the risk of retinal detachment. Ophthalmologists should be aware of retinal detachment development after YAG capsulotomy, especially in patients who have other risk factors such as myopia, lattice degeneration, retinal break, or previous retinal detachment surgery.

Evaluation of screening tests and prevalence of glaucoma: integrated health research program for the Thai elderly.

The purposes of this study were to evaluate the accuracy of glaucoma screening tests and to assess the prevalence of glaucoma in an elderly Thai population over 60 years of age. This was a cross-sectional study. 3706 subjects were recruited from 33 communities in the vicinity of Siriraj Hospital. All received an eye examination from ophthalmologists and general practitioners including visual acuity, Schiotz tonometry and optic disc evaluation in their residential communities. Subjects who were suspected of having glaucoma were re-examined at the Glaucoma Clinic, Siriraj Hospital. They were then classified as having definite glaucoma of a specific type or as not having glaucoma. The overall prevalence of glaucoma was 6.1 per cent (128/2092). The percentages of primary open angle glaucoma, primary angle closure glaucoma, normotension glaucoma and secondary glaucoma were 47.7 per cent, 41.4 per cent, 9.4 per cent, and 1.6 per cent respectively. The sensitivity and specificity of the screening tests performed by ophthalmologists were 100 per cent and 97.2 per cent and those performed by general practitioners were 21.7 per cent and 96.5 per cent.

Leukemic involvement of optic nerve.

We studied four cases of acute lymphoblastic leukemia with invasion of the optic discs and optic nerves. AII patients had central nervous system involvement. They received irradiation combined with intrathecal and systemic chemotherapy. The visual acuity improved in two cases, slightly improved in one case and did not improve in one case. However, fundoscopic examination showed clinical improvement after treatment in all cases. This combination therapy should be initiated on a semi-emergency basis in order to prevent irreversible visual loss in these patients.