Intravitreal bevacizumab for proliferative diabetic retinopathy with new dense vitreous hemorrhage after full panretinal photocoagulation.

PURPOSE: To evaluate the efficacy and safety of intravitreal bevacizumab (IVB) injections for the treatment of proliferative diabetic retinopathy (PDR) with new dense vitreous hemorrhage (VH) after previous full panretinal photocoagulation (PRP). METHODS: Prospective study of consecutive PDR with prior complete PRP patients, who presented with new dense VH, were treated with IVB injection. Complete ophthalmic examination and/or ocular ultrasonography were performed at baseline and 1, 6, and 12 weeks and 6, 9, and 12 months after the first injection. Reinjection was done in non-clearing and recurrent VH. RESULTS: Eighteen eyes of 18 patients, mean age 47.7 ± 12.69 years were included. In all, 14 (77.78%) patients had type 2 diabetes mellitus. Systemic hypertension and dyslipidemia were the most common systemic diseases. All cases were phakic eye with previous complete PRP. Patients received 1.6 ± 0.42 intravitreal injections over a 12-month period. VH cleared completely in 7 (38.89%), 9 (50%), and 13 (72.22%) eyes after 6 weeks, 6 months, and 12 months, respectively. Re-bleeding, however, occurred in 10 (56%) eyes during the follow-up period, and 5 (28%) eyes still had residual VH at the last visit. Statistically significant visual gain was observed in 9 (50%) eyes. Unfortunately, 2 (11%) eyes had severe visual loss because of the tractional retinal detachment (TRD). Mild ocular complication was detected in one patient. CONCLUSION: IVB injection had good efficacy and safety for treatment of new VH in patients with PDR and prior complete PRP. This procedure may be especially relevant for diabetic patients at high-risk for surgical intervention.

Ocular angiostrongyliasis: clinical study of three cases.

PURPOSE: To report three patients with ocular angiostrongyliasis who presented with a variety of clinical findings. METHOD: Retrospective, observational case series. The medical charts, photographs, and electrophysiologic records were reviewed. RESULTS: All patients presented with blurred vision and one had a history of eosinophilic meningitis. In each respective case, only one living larva was found in the anterior chamber, vitreous cavity, and subretinal space. The fundus examination revealed generalized retinal pigment epithelial alteration, subretinal tracks, retinal oedema, macular oedema, and a pale disc. Visually evoked potentials showed delayed latency time in one patient, which represented the secondary optic neuritis. Blood eosinophilia was not detected, and stool examinations did not show Angiostrongylus cantonensis larva or its egg. In both cases of surgical removal, an immature male worm was identified by the parasitologist. After treatment, the visual acuity was slightly improved in all cases. CONCLUSION: This case series illustrated the different ocular manifestations of angiostrongyliasis and that although several treatments were used, the visual outcome was not markedly improved and depended mainly on the initial visual acuity.

Cortical blindness after motorcycle accident: a case report.

A 47 year-old Thai man presented with acute bilateral blindness after suffering head trauma in a motorcycle accident. No neurological deficit was found. The visual acuity was light perception with poor light projection on both eyes. Other ocular examinations were normal except ecchymosis on both lower eyelids and mild subconjunctival hemorrhage on the left eye. Emergency computerized tomography showed normal appearance of optic nerves, optic canals and multiple contusional intracerebral hemorrhages at both occipital lobes. This case demonstrated a rare condition of permanent cortical blindness without other neurological deficits resulting from a head trauma.

Dexamethasone and methylprednisolone in treatment of indirect traumatic optic neuropathy.

A randomized, double blind study was carried out to compare the efficacy of dexamethasone and methylprednisolone in the treatment of indirect traumatic optic neuropathy. Twenty-one patients, 20 male and 1 female, were diagnosed as having suffered from indirect traumatic optic neuropathy. The time from injury to treatment was within 7 days. The average age was 26.38 +/- 11.89 years. The most common cause of injury was motor vehicle accident (MVA). Associated head and maxillofacial injury were reported 43.48 and 34.78 per cent, respectively. Before treatment, no light perception was detected in 19.05 per cent of the participants. Treatments were randomized: ten patients received dexamethasone intravenously for 72 hours and 11 methylprednisolone. The best corrected visual acuities (BCVA) were determined using the Snellen Chart before and 1, 2, 3, 7, 14 and 60 days after treatment. Three or more lines of improvement of the BCVA, were found in 70 and 67 per cent of patients treated with dexamethasone, and 45.45 and 33.33 per cent of patients treated with methylprednisolone, at 2 weeks and 2 months, respectively. There were no significant differences in age, cause of injury, injury to treatment interval, initial BCVA and visual improvement between the two groups.

Causes of blindness and restoration of sight for the students in the School for the Blind, Khon Kaen.

One hundred and twenty-seven students from the School for the Blind, Khon Kaen, were seen between August 1984 and December 1987. There were 92 males (72.4%) and 35 females (27.6%). The age ranged from 3 to 19 years with the predominant age group being 6-15 years. The majority of the students (95.3%) resided in the Northeast. Only 26 students (20.5%) had positive family histories. Blindness caused by lesions affecting the whole eye was the leading cause of blindness (36.2%). About half of the cases of blindness were preventable and treatable. Most of them (58.3%) were second grade blind. Of all the students seen, 26 students (20.5%) were subjected to treatment for restoration of sight. Only 19 students had complete follow-up post-operative vision. The average visual improvement after treatment was forty-two per cent. The category of blindness was changed to the better side. Blindness was decreased. Visual impairment increased 36.8 per cent after treatment.

Traumatic hyphema: clinical study of 149 cases.

The natural course, related complications and factors affecting prognosis of traumatic hyphema in 149 Thai patients were reported. Male preponderance and high prevalence of patients younger than 15 years were noted in this study. Blunt ocular trauma was the most common type of eye injury (88.59%), with penetrating injury (7.38%) and missile (4.03%) being the next in order of decreasing frequency. Duration of injury was acute in 81.88 per cent, subacute in 12.08 per cent and chronic in 6.04 per cent. Complications from secondary glaucoma accounted for 24.16 per cent, whereas, corneal blood staining and rebleeding were 10.07 and 6.71 per cent respectively. Shorter duration of injury, good initial visual acuity and absence of complications were responsible for favorable visual prognosis. However, age, grade of the initial hyphema and surgical intervention were not demonstrated to have any influence on the eventual visual outcome.

Ocular thelaziasis in Thailand: a case report.

Ocular thelaziasis in an 1-year-old boy from Phetchabun province was reported. A total of eleven worms was removed from his right conjunctival cul-de-sac. Only three males and four females were available for parasitological examination, and identified as Thelazia callipaeda, based on the position of the vulva relative to the esophagointestinal junction in the females, the pattern and number of caudal papillae and the presence of unequal spicules in the males. Subsequent survey of dogs in the vicinity of patient's home revealed the same species as those from the patient. Possible mode of infection in this patient was discussed.

Early laser photocoagulation for idiopathic central serous choroidopathy.

Prolonged or recurrent serous detachment at the macula may cause permanent visual impairment in patients with idiopathic central serous choroidopathy. Early treatment and early resolution of the disease are therefore hypothesized to prevent this visual deficit. In this study, early laser photocoagulation of the leakage site in 25 patients with idiopathic central serous choroidopathy was performed, as compared to 25 control patients. The results of the study were promising. Rapid absorption of subretinal fluid was noted in the laser-treated group (2.37 +/- 1.63 weeks), compared to the untreated control group (7.55 +/- 4.17 weeks). Early visual recovery was also noted in the laser-treated group. Moreover, there was no recurrence in the treated group after a one-year follow-up period. Contrast this with the control group who showed cumulative recurrent probability of 70.84 per cent by using Kaplan Meier survival analysis.

Clinical observations of ocular quinine intoxication.

A case of a 13-year-old boy with ocular quinine intoxication was reported. He had been diagnosed as having cerebral malaria and had received quinine dihydrochloride for one week by intravenous drip infusion; the total dose was 12.6 g. When the patient was examined by us at the time of admission to our Hospital the visual acuity was zero in both eyes. During the hospitalization, recordings of electroretinogram and visually evoked potential were repeated, in addition to the conventional ophthalmological examinations. Although no particular treatment was given, the visual acuity showed a gradual recovery in both eyes; it was 20/200 at the 4th week and 20/30 at the 21st week after admission. Fluorescein fundus angiography at one week after admission revealed a moderate narrowing of the retinal arterioles and a slight reduction of capillaries on the optic disk. The electroretinogram and visually evoked potential were nonrecordable initially, but they showed recovery concomitantly with the recovery of the visual acuity. It was suggested that all of the retinal layers and also the optic nerve were affected by the intoxication.