Health-related quality of life of daily-life-affected benign essential blepharospasm: Multi-center observational study.

PURPOSE: To compare Thais' health-related quality of life (HRQOL) and severity grading, efficacy and safety in daily-life-affected benign essential blepharospasm (BEB) patients at baseline and after Botulinum toxin type A (BTX-A) treatment. DESIGN: Prospective-observational study. PARTICIPANTS: BEB patients with Jankovic rating scale (JRS) at least 3 in both severity and frequency graded from 14 institutes nationwide were included from August 2020 to June 2021. METHODS: Demographic data, HRQOL evaluated by the Thai version of EQ-5D-5L and NEI-VFQ-25 questionnaires, and severity grading score evaluated by Jankovic rating scale (JRS) at baseline, 1, and 3 months after the treatment were collected. The impact of the BTX-A injections and their complications were recorded. RESULTS: 184 daily-life-affected BEB patients were enrolled; 159 patients (86.4%) had complete data with a mean age of 61.40±10.09 years. About 88.05% were female, and 10.1% were newly diagnosed. Most of the patients had bilateral involvement (96.9%) and 12.6% had history of BEB-related accident. After BTX-A treatment, HRQOL improved significantly in 4 dimensions of EQ-5D-5L, except self-care. The EQ_VAS (mean±SD) was 64.54±19.27, 75.13±15.37, 73.8±15.85 (p<0.001) and EQ-5D-5L utility score was 0.748±0.23, 0.824±0.19 and 0.807±0.19 at baseline, 1, 3 months after treatment, respectively. From NEI-VFQ-25, HRQOL also improved in all dimensions, except eye pain. The JRS improved in all patients. Self-reported minor adverse events were 22.6%, which mostly resolved within the first month. CONCLUSION: Daily-life-affected BEB impacted HRQOL in most dimensions from both generic and visual-specific questionnaires. BTX-A treatment not only decreased disease severity, but also improved quality of life.

Neuro-ophthalmic manifestations in sinusitis patients who underwent endoscopic sinus surgery.

OBJECTIVE: To describe neuro-ophthalmic manifestations in sinusitis patients who underwent functional endoscopic sinus surgery MATERIAL AND METHOD: The medical records of 341 patients who underwent functional endoscopic sinus surgery (FESS) between October and January 2001 were reviewed in this retrospective study. RESULTS: Patient mean age was 37.09 years (range, 3-77) and 171 (50.15%) patients had no underlying disease. Visual loss and limited ocular motility were revealed in 43 (12.72%) and 40 (11.83%) patients, respectively Sphenoid sinus was the most commonly affected sinus in patients presenting with either visual loss (odds ratio 5.88; 95% CI 2.79-12.38) or ophthalmoplegia (OR 7.09; 95% CI 3.28-15.32). Twenty-three percent of patients with visual loss had abnormal funduscopy, while 30.23% had abnormal radiologic imaging study. After FESS, 12 (27.91%) patients had better visual acuity, but 11 (25.58%) had permanent visual loss. Isolated oculomotor and combined oculomotor with abducens nerve involvement were revealed in nine (22.50%), and 31 (77.5%) patients, respectively. Diabetes was a significant risk factor associated with ocular complications in patients with either visual loss (OR 2.98; 95% CI 1.37-6.44) or ophthalmoplegia (OR 2.56; 95% CI 1.17-5.61). CONCLUSION: Sphenoid sinusitis significantly increased the risk of neuro-ophthalmic manifestations, particularly among diabetic patients.

Agreement and reproducibility of contact and immersion techniques for axial length measurement and intraocular lens power calculation.

OBJECTIVE: To investigate the agreement and reproducibility of contact and immersion ultrasound biometry in an axial length measurement and intraocular lens power calculation. STUDY DESIGN: Prospective cross-sectional study. MATERIAL AND METHOD: Axial length was measured in 198 cataract patients using both contact and immersion techniques, randomly assigned to two measurers, one with more experience than the other Both techniques were repeated by each measurer. The mean difference of both techniques was calculated for the difference of the intraocular lens power. RESULTS: The respective mean differences of both techniques for the first and the second measurers were 0.03 and 0.07 mm. The repeatability coefficient was two-fold for the contact but was similar for the immersion technique. The respective difference of the intraocular lens power of both measurers was 1.15 and 1.65 diopters (D). A statistically significant agreement was noted between both techniques. The reproducibility of both techniques was similar when performed by an experienced measurer however, the less experienced measurer had greater reproducibility with the immersion technique. CONCLUSION: The difference in the intraocular lens power from both techniques may have clinical significance; hence, the immersion technique should be considered, particularly for less-experienced measurer.

Optic neuritis caused by intraocular angiostrongyliasis.

A 21-year-old Thai man first presented with eosinophilic meningitis. One week later he developed visual impairment of the left eye with a visual acuity of 20/600. He had a Marcus Gunn pupil, constricted visual field, prolongation of visual evoked potential and the presence of inflammatory cells in the vitreous cavity of the affected eye. On funduscopic examination there was disc swelling with hyperemia of the left eye. These ocular findings are compatible with optic neuritis. The causative agent, Angiostrongylus cantonensis, was identified in the vitreous cavity. To our knowledge this is the first case of optic neuritis caused by intraocular angiostrongyliasis. Ten days after administration of corticosteroid his severe headache was resolved, and by 4 weeks the disk swelling of the left eye subsided. Eight months after treatment the visual acuity of the left eye had not improved due to permanent damage to the retinal pigment epithelium caused by the intraocular parasite.

Ocular manifestations of suprasellar tumors.

OBJECTIVE: To determine ocular manifestations of suprasellar tumors and to identify the pre-operative factors that might influence final visual outcomes. MATERIAL AND METHOD: Medical records of 69 patients with a diagnosis of suprasellar tumor at Srinagarind Hospital between January 1995 and December 2005 were retrospectively reviewed. RESULTS: The present study focused on 69 patients (39% men and 61% women) with averaged 37.74 years of age (range, 6 to 75). The duration of symptoms was between 4 days and 5 years (average, 7.7 months). The ocular manifestations included visual loss in 59 (86%), eye pain in six (9%), diplopia in three (4%), and ptosis in one (1%) patient. The respective definite diagnosis were pituitary adenoma, suprasellar meningioma, and craniopharyngioma in 33 (48%), 19 (28%), and 17 (25%) patients. According to the pre-operative visual acuity in the worse eye, seven (10%), seven (10%), and 55 (80%) patients were stratified to Group I (VA 6/5 to 6/12), Group II (VA 6/18 to 6/36), and Group III (VA 6/60 to no vision), respectively. Post-operatively two (29%) patients in Group II and 14 (25%) in Group III had improved visual acuity. Three groups of visualfield defect were revealed, viz., Group A (normal visual field), Group B (typical field defect) and Group C (atypical field defect) in seven (10%), 49 (71%), and 13 (19%) patients, respectively. Positive relative afferent pupillary defect was detected in 31 patients (45%) and optic disc atrophy was detected in 26 patients (38%). CONCLUSION: Pituitary adenoma was the most frequent suprasellar tumor and visual loss was the most common ocular presentation. Bitemporal hemianopia frequently occurred in these patients, but was usually asymmetrical and unpredictable in its evolution.

Effect of horizontal strabismus surgery on the astigmatism.

OBJECTIVE: To investigate the effect of horizontal rectus muscle surgery on astigmatism. MATERIAL AND METHOD: A prospective descriptive study was conducted between July 2004 and June 2005, we recruited 16 strabismic patients with bilateral recession or recession of one horizontal muscle or monocular recession and resection for this study at Srinagarind Hospital. The authors measured the patients' best-corrected visual acuity and ocular alignment using the prism cover test and the Modified Krimsky tests, respectively. Auto-refraction was performed on the pre- operative and first post operative day by a technician not apprised of the type and/or amount of surgery. Any differences between the pre-operative and post operative astigmatism were calculated using the x-y coordinate system and the mean value for astigmatism. Descriptive statistics were used to analyze the data. RESULTS: Included were 23 eyes from 16 patients who met the inclusion criteria; 8 females; 8 males; average age 14.75 +/- 11.76 (range, 4-40) years. Seven patients (43.75%) had esotropia and nine (56.25%) exotropia. For all procedures, the respective mean cylinder of the pre- operative and first post-operative day were 0.74 +/- 1.20 D in 67.56 degrees axis and 0.69 +/- 0.86 D in 56.30 degrees axis, in the same direction as the cylinders for each type. There was no statistically significant change in the refractive error between the pre- operative and first postoperative day. CONCLUSION: In contrast to previous studies, astigmatism was not significantly affected by horizontal rectus muscle surgery; however, the present study population was small. Therefore, a larger prospective control trial would be necessary to definitively answer this question.

Ocular myasthenia gravis and auto-immune thyroiditis in children.

A 7-year-old girl presented at a university hospital with ptosis of the left eye. This resolved spontaneously within 4 weeks but then the right eye became similarly affected but responded to prostigmine. Left hypertropia with restriction of the right inferior rectus, mild exophthalmos, non-tender diffuse enlargement of the thyroid, normal thyroid function tests, anti-thyroglobulin, and anti-microsomal antibodies indicated an association of autoimmune thyroiditis and ocular myasthenia. The ptosis was remedied with pyridostigmine and short-course oral prednisolone, but the hypertropia persisted.

Orbital aspiration as treatment of microphthalmos with orbital cyst: a case report.

A 6-month-old girl came to the hospital with swelling of the right lower eyelid, exophthalmos, chemosis and upward deviation of the eyeball--all of which had been present since birth. Iris, optic disc, and chorioretinal coloboma were also apparent. Magnetic resonance imaging revealed a small globe with a large cystic lesion in the orbit of the right eye. Pre- and post-operative photographs and magnetic resonance imaging indicated a safe, simple single orbital aspiration as an alternative treatment for mild microphthalmos with an orbital cyst.

Upward gaze paralysis as the initial manifestation of HIV-infected patient: a case report.

Upward gaze palsy developed in a 23-year-old man without any other abnormal findings except pupillary light-near dissociation in ocular examination. The neuroradiologic examination was consistent with cerebral toxoplasmosis--the most frequent opportunistic infection of the brain in AIDS patients. The serologic work-up revealed a positive HIV test. Symptoms and neuroradiologic abnormality improved after treatment for cerebral toxoplasmosis. HIV infection should be considered in patients who have upward gaze paralysis and neuroimaging compatible with cerebral toxoplasmosis. Empirical treatment may alleviate the upward gaze palsy.