Bupivacaine injection to treat exotropia and esotropia.

PURPOSE: To report the results of bupivacaine injection into the extraocular muscles to treat horizontal strabismus, both exotropia and esotropia. METHODS: Bupivacaine, 4.5 ml of a 0.50% solution, was injected into the medial rectus muscle in each of 14 exotropic patients and into the lateral rectus muscle in each of 6 esotropic patients with electromyographic control. The measures of alignment were made before the procedure and 1, 3, 6, and 12 months after injection. RESULTS: Of 20 patients, 15 had improved ocular alignment with the average change of 8.46, 8.2, 8.33 and 9 prism diopters (PD) at 1,3, 6 and 12 months, respectively. Two of 5 (40%) incomitant strabismus patients and 13 of 15 (86.66%) comitant strabismus patients had improvement in ocular alignment. Eleven of 14 exotropic patient and 4 of 6 esotropic patients had improvement in ocular alignment, averaging 9.73, 9.36, 9.54 and 6 PD in the exotropic group and 5, 5, 5, and 10.5 PD in the esotropic group. There was no serious complication from the injections. CONCLUSIONS: Bupivacaine injection improved ocular alignment in some patients. Denervated extraocular muscle did not respond well to bupivacaine. Bupivacaine improved ocular alignment equally in esotropic and exotropic patients.

Eye health in the priests and novices in central Bangkok.

BACKGROUND: Early detection and proper management of eye diseases in priests and novices is cost effective, and minimize serious ocular damage and permanent loss of vision. Therefore, the Department of Ophthalmology, Priest Hospital set-up an eye examination project for the priests and novices who came for physical examination. The laboratory test was part of the Sustained and Holistic Healthcare Program for Priests and Novices as Commemoration of His Majesty the King's 60 Years of Accession to the Throne. OBJECTIVE: To evaluate eye health status and screening for refractive error in priests and novices and to provide free spectacles and eye health education to fulfill the criteria of voluntary Buddhist eye health workers. MATERIAL AND METHOD: Between February and June 2006, the Department of Ophthalmology, Priest Hospital conducted eye examination for the priests and novices in 28 temples in central Bangkok. The priest and novices with refractive error and abnormal eye examination received appointment for repeated refraction and complete eye examination in Priest Hospital. RESULTS: Six hundred forty nine priests and novices had complete eye examination. Normal visual acuity (Snellen VA 20/20) was found in 355 (54.69%) cases. The most common eye diseases were refractive error with 294 cases (45.30%), cataract with 41 cases (6.32%), glaucoma with 10 cases (1.54%) and vitreoretinal diseases, which included diabetic retinopathy, age related macular degeneration and branch retinal venous occlusion with eight cases (1.23%). Three novices had amblyopia (0.46%). CONCLUSION: Most of the priests and novices in central Bangkok had good eye health. Half of the eye problems were refractive errors. Since most of other eye diseases reported in priests were associated with aging and systemic diseases as hypertension, diabetes, and ischemic heart disease, regular ophthalmic examination should be provided in this risk group. Eye health education should be provided for sustainable eye health development as voluntary eye health workers in Buddhism.

Diabetic retinopathy in Priest Hospital.

BACKGROUND: Diabetic retinopathy (DR) is common complication of DM and is one of the leading causes of visual loss in working age population in developed and developing countries. The known risk of retinopathy is directly related to the degree and duration of hyperglycemia. Priests are one of the disadvantageous groups because they cannot select their food and have poor access to health care. These two reasons are suspected to be causes of high prevalence of DM and DR in the priests. OBJECTIVES: To perform complete eye examinations and take fundus pictures at DR screening to estimate the prevalence of DR in the priests and to perform appropriate treatment. MATERIAL AND METHODS: Retrospective review of the medical records of the priests and novices who had diabetes in Priest Hospital between October 2005 and September 2007 was done. Appointment for crosssectional DR screening for those who never had an eye exam and to complete DR treatment. RESULTS: Four hundred and fourteen diabetic priests and novices were enrolled in the study with the mean age was 61.65 years. Only 297 (71.74 %) of the diabetic priests had a visual acuity measurement previously. DR screening program was done in 176 priests. The result revealed that 123 priests had no DR (69.89 %), 33 (18.75%) had non-proliferative DR (NPDR), 20 (11.36%) had proliferative DR (PDR), and 11 (6.25% or 33.33% of NPDR) had clinically significant macula edema (CSME). From the previously diagnosed patients, 15 (28.3%) had Laser treatment performed and 2 (3.77%) had pars plana vitrectomy (PPV). CONCLUSION: Although Priest Hospital sent DR screening postcards to diabetic priests twice, only 176 (42.51%) priests came, and of those, 53 (30.11%) had DR. There is poor co-operation from the priests because of their lack of medical knowledge about DM complication and DR. The priest who came for the appointment were concerned with their health therefore, they had low prevalence of DR with moderate glycemic control. DR in the priests led to low vision (11.83%) and blindness (5.92%). For the priests, adherence to clinical guidelines for glycemic and BP control was low, even in a well-developed health care system with free ophthalmic care access because they cannot select their food and have poor transportation services to health care facilities.