Prevalence of Preoperative Corneal Astigmatism in Patients Undergoing Cataract Surgery at Mettapracharak Hospital, Thailand.

OBJECTIVE: To describe and analyze the demography and distribution of preoperative corneal astigmatism in patients undergoing cataract surgery at Mettapracharak Hospital. MATERIAL AND METHOD: The medical records of consecutive patients who had cataract surgery between October 1, 2010 and September 30, 2011 at Mettapracharak Hospital were retrospectively reviewed and analyzed. Patient demographic and keratometric data were collected and analyzed. RESULTS: The present study evaluated the keratometric data in 2,688 eyes of 2,671 patients who had cataract surgery with the mean age of 66.23±10.79 years. The mean corneal astigmatism was 1.09 D (range 0.00-8.50 D). Corneal astigmatism was higher than 1.00 D in 36.6%, between 0.51 D and 1.00 D in 37.9% and 0.50 D or less in 25.5% of eyes. The mean steep keratometry and flat keratometry values were 44.89±1.52 D and 43.81±1.57 D respectively. The magnitude of corneal astigmatism was positively correlated with age (p<0. 001) and there was a tendency for corneal astigmatism to increase with age above 50 years. Female had significantly steeper corneas than male. Corneal astigmatism was mainly against-the-rule (the steepest meridian at 180±30 degrees). The type of corneal astigmatism was strongly correlated with age. Against-the-rule astigmatism increased with older age. While aging decreased with-the-rule astigmatism. CONCLUSION: The present report showed the pattern of corneal astigmatism before cataract surgery in Thai governmental hospital, approximately one third of cataract patients had more than 1.00 D of astigmatism. This finding provide the important normative reference and help ophthalmologists to plan and manage the cost-effective correction of preexisting corneal astigmatism in cataract patients to achieve the best visual outcome.

The first rapid assessment of avoidable blindness (RAAB) in Thailand.

BACKGROUND: The majority of vision loss is preventable or treatable. Population surveys are crucial for planning, implementation, and monitoring policies and interventions to eliminate avoidable blindness and visual impairments. This is the first rapid assessment of avoidable blindness (RAAB) study in Thailand. METHODS: A cross-sectional study of a population in Thailand age 50 years old or over aimed to assess the prevalence and causes of blindness and visual impairments. Using the Thailand National Census 2010 as the sampling frame, a stratified four-stage cluster sampling based on a probability proportional to size was conducted in 176 enumeration areas from 11 provinces. Participants received comprehensive eye examination by ophthalmologists. RESULTS: The age and sex adjusted prevalence of blindness (presenting visual acuity (VA) <20/400), severe visual impairment (VA <20/200 but ≥20/400), and moderate visual impairment (VA <20/70 but ≥20/200) were 0.6% (95% CI: 0.5-0.8), 1.3% (95% CI: 1.0-1.6), 12.6% (95% CI: 10.8-14.5). There was no significant difference among the four regions of Thailand. Cataract was the main cause of vision loss accounted for 69.7% of blindness. Cataract surgical coverage in persons was 95.1% for cut off VA of 20/400. Refractive errors, diabetic retinopathy, glaucoma, and corneal opacities were responsible for 6.0%, 5.1%, 4.0%, and 2.0% of blindness respectively. CONCLUSION: Thailand is on track to achieve the goal of VISION 2020. However, there is still much room for improvement. Policy refinements and innovative interventions are recommended to alleviate blindness and visual impairments especially regarding the backlog of blinding cataract, management of non-communicative, chronic, age-related eye diseases such as glaucoma, age-related macular degeneration, and diabetic retinopathy, prevention of childhood blindness, and establishment of a robust eye health information system.

Efficacy of fluconazole subconjunctival injection as adjunctive therapy for severe recalcitrant fungal corneal ulcer.

OBJECTIVE: To assess the efficacy of 2% fluconazole subconjunctival injection as an adjunctive treatment in severe recalcitrant fungal corneal ulcer. DESIGN: Retrospective, non-comparative interventional case series. MATERIAL AND METHOD: From January 2007 to August 2007, the present study included six eyes of six patients with severe fungal corneal ulcer that did not respond to therapy with topical antifungal drugs, oral itraconazole (200 mg) twice a day and 10 microg intracameral amphotericin B. All of them were treated with 0.5 ml of 2% fluconazole subconjunctival injection twice a day as adjunctive therapy for 5 days then once a day till 14 days RESULTS: Three patients were successfully treated within 14 days. Two patients partially responded, and one of them underwent evisceration. The last patient did not respond to treatment and enucleation was done. Severe local and systemic side effects were not found. CONCLUSION: 0.5 ml of 2% Fluconazole subconjunctival injection can be a very useful treatment as adjunctive therapy for severe fungal keratitis, with a few mild complications, especially in cases of impending perforation or post operative such as glue application for ruptured cornea.