An innovation of manual small incision cataract surgery (MSICS: A Technique) for advanced cataract disease in Thailand.

OBJECTIVE: Described a new surgical technique of manual small incision cataract surgery (MSICS: A technique), analyze the outcome and complications. MATERIAL AND METHOD: The present study was retrospective and non-comparative. The advanced (mature and brunescent) cataract patients were operated with a new surgical technique of manual small incision cataract surgery (MSICS: A technique). Data was collected from medical records between October 2011 and September 2013 at Prasat Neurological Institute. The records of 30 advanced cataract eyes that received surgery were reviewed. The clinical data of visual acuity (VA), pre- and post-operative astigmatism, intraoperative, and post-operative complications, andfollow-up from day 1, 5, 28, and 90post-operative days were collected RESULTS: Thirty eyes of 25 patients were operated with MSICS (A technique). Post-operative BCVA results were 20/20 or better in 12 eyes (40%), 20/25 to 20/70 in 16 eyes (53.3%), 20/80 to 20/160 in one eye (3.3%), and 20/200 or worse in one eye (3.3%). The different astigmatism was (pre- minus post-operative astigmatism) 0.58±1.12 diopters, range -1.75 to 3.25, 95% CI 0.16-0.99 (p<0. 01). No major surgical complication was found CONCLUSION: The new MSICS (A technique) can be recommended as a safe alternative cataract surgery for mature and brunescent cataract disease in developing countries.

A 4-year prospective study on long-term complications of type 2 diabetic patients: the Thai DMS diabetes complications (DD.Comp.) project.

OBJECTIVE: To assess the clinical course of long-term diabetic complications; diabetic retinopathy, nephropathy, and foot problems in Thai patients with type 2 diabetes. MATERIAL AND METHOD: Patients with type 2 diabetes were followed for four years between March 2006 and September 2010. Seven hospitals in all levels of care under the Ministry of Public Health Thailand were included in the present study. A physical examination and a diabetic complications assessment were performed each year during the study period, by physician specialists in the related areas. RESULTS: Among 1,120 patients who participated in the present study, 705 (62.95%) patients completed the 4-year follow-up time. There were 88 (7.86%) patients reported deaths during the present study period. The mean age was 59.14 +/- 10.12 years. The average duration of diabetes was 7.30 +/- 6.14 years. Approximately 57.32% of patients had a family history of diabetes. The average plasma glucose level and HbA1C were 153 to 160 mg/dl and 8.25 to 8.75%. Moreover less than one-fourth of patients had HbA1C below 7%. The prevalence for diabetic retinopathy and nephropathy were approximately 23.7% and 38.3%. In addition, more than 15% of patients had diabetic foot problems, loss of protective sensation and pedal pulse deficit. Finally, the incidence rates were 80.1 per 1,000 person-years (95% CI 69.7, 91.8) for diabetic retinopathy, and 91.1 per 1,000 person-years (95% CI 78.8, 105.1) for diabetic nephropathy CONCLUSION: Problems regarding poor diabetes control exist in Thai diabetes patients. It results in high prevalence and incidence of diabetic complications. As such, it is crucial to establish the country's diabetes management plan as well as evaluate the long-term complications in diabetic patients annually, in order for patients to receive the benefits of early treatment and prevent further complications.

The Thai DMS Diabetes Complications (DD.Comp.) project: prevalence and risk factors of diabetic retinopathy in Thai patients with type 2 diabetes mellitus.

OBJECTIVE: To determine the prevalence of diabetic retinopathy (DR) among patients with type 2 diabetes mellitus (T2DM) in Thailand and their associated risk factors. MATERIAL AND METHOD: A cross-sectional, multi-sites, hospital-based study was carried out between June and December 2006. Diabetic patients from the outpatient department of seven public hospitals (3 tertiary, 2 secondary and 2 community hospital) in Thailand were performed by retinal specialist. RESULTS: One thousand seven of 1,120 diabetic patients received retinal examination using indirect ophthalmoscope. Patients were divided into two groups (absent and present DR). Most patients in both groups were female (72.7 and 68.0%). The prevalence of DR was 24.0% (n = 242), mild NPDR 9.4% (n = 95), moderate NPDR 10.5% (n = 106), severe NPDR 1.3% (n = 13), and proliferative (PDR) 2.8% (n = 28). Age at onset, duration of DM, systolic blood pressure, body mass index (BMI), fasting plasma glucose (FPG), HbA1c, Triglyceride (TG), alcohol consumption, foot ulcer, and proteinuria were recorded. Metformin and insulin taking were statistically, significantly different among these groups. There is more prevalent NPDR and PDR in insulin-taking than non-insulin-taking groups. The grading of diabetic retinopathy is associated with the duration of diabetes. In multivariate regression analysis, associated risk factors of DR patients were the duration of DM, HbA1c levels, and proteinuria. CONCLUSION: Diabetic retinopathy was present in about one fourth of type 2 diabetic patients in this study. Associated risk factors of DR were the duration of DM, HbA1c levels, and proteinuria. Regular screening for DR especially in T2DM with associated risk factor should be done for early treatment.

Prevalence of factors predisposing to foot complication and their relation to other risks.

BACKGROUND: Diabetic neuropathy and peripheral vascular disease (PVD) have been identified as major risk factors for diabetic foot ulceration and amputation in patients with type 2 diabetes mellitus (T2DM) but in Thailand have been a few of prospective studied about the prevalence and risk factors of diabetic neuropathy and PVD. OBJECTIVE: To evaluate the prevalence of diabetic neuropathy and PVD in Thai patients with T2DM and to determine other factors that related with them. MATERIAL AND METHOD: A cross-sectional study of 899 Thai T2DM patients from the out-patient department of seven public hospitals in Thailand between January 2007 and September 2008 was performed. Histories of these patients, complete physical examinations, feet examination, and blood with urine chemistry were obtained. RESULTS: Most of the patients were females with the average age of 59.64 years, the average of body mass index (BMI) was 27.32 kg/m2, the average duration of diabetes was 8.12 years and 85.17% of patients were HbA1C > or = 7%. Diabetic patients with PVD group compared with no PVD group, there were statistically significant differences for duration of having diabetes (OR 1.08; 95% CI [1.01-1.16]; p-value 0.047), creatinine level (OR 1.62; 95% CI [1.12-2.33]; p-value 0.01), present diabetic neuropathy (OR, 7.37; 95% CI [2.52-21.59]; p-value < 0.001). Patients with diabetic neuropathy group compared with no diabetic neuropathy group, there were statistically significant differences of age (OR, 1.04; 95% CI [1.01-1.06]; p-value 0.003), duration of having diabetes (OR, 1.04; 95% CI [1.01-1.07]; p-value 0.008), on ACEI or ARB drug (OR, 1.77; 95% CI [1.24-2.55]; p-value 0.002), HbA1C (OR, 1.14; 95% CI [1.03-1.27]; p-value 0.012), creatinine level (OR, 1.38; 95% CI [1.04-1.79]; p-value 0.014), present diabetic retinopathy (OR, 1.96; 95% CI [1.22-3.13]; p-value 0.005), present PVD (OR, 7.37; 95% CI [2.52-21.59]; p-value < 0.001), present diabetic nephropathy with microalbuminuria (OR, 1.74; 95% CI [1.12-2.69]; p-value 0.013). CONCLUSION: Two percent of T2DM patients had PVD that associated with duration of diabetes, creatinine level, and diabetic neuropathy and 15% of T2DM patients had diabetic neuropathy that depended on age, duration of having diabetes, on ACEI or ARB drug, creatinine level, HbA1C, diabetic retinopathy, diabetic nephropathy, and PVD.

Cost-effectiveness analysis of manual small incision cataract surgery (MSICS) and phacoemulsification (PE).

BACKGROUND: Cataract is the most common cause of blindness, responsible for 50 to 80% of all blindness in South-East Asia. Method of cataract surgery that has cost-effective, low technology procedure and a low complication rate in the shortest amount of time is needed. This study provides the useful resources comparing clinical outcomes and cost of phacoemulsification (PE) and manual small incision cataract surgery (MSICS) based on hospital perspective. OBJECTIVE: To compare the costs and effectiveness of two-cataract-surgery methods, MSICS and PE, using the hospital's perspective. SETTING: Department of Ophthalmology, Phrapoklao hospital, Thailand. MATERIAL AND METHOD: This study was prospective and comparative. Data was collected from medical charts and through patient interviews using data collection forms. Labor material and capital cost were recorded for both surgical methods. The effectiveness was measured in visual acuity (VA), astigmatism and complications occurring at 90 days after surgery. RESULTS: The average total cost was 10,043.81 bath/case for MSICS and 11,590.72 bath/case for PE. After 90 days after surgery, the average VA of MSICS and PE groups were 0.83 +/- 0.225 (0.10-1.00) and 0.76 +/- 0.268 (0.06-1.00). There was no statistically significant difference in both groups. The average astigmatism at 90 days after surgery was 1.01 +/- 0.733 (0.00-3.50) D and 0.99 +/- 0.713 (0.00-4.25) D for MSICS and PE method. The average change in astigmatism was 0.15 and 0.20 D for the MSICS and PE groups. The intraoperative complication was vitreous loss (1.40%) in the PE group. The postoperative complication was corneal edema (5.60%) in the MSICS group. There was no statistically significant difference in the number of postoperative complications in both groups (p = 0.16). CONCLUSION: The effectiveness of MSICS and PE methods was not significantly different, but PE method had higher costs. Therefore, MSICS has better cost-effectiveness than PE thus, MSICS should be a preferred cataract surgery method to PE method, based on the hospital's perspective.

Prevalence and risk factors of diabetic nephropathy among Thai patients with type 2 diabetes mellitus.

BACKGROUND: Diabetic nephropathy (DN) is the leading cause of end stage renal disease. Clinically, DN is classified into 3 stages: microalbuminuria (MA), macroalbuminuria and ESRD. The prevalence and risk factors of DN among patients with type 2 diabetes mellitus (T2DM) in Thailand have not been well studied. OBJECTIVE: To assess the prevalence of DN in patients with T2DM and to determine their associated risk factors. MATERIAL AND METHOD: A cross-sectional study evaluating 877 T2DM patients from the out-patient department of seven public hospitals in Thailand was performed. Three random spot urine samples from all patients were collected during 3 consecutive months. Normoalbuminuria, MA and macroalbuminuria were defined as the presence of at least two out of three spot urine tests for urine albumin/creatinine ratio showing less than 30, 30-300 and more than 300 mg/gm respectively. RESULTS: Most patients were female, 60 years of age or older, with BMI above 25 kg/m2, a family history of DM, uncontrolled blood pressure, HbA1c above 7.0% and LDL above 100 mg/dl. The prevalence of normoalbuminuria, MA and macroalbuminuria was 62.8, 26.0 and 11.2% respectively. The prevalence of diabetic retinopathy in T2DM with normoalbuminuria, MA and microalbuminuria was 18.5, 35.5 and 48.0% respectively. Associated risk factors of DN were the duration of DM, HbA1c levels and uncontrolled hypertension. CONCLUSION: The prevalence of all DN was 37.2%. Associated risk factors of DN were the duration of DM, HbA1c levels and uncontrolled hypertension.

Accuracy of urine dipstick test for microalbuminuria in type 2 diabetes mellitus patients.

BACKGROUND: Testing for microalbuminuria (MA) is an important tool for detection of the earliest clinical manifestation of diabetic nephropathy Dipstick test for MA is commonly used for screening MA but this dipstick test has not been validated in Thai patients with DM. OBJECTIVE: To evaluate the diagnostic accuracy of the dipstick test for MA in random spot urine samples of type 2 diabetic mellitus patients, using urinary albumin to creatinine ratio (UACR) as the reference standard method. MATERIAL AND METHOD: Type 2 diabetic mellitus patients from the out-patient department of seven public hospitals were recruited. Random spot urine samples from all patients were screened for microalbuminuria by Combi-Screen dipstick test and UACR. RESULTS: A total of 6,223 urine samples from 899 diabetic patients were screened for MA. From UACR criteria, these urine samples were classified as normoalbuminuria (4,016 samples, 64.5%), MA (1,795 samples, 28.8%) and macroalbuminuria (412 samples, 6.6%). The dipstick test for MA had an overall sensitivity of 83.7%, specificity of 92.6% with a positive predictive value of 83.4% and a negative predictive value of 92.7%. The area under the receiver operating characteristics curve of the dipstick test for MA is 0.9427. CONCLUSION: The dipstick test for MA may be a useful method to initially screen for MA in Thai patients with type 2 DM.

The relationship between microalbuminuria by using urine dipsticks and diabetic retinopathy in type 2 diabetes.

OBJECTIVE: Study the association between microalbuminuria and diabetic retinopathy in type 2 diabetic patients. MATERIAL AND METHOD: A cross-sectional analytic study of 1,111 cases with type 2 diabetic patients recruited from seven public hospitals, between June and December 2006 was performed RESULT: Two hundred eighty six subjects (79 males and 207 females) with urine dipsticks for microalbuminuria detection tested positive at least 2 of the 3 morning urine samples within 6 months. They were divided into 2 equal groups, micro- and normoalbuminuria based on quantity of albumin. Indirect ophthalmologic examination of all subjects' eyes for diabetic retinopathy was performed by ophthalmologists (retinal specialists). The present study showed that the proportion of diabetic retinopathy was 19.6% (28/143) and 12.6% (18/ 143) in micro- and normoalbuminuric groups, respectively. The difference of proportion between the groups was 7% but was statistically not significant (p = 0.108). CONCLUSION: Microalbuminuria detected using urine dipstick was not cross-sectionaly associated with diabetic retinopathy in type 2 diabetic patients.

Clinical results with the medennium phakic refractive lens for the correction of high myopia.

PURPOSE: To evaluate the predictability, safety, stability, complications, and biocompatibility of the phakic refractive lens (PRL) as a posterior chamber intraocular lens to correct high myopia. METHODS: Fifty eyes of 31 patients who underwent posterior chamber PRL implantation were evaluated prospectively. Mean preoperative myopia was -12.54 +/- 4.22 diopters (D) (range: -4.50 to -23.50 D) and mean astigmatic refractive power was -1.38 +/- 1.24 D (range: -1.00 to -4.50 D). Surgical implantation was performed through a 3.0- to 4.0-mm clear cornea sutureless incision using parabulbar (sub-Tenon's) anesthesia. Intra- and postoperative complications were recorded. RESULTS: Three months after surgery, the mean spherical equivalent refraction was -0.21 +/- 0.42 D (range: +1.00 to -1.75 D). At 6 and 12 months, mean spherical equivalent refraction was -0.23 +/- 0.38 D (range: 0 to -1.25 D). At the last examination, uncorrected visual acuity was > or = 20/40 in 41 (82%) eyes and > or = 20/20 in 22 (44%) eyes. Best spectacle-corrected visual acuity (BSCVA) was > or = 20/40 in 42 (84%) eyes and > or = 20/20 in 27 (54%) eyes. Comparison of pre- and postoperative BSCVA at 12 months showed that 12 (36.4%) of 33 eyes gained > or =1 lines of BSCVA and 7 (21.2%) of 33 eyes gained > or =2 lines. One (2%) eye developed anterior subcapsular cataract requiring lens exchange, and 1 (2%) eye developed acute angle closure glaucoma requiring YAG-iridotomy. One (2%) eye developed macular hemorrhage. CONCLUSIONS: At 6 months and 1 and 2 years, PRL implantation yielded encouraging visual and refractive results with excellent biocompatibility. The efficacy, stability, and short-term safety of this lens was established. Serious complications, such as cataract and acute angle closure glaucoma, may occur, and long-term safety needs to be evaluated.