Comparison of performances of femtosecond laser and microkeratome for thin-flap laser in situ keratomileusis.

OBJECTIVE: To compare the clinical outcomes of femtosecond laser (FS) and microkeratome (MK) for thin-flap in situ keratomileusis (LASIK). MATERIALS AND METHODS: Data from patients with moderate to high myopia (spherical equivalent, >-4 diopters [D]) who underwent thin-flap LASIK using FS (199 eyes/110 patients) and MK (157 eyes/86 patients) were analyzed in this retrospective study. Preoperative and postoperative data were recorded from day 1 and months 1 and 3, postoperatively. Visual and refractive outcomes were compared for efficacy, safety, predictability, stability, and the efficacy and safety indices. RESULTS: Three months postoperatively, more eyes in the FS group had an uncorrected distance visual acuity (UCVA) of 20/40 or better compared to MK group (relative risk [RR] 1.01, 95% confidence interval [CI], 0.97-1.05, P = 0.58); significantly more eyes in FS group had an UCVA of 20/20 or better (RR, 1.26, 95%CI, 1.08-1.48, P = 0.003). Intraoperative bleeding occurred in 5% and 36.7%, respectively, of FS and MK groups. There were no significant differences in the refractive predictability within spherical equivalents of 0.5 D (FS, 72%; MK, 63%) and 1.0 D (FS, 90%; MK, 86%). Both groups showed good stability 3 months, postoperatively. The efficacy index in FS group was 113.4%; that in MK group was 102.5% at 3 months postoperatively (P < 0.05). The safety indices for FS and MK groups at 3 months postoperatively were 116.4% and 108.2%, respectively (P < 0.05). CONCLUSIONS: Both methods of thin-flap created LASIK were effective, safe, predicable, and stable. FS group had significant improvements in efficacy and safety, confirmed by the efficacy and safety indices, compared to MK group. Lasers Surg. Med. 48:596-601, 2016. © 2016 Wiley Periodicals, Inc.

Assessing the Risk Factors For Diagnosed Symptomatic Dry Eye Using a Smartphone App: Cross-sectional Study.

BACKGROUND: Dry eye (DE) is a chronic inflammatory disease of the ocular surface of the eye that affects millions of people throughout the world. Smartphone use as an effective health care tool has grown exponentially. The "Dry eye or not?" app was created to evaluate the prevalence of symptomatic DE, screen for its occurrence, and provide feedback to users with symptomatic DE throughout Thailand. OBJECTIVE: The purpose of this study was to compare the prevalence of symptomatic dry eye (DE), blink rate, maximum blink interval (MBI), and best spectacle-corrected visual acuity (BSCVA) between people with and without symptomatic DE and to identify risk factors for symptomatic DE in Thailand. METHODS: This cross-sectional study sourced data from the "Dry eye or not?" smartphone app between November 2019 and July 2020. This app collected demographic data, Ocular Surface Disease Index (OSDI) score, blink rate, MBI, BSCVA, and visual display terminal (VDT) use data. The criterion for symptomatic DE was OSDI score ≥13. RESULTS: The prevalence of symptomatic DE among individuals using this smartphone app in Thailand was 85.8% (8131/9482), with the Northeastern region of Thailand having the highest prevalence, followed by the Northern region. Worse BSCVA (median 0.20, IQR 0.40; P=.02), increased blink rate (median 18, IQR 16; P<.001), reduced MBI (median 8.90, IQR 10.80; P<.001), female sex (adjusted OR 1.83; 95% CI 1.59-2.09; P<.001), more than 6 hours of VDT use (adjusted OR 1.59; 95% CI 1.15-2.19; P=.004), and lower than bachelor's degree (adjusted OR 1.30; 95% CI 1.03-1.64; P=.02) were significantly associated with symptomatic DE. An age over 50 years (adjusted OR 0.77; 95% CI 0.60-0.99) was significantly less associated with symptomatic DE (P=.04). CONCLUSIONS: This smartphone DE app showed that the prevalence of symptomatic DE in Thailand was 85.8%. Signs and risk factors could be also evaluated with this smartphone DE app. Screening for DE by this app may allow for the development of strategic plans for health care systems in Thailand.

Identification of a novel t17 genotype of acanthamoeba from environmental isolates and t10 genotype causing keratitis in Thailand.

We analyzed the nuclear small-subunit rRNA genes of Acanthamoeba isolates from freshwater sources (n=16) and from patients (n=6) in Bangkok and surrounding areas. The T10 genotype from a keratitis patient and a novel T17 genotype from water samples were diagnosed for the first time in this study.

Stromal Keratitis with Endophthalmitis Caused by Vittaforma Corneae in an Immunocompetent Patient: A Case Report.

Purpose: To describe a case of microsporidial stromal keratitis with endophthalmitis in an immunocompetent patient.Methods: Case reportResults: A 58-year-old HIV-negative man presented with stromal keratitis in his right eye. The patient demonstrated subsequent vitritis, multifocal retinitis and arteritis, and macular edema with recurrent vitreous hemorrhage after therapeutic keratoplasty. Numerous microsporidial spores were detected in corneal tissues by modified trichrome stain. Both corneal tissues and vitreous sample of the affected eye showed positive results by polymerase chain reaction targeting the microsporidial small subunit rRNA gene whose sequences belonged to Vittaforma corneae. Post-keratoplasty and vitrectomy, his best-corrected visual acuity was hand motion due to pale optic disc.Conclusion: Endophthalmitis can be a consequence of microsporidial stromal keratitis in an immunocompetent host. Early recognition and prompt treatment should be considered in patients diagnosed with microsporidial keratitis presenting with mild vitritis, retinitis, and recurrent vitreous hemorrhage.

Femtosecond laser-assisted anterior lamellar keratoplasty in stromal keratitis caused by an Endoreticulatus-like microsporidia.

PURPOSE: To describe a case of stromal keratitis caused by an Endoreticulatus-like microsporidia satisfactorily treated with femtosecond-assisted anterior lamellar keratoplasty (femto-ALK). METHODS: Case report. RESULTS: A 65-year-old healthy woman had a 10-month history of foreign body sensation and blurred vision after a flying insect struck her right eye. The patient presented with focal central to paracentral anterior stromal infiltration and edema with keratic precipitates of the right cornea. Confocal microscopy showed enhanced keratocytes with intracellular hyperreflective round and ovoid bodies confined to the anterior two thirds of corneal stroma. Femto-ALK was performed for excisional biopsy and replacement with anterior stromal donor cornea. A modified trichrome stain of corneal tissue showed numerous microsporidial spores whose small subunit rRNA sequence belonged to that of an Endoreticulatus-like microsporidia. CONCLUSIONS: Besides systemic infection, Endoreticulatus-like microsporidia can cause stromal keratitis. With careful patient selection, femto-ALK may be considered a new surgical alternative with satisfactory treatment outcomes.

Clinical evaluation of ophthalmic lomefloxacin 0.3% in comparison with fortified cefazolin and gentamicin ophthalmic solutions in the treatment of presumed bacterial keratitis.

OBJECTIVE: To evaluate the efficacy and safety of 0.3% lomefloxacin single agent solution, by comparing to a combination of fortified ophthalmic solutions of cefazolin sodium 50 mg/ml and gentamicin sulfate 14 mg/ml, in the treatment of acute bacterial keratitis. DESIGN: Prospective, double-masked, randomized comparative trial. METHOD: Forty patients with clinical diagnosis of any grade of severity of acute bacterial keratitis were randomized into 2 treatment groups: 20 to fortified cefazolin-gentamicin group, and 20 to lomefloxacin-normal saline group. The dosing of the drugs were scheduled for both treatment groups as follows: 1 drop of each solution was alternately instilled every 5 minutes for the first 30 minutes (as loading dose), then 1 drop with 5-minute interval between 2 bottles instilled hourly for day 1-3, tapering to every 2 hours on day 4-6, and every 4 hours on day 7-14. After day 14, dosing discretion was clinically adjusted, based on the clinical condition and finally discontinued after complete healing. Corneal scraping for cultures was obtained before starting the treatment. Ocular symptoms and signs, time to heal and adverse reactions were evaluated and compared between the 2 groups on day 2, 4, 7, 14, 21 and 28. RESULTS: No clinically or statistically significant difference were noted between two treatment groups, regarding demographic, symptoms and signs associated with bacterial keratitis. Positive results of bacterial corneal cultures were obtained in 27.5%. There was no statistically significant difference in time to complete re-epithelialization in all types of bacterial keratitis (P=0.251). By day 7, the keratitis was healed: 44% in lomefloxacin group, and 33% in fortified antibiotic group. Both study medications were well-tolerated, with no incidence of reported adverse event. CONCLUSION: In this study, eventhough there is no statistically significant difference of symptoms and signs between the two study groups at any study visit, we found clinical improvement in all patients in lomefloxacin group. So, lomefloxacin may be used as an alternative to standard treatment in acute bacterial keratitis.

Infectious keratitis at King Chulalongkorn Memorial Hospital: a 12-year retrospective study of 391 cases.

A retrospective study of 391 severe infectious keratitis admitted to King Chulalongkorn Memorial Hospital from January 1988 to December 2000 were analyzed. Most patients came from the central part of Thailand. There were 2 bimodal peak incidence distributions which fell in the age group 21-30 and 51-60 years of age. The most common predisposing to corneal ulceration was trauma from several materials, including leaves, branches, dust and stone, which accounted for 47.82 per cent. Culture results were collected 74.68 per cent (292/391). The data showed negative culture results of 52.74 per cent (154/292), positive results occurred in 47.26 per cent (138/292); including bacteria 32.53 per cent (95/292), fungus 11.64 per cent (34/292), virus 2.05 per cent (6/292) and mixed organism 1.02 per cent (3/292). Pseudomonas aeruginosa was the most common bacteria isolated; 47 per cent. The second most common was Streptococcus pneumoniae which accounted for 9 per cent. Fusarium spp was the most common fungus found (34.29%); Aspergillus and Curvularia spp were the next (20.0% each). Herpes simplex was the most common virus isolated; 83.3 per cent. The treatment of infectious keratitis included application of topical/intraocular injection of antimicrobial agent and surgery, which accounted for 184 cases. Penetrating keratoplasty was the most common surgery performed, 34.24 per cent (63/184), followed by evisceration and enucleation accounted for 25 per cent (46/184).

Keratitis caused by Trachipleistophora anthropopthera.

We report a case of intrastromal keratitis in a 42-year-old male with underlying human immunodeficiency virus-1 infection. Numerous microsporidial spores were found from corneal biopsy. Ultrastructural studies of corneal tissues revealed dimorphic sporophorous vesicles containing characteristic spores belonging to Trachipleistophora anthropopthera. Infection could be controlled by penetrating keratoplasty but not by topical fumagillin and systemic albendazole per se. This is the first report of human keratitis caused by this organism.

Clinical evaluation of ophthalmic lomefloxacin 0.3% in comparison with fortified cefazolin and gentamicin ophthalmic solutions in the treatment of presumed bacterial keratitis.

OBJECTIVE: To evaluate the efficacy and safety of 0.3% lomefloxacin single agent solution, by comparing to a combination of fortified ophthalmic solutions of cefazolin sodium 50 mg/ml and gentamicin sulfate 14 mg/ml, in the treatment of acute bacterial keratitis. DESIGN: Prospective, double-masked, randomized comparative trial. METHOD: Forty patients with clinical diagnosis of any grade of severity of acute bacterial keratitis were randomized into 2 treatment groups: 20 to fortified cefazolin-gentamicin group, and 20 to lomefloxacin-normal saline group. The dosing of the drugs were scheduled for both treatment groups as follows: 1 drop of each solution was alternately instilled every 5 minutes for the first 30 minutes (as loading dose), then 1 drop with 5-minute interval between 2 bottles instilled hourly for day 1-3, tapering to every 2 hours on day 4-6, and every 4 hours on day 7-14. After day 14, dosing discretion was clinically adjusted, based on the clinical condition and finally discontinued after complete healing. Corneal scraping for cultures was obtained before starting the treatment. Ocular symptoms and signs, time to heal and adverse reactions were evaluated and compared between the 2 groups on day 2, 4, 7, 14, 21 and 28. RESULTS: No clinically or statistically significant difference were noted between two treatment groups, regarding demographic, symptoms and signs associated with bacterial keratitis. Positive results of bacterial corneal cultures were obtained in 27.5%. There was no statistically significant difference in time to complete re-epithelialization in all types of bacterial keratitis (P=0.251). By day 7, the keratitis was healed: 44% in lomefloxacin group, and 33% in fortified antibiotic group. Both study medications were well-tolerated, with no incidence of reported adverse event. CONCLUSION: In this study, eventhough there is no statistically significant difference of symptoms and signs between the two study groups at any study visit, we found clinical improvement in all patients in lomefloxacin group. So, lomefloxacin may be used as an alternative to standard treatment in acute bacterial keratitis.

Infectious keratitis at King Chulalongkorn Memorial Hospital: a 12-year retrospective study of 391 cases.

A retrospective study of 391 severe infectious keratitis admitted to King Chulalongkorn Memorial Hospital from January 1988 to December 2000 were analyzed. Most patients came from the central part of Thailand. There were 2 bimodal peak incidence distributions which fell in the age group 21-30 and 51-60 years of age. The most common predisposing to corneal ulceration was trauma from several materials, including leaves, branches, dust and stone, which accounted for 47.82 per cent. Culture results were collected 74.68 per cent (292/391). The data showed negative culture results of 52.74 per cent (154/292), positive results occurred in 47.26 per cent (138/292); including bacteria 32.53 per cent (95/292), fungus 11.64 per cent (34/292), virus 2.05 per cent (6/292) and mixed organism 1.02 per cent (3/292). Pseudomonas aeruginosa was the most common bacteria isolated; 47 per cent. The second most common was Streptococcus pneumoniae which accounted for 9 per cent. Fusarium spp was the most common fungus found (34.29%); Aspergillus and Curvularia spp were the next (20.0% each). Herpes simplex was the most common virus isolated; 83.3 per cent. The treatment of infectious keratitis included application of topical/intraocular injection of antimicrobial agent and surgery, which accounted for 184 cases. Penetrating keratoplasty was the most common surgery performed, 34.24 per cent (63/184), followed by evisceration and enucleation accounted for 25 per cent (46/184).