Rare presentation of intractable tuberculous panophthalmitis with intraocular and intraorbital abscesses: a case report.

BACKGROUND: We report a rare presentation of extrapulmonary tuberculosis. CASE PRESENTATION: A 29-year-old Burmese woman with human immunodeficiency virus infection and known pulmonary tuberculosis who had been treated for 5 months presented to our hospital with unilateral progressive painful visual loss of 1 month's duration. She was diagnosed with tuberculous panophthalmitis with subretinal and intraorbital abscesses, conjunctival abscess, and extraocular muscle tuberculoma. The diagnosis was confirmed by a conjunctival pus swab with a positive result for acid-fast bacilli and a positive result for a mycobacterial culture. There was high suspicion of multidrug-resistant tuberculosis. Despite receiving ongoing aggressive treatment with conventional antituberculous medications, this patient required subtotal orbital exenteration to control her infection and prevent further progression. Second-line antituberculous medications were added to the first-line therapy, with satisfactory results achieved. CONCLUSIONS: Tuberculous panophthalmitis with intraocular and intraorbital abscesses is a rare presentation of extrapulmonary tuberculosis. Patients who do not respond to first-line antituberculous therapy might be infected with either single-drug or multidrug-resistant Mycobacterium tuberculosis. Patient compliance is one of the key factors that can alter the course of treatment. Careful patient monitoring can improve disease progression, outcome, and prognosis.

Role of artificial tears in reducing the recurrence of pterygium after surgery: a prospective randomized controlled trial.

PURPOSE: To determine whether artificial tears can reduce recurrence of pterygium after surgery. METHODS: A total of 128 primary pterygium cases after excision were randomized into two groups according to postoperative drugs: 64 cases received topical dexamethasone (control group), and 64 cases received topical dexamethasone and hydroxypropyl methylcellulose (treatment group). The pterygium was removed with amniotic membrane graft technique in all cases. Recurrence was observed within 6 months after surgery, and survival analysis was used to evaluate the difference between groups. RESULTS: There were no significant differences in age and gender of patients, size of pterygium, Schirmer's test results and tear breakup time between both groups (p > 0.05). Recurrence rate in the treatment group (16%) was significantly less than the control group (33%), p = 0.018 (log-rank test). CONCLUSION: Using artificial tears as an adjunctive drug could lower pterygium recurrence after excision.

A Comparative Study of Higher order Aberrations between Pterygium and Non-Pterygium Eyes.

Background: Pterygium may induce pressure and distortion on the corneal surface leading to ocular aberrations. Objective: To evaluate higher order aberrations in pterygium eyes. Material and Method: Thirty-two patients with unilateral primary pterygium were enrolled. Wavefront analysis technique was used to determine the higher order aberrations in pterygium eyes and normal fellow eyes in individuals. Higher order aberration values were compared between both eyes with paired t-test. Pearson correlation was used to assess the correlations of higher order aberration values with pterygium size. Results: Of the 32 patients, there were 15 males (47%) and 17 females (53%), mean age was 48.9±12.2 years. The average horizontal size of pterygium was 2.6+0.9 millimeters. For pterygium eyes, the mean of coma, trefoil, spherical aberration, and quadrafoil were 0.87±1.01, 1.45±1.55, 0.28±0.27, and 0.79±0.94 micrometers, respectively. And those of normal fellow eyes were 0.46±0.37, 0.80±0.71, 0.15±0.33, and 0.39±0.47 micrometers, respectively. Comparing between pterygium and contralateral normal eyes, a significant difference was present in all parameters (paired t-test, p<0.05). Coma, trefoil, and quadrafoil of pterygium eyes had a significant relationship with pterygium size (Pearson correlation, p<0.05) except for spherical aberration. Conclusion: The findings suggest that higher order aberrations have a tendency to increase in pterygium eyes compared to contralateral normal eyes, and most have a correlation with pterygium size.

Comparative Knowledge and Behavior of Contact Lens Care between Medical and Non-Medical Students.

OBJECTIVE: To compare knowledge and behavior of contact lens care between medical and non-medical students. MATERIAL AND METHOD: Cross sectional study. Participants consisted of 200 medical students (M) and 200 non-medical students (N) who wore contact lenses within the recent one year. A structured questionnaire was filled in by subjects. RESULTS: Approximately 50% of participants had been contact lens wearers for less than one year The purposes ofwearing lenses included vision correction (73.6%) and cosmetic (26.4%). Non-medical students wore color lenses significantly more than medical students. Non-medical students bought lenses from internet and markets significantly more than medical students did. For the knowledge component, the contact lens-related complications which participants can name were significantly different in both groups including allergic conjunctivitis (M: 73.2%, N: 61.3%), corneal abrasion (M: 58%, N: 36.7%), corneal ulcer (M: 61.6%, N: 45.7%), and corneal neovascularization (M: 29.8%, N: 18%). The behavior that participants had differed significantly in both groups were included rinsing lenses with tap water (M: 19.7%, N: 29.8%), and washing hands before handling lenses (M: 82.7%, N: 71%). The five common improper behaviors of lens care were similar in both groups and included wearing lenses longer than recommended, not changing lens storage solution daily, swimming while wearing lenses, using tap waterfor rising lenses and not washing hands before handling lenses. CONCLUSION: Medical students had better knowledge and behavior of contact lens care than non-medical students. However, both groups ofstudents still lacked adequate knowledge and were non-compliant with contact lens care instruction.

Frosted branch angiitis as a result of immune recovery uveitis in a patient with cytomegalovirus retinitis.

BACKGROUND: Since the introduction of Highly Active Antiretroviral Therapy (HAART), AIDs related morbidity and mortality have declined. However, the advent of HAART brought the new problem of immune recovery inflammatory syndrome. Cytomegalovirus retinitis remains the most common cause of visual loss in AIDs patients. Some patients with cytomegalovirus retinitis who experienced immune recovery as a consequence of HAART develop worsening of visual symptoms from immune recovery uveitis (IRU). FINDINGS: We report a case of cytomegalovirus retinitis and AIDs who developed an unusual presentation of IRU after the initiation of HAART. A 40-year-old woman presented with a history of blurry vision in the right eye. She was diagnosed with human immunodeficiency virus infection and cytomegalovirus retinitis, treated with intravitreal injections of ganciclovir. The retinitis improved. One week after HAART initiation, she developed IRU, characterized by increased intraocular inflammation, extensive frosted branch angiitis and cystoid macular edema. The CD4+ T lymphocyte count increased from 53 to 107 cells/mm3. Systemic prednisolone with continuation of HAART and intravitreal injections of ganciclovir were given with significant improvement. CONCLUSION: Atypical presentation of IRU, characterized by extensive frosted branch angiitis and increased intraocular inflammation may occur in immunocompromised patients with cytomegalovirus retinitis who experienced immune recovery. The time from HAART initiation to develop IRU may vary from days to months. This case demonstrated a very rapidly developed IRU which should be recognized and appropriately managed to avoid permanent damage of the eye.

Clinical profiles of Thai patients with ocular myasthenia gravis in Siriraj Hospital.

Ninety-six patients with ocular myasthenia gravis (OMG) seen at Siriraj Hospital during 1994 to 2004 were retrospectively reviewed. There were 59 female (61.5%) and 37 (38.5%) male patients with mean ages of 39.5 and 33.8 years, respectively Patients presented with initial symptoms of only ptosis in 46.9%, only diplopia in 13.5% and both ptosis and diplopia in 39.6%. However, diplopia alone is uncommon in childhood OMG. Fifteen percent developed systemic symptoms within two years of diagnosis. Thyroid function test was abnormal in 27.5% of investigated patients. Most abnormalities were hyperthyroidism. Thymoma associated with OMG is a rare condition. Most purely OMG patients can control the disease by pyridostigmine, prednisolone or immunosuppressive drugs.