Ocular surface squamous neoplasia in Northern Thailand: a 16-year review.

PURPOSE: To evaluate clinical characteristics, treatments, and outcomes in patients with ocular surface squamous neoplasia (OSSN) at a tertiary center in Northern Thailand. METHODS: Patients diagnosed with either corneal-conjunctival intraepithelial neoplasia (CIN) or squamous cell carcinoma (SCC) from May 2000 to December 2015, were recruited. The patients' demographics, symptoms, clinical characteristics, cytopathology, treatments, and outcomes were reviewed. RESULTS: Overall 171 eyes from 168 patients, 92 eyes were CIN and 79 eyes were SCC. Males were affected in 65.5%. The mean age was 58.8 ± 16.8 (29-99) years. In most cases (60.3%), the tumors were located at the limbus. The most common clinical characteristic was papilliform appearance (46.2%). Human immunodeficiency virus (HIV) infection was found in 37 (22.0%) patients with a mean age of 40.5 ± 7.7 years. The treatments and outcomes were evaluated in 136 eyes whose main initial treatment was wide excision with adjunctive cryotherapy (47.8%), followed by topical mitomycin C (30.9%). The mean follow-up time after treatment was 20.8 ± 2.2 (3-110) months and the recurrence occurred in 18 eyes (13.2%) during the follow-up period. The mean recurrence-free time (months) for CIN was significantly longer than that of SCC (81.3 ± 10.0 [95%CI 61.5 - 101.1] vs 33.2 ± 4.6 [95%CI 24.0 - 42.3], p = 0.030). SCC was the only significant risk factor that influences the recurrence of the tumors with the adjusted hazard ratio of 5.69 (p = 0.005). CONCLUSION: OSSN in Northern Thailand usually involved a limbal area and presented as a papilliform mass. HIV infection should be suspected in young patients. CIN had better outcomes after treatments than invasive SCC.

Accuracy of Computed Tomography and Magnetic Resonance Imaging for Detection of Pathologic Risk Factors in Patients Diagnosed with Retinoblastoma.

Aim: To assess and compare the diagnostic accuracy of magnetic resonance imaging (MRI) and computed tomography (CT) for detecting the extent of tumor invasion in eyes with advanced retinoblastoma prior to enucleation using histopathologic analysis as a reference.Methods: A total of 56 patients (68 eyes) enucleated for retinoblastoma were reviewed. Eyes with complete data (CT 28, MRI 16) were included for analysis. Imaging data were reviewed by a pediatric radiologist, blinded to histopathology results. Four high-risk factors which included scleral, choroidal, anterior eye segment invasion, and postlaminar optic nerve invasion were assessed.Results: For CT, the diagnostic odds ratio (DOR), sensitivity, and specificity for detecting postlaminar optic nerve invasion were 1.7%, 25%, and 83.3%. Choroidal invasion was correctly identified in only 2 of 10 eyes (DOR 0.5, sensitivity 20%, specificity 66.7%). For scleral invasion, CT showed a diagnostic ratio of 1.5%, sensitivity 40%, specificity 69.6% whereas for anterior segment invasion DOR was 9.2%, sensitivity 100%, and specificity 65.4%. MRI showed a higher DOR for detecting postlaminar optic nerve invasion of 39%, sensitivity 77.8%, and specificity 100%. Choroidal and scleral invasion on MRI had a DOR of 6.5% (sensitivity 25%, specificity 100%) and 6% (sensitivity 33.3%, specificity 92.3%) respectively while DOR for anterior segment invasion was 1.3% (sensitivity 50%, specificity 57.1%).Conclusion: CT showed a poor diagnostic accuracy for all four high-risk factors in advanced retinoblastoma and therefore may not be a useful tool for assessment of tumor extension. For MRI, detection of postlaminar optic nerve invasion was moderately accurate although less accurate for detection of other risk factors. Decision-making for each child should not be based on any single parameter but rather on consideration of clinical factors in combination with radiologic findings.

Development and psychometric properties of the Thai Graves' ophthalmopathy quality of life (GO-QOL) questionnaire.

PURPOSE: To develop and assess the psychometric properties of the Thai version of the Graves' Ophthalmopathy Quality of Life (GO-QOL) questionnaire. BACKGROUND: Graves' ophthalmopathy (GO) is a chronic condition that causes negative self-image and impaired visual function. These conditions impact quality of life (QOL) but are rarely documented. Graves' Ophthalmopathy Quality of Life Questionnaire (GO-QOL) has good validity, reliability and responsiveness. In this study we developed a Thai GO-QOL questionnaire by translating the questionnaire from English to the Thai language and evaluated its reliability and validity. PATIENTS AND METHODS: Forward and backward translations were performed independently by four translators with extensive experience in both English and Thai. Seventy patients at the thyroid clinic responded to the Thai translated version upon their first visit and again 2-3 weeks afterwards. Validity was assessed by the content validity index (CVI) and correlation with relevant clinical parameters. Reliability was evaluated by Cronbach's alpha, the intraclass correlation coefficient, and the Bland-Altman plot. RESULTS: The Thai GO-QOL version showed high CVI (0.97) and a moderate negative correlation of the functional QOL score with disease severity (r = - 0.49), the clinical activity score (r = - 0.31), and exposure parameter (r = - 0.32). It showed good reliability with a high intraclass correlation coefficient (0.92) and high Cronbach' s coefficient (0.86). CONCLUSION: The Thai GO-QOL has good validity and reliability. It can be used to evaluate the quality of life of Graves' ophthalmopathy patients as a consequence of their disease in thyroid treatment programs.

Clinical presentation and treatment outcomes of primary ocular adnexal MALT lymphoma in Thailand.

BACKGROUND: Primary ocular adnexal extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (POML) is the most common subtype of lymphoma involving the eyes in Thailand. We sought to assess the characteristics and treatment outcomes of patients with POML in Thailand. METHODS: We retrospectively reviewed patient data and included patients diagnosed with POML between January 2004 and December 2016 at Chiang Mai University Hospital and King Chulalongkorn Memorial Hospital, Thailand. We collected and analyzed patients' clinical characteristics and treatment outcomes. RESULTS: Among 146 patients with lymphoma involving the eyes, 121 (82%) were diagnosed with POML. Sixty-four (52.9%) were women with median age 58 (range, 22-86) years. The most common presenting symptom was orbital mass (71.1%). Common sites of origin were the orbit (46.3%) and lacrimal gland (34.7%). At presentation, 22.3% of patients had bilateral eye involvement. About half of patients had stage I disease (N=59, 56.2%) and 20% had stage IV. Most patients (73.3%) had a low-risk International Prognostic Index. Radiotherapy was the main treatment for patients with limited-stage disease (66.7% in stage I and 56.5% in stage II). The overall response rate was 100% with complete response rates 80%, 77.3%, and 64.7% for stages I, II, and IV, respectively. Five-year progression-free survival (PFS) and overall survival were 66.1% and 94.0%, respectively. For patients with limited-stage disease, radiotherapy significantly improved PFS compared with treatment not involving radiotherapy (5-year PFS 89.9% vs. 37.3%, P=0.01). CONCLUSION: We revealed that POML has good response to treatment, especially radiotherapy, with excellent long-term outcome.

Incidence of short-term complications and associated factors after primary trabeculectomy in Chiang Mai University Hospital.

BACKGROUND: To determine the incidence of early postoperative complications and associated factors after primary trabeculectomy in Thai glaucoma patients. DESIGN: This was a retrospective observational study performed in Chiang Mai University Hospital. PARTICIPANTS: One hundred and eighteen glaucoma patients participated in the study. METHODS: All glaucoma patients underwent primary trabeculectomy with mitomycin C (MMC) using fornix-based conjunctival flap technique between December 2011 and May 2013. Surgical complications during the first 3 months of follow-up were recorded, and associated risk factors were analyzed. MAIN OUTCOME MEASURES: The incidence of posttrabeculectomy complications was the main outcome measure. RESULTS: One hundred and eighteen eyes of 118 patients were included. Early postoperative complications developed in 55 eyes (56.7%). Complications included hypotony (25 eyes, 27.2%), serous choroidal detachment (CD) (14 eyes, 15.6%), subconjunctival hemorrhage (12 eyes, 13.0%), hyphema (11 eyes, 12.4%), bleb leak (8 eyes, 8.8%), encapsulated bleb (2 eyes, 2.2%), aqueous misdirection (1 eyes, 1.1%), corneal epithelial defect (1 eyes, 1.1%), and overfiltration (1 eyes, 1.1%). There were no reported cases of endophthalmitis or blebitis. Hypotony was associated with serous CD (P = 0.006), and hyphema was associated with neovascular glaucoma (NVG) patients (P = 0.009). NVG was not associated with the increased rate of surgical failure (P = 0.083). CONCLUSIONS: The incidence of early complications after first-time trabeculectomy with MMC was high (56.7%) in this Thai clinic setting, but most were transient and self-limited conditions. The correlations between hypotony and CD as well as hyphema and NVG were compatible with the previous studies.

Cutis laxa with pulmonary emphysema, conjunctivochalasis, nasolacrimal duct obstruction, abnormal hair, and a novel FBLN5 mutation.

We report on a 4-year-old girl with autosomal recessive cutis laxa, type IA, or pulmonary emphysema type (ARCL1A; OMIM #219100), with loose and wrinkled skin, mitral and tricuspid valve prolapse, conjunctivochalasis, obstructed nasolacrimal ducts, hypoplastic maxilla, and early childhood-onset pulmonary emphysema. Mutation analysis of FBLN5 showed a homozygous c.432C>G missense mutation, and heterozygosity in the parents. This is predicted to cause amino acid substitution p.Cys144Trp. Conjunctivochalasis or redundant folds of conjunctiva and obstructed nasolacrimal ducts have not been reported to be associated with FBLN5 mutations. Histopathological study of the conjunctival biopsy showed that most blood vessels had normal elastic fibers. The gingiva appeared normal, but histologically elastic fibers were defective. Scanning electron micrography of scalp hair demonstrated hypoplastic hair follicles. The cuticles appear intact underneath the filamentous meshwork.

Histopathological diagnosis of eyelid tumors in Chiang Mai University Hospital.

OBJECTIVE: To report the histopathological diagnosis ofeyelid tumors and to study the prevalence of eyelid tumors in Chiang Mai University Hospital Chiang Mai, Thailand. MATERIAL AND METHOD: A retrospective review of medical and pathological records ofpatients diagnosed as eyelid tumor that underwent histopathological biopsy between January 2007 and December 2013 in Chiang Mai University Hospital was done. RESULTS: Three hundred sixteen cases of eyelid tumors were reviewed. The mean age at diagnosis was 54.2 +/- 19.6 years (range 1 month-99 years), women were 59.5% (n = 188) and men 40.5% (n = 128). The tumor sites were left lower eyelid (27.5%), right upper eyelid (24.4%), right lower eyelid (21.2%), and left upper eyelid (18.7%). There were 204 (64.6%) benign tumors and 112 (35.4%) malignant tumors. Nevi were the most common in benign group (16.4%) and basal cell carcinoma was the most common eyelid malignancy (18.0%). CONCLUSION: The most common histopathological diagnosis for benign eyelid tumor was nevus, while the most common malignant eyelid tumor was basal cell carcinoma at Chiang Mai University Hospital.

A survey of pterygium surgery in Thailand 2010.

OBJECTIVE: To survey and investigate the pterygium surgery among Thai ophthalmologists in 2010. MATERIAL AND METHOD: Questionnaires were distributed to 930 ophthalmologists who were the member of the Ophthalmological Society and Royal Colleges of Ophthalmologists of Thailand. Data received from 414 respondents were assessed and analyzed RESULTS: The majority of respondents were male (53.1%) while 46.9 % were female. Visual disturbance (57.6%) was the most common indication for surgery. Most of the respondents (41.1%) preferred pterygium excision combined with conjunctival autograft transplantation. Bare scleral technique was the second most common preferential procedure. Recurrence was the main postoperative complication. CONCLUSION: Although there was a great variation pterygium surgical pattern, excision with conjunctival autograft transplantation was the major preferential practice. Recurrent pterygium was the most common complication.

Two cases of periocular cutaneous angiosarcoma.

Angiosarcoma is a rare malignancy with only 8 previous reports of eyelid involvement. The authors report 2 further cases, one as a primary lesion and the other as a recurrence from a contiguous area. In both cases, the lesions appeared relatively inconspicuous, and their extent during micrographic excision was considerably larger than anticipated. Although wide surgical margins were obtained and adjuvant radiotherapy and chemotherapy was undertaken, one patient had died from distant metastasis, while the second had distant cutaneous recurrences within 1 year.

Bilateral microphthalmos with cyst: excision with orbital free fat graft.

Bilateral microphthalmos with cyst was diagnosed in a 4-month-old female term infant who presented with bilateral lower eyelid cysts and the right eye displaced beneath the upper eyelid. Imaging of the orbits revealed bilateral microphthalmic globes with large orbital cysts. Treatment consisted of bilateral cyst removal and free fat grafts for volume replacement, which yielded good cosmetic results with reduction of right globe displacement.

Management of optic neuropathy from an apical orbital-cavernous sinus hemangioma with radiotherapy.

We document a case of reversal of compressive optic neuropathy caused by a cavernous sinus-orbital cavernous hemangioma following treatment by conformal stereotactic radiotherapy.