Physical effects and cognitive function after exercising "Rue-si-dad-ton" (exercise using the posture of the hermit doing body contortion): a randomized controlled pilot trial.

BACKGROUND: This study aims to preliminarily evaluate effect on physical properties of shoulder joints and cognitive function after practicing Rue-si-dad-ton, a Thai traditional exercise using the postures of the hermit doing body contortion which still lacks systematically conducted evidence-based regarding its benefits. MATERIAL AND METHOD: Thirty-seven participants who have routinely worked on computer at least 3 hours per day were recruited and randomized into intervention (n = 19) or control group (n = 18). Physical effect on shoulder joints was evaluated by measuring shoulder range of motion (ROM) and evaluating shoulder function with the American Shoulder & Elbow Surgeons Standardized Shoulder Assessment Form. Cognitive function was determined by Verbal Fluency Test, Trail Maker B Test, and Digit Span Test. Both study groups were assessed by all tests at the beginning and at the end of study by blinded assessors. The intervention group performed 3 postures of Rue-si-dad-ton exercise (an hour per day for 4 days by a well-trained instructor) before thefinal measurement. RESULTS: Only left and right shoulder flexion of the intervention group (p-value = 0.006 and 0.010 respectively) showed significant increment compared with the control group using ANCOVA test with baseline adjusted as covariate. Other variables, including joint and cognitive function, indicated no significant changes between groups. No complications from exercise were found during the study CONCLUSION: Rue-si-dad-ton may safely help improve range of joint motion with potential benefit for joint and cognitive function. Additional extensive studies with adequate number of participants and longer period of exercise are warranted.

Classification and regression tree analysis for predicting visual outcome after open-globe injuries in Siriraj Hospital.

OBJECTIVE: To create a model for predicting visual outcome after open-globe injuries by using data of Siriraj Hospital. MATERIAL AND METHOD: Retrospective data of patients presented with open-globe injuries between January 2007 and December 2010 were used to create prognostic model. Seventeen factors at initialpresentation were collected and evaluated to develop the model by mean of Classification and Regression Tree analysis (CART). The prognostic tree was validated by using the sample ofopen-globe patients who presented between January 2011 and July 2011. RESULTS: The information of 231 eyes from 230 patients was analyzed to create a classification tree model. The calculated model composed of the two greatestpredictivefactors, no light perception (NPL), andpresence of relative afferentpupillary defect (RAPD). No patient with NPL at initial examination had vision at the six-month follow-up period. The other patients could be classified and predicted vision by using the presence of RAPD. CONCLUSION: The classification tree model developed in the present study is easy to calculate and has major significant predictive outcome for the open-globe injured patients.

Enhanced depth imaging spectral-domain optical coherence tomography of the choroid in Thai population.

OBJECTIVE: To examine subfoveal choroidal thickness (SFCT) in Thai population using enhanced depth imaging spectral- domain optical coherence tomography (EDI-OCT) and to study its correlation with foveal retinal pigment epithelium thickness (FRPE), central neurosensory retinal thickness (CNRT), age, and refraction. MATERIAL AND METHOD: Four hundred eighty eyes from 240 subjects without glaucoma, retinal, or choroidal diseases underwent scanning of the retina and choroid using EDI-OCT SFCT FRPE, and CNRT measurements were based on the 1:1 micron images and wereperformed by two independent observers. The reliability ofmeasurements between the observers was evaluated by intraclass correlation coefficient (ICC). The correlations of SFCT with FRPE, CNRT, age, and refractive error were analyzed RESULTS: The mean age of the subjects was 36.22 years (range 20-81years). The means (95% reference intervals) of SFCT, CNRT andFRPE were 294.02 µm (137.14-450.90 µm), 174.22 µm (141.82-206.62 µm), and 41.94 µm (34.65-49.23 µm), respectively. SFCT and CNRThad excellent reliability between the two observers [ICC = 0.947 (95% CI, 0.918-0.963) and 0.929 (95% CI, 0.906-0.945), respectively], while FRPE showed good reliability [ICC = 0. 729 (95% CI, 0.637-0.793)]. SFCT had a low positive correlation with FRPE (r = 0.179, p<0. 0001) but not with CNRT (p = 0.317). SFCT showed a positive correlation with refraction (r = 0.338, p<0.0001) and a negative correlation with age (r = -0.166, p<0.0001). Regression analysis suggested that the SFCT decreased by 12.23 pm per one decade oflife and by 11.42 pm per one diopter of myopia. CONCLUSION: Normal values of SFCT in Thai population were obtained SFCT significantly decreased with older age and higher myopia. SFCT was associated with FRPE, reflecting the same vascular supply of the choroid and retinal pigment epithelium. When measured with our technique based on the 1:1 micron images, the reliability ofSFCT measurement was very high despite highly morphologic inter-individual variations.

Optic atrophy after anti-vascular endothelial growth factor injection in diabetic patients with proliferative diabetic retinopathy.

OBJECTIVE: To study the prevalence of optic atrophy in patients with proliferative diabetic retinopathy (PDR) who underwent intravitreal bevacizumab injection and risk factors associated with optic atrophy. MATERIAL AND METHOD: A retrospective case control study enrolled 269 cases (394 eyes) of patients with PDR, in which 166 cases (219 eyes) received intravitreal bevacizumab injection. Associated factors such as type of DM, hemoglobin A1c level, hypertension, hypercholesterolemia, chronic kidney disease, previous intravitreal surgery retinal detachment, and vitreous hemorrhage were recorded. Criteria for diagnosis of optic atrophy were decreased visual acuity, pale optic disc and decreased nerve fiber layer thickness, which was measured by Stratus optical coherence tomography (OCT). The association between intravitreal bevacizumab injection and optic atrophy was analyzed by multiple logistic regression. RESULTS: Two hundred sixty nine patients with PDR, consisting of 166 patients with intravitreal bevacizumab injection and 103 cases without bevacizumab injection. Optic atrophy was found in 11.4% (25/219 eyes) and 8% (14/175 eyes) respectively. There was no evidence that intravitreal bevacizumab injection and associated systemic diseases were related to optic atrophy. The risk factor that was related to optic atrophy was previous intravitreal surgery (adjusted odds ratio (OR), 2.57 [95% CI, 1.13, 5.84], p = 0.024). CONCLUSION: Anti-VEGF (bevacizumab) does not increase the risk of optic atrophy. The ophthalmologists should be aware of subsequent optic atrophy development in patients with PDR who undergo surgical intervention.

Visual outcome and prognostic factors in posterior segment intraocular foreign bodies.

OBJECTIVE: To identify the prognostic factors that predict visual outcome in eyes with penetrating ocular injuries with retained intraocular foreign bodies (IOFBs). DESIGN: Retrospective cases series MATERIAL AND METHOD: The authors reviewed the records of 228 patients who had penetrating eye injuries with retained posterior segment IOFBs managed at Siriraj Hospital between June 1995 and February 2008. One hundred and forty-one patients (61.8%) were included in the present study. Associations between final visual outcome and various pre-operative and post operative variables were statistically analyzed. RESULTS: After a mean follow-up of 10.4 +/- 7.7 months, 68 eyes (48.2%) achieved visual acuity of 6/18 or better The final visual acuity ranged between 6/24 and 6/60 in 22 eyes (15.6%) and 51 eyes (36.2%) had visual acuity less than 6/60. Final visual acuity significantly depended on initial visual acuity (p = 0.002), size of entry wound (p = 0.020), size of foreign body (p = 0.018), presence of vitreous hemorrhage (p = 0.014), retinal detachment (p = 0.026) and endophthalmitis (p < 0.0001). CONCLUSION: Visual outcome in penetrating ocular injuries with retained IOFBs was affected by initial visual acuity, size of entry wound, size of foreign body, vitreous hemorrhage, retinal detachment and endophthalmitis. These factors may be helpful for pre-operative counseling and predicting the final visual outcome.

Nonmydriatic digital retinal images for determining diabetic retinopathy.

OBJECTIVE: To evaluate the efficacy of nonmydriatic digital retinal images for determining diabetic retinopathy. MATERIAL AND METHOD: Single field 45-degree digital retinal images of 225 eyes from 142 diabetic patients were obtained with a nonmydriatic camera. The images were diagnosed and graded by a general ophthalmologist. These results were compared with clinical diagnosis obtained by retinal specialists, after examination by using biomicroscope with plus lens and indirect ophthalmoscope of the patients. International clinical diabetic retinopathy disease severity scale was used for grading diabetic retinopathy in all cases. RESULTS: Presence of diabetic retinopathy was detected in 70 eyes (31.1%). The sensitivity and specificity for determining diabetic retinopathy was 68.57% (95%CI 57.00-78.20) and 92.25% (95%CI 87.00-95.50), respectively. The positive predictive value and negative predictive value was 80.00% (95%CI 68.20-88.20) and 86.67% (95%CI 80.60-91.00). Overall accuracy was 84.89%. CONCLUSION: Single field 45-degree nonmydriatic digital retinal images were limited by fair sensitivity for determining diabetic retinopathy although overall accuracy from the present study was relatively high. Upcountry, this tool might facilitate increased access of diabetic patients for eye evaluation but cannot replace standard eye examination.