Reliability, validity, and responsiveness of the Thai version of the Dry Eye-Related Quality-of-Life Score questionnaire.

Dry eye disease (DED) is a common and growing eye problem worldwide. Chronic DED symptoms can, subsequently, affect the patients' quality of life (QOL). This prospective cross-sectional study aimed to assess the reliability, validity, and responsiveness of the Thai version of the Dry Eye-Related Quality-of-Life Score (DEQS-Th) questionnaire and to evaluate its accuracy in DED screening. Psychometric validation was conducted on DED participants. All participants completed the DEQS-Th and other measurements including the Ocular Surface Disease Index (OSDI) and the 5-level EQ-5D (EQ-5D-5L). Internal consistency, concurrent validity, convergent, and discriminant validity were evaluated. The standardized response mean (SRM) was used to evaluate the responsiveness of the DEQS-Th. The optimal cut-off score of DEQS-Th for DED screening was assessed. Among 100 participants with a mean age of 50.9 ± 14.4 years, and 89.0% female, the internal consistency of the DEQS-Th was excellent (Cronbach's alpha: 0.80-0.92). The test-retest intraclass correlation was 0.82-0.92. It showed concurrent validity with the OSDI (r = 0.694, p < .001) and EQ-5D-5L index scores (r = -0.578, p < .001). DED is suspected if the DEQS-Th score ≥ 18.33 (AUC = 0.897, sensitivity 90.0%, specificity 76.7%) or its Short Form score ≥ 3 (AUC 0.857, sensitivity 93.0%, specificity 63.3%). The SRM of the symptom subscale of DEQS-Th was 0.82, indicating relatively large responsiveness, whereas the impact on daily life subscale and the summary score was small. In conclusion, the DEQS-Th is valid and reliable for evaluating the multifaceted effects of DED on a patient's QOL. It can be useful for primary assessment and monitoring of DED in routine clinical practice.

Assessing the Risk Factors For Diagnosed Symptomatic Dry Eye Using a Smartphone App: Cross-sectional Study.

BACKGROUND: Dry eye (DE) is a chronic inflammatory disease of the ocular surface of the eye that affects millions of people throughout the world. Smartphone use as an effective health care tool has grown exponentially. The "Dry eye or not?" app was created to evaluate the prevalence of symptomatic DE, screen for its occurrence, and provide feedback to users with symptomatic DE throughout Thailand. OBJECTIVE: The purpose of this study was to compare the prevalence of symptomatic dry eye (DE), blink rate, maximum blink interval (MBI), and best spectacle-corrected visual acuity (BSCVA) between people with and without symptomatic DE and to identify risk factors for symptomatic DE in Thailand. METHODS: This cross-sectional study sourced data from the "Dry eye or not?" smartphone app between November 2019 and July 2020. This app collected demographic data, Ocular Surface Disease Index (OSDI) score, blink rate, MBI, BSCVA, and visual display terminal (VDT) use data. The criterion for symptomatic DE was OSDI score ≥13. RESULTS: The prevalence of symptomatic DE among individuals using this smartphone app in Thailand was 85.8% (8131/9482), with the Northeastern region of Thailand having the highest prevalence, followed by the Northern region. Worse BSCVA (median 0.20, IQR 0.40; P=.02), increased blink rate (median 18, IQR 16; P<.001), reduced MBI (median 8.90, IQR 10.80; P<.001), female sex (adjusted OR 1.83; 95% CI 1.59-2.09; P<.001), more than 6 hours of VDT use (adjusted OR 1.59; 95% CI 1.15-2.19; P=.004), and lower than bachelor's degree (adjusted OR 1.30; 95% CI 1.03-1.64; P=.02) were significantly associated with symptomatic DE. An age over 50 years (adjusted OR 0.77; 95% CI 0.60-0.99) was significantly less associated with symptomatic DE (P=.04). CONCLUSIONS: This smartphone DE app showed that the prevalence of symptomatic DE in Thailand was 85.8%. Signs and risk factors could be also evaluated with this smartphone DE app. Screening for DE by this app may allow for the development of strategic plans for health care systems in Thailand.

Pseudomonas aeruginosa Scleritis following Pterygium Surgery with Mitomycin C or Beta Irradiation: Three-Case Report.

Purpose: To report three cases of culture-positive Pseudomonas aeruginosa scleritis following pterygium surgery. Patients and Methods. A retrospective study of all patients of Pseudomonas aeruginosa scleritis after pterygium surgery presented from May 2017 to May 2020 was performed. Patient demographics and clinical characteristics included age, gender, time between prior surgery and onset, adjunctive therapy, risk factors, initial visual acuity, final visual acuity, clinical features, medical treatment, and surgical intervention were analyzed. Results: Three eyes of three patients with clinical characteristics and laboratory-confirmed Pseudomonas aeruginosa scleritis were identified. Two patients were related with mitomycin C application after pterygium surgery, and only one had beta irradiation. Antibiotic administration and scleral debridement were required in 3 patients. One eye was enucleated. Final visual outcomes of two patients were improved. Conclusions: Pseudomonas aeruginosa scleritis after pterygium surgery is a crucial ophthalmic disease. An early diagnosis with a prompt intensive antibiotic treatment in combination with surgical interventions may improve visual outcome.

Role of neuroticism and perceived stress on quality of life among patients with dry eye disease.

This hospital-based, cross-sectional observational study aimed to examine whether neuroticism has an impact on stress that is related to dry eye disease (DED) and quality of life (QOL). One hundred participants who had DED completed the Dry Eye-Related Quality-of-Life Score (DEQS) questionnaire, a 5-level EQ-5D (EQ-5D-5L), Neuroticism Inventory (NI), and 10-Item Perceived Stress Scale (PSS). Hierarchical linear regression was applied to determine the predictive effect of the independent variables. Participants' mean age was 50.91 ± 14.3 years, and females totalled 89.0%. Hierarchical linear regression analysis showed that DESQ-Ocular symptoms were the strongest predictor for QOL either assessed by DEQS or EQ-5D, and its effect was lessened when perceived stress and neuroticism were added to the model. The final model explained up to 30-39% variance of the QOL, compared with 13-32% by DESQ-Ocular symptoms alone. QOL of the patients with DED, is not only related to eye symptoms but perceived stress. Moreover, neuroticism was a strong predictor contributing to the QOL among patients with DED. The study showed a significant association between perceived stress, neuroticism and the QOL of patients with DED. Personality has some impact on both subjective dry eye symptoms and impact on daily life, along with the general health-related QOL.

Ocular surface squamous neoplasia in Northern Thailand: a 16-year review.

PURPOSE: To evaluate clinical characteristics, treatments, and outcomes in patients with ocular surface squamous neoplasia (OSSN) at a tertiary center in Northern Thailand. METHODS: Patients diagnosed with either corneal-conjunctival intraepithelial neoplasia (CIN) or squamous cell carcinoma (SCC) from May 2000 to December 2015, were recruited. The patients' demographics, symptoms, clinical characteristics, cytopathology, treatments, and outcomes were reviewed. RESULTS: Overall 171 eyes from 168 patients, 92 eyes were CIN and 79 eyes were SCC. Males were affected in 65.5%. The mean age was 58.8 ± 16.8 (29-99) years. In most cases (60.3%), the tumors were located at the limbus. The most common clinical characteristic was papilliform appearance (46.2%). Human immunodeficiency virus (HIV) infection was found in 37 (22.0%) patients with a mean age of 40.5 ± 7.7 years. The treatments and outcomes were evaluated in 136 eyes whose main initial treatment was wide excision with adjunctive cryotherapy (47.8%), followed by topical mitomycin C (30.9%). The mean follow-up time after treatment was 20.8 ± 2.2 (3-110) months and the recurrence occurred in 18 eyes (13.2%) during the follow-up period. The mean recurrence-free time (months) for CIN was significantly longer than that of SCC (81.3 ± 10.0 [95%CI 61.5 - 101.1] vs 33.2 ± 4.6 [95%CI 24.0 - 42.3], p = 0.030). SCC was the only significant risk factor that influences the recurrence of the tumors with the adjusted hazard ratio of 5.69 (p = 0.005). CONCLUSION: OSSN in Northern Thailand usually involved a limbal area and presented as a papilliform mass. HIV infection should be suspected in young patients. CIN had better outcomes after treatments than invasive SCC.

Effect of 2% Hyaluronic Acid on the Rate of Healing of Corneal Epithelial Defect After Pterygium Surgery: A Randomized Controlled Trial.

PURPOSE: The study aimed to investigate the effects of 2% hyaluronic acid (HA) on corneal epithelial defect after pterygium surgery in comparison with the control group, measured in terms of the healing rate of corneal epithelial defect and pain score after surgery. METHODS: In this double-blind randomized clinical trial, fifty patients with primary pterygium were randomized into 2 groups: a control group or the group treated with a single topical application of 2% HA. Comprehensive ophthalmological examinations included measuring the area of corneal epithelium defect using ImageJ freeware and the pain score assessment after the operation. RESULTS: The mean and SD of the area of epithelial defect measured on postoperative Day 0, 1, and 2 were 10.89 ± 1.33 mm2, 5.04 ± 0.87mm2, and 2.44 ± 0.74 mm2 for the HA group, and 11.14 ± 1.11 mm2, 7.74 ± 1.17 mm2, and 5.31 ± 1.15 mm2 for the control group, respectively. While the initial area of the defect on Day 0 was essentially the same for both groups (p = 0.478), the area of the defect in the HA group was significantly smaller on both Day 1 and Day 2 (p < 0.001, p < 0.001), respectively. Similarly, the HA group exhibited a statistically significant higher rate of healing for the cornea epithelial defect over Day 0 and 1 compared to the control group (5.85 ± 0.89 mm2/day vs 3.14 ± 1.28 mm2/day, p < 0.001), respectively. The median (range) pain scores were evaluated at Day 0 was 7 (4-10) in the HA group and 7 (3-10) in the control group (p = 0.953). There was no statistically significant difference between two groups (p > 0.05) for Days 1, 2, and 3. CONCLUSION: A single topical application of 2% HA tended to accelerate the healing process of corneal epithelium defect after pterygium surgery without any observable adverse effects during short-term follow-up.

Two-Step Transepithelial Photorefractive Keratectomy with WaveLight EX500 Platform for Adolescents and Adults with Low to Moderate Myopia: A 12-Month Comparative Evaluation.

PURPOSE: To compare the visual and refractive results obtained after two-step TransPRK using an EX500 excimer laser for low to moderate myopic correction in adolescents and adults. PATIENTS AND METHODS: Retrospectively, 91 eyes of 52 patients were categorized into four groups based on age and level of myopia. The demographics, data of efficacy, safety, predictability, stability, and post-operative complications were evaluated at 1, 3, 6, and 12 months post-operatively. RESULTS: At 1-month, adolescents with low myopia achieved the highest mean efficacy index (P =0.034). The efficacy indices continuously increased during the 1-year follow-up in all groups, except in adolescents with moderate myopia. The highest safety and efficacy indices were recorded in adolescents with low myopia at 1-year. Post-operative spherical equivalent within ±0.50 D at 1 year was 48.75% of all treated eyes; however, the final mean refractive spherical equivalent (MRSE) was under-corrected in all groups. By month 3, the percentage of eyes that had grade 0.5 haze was most prevalent in adolescents with moderate myopia (P <0.001). CONCLUSION: two-step TransPRK using an EX500 proved to be an effective, predictable, stable and safe procedure for the correction of low to moderate myopia with or without astigmatism at 1 year. Adolescents with low myopia achieved the best-post-operative UDVA, efficacy and safety indices. Adolescents tolerated night visual problems and dry eye symptoms better than adults.

Thai version of the dry eye-related quality-of-life score questionnaire: preliminary assessment for psychometric properties.

BACKGROUND: This study aimed to develop a Thai version of the Dry Eye-Related Quality-of-Life Score (DEQS-Th) questionnaire and evaluate its validity, reliability, and feasibility among Thai participants. METHODS: The DEQS-Th, a 15-item self-report measuring dry eye and its impact on quality of life (QOL) was developed based on the DEQS. The questionnaire was divided into two subscales: Bothersome Ocular Symptoms (six questions), and Impact on Daily Life (nine questions). It employed a 5-point Likert scale, addressing on both the frequency and the degree of symptoms. Backward and forward and cultural adaptation process translation methods were employed. Thirty healthy participants were enrolled to evaluate the feasibility of the DEQS-Th in terms of difficulty and convenience. Reliability was assessed using internal consistency determined by Cronbach's alpha, with values > 0.7 considered acceptable. Convergent validity was determined by the correlation between DEQS-Th and overall health status. Confirmatory factor analysis was conducted for its factor structure. RESULTS: The participants' mean age was 38.6 ± 12.9 years, and 23 (76.7%) were females. The mean time to complete the questionnaire was 9.3 ± 2.7 min. The Cronbach's alpha of the ocular symptoms subscale, impact on QOL subscale, and summary score on frequency and degree were 0.80 and 0.70, 0.89 and 0.89, and 0.90 and 0.89, respectively. The overall health status significantly correlated with the summary score (r = 0.564, p = .001), subscale ocular symptoms (r = 0.594, p = .001), and impact on QOL scores (r = 0.626, p < .001) of the DEQS-Th, respectively. A one-factor model fitted the data the best for both the ocular symptoms subscale (CFI = 1.000, TLI = 1.000, RMSEA = 0.000) and the impact on QOL subscale (CFI = 0.998, TLI = 0.997, RMSEA = 0.053). CONCLUSION: When tested among normal participants, the DEQS-Th is a valid and reliable measurement for dry eye symptoms and impact on QOL.

The Clinical Features and Prognostic Factors for Treatment Outcomes of Dematiaceous Fungal Keratitis over 9 Years at a Tertiary Eye Care in Northern Thailand.

Dematiaceous fungal keratitis is an important etiology of visual loss, particularly in an agricultural society. From a retrospective review of medical records from 2012 to 2020, 50 keratitis cases of cultured-positive for dematiaceous fungi were presented at a tertiary care hospital in Northern Thailand. The study aimed to identify the isolated causative dematiaceous species using the PCR technique and to explore their related clinical features, including treatment prognoses. Sequencing of the amplified D1/D2 domains and/or ITS region were applied and sequenced. Of the 50 dematiaceous fungal keratitis cases, 41 patients were males (82%). In most cases, the onset happened during the monsoon season (June to September) (48%). The majority of the patients (72%) had a history of ocular trauma from an organic foreign body. The most common species identified were Lasiodiplodia spp. (19.35%), followed by Cladosporium spp. and Curvularia spp. (12.90% each). About half of the patients (52%) were in the medical failure group where surgical intervention was required. In summary, ocular trauma from an organic foreign body was the major risk factor of dematiaceous fungal keratitis in Northern Thailand. The brown pigmentation could be observed in only 26%. Significant prognostic factors for medical failure were visual acuity at presentation, area of infiltrate, depth of the lesions, and hypopyon.

Fungal keratitis at a tertiary eye care in Northern Thailand: Etiology and prognostic factors for treatment outcomes.

PURPOSE: To evaluate etiology and prognostic factors for treatment outcomes of fungal keratitis (FK). METHODS: Culture-positive FK patients between 2012 and 2017 were reviewed. Treatment outcomes were categorized into success (resolved within two weeks), slow response and medication failure (no improvement or required surgery). Etiology and risk factors for poor treatment outcomes were analyzed. RESULTS: A total of 113 eyes of 113 patients (77% males) were recruited. Ocular trauma (69.0%) was the most common predisposing factor. Of this, 80% were exposed to organic foreign bodies. The most common pathogen was Fusarium spp. (45.2%), while dematiaceous fungi were discovered in 29.6%. Medical treatment was successful in 24.8% of eyes, while 29.2% had a slow response and 42.5% failed medication. Therapeutic keratoplasty was performed in 22.1% of eyes and 11.5% eventually required eye removal. Significant risk factors for medication failure were advanced age (P = 0.005), delayed antifungal treatment (P = 0.038) and large-size lesion (P = 0.003). CONCLUSIONS: Ocular trauma was the major predisposing factor of FK in the Northern Thailand. Fusarium was the most common identified pathogen. Many cases were refractory to medications and required surgical intervention. Aging, delayed treatment and a large lesion were predictors for poor outcomes.

Harboyan syndrome: novel SLC4A11 mutation, clinical manifestations, and outcome of corneal transplantation.

Harboyan syndrome or corneal dystrophy and progressive deafness (MIM #217400) is characterized by congenital hereditary endothelial dystrophy (CHED) and progressive, sensorineural hearing loss. Mutations in SLC4A11 are responsible for this rare genetic syndrome. Eight patients from seven unrelated families affected with Harboyan Syndrome with mean follow-up of 12.0 ± 0.9 years were thoroughly investigated for the ocular, hearing, and kidney function abnormalities and the outcome of penetrating keratoplasty (PK). Mutation analysis of SLC4A11 was performed. All patients presented with bilateral cloudy corneas since birth. Sensorineural hearing loss was detected in all patients. Seven patients (11 eyes) underwent PK with the median age at surgery of 10.1 years (7.1-22.9). The overall corneal graft survival rate after primary PK was 72.7% (8/11 eyes). The mean graft survival time was 94.6 months (95% CI 83.1-126.0). All patients had unremarkable kidney function. The c.2264G>A (p.Arg755Gln) mutation in SCL4A11 was detected in most patients (87.5%). All unrelated Karen tribe patients had p.Arg755Gln mutation, suggestive of founder effect. We found the allele frequency of this variant in the Karen population to be 0.01. The c.2263C>T (p.Arg755Trp) mutation was found in one patient with mild phenotype and the novel truncating protein mutation c.2127delG (p.Gly710fsx*25) in SCL4A11 was identified in two Thai sisters. Visual outcome and graft survival after PK were satisfactory. Our study shows that all studied patients with SLC4A11 mutations had CHED and sensorineural hearing loss, and SLC4A11 mutations were not related to the onset and severity of hearing loss or outcome of keratoplasty.

Twelve-Month Outcomes of the Wavefront-Optimized Photorefractive Keratectomy for High Myopic Correction Compared with Low-to-Moderate Myopia.

PURPOSE: To evaluate the 12-months outcomes of photorefractive keratectomy (PRK) in patients with high myopia (≥ 6.0 diopters, D) compared with low-to-moderate myopia (< 6.0 D). PATIENTS AND METHODS: Records of 46 patients (69 eyes) who underwent PRK for myopic and astigmatic correction between October 2015 and December 2018 were reviewed. High myopic eyes (29 eyes) were compared with low-to-moderate myopic eyes (40 eyes). All surgeries were adjunct with 0.02% mitomycin C intraoperatively. Measured outcomes included postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent, corneal haze rate, and any complications. RESULTS: At 12 months post-PRK, 26 eyes (89.7%) in the high myopia and 39 eyes (97.5%) in the low-to-moderate myopia group had UDVA ≥ 20/20, (p=0.30). Average postoperative logMAR UDVA at 12 months was -0.04 (20/18) and -0.11 (20/15) for the high myopia and low-to-moderate myopia groups, respectively. No eyes in either group had residual refractive errors >1 D. No eyes in both groups developed significant corneal haze at month 12. No eyes had a loss of greater than two Snellen lines of CDVA at 12 months post-surgery. The efficacy and safety indices at 12 months post-surgery were not significantly different between groups (1.06±0.26 vs.1.14±0.27, p =0.25 and 1.14±0.27 vs 1.17±0.26, p=0.60 for low-to-moderate myopia vs high myopia groups, respectively). CONCLUSION: PRK with high myopic correction provides excellent refractive outcomes and is safe, compared to those of low-to-moderate myopic correction.

Incidence and predisposing factors of anterior chamber gas bubbles during femtosecond laser flap creation.

AIM: To investigate the incidence and the predisposing factors of anterior chamber (AC) gas bubbles during femtosecond laser (FS) flap creation for laser in situ keratomileusis (LASIK). METHODS: All patients who underwent FS-LASIK surgery at CMU LASIK Center between January 2013 and May 2016 were retrospective reviewed. Preoperative and intraoperative data including keratometry, white-to-white (WTW) corneal diameter, flap parameters (diameter, thickness, hinge position, and tunnel length) and pulse energy were reviewed and compared between incident group and control group. To determine the risk factors, univariate and multivariate conditional logistic regression were used; the eye was unit of analysis. RESULTS: The incidence of AC gas bubbles was 1.6% (22 out of 1378 eyes). The median WTW in the AC bubbles group was 11.5 mm (range 11.1-12.1), which was significantly different from the control group (11.7 mm, range 10.5-12.8, P=0.021). The result of the median WTW minus the flap diameter in the AC bubbles group was 2.5 mm (range 2.1-3.2), which was statistically different to the control group (2.7 mm, range 1.5-3.8, P=0.008). The logistic regression analysis showed that the result of the WTW minus the flap diameter in the AC bubbles group had an adjusted odds ratio of 0.204 (95%CI; 0.056-0.747, P=0.016). CONCLUSION: Development of AC gas bubbles during FS flap creation is not an uncommon event in Asian eyes which typically have a small WTW. The flap diameter when adjusted relatively to the WTW is a predisposing factor to the possibility of AC gas bubbles occurrence.

Corneal thickness and endothelial morphology in Normal Thai eyes.

BACKGROUND: This study aimed to determine the influence of age on central corneal thickness and corneal endothelial morphology as well as to identify the relationship between them in normal Thai eyes. METHODS: Non-contact specular microscopy was performed in volunteers stratified into seven age groups ranging from 11 to 88 years. The corneal endothelial parameters studied included central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variation in cell size (CV), cell area (CA) and percentage of regular hexagonal cells. RESULTS: In a total of 501 subjects (1002 eyes), the mean age was 43.12 ± 18.80 years and 347(69.3%) were females. The mean CCT, ECD, CV, CA, and hexagonality was 533.80 ± 33.00 µm, 2732 ± 258 cell/mm2, 37.61 ± 6.76%, 369.04 ± 37.90 µm, and 49.03 ± 7.53%, respectively. There was a significant inverse correlation between age and CCT (r = - 0.215, P <  0.001), ECD (r = - 0.496, P <  0.001),and hexagonality (r = - 0.265, P <  0.001). The CV and CA directly correlated with age (r = 0.242, P <  0.001 and r = 0.470, P <  0.001). The estimate rate of endothelial cell loss was 0.2% per year. There was no correlation between CCT and ECD (P = 0.106). CONCLUSION: Normative data for corneal endothelial morphology in healthy Thai eyes showed that CCT, ECD, and hexagonality were significantly decreased, while the endothelial cell area and the variation in cell size were increased with aging. The central corneal thickness did not correlate with the endothelial cell density.

Epidemiology of Eye Injuries Resulting in Hospitalization, a Referral Hospital-Based Study.

PURPOSE: To determine the characteristics of hospitalized eye injuries in Northern Thailand, a tertiary referral center. METHODS: The medical records of patients who sustained an eye injury and were admitted to the Department of Ophthalmology, Chiang Mai University, Thailand, from February 2015 to February 2016 were retrospectively reviewed. Demographics and characteristics of each injury were collected. RESULTS: A total of 249 injured patients were included, of which 227 (91.2%) were male. There was no significant difference in the mean (standard deviation) age between genders, 39.8 (22.9) years of age for females and 43.8 (17.8) for males (P = 0.43). Most injuries occurred in the workplace (149/249, 59.8%). Nearly similar proportions of the opened globe and closed globe injuries were observed, 121/249 (48.6%) patients and 109/249 (43.8%) patients. A small proportion sustained eyelid/adnexal and chemical injury, 19/249 (7.6%) patients. Corneal penetration (52/249, 20.9%) and intraocular foreign body (37/249 14.9%) were the most prevalent conditions for opened globe injury. Traumatic lens subluxation/dislocation (31/249, 12.4%) and a traumatic corneal ulcer (25/249, 10.1%) were the common conditions for closed globe injury. A delayed presentation to the hospital was noted in closed globe injury. The eyelid/adnexal injury group had a better final visual acuity compared to the opened and closed globe injury group. CONCLUSION: Activities related to hospitalized eye injuries were varied in different age groups, specifically adults at workplace, and children at playground; therefore different strategies should be applied to prevent visual impairments and disabilities in specific high-risk groups.

The First Acanthamoeba keratitis Case of Non-Contact Lens Wearer with HIV Infection in Thailand.

Acanthamoeba keratitis (AK) is a rare sight-threatening corneal infection, often reporting from contact lens wearers. An asymptomatic human immunodeficiency virus (HIV)-infected Thai male without history of contact lens use complained foreign body sensation at his left eye during motorbike riding. He had neither specific keratitis symptoms nor common drugs responding, which contributed to delayed diagnosis. By corneal re-scraping, Acanthamoeba-like cysts were detected by calcofluor white staining and agar culture. The etiological agent obtained from the culture was molecularly confirmed by Acanthamoeba spp.-specific PCR, followed by DNA sequencing. The results from BLAST and phylogenetic analysis based on the DNA sequences, revealed that the pathogen was Acanthamoeba T4, the major genotype most frequently reported from clinical isolates. The infection was successfully treated with polyhexamethylene biguanide resulting in corneal scar. This appears the first reported AK case from a non-contact lens wearer with HIV infection in Thailand. Although AK is sporadic in developing countries, a role of free-living Acanthamoeba as an opportunistic pathogen should not be neglected. The report would increase awareness of AK, especially in the case presenting unspecific keratitis symptoms without clinical response to empirical antimicrobial therapy.

Corneal perforation after noncontact tonometry in patients with active recurrent herpes simplex keratitis: case report.

PURPOSE: To report iatrogenic complications and to review the potential complications caused by noncontact tonometry (NCT) in related literature. METHODS: This case report describes two cases of active recurrent herpes simplex keratitis (HSK) on top of a thin corneal scar. The cornea was perforated by the air pulse from the NCT, resulting in an air bubble in the anterior chamber. RESULTS: Both patients were diagnosed with active recurrent necrotizing stromal HSK on top of a thinned corneal scar after previous therapeutic treatment involving tissue adhesive glue with a bandage contact lens (BCL) to treat a perforated cornea. During a follow-up visit, both patients reported similar symptoms of acute pain and fluid exuding from their eyes immediately after undergoing NCT. Slit-lamp examination revealed a perforated cornea with an intracameral air bubble. Treatment involved use of tissue adhesive glue and BCL in both cases. CONCLUSION: NCT may not be sufficiently safe in patients with active infectious keratitis, particularly in cases where the cornea is relatively thin and necrotic.

A Randomized Controlled Double-Masked Study of Transdermal Androgen in Dry Eye Patients Associated With Androgen Deficiency.

PURPOSE: To evaluate the efficacy, safety, and quality of life (QOL) of transdermal androgen in treatment of dry eye patients associated with androgen deficiency. DESIGN: Randomized controlled trial. METHODS: Fifty patients with dry eye from a tertiary eye center in northern Thailand were randomized to receive transdermal androgen (AndroGel; Besins Healthcare, Brussels, Belgium) or placebo for 4 weeks. Main outcome measures were symptoms and signs of dry eye. Serum level of sex hormone and QOL questionnaires were also evaluated at the baseline and after treatment. RESULTS: After 4 weeks, the Ocular Surface Disease Index decreased significantly in the AndroGel group compared to the placebo (-14.36 ± 7.76 vs 0.14 ± 14.60, P < .001). Significant improvements of tear break-up time (7.40 ± 3.37 vs -1.14 ± 1.68 seconds, P < .001), corneal fluorescein staining (-0.62 ± 0.30 vs 0.19 ± 0.37, P < .001), and Schirmer test (6.84 ± 5.10 vs -0.48 ± 2.14 mm, P < .001) were observed in the AndroGel group compared to the placebo. Serum testosterone in female patients significantly increased in the AndroGel group compared to the placebo (P < .001), while no different change was observed in serum testosterone in male subjects and the sex hormone-binding globulin in both groups. In the AndroGel group, 20% of patients had oily skin and 4% had acne. No serious adverse effects were reported. The menopause rating score improved significantly in the AndroGel group compared to the placebo (P < .001), while the aging male symptoms were not different in both groups (P = .589). CONCLUSIONS: Transdermal androgen was effective in relieving symptoms and signs of dry eye as well as improving QOL in aging patients. There were no serious side effects during a short-term treatment.

Ocular Basidiobolomycosis: A Case Report.

BACKGROUND: Ocular basidiobolomycosis is an unusual infection caused by fungus of the order Entomophthorales. This fungus has been previously reported as a common cause of skin, subcutaneous, and gastrointestinal tract infection. The fungus isolation and its typical characteristics are clues for diagnosis of this uncommon pathogen. CASE REPORT: A 47-year-old male patient with nodular scleritis in the left eye after an eye injury from sawdust was treated as bacterial scleritis. The lesion improved with early surgical drainage and antibacterial therapy; then, he was discharged from the hospital. Thereafter, the patient was re-admitted due to progression of infectious scleritis with keratitis and orbital cellulitis. Surgical abscess drainage was performed again. The microbiological study demonstrated Basidiobolus ranarum. The patient was treated with topical ketoconazole, subconjunctival fluconazole injection, and oral itraconazole with partial response to the treatment. However, the patient eventually denied any further treatment and did not return for follow-up. CONCLUSIONS: B. ranarum is a rare pathogen of ocular infection in which a definite diagnosis requires isolation of the causative organism. Delay in diagnosis and appropriate treatment can lead to extension of the infection and poor outcomes.

Outcomes of LASIK for Myopia or Myopic Astigmatism Correction with the FS200 Femtosecond Laser and EX500 Excimer Laser Platform.

PURPOSE: To evaluate the efficacy, predictability, stability and safety of laser in situ keratomileusis (LASIK) using the FS200 femtosecond laser and EX500 excimer laser platform. METHODS: The outcomes of 254 eyes of 129 consecutive patients with myopia or myopic astigmatism who underwent full correction femtosecond laser-assisted LASIK at CMU LASIK Center were assessed. Pre-operative and post-operative parameters including manifest refraction, Uncorrected Distance Visual Acuity (UDVA), Best Corrected Distance Visual Acuity (BDVA), corneal topography and tomography were analyzed. The results between low to moderate myopia and high myopia were compared up to 12 months. RESULTS: Mean pre-operative Spherical Equivalent (SE) was -5.15±2.41 Diopters (D) (range -0.50 to -11.50 D) and -0.13±0.28 D, -0.13±0.27 D, -0.13±0.28 D and -0.14±0.30 D at 1, 3, 6, and 12 months, post-operatively. At 12 months, the propor¬tion of eyes achieving UDVA ≥ 20/20 was 90.0% and ≥20/40 was 98.8%. The proportion of eyes achieving post-operative mean SE ±0.5 D, and ±1 D was 91.3%, and 98.5%. No eyes lost more than two lines of BDVA. The low to moderate myopic group had a statistically significant better UDVA at one (p=0.017) and three months (p=0.014) but no difference at six (p=0.061) and 12 months (p=0.091). The mean post-operative SE was better in low to moderate myopic group at every follow-up visit (p=0.001, 0.007, <0.001 and <0.001). CONCLUSION: One-year clinical results of LASIK with the FS200 femtosecond laser and EX500 excimer laser showed high efficacy, predictability, stability and safety.