Reliability and usability of telemedicine evaluations for facial dystonia.

This study investigated telemedicine reliability and usability in evaluating facial dystonia grading and treatment complications. Eighty-two telemedicine recordings from 43 adults with blepharospasm (12, 28%) and hemifacial spasm (31, 72%) were obtained (mean age 64.5 ± 9.3 years, 32 females [64%]). Two recorded in-hospital telemedicine visits were arranged with in-person visits at baseline and 4-6 weeks. After 8 weeks, neuro-ophthalmologists who performed the in-person visits re-evaluated the telemedicine video records. Intra-rater agreements in assessing spasm gradings were moderate (severity: kappa = 0.42, 95% confidence interval [CI] 0.21-0.62; frequency: kappa = 0.41, 95% CI 0.21-0.61) with substantial agreement in detecting lagophthalmos (kappa = 0.61, 95% CI 0.36-0.86). Adding symptoms to signs increased sensitivity and negative predictive value (NPV) in detecting lagophthalmos (67%-100% and 94%-100%) and drooping lips (38%-75% and 94%-96%), respectively. Thai version Telehealth Usability Questionnaire showed high mean usability score of 6.5 (SD 0.8) out of 7. Telemedicine could further be developed as an alternative platform to evaluate facial dystonia.

Ocular Brugia pahangi Filariasis Complicated by Severe Macular Damage in Thailand: Case Report and Literature Review.

Extralymphatic filariasis caused by filaria of zoonotic origins has been frequently reported in Thailand over recent years. Here, we report the first case of ocular filariasis in a 7.5-year-old Thai boy who initially presented with progressive conjunctival redness and blurred vision in his right eye. A small, slender, coiled worm was found and surgically removed from the right anterior chamber. Histopathological examination illustrated predominant eosinophilic inflammation surrounding the parasite, which showed smooth and thin cuticle, prominent lateral chords, flat and broad muscle cells, one intestine, and two reproductive tubes with unsegmented ova, typically characteristic of a female adult Brugia filarial nematode. The parasite was also molecularly identified as B. pahangi, based on mitochondrial cytochrome c oxidase subunit I sequence analysis. The patient was then empirically prescribed albendazole, systemic prednisolone, and topical methylprednisolone. Unfortunately, his vision did not recover after 2 months due to severe maculopathy, most likely resulting from parasitic infestation and subsequent vitreous inflammation. To the best of our knowledge, this is the first case of ocular infestation by B. pahangi with visual complications that occurred outside a filariasis-endemic area of Thailand. Furthermore, this report provides clinical data on preceding cases of B. pahangi filariasis formally reported in southeast Asian countries, including Thailand and Malaysia, which facilitate a better understanding of the epidemiology of this sporadic zoonotic infection for effective disease elimination.

Data sharing implementation in top 10 ophthalmology journals in 2021.

BACKGROUND/AIMS: Deidentified individual participant data (IPD) sharing has been implemented in the International Committee of Medical Journal Editors journals since 2017. However, there were some published clinical trials that did not follow the new implemented policy. This study examines the number of clinical trials that endorsed IPD sharing policy among top ophthalmology journals. METHOD: All published original articles in 2021 in 10 highest-ranking ophthalmology journals according to the 2020 journal impact factor were included. Clinical trials were determined by the WHO definition of clinical trials. Each article was then thoroughly searched for the IPD sharing statement either in the manuscript or in the clinical trial registry. We collected the number of published clinical trials that implemented IPD sharing policy as our primary outcome. RESULTS: 1852 published articles in top 10 ophthalmology journals were identified, and 9.45% were clinical trials. Of these clinical trials, 44% had clinical trial registrations and 49.14% declared IPD sharing statements. Only 42 (48.83%) clinical trials were willing to share IPD, and 5 (10.21%) of these share IPD via an online repository platform. In terms of sharing period, 37 clinical trials were willing to share right after the publication and only 2 showed the ending of sharing period. CONCLUSION: This report shows that the number of clinical trials in top ophthalmology journals that endorsed the IPD sharing policy and the number of registrations is lower than half even though the policy has been implemented for several years. Future updates are necessary as policy evolves.

Evaluation of Psychometric Properties of Thai Version Telehealth Usability Questionnaire (T-TUQ).

This cross-sectional validation study aimed to translate, cross-culturally adapt, and investigate the psychometric properties of a Thai version of the Telehealth Usability Questionnaire (T-TUQ). Two hundred and ten Thai participants, mean age of 61.2±15.2 years, were recruited from three specialty clinics: 50 (23.8%) hematology, 70 (33.3%) movement disorders, and 90 (42.9%) general neurology. The T-TUQ was translated from the original English version to produce a Thai language version. Back translation and pilot cognitive interviews were completed. All five subscales (usefulness, ease of use, effectiveness, reliability, and satisfaction) showed excellent internal consistency (alpha >0.80), displayed by Cronbach's alpha coefficient of 0.83, 0.94, 0.86, 0.83, and 0.92, respectively. For construct validity, exploratory factor analysis revealed two dimensions from eigenvalues and scree plot, defined as utility and accessibility subscales. In conclusion, the T-TUQ could be a reliable and valid instrument to evaluate the usability of telehealth with a Thai population.

Mortality risk factors of COVID-19 infection in kidney transplantation recipients: a systematic review and meta-analysis of cohorts and clinical registries.

Kidney transplantation recipients (KTR) with coronavirus disease 2019 (COVID-19) are at higher risk of death than general population. However, mortality risk factors in KTR are still not clearly identified. Our objective was to systematically analyze published evidence for risk factors associated with mortality in COVID-19 KTR. Electronic databases were searched for eligible studies on 1 August 2021. All prospective and retrospective studies of COVID-19 in KTR were considered eligible without language restriction. Since data in case reports and series could potentially be subsets of larger studies, only studies with ≥ 50 patients were included. Random-effects model meta-analysis was used to calculate weighted mean difference (WMD) and pooled odds ratio (OR) of factors associated with mortality. From a total 1,137 articles retrieved, 13 were included in the systematic review and meta-analysis comprising 4,440 KTR. Compared with survivors, non-survivors were significantly older (WMD 10.5 years, 95% CI 9.3-11.8). KTR of deceased donor were at higher risk of death (OR 1.73, 95% CI 1.10-2.74). Comorbidities including diabetes mellitus, cardiovascular disease, and active cancer significantly increased mortality risk. KTR with dyspnea (OR 5.68, 95% CI 2.11-15.33) and pneumonia (OR 10.64, 95% CI 3.37-33.55) at presentation were at higher mortality risk, while diarrhea decreased the risk (OR 0.61, 95% CI 0.47-0.78). Acute kidney injury was associated with mortality (OR 3.24, 95% CI 1.36-7.70). Inflammatory markers were significantly higher in the non-survivors, including C-reactive protein, procalcitonin, and interleukine-6. A number of COVID-19 mortality risk factors were identified from KTR patient characteristics, presenting symptoms, and laboratory investigations. KTR with these risk factors should receive more intensive monitoring and early therapeutic interventions to optimize health outcomes.

Clinical Characteristics, Histopathology, and Treatment Outcomes of Pythium Keratitis: A Retrospective Cohort Study.

PURPOSE: To identify factors associated with the prognosis in Pythium keratitis. PATIENTS AND METHODS: The medical records of 25 patients (26 eyes) diagnosed with Pythium keratitis at a referral institution were reviewed. The demographic and clinical characteristics, treatment, microbiological diagnosis, histopathological features, and outcomes were recorded. The histopathological specimens were reviewed. The patients were divided into a globe removal group and a globe salvage group. Univariate analysis was used to identify factors associated with poor outcomes. RESULTS: Fifteen eyes (57.7%) were removed. Patients in the globe removal group were on average 16.4 years older (95% CI 6.98 to 25.88) than those in the globe salvage group, received the first medication (either topical antifungals or antibiotics) later than one day after the onset of symptoms (RR = 2.75, 95% CI 1.18 to 6.42), and had a maximal diameter of the infiltration area ≥6 mm (RR = 3.14, 95% CI 1.17 to 8.45). The globe removal group showed satellite, multifocal, or total corneal infiltration patterns (RR = 2.82, 95% CI 1.03 to 7.74) and a hypopyon (RR = 3.43, 95% CI 1.26 to 9.35) as risk factors. The histopathological examination showed a higher density of Pythium in the globe removal group than the globe salvage group (median 376 (interquartile range 323, 620) versus 107 (interquartile range 16, 260) hyphae per high power field; P = 0.035). CONCLUSION: The risk of globe removal in patients with Pythium keratitis increased with age, delayed initial topical antifungal or antibiotic treatment, advanced disease at presentation, and dense Pythium hyphae infiltration of the cornea. Early recognition and treatment are critical to successfully eradicate the infection.

Time to Keratometric Stability After Pterygium Excision and the Associated Factors: A Clinical Perspective.

PURPOSE: To determine the percentage of eyes with corneal astigmatic power stability and mean corneal keratometric power at 6-month post-pterygium excision, and to identify the time, and the associated factors, required to achieve stability. METHODS: This prospective observational study enrolled patients undergoing pterygium excision. Patients were evaluated for baseline characteristics and keratometric data before and every month after pterygium excision for six months using IOL Master 500® (Carl Zeiss, Meditec). Clinically stable corneal astigmatic power and keratometric power were, respectively, defined as changes in these parameters of less than 0.25 and 0.27 diopters after two consecutive visits. Time to corneal astigmatic and keratometric power stability, as well as factors associated with the stability, were analyzed. RESULTS: Forty percent and 73.3% of eyes, respectively, demonstrated corneal astigmatic and corneal keratometric stability at six months post-operation. Within three months of reaching initial stability, the corneal astigmatic power and the mean keratometric power showed instability in 46.7% and 27.3% of patients, respectively. No patients with keratometric stability for more than three months became unstable during the study period. The extension of pterygium exceeding 3.0 mm was associated with a delay in time to corneal astigmatic stability (HRadjusted 0.41; 95% CI 0.19-0.89; P= 0.02). CONCLUSION: According to the clinical relevance, 40% and 73% of patients, respectively, presented corneal astigmatic and keratometric stability within six months post-operation. Patients with a pterygium extension of more than 3 mm required a longer time for corneal astigmatic stability. It is recommended that keratometric stability be achieved for at least three months before commencing with additional procedures.

Ocular Sparganosis: The First Report of Spirometra ranarum in Thailand.

A 22-year-old Thai man from the Northeast region presented with acute eye swelling, itching, and discharge on his left eye. He was suspected of having gnathostomiasis and treated with albendazole and prednisolone for 3 weeks. Nine months later, he was treated with high-dose oral prednisolone for the preliminary and differential diagnoses with thyroid-associated orbitopathy and lymphoma. He had been administered prednisolone intermittently over a few years. Then he developed a painless movable mass at the left upper eyelid and recurrent pseudotumor oculi was suspected. The surgical removal of the mass was performed. A white pseudosegmented worm revealed a definite diagnosis of ocular sparganosis by a plerocercoid larva. Molecular diagnosis of the causative species was made based on the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene. Proper technique of extraction and amplification of short fragments DNA from formalin-fixed paraffin-embedded tissue successfully identified parasite species. The result from the sequencing of the PCR-amplified cox1 fragments in this study showed 99.0% sequence homology to Spirometra ranarum. This is the first report of S. ranarum in Thailand.

Conjunctival sporotrichosis from cat to human: Case report.

PURPOSE: To report a case of conjunctival plaque infected from Sporothrix schenckii, which was possible transmitted from a cat. OBSERVATIONS: A case of Thai woman presented with chronic painless ulcerated conjunctiva with white plaque. The lesion was not healed for one month after excision. She became concerned of getting infection from her cat because it developed chronic and multiple skin lesions on its legs. Identification of Sporothrix schenckii by PCR method was confirmed in the tissues from her conjunctiva and cat's skin. CONCLUSION AND IMPORTANCE: The diagnosis of Sporothrix infection should be suspected in atypical conjunctival lesion in patient who had closed contact with infected cat. This brought awareness to doctors and cat owners, even though it was uncommon.

Eye lens dosimetry and the study on radiation cataract in interventional cardiologists.

PURPOSE: To determine the eye lens dose of the Interventional Cardiology (IC) personnel using optically stimulated luminescent dosimeter (OSLD) and the prevalence and risk of radiation - associated lens opacities in Thailand. METHODS AND RESULTS: 48 IC staff, with age- and sex- matches 37 unexposed controls obtained eye examines. Posterior lens change was graded using a modified Merriam-Focht technique by two independent ophthalmologists. Occupational exposure (mSv) was measured in 42 IC staff, using 2 OSLD badges place at inside lead apron and at collar. Annual eye lens doses (mSv) were also measured using 4 nanoDots OSL placed outside and inside lead glass eyewear. The prevalence of radiation-associated posterior lens opacities was 28.6% (2/7) for IC, 19.5% (8/41) for nurses, and 2.7% (1/37) for controls. The average and range of annual whole body effective dose, Hp(10), equivalent dose at skin of the neck, Hp(0.07) and equivalent dose at eye lens, Hp(3) were 0.80 (0.05-6.79), 5.88 (0.14-35.28), and 5.73 (0.14-33.20) mSv respectively. The annual average and range of eye lens dose using nano Dots OSL showed the outside lead glass eyewear on left and right sides as 8.06 (0.17-32.45), 3.55(0.06-8.04) mSv and inside left and right sides as 3.91(0.05-14.26) and 2.44(0.06-6.24) mSv respectively. CONCLUSION: Eye lens doses measured by OSLD badges and nano Dot dosimeter as Hp(10), Hp(0.07) and Hp(3). The eyes of the IC personnel were examined annually by two ophthalmologists for the prevalence of cataract induced by radiation.

The Clinical Spectrum and a New Theory of Pathogenesis of True Exfoliation Syndrome.

PURPOSE: To describe the clinical spectrum and a new theory of pathogenesis of true exfoliation syndrome. DESIGN: Cross-sectional and prospective, observational case series. PARTICIPANTS: Consecutive patients with characteristic peeling of the anterior lens capsule. METHODS: After maximal mydriasis, slit-lamp biomicroscopy, and photography, imaging of the anterior capsule and zonules was performed. The condition was classified into 4 clinical stages: annular anterior capsule thickening with a distinct splitting margin (stage 1), an inward detached crescentic flap lying on the anterior lens (stage 2), a floating and folding translucent membrane behind the iris (stage 3), and a broad membrane within the pupil (stage 4). Serial photography was performed at each 3-month follow-up visit. Ultrastructural examination of dislocated lenses and excised anterior capsules was performed. MAIN OUTCOME MEASURES: Detached membrane morphologic features, zonular defects, pigment deposition, glaucoma, phacodonesis, and cataract. RESULTS: We enrolled 259 patients (424 eyes). Ages ranged from 52 to 97 years (mean age, 75.2±7.1 years). Eleven patients were associated with trauma (n = 1) or intense heat (n = 10), whereas 248 were idiopathic. Two hundred ten patients were followed up every 3 months, with a mean follow-up of 9.6±6.1 months (range, 3-50 months). The detachment started along the anterior zonular insertions in association with zonular disruption. It progressed centrally to higher stages, manifesting a spectrum of disease. Several stages coexisted in a single eye. At the final visit, including 49 patients who were examined once, there were 70, 87, 85, and 17 patients in stages 1, 2, 3, and 4, respectively. All stages shared common histologic findings consisting of diffuse capsular lamellar separation and anterior zonular disruption. All developed cataract. Pigment deposition on the membrane was present in 178 patients (68.7%). Twenty-six patients (10%) had spontaneous phacodonesis. Eighteen eyes (4.2%) demonstrated secondary delamination. CONCLUSIONS: Capsular lamellar separation and anterior zonular disruption are characteristic findings. Aging, heat exposure, and trauma are risk factors. Initial capsular splits occur along the insertions of disrupted anterior zonules. The peeling progresses centrally in association with iris movement and aqueous flow. A second detachment can occur.

Congenital uveal malignant melanoma.

We report the clinical and pathological findings of a rare case of congenital uveal melanoma. A 7-week-old girl presented with history of a black area at the inner corner of her left eye since birth. Examination revealed an enlarged globe with an area of visible uveal pigment nasal to the cornea, an iris mass, and shallow anterior chamber in the left eye. Magnetic resonance imaging revealed an intraocular mass. Enucleation was performed when the girl was 2 months of age. Pathologic examination confirmed a malignant melanoma epithelioid cell type with extraocular extension. She was treated with chemotherapy and subtotal exenteration.

Trials registration: a new era in Thailand.

Registration of clinical trials or research can result in many benefits. Patients have access to pertinent information. We have a better and more indicative picture of research status in areas where registration is mandatory. Researchers can use the information to form a common interest group and collaborate their research as well as to avoid unnecessary duplication. Registered information can also enable detection of defective design and can lead to improvements of trial protocol or its implementation. Most importantly, it can help to reduce problems of publication bias and selective reporting. Journals do not like to publish negative or inconclusive results. Pharmaceutical companies are reluctant to report results that may jeopardize their revenue. We need absolute transparency to utilize evidence with trust.

Prevalence and clinicopathologic findings of conjunctival epithelial neoplasia in pterygia.

PURPOSE: To study the prevalence of conjunctival neoplasia in clinically diagnosed pterygia and the clinicopathologic characteristics of conjunctival tissues obtained from pterygium excision. DESIGN: Prospective, observational case series. PARTICIPANTS: From February through August 2007, consecutive subjects indicated for pterygium excision were enrolled from an outpatient eye clinic of King Chulalongkorn Memorial Hospital, Bangkok, Thailand, and from the eye camp at the 6th Station of the Thai Red Cross Society, Aranyaprathet District, Sa Kaeo, Thailand. A total of 498 eyes from 482 subjects were studied. The mean age of the subjects was 56.5 ± 11.7 years. The male-to-female ratio was 3:7. METHODS: Clinical data were gathered, including age, sex, occupation, family history, and medical history. Pterygia were clinically graded as mild, intermediate, or fleshy. Tissues from surgical fields were fixed in formalin and processed using standard pathology laboratory methods. MAIN OUTCOME MEASURES: Histopathologic results were examined in a masked fashion by 3 pathologists. RESULTS: Ninety-one percent of tissue was from primary pterygia. Most lesions were classified as intermediate grade (45.2%). Histopathologic results showed that 4 eyes had conjunctival intraepithelial neoplasia. Two eyes had minimal cellular atypia at the conjunctival epithelium. Two eyes had complex choristoma. For the subjects who had conjunctival epithelial neoplasia, the mean age was 57.0 ± 8.0 years, 44.4% were male, and none had a history of carcinoma in other organs or any history of herpes virus, human papilloma virus, or human immunodeficiency virus infections. CONCLUSIONS: The prevalence of conjunctival epithelial neoplasia in clinically diagnosed pterygia is approximately 1.8%. Because the clinical characteristics of subjects who have conjunctival epithelial neoplasia apparently did not differ from those without, tissue pathologic examination may be required to diagnose the condition.

Thai clinical trials registry.

The Thai Clinical Trials Registry (TCTR) was established in 2009 by a group of university academics. The Thailand Center of Excellence for Life Sciences has supported the registry financially, while the basic infrastructure including the administration, staff and computer servers has been provided by the Clinical Research Collaboration Network and the Medical Research Foundation. In December 2010, the Ministry of Public Health of Thailand endorsed the registry. In addition to the major purposes of reducing publication bias, promoting research transparency, and reducing redundancy in clinical research, TCTR aims to create a collective database of the clinical researches in Thailand, in order to help construct a pool database for local researchers.

Combined deep topical and superior subconjunctival anesthesia for extracapsular cataract extraction in a rural eye camp.

BACKGROUND: Anesthesia for cataract surgery at eye camps needs to be simple, safe, and effective. METHODS: We prospectively studied 98 patients undergoing cataract extraction in a rural eye camp in Thailand. Patients undergoing extracapsular cataract extraction with intraocular lens implantation (ECCE/IOL) received deep topical anesthesia with subconjunctival anesthesia. Patients undergoing phacoemulsification with intraocular lens implantation (Phaco/IOL) received topical anesthesia. Pain visual analog score, operative and anesthetic complications, operative time, and additional medications were recorded. RESULTS: A mean age of 68.7 vs 67.5 yr, an operative time of 16.1 +/- 6.7 min vs 12.0 +/- 4.7 min, and a median (interquartile range) pain score of 30.5 mm (12.3-54.6 mm) vs 20.0 mm (9.0-45.9 mm) were seen in the ECCE/IOL and Phaco/IOL groups, respectively. Three cases of ruptured posterior capsule occurred in the Phaco/IOL group. No additional anesthesia was needed. No anesthetic complications occurred. CONCLUSION: In a rural eye camp, deep topical anesthesia with subconjunctival anesthesia for ECCE/IOL and topical anesthesia for Phaco/IOL provide effective anesthesia for cataract surgery.

Multifocal squamous cell carcinoma of the conjunctiva with intraocular penetration in a patient with AIDS.

PURPOSE: To describe the clinical findings and to study the histopathology of conjunctival masses in a patient with HIV infection. METHODS: A case report. RESULTS: The histopathology from a 38-year-old Thai female patient who presented with visual loss on the left eye was studied. She had been diagnosed with AIDS 3 years before and was treated with highly active antiretroviral therapy and anti-tuberculous drugs for 1 year. The left eye was blind and showed 2 separate whitish masses on the bulbar conjunctiva in adjacent to the inferomedial limbus. Multiple nodules under the conjunctiva were seen inferiorly. Computerized tomography of the orbit revealed slight thickening of the left lower eyelid but could not show any globe involvement. The patient underwent orbital exenteration. Gross pathology showed multiple areas of the tumor. Histopathology revealed dysplastic squamous epithelium invading into the substantia propria of the conjunctiva with intraocular penetration. The anterior surface of the iris was filled with tumor cells containing keratin pearls. CONCLUSION: Squamous cell carcinoma can be multifocal and aggressive in HIV-infected patients. Rapid progression to intraocular penetration can be observed.

Disappearance of primitive basaloid cells after external irradiation in adenoid cystic carcinoma of the lacrimal gland.

OBJECTIVE: To study the histopathological findings of basaloid adenoid cystic carcinoma after high dose orbital irradiation. MATERIAL AND METHOD: The histopathology study was done in a 38-year-old Thai female patient who had basaloid adenoid cystic carcinoma of the right lacrimal gland confirmed by incisional biopsy. After a 60-Gy external irradiation, the mass decreased in size and finally could not be palpated, but subsequent orbital imaging still showed infiltrative soft tissue mass at the right lacrimal gland with bony defects at posterosuperior and lateral walls without extraorbital extension. Orbital exenteration and lateral orbitectomy was performed. The specimen was submitted for histopathological examination. RESULTS: Microscopic examination revealed periglandular infiltration with chronic inflammation of the palpebral lobe of lacrimal gland. The orbital lobe was extensively replaced with fibrous tissue. There was only a small area of cribiform pattern of the adenoid cystic carcinoma left; no basaloid pattern was seen in the tissue. CONCLUSION: The primitive cells (basaloid pattern) disappear after orbital irradiation for adenoid cystic carcinoma of the lacrimal gland. Replacement with fibrous tissue is seen.