Predictors for Visual Outcome After Silicone Oil Removal in Eyes with Complicated Retinal Detachment.

Purpose: To determine the predictors for visual outcome after silicone oil removal (SOR) in eyes with complicated retinal detachment. Patients and Methods: A total of 182 eyes with complicated retinal detachment that had undergone SOR were retrospectively reviewed. Snellen best-corrected visual acuity (BCVA), intraocular pressure (IOP) and complications were recorded at baseline, 1 day, 1 month and 3 months postoperatively. Good visual outcome was defined as best-corrected visual acuity of ≥20/200 at 3 months visit. Factors predicting visual outcome were evaluated using univariate and multivariate analysis. Results: After SOR, anatomical retinal reattachment was noted in 165 eyes (90.66%). Good visual outcome (VA ≥ 20/200) was achieved in 104 eyes (57.14%) at 3 months after SOR. For the eyes that remained attached after SOR, the percentage of good visual outcome was 63.03%. With univariate and multivariate analysis, visual acuity before SOR (p<0.001), circumferential peripheral retinopexy (p=0.037), additional endolaser during SOR (p=0.004), and pseudophakia status at the last follow up (p=0.021) were associated with visual outcome. Complications after SOR included redetachment (9.4%), hypotony (6.6%) and bullous keratopathy (1.7%). Conclusion: While anatomically attached retina was achieved in most of the patients, the functional outcomes were still much lower. Good BCVA before SOR and pseudophakia status at the last follow up were predictors for good visual outcomes, whereas circumferential peripheral retinopexy and additional endolaser during SOR were predictors for poor visual outcomes after SOR in eyes with complicated retinal detachment.

Cost-Utility Analysis of Drug Treatments in Patients with Polypoidal Choroidal Vasculopathy in Thailand.

PURPOSE: The aim of this study was to estimate the cost-utility and budget impact of pharmacological treatments for the eye with polypoidal choroidal vasculopathy (PCV) in Thailand. METHODS: A Markov model-based cost-utility analysis (CUA) and budget impact analysis were conducted. The lifetime cost and outcomes of PCV treatments were estimated. We discounted costs and outcomes at 3% per annum. Parameters were estimated using data from published literatures, local cost and utility data, and epidemiology data among Thai patients. Univariate and probabilistic sensitivity analyses were performed to account for parameter uncertainty. RESULTS: Intravitreal bevacizumab (IVB) resulted in the lowest lifetime cost, followed by IVB plus verteporfin photodynamic therapy (IVB+vPDT) and intravitreal aflibercept (IVA). The combination of IVB or intravitreal ranibizumab (IVR) and verteporfin photodynamic therapy (IVB+vPDT or IVR+vPDT) yielded the highest quality-adjusted life-years (QALY). When compared with IVB from a societal perspective, the incremental cost-effectiveness ratio for patients with PCV receiving IVB+vPDT, IVR+vPDT, IVA were 10,304; 54,135; and 82,738 the United States dollar (USD) per QALY gained, respectively. At the Thai societal willingness to pay threshold of 4884 USD, IVB had the highest probability of being cost-effective (99%) followed by IVB+vPDT (1%). IVB+vPDT could be a cost-effective strategy and required a budget of 12.61 million USD over five fiscal years when the price of verteporfin reduced by approximately 45%. CONCLUSION: None of the drug treatments for PCV was cost-effective in the Thai context. The decreased price of verteporfin is required to support the inclusion of IVB+vPDT in the Thai National List of Essential Medicines for the treatment of PCV.

Efficacy of Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Treatment of Large Idiopathic Full-Thickness Macular Holes.

PURPOSE: To evaluate anatomical and visual outcomes of pars plana vitrectomy (PPV) with internal limiting membrane peeling (ILMP) in large idiopathic full-thickness macular holes (FTMH). Predictive factors also formed part of the study. PATIENTS AND METHODS: A retrospective review of medical charts and optical coherence tomography images of patients with large idiopathic FTMH (≥400 µm) was conducted. RESULTS: One hundred and fifty-eight eyes of 155 patients with a mean age of 62.94±7.50 years were included in the study. Mean preoperative visual acuity (VA) was 1.26±0.36 logMAR. Mean preoperative minimum linear diameter (MLD) and basal linear diameter (BLD) were 644.89±136.85 µm and 1208.11±307.14 µm, respectively. At 12 weeks postoperative follow-up, FTMH closure rate was 61.39% and mean postoperative BCVA was 0.92±0.36 logMAR. Multivariate logistic regression analyses showed the anatomical outcome was significantly associated with BLD ≤1200 µm, preoperative vitreomacular interface (VMI) disorder and extended ILMP (a radius of 2 disc diameters), whereas only postoperative ellipsoid loss ≤500 µm was significantly associated with visual outcome. In subgroup analyses, the large FTMH group (400-600 µm) had significantly better results in closure rate (70.97% vs 55.21%, P = 0.047) and visual results (P = 0.031) than the extra-large FTMH group (>600 µm). CONCLUSION: PPV with conventional ILMP provided relatively low closure rate in large FTMH. Surgical success was significantly associated with BLD ≤1200 µm, no preoperative VMI abnormality, extended ILMP and postoperative ellipsoid defect ≤500 µm. Therefore, we suggest the extended ILMP if conventional ILMP technique is used. The large FTMH group had significantly better surgical outcomes than the extra-large group, so there is a need for reclassification of large FTMH.

Emulsification of Different Viscosity Silicone Oil in Complicated Retinal Detachment Surgery: A Randomized Double-Blinded Clinical Trial.

OBJECTIVE: To study silicone oil (SO) emulsification, anatomic and visual outcome after complicated retinal detachment surgery by pars plana vitrectomy (PPV) with intraocular SO tamponade, comparing between low and high viscosity SO. DESIGN: Randomized, double-blinded, controlled trial. PATIENTS AND METHODS: Patients with complicated retinal detachment who had been surgically treated by PPV and intraocular SO tamponade were randomly divided into low viscosity (Group 1) or high viscosity (Group 2). Main Outcome Measures were rate of silicone oil emulsification, anatomic retinal reattachment and visual outcome, assessed at 1,3,6,9 and 12 months. RESULTS: One hundred patients were divided into 50 patients in each group. The rate of silicone oil emulsification in Group 1 (63.64%) was higher than Group 2 (40%), but the difference was not statistically significant (p = 0.08). Rates of anatomic retinal reattachment were 88% in Group 1 and 90% in Group 2 (p = 0.76). For functional visual outcome, final best-corrected visual acuity (BCVA) at Month 12 compared with the baseline BCVA was improved vision 52% in Group 1 and 58% in Group 2 (p = 0.82). CONCLUSION: SO emulsification rate in low viscosity group is non-significantly higher than high viscosity group, but results in a comparable reattachment rate and final visual recovery. Emulsification in both groups is detected at as early as 1 month and mostly within 3 months. We recommend using either low or high viscosity SO in complicated retinal detachment surgery and removing it as early as possible to prevent the consequent serious complications. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02988583.

Predictors for Visual Outcomes in Eye Injuries with Intraocular Foreign Body.

OBJECTIVE: To study the visual outcomes and identify the predictive factors for visual outcomes in patients with eye injuries and retained intraocular foreign bodies (IOFBs). PATIENTS AND METHODS: The medical records of 359 consecutive patients with eye injuries and retained IOFBs were retrospectively reviewed during 2009-2018. Demographic data, clinical findings, treatment and visual outcomes were studied. Univariate and multivariate analyses were used to identify the predictive factors. RESULTS: Most of the patients were male and the average age was 36.4 years old. The three most common causes of eye injuries were grass trimming (25.07%), chiseling (23.12%) and hammering (13.93%). Most of the patients (79.39%) presented with poor initial best-corrected visual acuity (BCVA) (<3/60). Pars plana vitrectomy with IOFB removal was done in 273 eyes (76.04%). After treatment, eyes with poor BCVA (<3/60) decreased from 79.39% to 62.95% and eyes with good BCVA (≥3/60) increased from 20.61% to 37.05%. Poor initial best-corrected visual acuity (odds ratio 23.39, P<0.001), rhegmatogenous retinal detachment (odds ratio 9.91, P<0.001) and the presence of infectious endophthalmitis (odds ratio 2.06, P=0.02) were statistically significant predictive factors for poor visual outcome. CONCLUSION: Most patients with eye injuries and IOFBs usually have poor final BCVA. Poor presenting BCVA, retinal detachment and endophthalmitis are significant predictive factors for poor visual outcomes. These factors can be used to inform the visual prognosis and plan prompt surgical intervention for the patients. Causes of IOFBs were mostly work-related and could be preventable. Education and activation of using appropriate protective safety glasses during work are necessary to avoid serious eye injuries and blindness.

Digital image processing software for diagnosing diabetic retinopathy from fundus photograph.

OBJECTIVE: The aim of this study was to develop automated software for screening and diagnosing diabetic retinopathy (DR) from fundus photograph of patients with diabetes mellitus. METHODS: The extraction of clinically significant features to detect pathologies of DR and the severity classification were performed by using MATLAB R2015a with MATLAB Image Processing Toolbox. In addition, the graphic user interface was developed using the MATLAB GUI Toolbox. The accuracy of software was measured by comparing the obtained results to those of the diagnosis by the ophthalmologist. RESULTS: A set of 400 fundus images, containing 21 normal fundus images and 379 DR fundus images (162 non-proliferative DR and 217 proliferative DR), was interpreted by the ophthalmologist as a reference standard. The initial result showed that the sensitivity, specificity and accuracy of this software in detection of DR were 98%, 67% and 96.25%, respectively. However, the accuracy of this software in classifying non-proliferative and proliferative diabetic retinopathy was 66.58%. The average time for processing is 7 seconds for one fundus image. CONCLUSION: The automated DR screening software was developed by using MATLAB programming and yielded 96.25% accuracy for the detection of DR when compared to that of the diagnosis by the ophthalmologist. It may be a helpful tool for DR screening in the distant rural area where ophthalmologist is not available.

A real-world study of effectiveness of intravitreal bevacizumab and ranibizumab injection for treating retinal diseases in Thailand.

BACKGROUND: To evaluate the effectiveness of intravitreal bevacizumab (IVB) and intravitreal ranibizumab (IVR) in actual practice for treating patients with retinal diseases in Thailand. METHODS: A prospective, multi-centre, observational study was conducted among eight hospitals in their ophthalmology outpatient departments. Participants consisted of patients who had previously not received any IVB or IVR treatment between 2013 and 2014. The primary outcome measurement was the change in best-corrected visual acuity (BCVA) at the end of the follow-up period compared to baseline. RESULTS: There were 1629 treatment-naïve patients for the pro re nata (PRN) treatment pattern and 226 treatment-naive patients for the three-injections (3Inj) treatment pattern. BCVA improvements were found in 35% of the PRN group and 47% of the 3Inj group; however, it was not clinically meaningful between the IVB and IVR groups (P-value = 0.568 for PRN, P-value = 0.103 for 3Inj). A multivariable logistic regression (using the propensity score) showed that positive factors associated with vision improvement for the PRN pattern were the number of drug injections, having retinal vein occlusion, and under 60 years of age, while good BCVA at baseline was a negative predictive factor. For the 3Inj pattern, under 60 years of age and baseline BCVA were statistically significant predictors. Nonetheless, diabetes mellitus (DM) without other comorbidities was a statistically significant predictor of low response to vision improvement compared to DM with other comorbidities. CONCLUSIONS: This study was the first observational, prospective study to evaluate the real-life effectiveness of IVB and IVR in Thailand. The majority of participants who used IVB or IVR showed improvements in BCVA after treatment. Further evaluation such as long-term follow-ups and subsequent comparison of effectiveness between IVB and IVR should be investigated due to the limited sample of IVR patients. TRIAL REGISTRATION: Thai Clinical Trial Registry TCTR20141002001 . Registered 02 October 2014 (retrospectively registered).

Correction to: Real-World Safety of Intravitreal Bevacizumab and Ranibizumab Treatments for Retinal Diseases in Thailand: A Prospective Observational Study.

The Open Access license, which previously read.

Real-World Safety of Intravitreal Bevacizumab and Ranibizumab Treatments for Retinal Diseases in Thailand: A Prospective Observational Study.

BACKGROUND: There is very limited evidence examining serious systemic adverse events (SSAEs) and post-injection endophthalmitis of intravitreal bevacizumab (IVB) and intravitreal ranibizumab (IVR) treatments in Thailand and low- and middle-income countries. Moreover, findings from the existing trials might have limited generalizability to certain populations and rare SSAEs. OBJECTIVES: This prospective observational study aimed to assess and compare the safety profiles of IVB and IVR in patients with retinal diseases in Thailand. METHODS: Between 2013 and 2015, 6354 patients eligible for IVB or IVR were recruited from eight hospitals. Main outcomes measures were prevalence and risk of SSAEs, mortality, and endophthalmitis during the 6-month follow-up period. RESULTS: In the IVB and IVR groups, 94 and 6% of patients participated, respectively. The rates of outcomes in the IVB group were slightly greater than in the IVR group. All-cause mortality rates in the IVB and IVR groups were 1.10 and 0.53%, respectively. Prevalence rates of endophthalmitis and non-fatal strokes in the IVB group were 0.04% of 16,421 injections and 0.27% of 5975 patients, respectively, whereas none of these events were identified in the IVR group. There were no differences between the two groups in the risks of mortality, arteriothrombotic events (ATE), and non-fatal heart failure (HF). Adjustment for potential confounding factors and selection bias using multivariable models for time-to-event outcomes and propensity scores did not alter the results. CONCLUSIONS: The rates of SAEs in both groups were low. The IVB and IVR treatments were not associated with significant risks of mortality, ATE, and non-fatal HF. TRIAL REGISTRATION: Thai Clinical Trial Registry identifier TCTR20141002001.

Comparative efficacy of bevacizumab, ranibizumab, and aflibercept for treatment of macular edema secondary to retinal vein occlusion: a systematic review and network meta-analysis.

INTRODUCTION: Anti-vascular endothelial growth factor (VEGF) therapy has become the most commonly used treatment for macular edema secondary to retinal vein occlusion (RVO). Although its superior efficacy as compared to other interventions has been proven, there is a lack of evidence for relative efficacy among anti-VEGF drugs. Areas covered: This work systematically reviewed and compared the efficacy of intravitreal bevacizumab, ranibizumab, and aflibercept for treating macular edema due to RVO. PubMed, EMBASE, and the Cochrane Library were searched from their inception until October 2017. Eleven randomized controlled trials (18 articles; 1830 adult patients) were identified. The proportion of patients who gained at least 15 letters in best-corrected visual acuity (BCVA), mean change from baseline in BCVA, and mean change from baseline in central macular thickness (CMT) were reported and these efficacy outcomes at 6 months were analyzed in network meta-analysis. Expert commentary: Apparently, bevacizumab, ranibizumab, and aflibercept were significantly superior to sham injection in terms of BCVA improvement and CMT reduction and had good safety profiles. However, there were no statistically significant differences in any outcomes among anti-VEGF drugs. In selecting an anti-VEGF drug for individual patients, other factors including affordability, drug availability, and patient characteristics should be considered.

Factors affecting visual outcomes after treatment of infectious endophthalmitis in northeastern Thailand.

OBJECTIVE: To determine factors affecting visual outcomes after treatment of infectious endophthalmitis during 2012-2016 at a large referral eye center in northeastern Thailand. PATIENTS AND METHODS: Medical charts of patients with a diagnosis of infectious endophthalmitis including demographic data, types of endophthalmitis, causative organisms, methods of treatment, anatomical, and functional outcomes were retrospectively reviewed. Factors associated with improved visual outcomes were analyzed. RESULTS: Four hundred and eleven patients (417 eyes) were recruited for the study. The three most common types were post-traumatic (44.53%), post-operative (31.87%), and endogenous endophthalmitis (17.52%). Vitreous cultures revealed causative organisms in 41.25%. Most common Gram-positive organisms were coagulase-negative Staphylococcus 30% (36/120), Bacillus spp. 20% (24/120), and Streptococcus pneumoniae 18.33% (20/120). Most common Gram-negatives were Pseudomonas spp. 24.32% (9/37), Klebsiella spp. 24.32% (9/37), and Enterobacter spp. 16.21% (6/37). Methods of treatment were medical treatment (18.71%) and surgical treatment (81.29%), including pars plana vitrectomy with or without silicone oil tamponade (62.59%) and destructive surgery (18.71%). After treatment, visual improvement was noted in 44.6%, stable vision in 18.47%, and worse vision in 36.93%. Factors associated with improved visual outcomes were post-operative endophthalmitis (P<0.001), coagulase-negative Staphylococcus (P=0.003), and initial visual acuity before treatment of hand motion or better (P=0.017). CONCLUSION: Most infectious endophthalmitis patients were post-traumatic, post-operative, and endogenous. The most common method of treatment was pars plana vitrectomy. Treatment could improve visual outcomes and at least stabilize the vision in 63.07%. Factors associated with improved visual outcomes were types of endophthalmitis, causative organisms, and initial visual acuity before treatment.

Predictive factors in the treatment of streptococcal endophthalmitis.

OBJECTIVE: To evaluate visual outcomes and possible predictive factors in the treatment of infectious endophthalmitis caused by Streptococcus species during 2012-2016 at a large referral eye center in northeastern Thailand. METHODS: A retrospective medical record chart review of patients with culture-positive endophthalmitis caused by Streptococcus species was conducted. Demographic data including age, gender, occupation, duration of symptoms, time to surgery, surgical procedures, initial visual acuity at presentation, and final visual acuity after treatment were collected and analyzed. Possible predictive factors associated with improved visual outcomes were also studied. RESULTS: Forty-five eyes of 45 patients were recruited for the study. The 3 most common types of endophthalmitis were postoperative (35.56%), posttraumatic (20%), and endogenous (15.56%). At presentation, most patients (95.56%) had visual acuity of hand motion (55.56%), light perception (28.89%), or no light perception (11.11%). The 3 most common isolates were Streptococcus pneumoniae (44.44%), Group B ß-hemolytic Streptococcus (26.68%), and Streptococcus viridans (20%). Most patients (62.22%) were treated with surgical interventions, either pars plana vitrectomy with intravitreal antibiotics or pars plana vitrectomy with intravitreal antibiotics and silicone oil tamponade. After treatment, improved visual outcome was noted in only 9 patients (20%), and no visual improvement was seen in 36 patients (80%). Evisceration and enucleation were performed in 15 patients (33.33%). The only possible predictive factor associated with improved visual outcomes was early vitrectomy, performed within 3 days. CONCLUSION: Streptococcal endophthalmitis is often associated with poor visual prognosis. Only 9 patients (20%) had improved vision after treatment. The only possible predictive factor associated with improved visual outcomes was vitrectomy within 3 days. Early diagnosis and early vitrectomy are therefore recommended.

Systemic abnormalities associated with retinal vein occlusion in young patients.

OBJECTIVES: To study the systemic abnormalities associated with retinal vein occlusion in patients aged ≤50 years with a particular emphasis on atherosclerotic diseases and thrombophilic disorders. METHODS: Medical charts of patients, aged ≤50 years whose diagnoses were retinal vein occlusions during the period 1995-2015 were retrospectively reviewed. The primary outcome was the number of systemic abnormalities associated with these patients. Secondary outcomes included types of retinal vein occlusion and sites of occlusion. RESULTS: Atherosclerotic diseases were the most common systemic abnormalities associated with retinal vein occlusion and accounted for 55.1% of the patients in the study. Hypertension in 27.55%, diabetes mellitus in 16.33%, and 5.1% with dyslipidemia were noted. The number of thrombophilic disorders seemed to be less than expected and were noted in only 5.1%. Other systemic abnormalities included viral hepatitis infection, systemic lupus erythematosus, and acquired immunodeficiency syndrome. Oral contraceptives were used by some patients. CONCLUSION: Atherosclerotic diseases remained the most commonly associated systemic diseases in the majority of these patients. Approach to these patients should include a screening for hypertension, diabetes mellitus, and lipid abnormalities. Thrombophilia should also be considered where no obvious atherosclerotic diseases are found or if the patient is <40 years old, a history of thrombosis or a family history of thrombosis is possible.

Incidence of and risk factors for chloroquine and hydroxychloroquine retinopathy in Thai rheumatologic patients.

OBJECTIVE: To study the incidences of and risk factors for chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy in Thai rheumatologic patients. METHODS: A retrospective cohort study of 234 rheumatologic patients receiving either CQ or HCQ was conducted. Patients were divided based on whether or not they developed retinopathy as retinopathy-positive or negative groups. Medical records giving details regarding age, gender, body weight, underlying diseases, daily doses, and cumulative doses of CQ or HCQ were reviewed. CQ and HCQ retinopathy were diagnosed by indirect ophthalmoscopy, Humphrey visual field test, and optical coherence tomography. The main outcome measures were incidences and risk factors of CQ and HCQ retinopathy. RESULTS: The CQ retinopathy was detected in 14 of 173 patients (8.09%) who received CQ for 139-2,033 days, cumulative doses from 14.3 to 325.1 g, and daily doses from 0.8 to 18.5 mg/kg/d. Their ages ranged from 27 to 65 years. When compared to the CQ retinopathy-negative group, only age, body weight, and cumulative dose showed statistically significant differences. The HCQ retinopathy-positive group was comprised of 2 of 61 patients (3.28%) who received HCQ for 660-828 days, cumulative doses from 80 to 130 g, and daily dose from 1.9 to 4.4 mg/kg/d. Their ages were 36 and 39 years. Compared to the HCQ retinopathy-negative group, there were no statistically significant differences in studied risk factors. CONCLUSION: Incidences of and risk factors for CQ and HCQ retinopathy were reported. Since most patients developed retinopathy earlier than 5 years, it is suggested that patients taking long-term CQ or HCQ should undergo ophthalmologic screening annually after the baseline examination.

Macular sensitivity after half-dose verteporfin photodynamic therapy in central serous chorioretinopathy.

OBJECTIVE: To study the macular sensitivity after half-dose verteporfin photodynamic therapy in patients with resolved central serous chorioretinopathy using the automated static perimeter. METHODS: Prospective consecutive case study of 24 patients with resolved central serous chorioretinopathy was performed. The macular sensitivity was measured using a conventional automated static perimeter with the Swedish interactive threshold algorithm 10-2 and foveal threshold. Best corrected visual acuity, intraocular pressure, fundus examination, macular thickness, and volume were also examined. The mean macular sensitivities of the affected eyes and their normal fellow eyes were calculated and compared. P<0.05 was considered statistically significant. RESULTS: The mean macular sensitivities of the affected eyes were lower than the normal fellow eyes with a statistically significant difference in all areas of the study (P<0.05). Best corrected visual acuity improved significantly from pretreatment (0.26±0.3 logMAR) to posttreatment (0.075±0.15 logMAR, P<0.05). Macular thicknesses in affected eyes were 230.66±67.34 µm and in the normal eyes were 238.33±92.26 µm (P=0.68). Macular volumes in affected eyes were 8.77±0.49 and in the normal eyes were 8.70±0.50 (P=0.60). These findings were not statistically significant. CONCLUSION: Eyes with resolved central serous chorioretinopathy after half-dose verteporfin photodynamic therapy had lower macular sensitivity than normal fellow eyes. These findings agreed well with the previous microperimetric studies. The conventional automated static perimeter can also be used when a microperimeter is not available.

Epidemiology of Age-Related Macular Degeneration among the Elderly Population in Thailand.

OBJECTIVE: To estimate the prevalence and associated factors of age-related macular degeneration (AMD) in Thailand. MATERIAL AND METHOD: This cross-sectional survey was undertaken in 2010. Five provinces were selected and people aged 50 years and over were invited for eye examination. Demographic and health behaviors and data from eye examination equipment were registered. Ophthalmologists graded AMD as early or late based on fundus color photograph and image from optical coherence tomography. Logistic regressions were analyzed to establish associationfactorsfor AMD. RESULTS: Of the 7,043 participants, AMD wasfound in 862 people (12.2%), with more than half (53.1%) found in both eyes. Most cases (94.3%) were early dry, 1.8% early wet, 3.4% late dry, and 0.7% late wet AMD. Factors positively associated with AMD were age (OR 1.03, 95% CI 1.02-1.04), diabetes mellitus (OR 1.20, 95% CI 1.03-1.39), and consumption of yellow vegetable (OR 2.32, 95% CI 1.23-4.39). Factors that conversely associated with AMD were consumption of green vegetable (OR 0.51, 95% CI 0.33-0.79), physical exercise (OR 0.67, 95% CI 0.51-0.87), high bloodpressure (OR 0.75,95% CI 0.63-0.89), and heavy drinking habit (OR 0.45, 95% CI 0.26-0.75). CONCLUSION: The prevalence of AMD in Thai population age 50 and over was 12.2%. More than half (53.1%) of the cases were found in both eyes, but few at severe stages. The present study confirmed age and DM as positive associated factors, and green vegetable, exercise as negative associated factors. Further research should investigate the effects of hypertension, yellow vegetable, and alcohol drinking on AMD.

Infectious endophthalmitis: review of 420 cases.

BACKGROUND: To characterize the causative pathogens and the visual outcomes among patients with endophthalmitis at a large referral center in northeastern Thailand. METHODS: All cases of infectious endophthalmitis treated between 1983 and 2007 were reviewed retrospectively. The patient data - including age, sex, history of ocular injuries, previous treatment and duration of the symptoms - were recorded. The ocular examination included affected side, anterior chamber reaction, vitreous haze, and presence of intraocular foreign bodies. Smears and cultures were prepared from anterior chamber paracentesis and/or vitreous tapping. Intraocular antibiotics were administered at the time of anterior chamber paracentesis and/or vitreous tapping. Vitrectomy and/or lensectomy were performed when indicated. Initial visual acuity before treatment and the final best-corrected vision were compared. RESULTS: A total of 420 cases of endophthalmitis were reviewed: 181 cases (43.1%) had ocular trauma before the infection; 135 (32.2%) developed endophthalmitis after intraocular surgery; and, 122 (29.1%) had a positive culture. Bacteria were isolated in 114 cases (93.4%) and fungi were noted in eight (6.6%). The common causative bacterium was Staphylococcus epidermidis. Combined vitrectomy and intraocular antibiotics were performed in 189 cases (45.0%), whereas 69 cases (16.4%) were treated with intraocular antibiotics alone. CONCLUSION: Most of the reviewed cases were associated with trauma and intraocular surgery. The most frequently encountered bacterium causing infectious endophthalmitis was S. epidermidis. Most cases were treated with combined vitrectomy and intraocular antibiotics. The final visual outcomes seem to vary according to the type of endophthalmitis.

The use of comparative effectiveness research to inform policy decisions on the inclusion of bevacizumab for the treatment of macular diseases in Thailand's pharmaceutical benefit package.

There is increasing impetus to use pharmaceutical interventions, ie, ranibizumab or bevacizumab, for the treatment of particular macular diseases. This paper describes the evidence and decision-making of the National List of Essential Medicines Committee that recently announced the inclusion of bevacizumab for the treatment of macular diseases in its pharmaceutical benefit package. The findings of a systematic review and meta-analysis in this paper indicate that the intravitreal administration of bevacizumab is superior to nonpharmaceutical treatments for age-related macular degeneration (AMD) and diabetic macular edema (DME), but inconclusive for retinal vein occlusion, given the limited evidence. The study also failed to distinguish among the differences in terms of visual acuity improvement, reduction of central macular thickness, and response to treatment between AMD and DME patients treated with bevacizumab and those treated with ranibizumab. Although bevacizumab was not licensed for AMD and DME, the committee decided to include bevacizumab in the National List of Essential Medicines. It is expected that many patients who are in need of treatment but who are unable to afford the expensive alternative drug, ranibizumab, will be able to receive this effective treatment instead and be prevented from suffering irreversible loss of vision. At the same time, this policy will help generate evidence about the real-life effectiveness and safety profiles of the drug for future policy development in Thailand and other settings.

Analysis of eye health in the Thai population.

OBJECTIVE: To assess national eye health as a baseline for improving medical education, services and research. MATERIAL AND METHOD: Information on eye illness among out- and in-patients was based on hospital claims from the three national health insurance schemes in 2010. The data were analyzed by age groups. RESULTS: In 2010, 4,982,025 out-patient visits and 187,080 in-patient admissions were reported. The five most common outpatient eye conditions were disorders of the (1) conjunctiva (H10-H13) (2) eyelid, lacrimal system and orbit (H00-H06) (3) lens (H25-28) (4) sclera, cornea, iris and ciliary body (H15-H22) and (5) glaucoma (H40-H42). The five most common inpatient eye diseases were (1) disorders of lens (H25-H28) (2) conjunctiva (H10-H13) (3) sclera, cornea, iris and ciliary body (H15-H22) (4) choroid and retina (H30-H35) and (5) glaucoma (H40-H42). CONCLUSION: Information on the most frequent eye diseases-including the types and frequency of high risk conditions, the diseases causing the most impact on vision and resulting in the highest health expenditures-will be used to (a) revise the curricula for medical education (b) to improve eye care services and (c) to improve access to data for research themes tailored to local and national needs.

Management of cataract in the Thai population.

OBJECTIVE: To analyze the types of cataracts, surgical procedures, hospital charges and length of stays among the Thai population. MATERIAL AND METHOD: Information on cataracts among out- and in-patients in the fiscal year 2010 was retrieved from the databases of the three main national health insurance schemes. The data were analyzed according to the types of cataract, surgical procedures, hospital charges and length of stays. RESULTS: There were 654,352 out-patient visits and 146,994 in-patient admissions in the fiscal year 2010. The number of cataract patients was greatest among 61-80 year-olds. Senile cataract was the most frequent type of cataract (97.11%) followed by traumatic (0.59%), infantile, juvenile and pre-senile (0.45%), complicated (0.15%) and drug-induced (0.02%). Phacoemulsification with intraocular lens implantation was the most common surgical procedure used to restore vision among the elderly (83.07%). The average health expenditure for cataract was 18,527 baht and length of hospital stay 2.35 days. CONCLUSION: Cataracts and their management in the Thai population were analyzed. For health economic reasons, all cataract surgeries should be on an out-patient basis unless otherwise approved. Prospective studies should be designed to assess the relevant data on specific cataracts and the associated risk factors.