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Objective: To compare the efficacies of a single thermodynamic treatment system (LipiFlow®) and warm compresses used for 3 months in patients with a moderate severity of meibomian gland dysfunction (MGD). Methods: This prospective, randomized, controlled clinical study enrolled 28 patients (22 females, 6 males; mean age, 53.9 ± 14.8 years) diagnosed as having moderate MGD by plugging at the meibomian gland orifices between one-third and two-thirds of lid margins and at least one of the following: a Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire score of 6-12; a lipid layer thickness (LLT) score of 40-70 Interferometric Color Units; upper eyelid meiboscore of 1-2; and 3-6 expressible meibomian glands (EMGs) in the lower eyelid. Both eyes of each patient were randomized into study and control eyes. Study eyes were treated with a single, 12-minute LipiFlow® system, while control eyes received 5-minute warm compresses twice daily for 3 months. The dry eye symptoms, the number of EMGs, and LLTs were evaluated. Results: There were no significant differences in the dry eye symptoms, number of EMGs, and LLTs for both groups at baseline and at each follow-up. However, the total SPEED scores for the LipiFlow® group reduced significantly from baseline at each follow-up until 6 months. As to the warm compress group, the total SPEED scores reduced significantly from baseline at each follow-up until 3 months. Conclusion: The single LipiFlow® treatment and twice-daily warm compresses relieved the dry eye symptoms of patients with a moderate severity of MGD compared with their baseline symptoms, despite no statistical differences in the dry eye symptoms, number of EMGs, and LLTs of both treatments. [ABSTRACT FROM AUTHOR]

Objective: To determine two-year outcome of intrastromal corneal ring segment (ICRS) implantation in keratoconus in Thai patients Methods: A retrospective review of medical records of the patients underwent Ferrara-type ICRS implantation (single and two segments) at Siriraj Hospital between November 2013 and December 2017 was conducted. Clinical outcomes were assessed at 1 month, 6 months, 1 year, and 2 years postoperatively. Results: Of 9 eyes in 8 patients, the mean age of the patients was 24.6 ± 7.5 years. The mean follow-up time was 32.2 ± 9.4 months. Overall, the median visual acuity was significantly improved postoperatively (p value = 0.007). At 2 years, the uncorrected visual acuity (UCVA) improved from 1.00 logMAR to 0.56 logMAR, and the corrected distance visual acuity (CDVA) improved from 0.76 logMAR to 0.10 logMAR. Correspondingly, the median spherical equivalent refraction was significantly improved postoperatively from -7.38 D to -3.13 D (p < 0.001). Moreover, the median anterior corneal topographic data significantly changed between visits (p < 0.02). The Kmax decreased from 52.65 D to 46.65 D and the Kmean decreased from 48.10 D to 45.40 D at 2 years. Postoperative adverse effects were glare and halos (3 eyes), visually insignificant small white corneal deposits around the segments (2 eyes), extrusion of a ring segment needed removal with reversible to baseline vision (1 eye). Conclusion: This initial report in Thai patients showed that the ICRS implantation in keratoconus could improve the visual, refractive, and topographic parameters with stability at 2 years. However, appropriate case selection and surgical technique should be considered. [ABSTRACT FROM AUTHOR]

Objective: The primary objective was to find an agreement of intraocular pressure (IOP) assessed by Goldmann applanation tonometry (GAT) and Corvis in healthy, ocular hypertension (OHT) and primary open-angle glaucoma (POAG). The secondary objective was to find a reliability of intra-examiner and inter-examiner IOP measurement by GAT and Corvis. Methods: Fifty three eyes from 53 participants were included and were divided into healthy (N=20), OHT (N=13) and POAG group (N=20). Only right eyes were selected for further statistical analysis except one patient with only left eye eligible. The eyes with corneal pathologies, greater than 2.5 diopters astigmatism, or recent ocular surgery were excluded. Randomized examining sequence between GAT and Corvis was applied. To minimize an after measurement IOP fluctuation, five minutes and two minutes gap between measurements were strictly applied for Corvis and GAT respectively. The first ten patients had 3 measurements per measurer and two measurers were assigned per machine to evaluate intra-examiner and inter-examiner reliability. Intraclass correlation coefficient was used to analyze the reliability of the IOP measuring machine. Bland & Altman plot was used to analyze an agreement between the machines. Results: High ICCs were found in both measurers using GAT (ICC of measurer 1 = 0.954, measurer 2 = 0.977) and Corvis (ICC of measurer 1 = 0.920, measurer 2 = 0.927) which indicated excellent intra-examiner reliability. High ICCs were found when comparing IOP between 2 measurers who used the same machine (GAT ICC = 0.928, Corvis ICC = 0.915) which indicated excellent inter-examiner reliability. GAT tends to yield higher IOP reading. The mean IOP were 13.93±3.849 by GAT and 12.15±4.030 by Corvis. The mean IOP differences were 1.8, 1.7, 1.4 and 2.2 mmHg in total, healthy, OHT and POAG group respectively. POAG had highest mean difference and widest standard deviation which might result from poor agreement between 2 machines. According to Bland & Altman plot the values were scattered and no trend was found indicating higher or lower average IOP would result in higher or lower difference between the two machines. From the clinical point of view, 71.7% and 47.2% fall into IOP difference range of ±3 and ±2 mmHg respectively. Conclusion: Corvis-IOP is a good parameter with excellent intra-examiner and inter-examiner reliability. In clinical practice, the usefulness of Corvis-IOP is limited especially in POAG patients according to the poor agreement with gold standard GAT-IOP. [ABSTRACT FROM AUTHOR]

Background: Delayed diagnosis can lead to the development of endophthalmitis and blindness, which is difficult to manage because of the lack of an effective antimicrobial agent., Objective: Comparing the nested polymerase chain reaction (PCR) technique with the standard diagnostic culture method for Pythium insidiosum., Material and Method: Eighty-three patients with suspected fungal keratitis were enrolled in this observational, crosssectional study from the Faculty of Medicine Siriraj Hospital between February 2011 and February 2014. Patient symptoms, associated diseases, duration of ulcers, precipitating causes, best-corrected visual acuity, intraocular pressure, and other clinical findings were recorded. Corneal scrapings were taken for Gram staining, bacterial and fungal cultures, staining with potassium hydroxide preparation, and DNA extraction for nested PCR. The sensitivity, specificity, accuracy, and agreement of the nested PCR analysis and culture diagnosis of P. insidiosum were compared., Results: Five patients had a positive result for nested PCR amplification of P. insidiosum, while only one of these was also positive for culture growth of Pythium. Nested PCR sensitivity was 50% (95% confidence interval [95% CI] 1.3-98.7), specificity 94.7% (95% CI 86.9-98.5), and accuracy 93.5% (95% CI 85.7-97.2) with a fair agreement (kappa 0.258, p = 0.011)., Conclusion: Therefore, nested PCR may be an appropriate test for P. insidiosum in diagnosing Pythium keratitis with high accuracy, despite small amounts of corneal specimen.

Objective: To show the association between keratoconus and macular dystrophy., Material and Method: All patients with macular dystrophy and associated clinical findings leading to a diagnosis of keratoconus by corneal topography were retrospectively reviewed during a 10-year period. Uncorrected and best-corrected visual acuity, automated refraction, manifest refraction, corneal thickness, and corneal curvature by corneal topography were evaluated, Results: Three patients with macular dystrophy exhibiting decreased vision, multifocal white dense deposits, and haze surrounding the deposits in the corneal stroma were evaluated. All had a steep corneal curvature of >47 diopters and a thin cornea consistent with keratoconus. Penetrating keratoplasty was performed in one patient with severely decreased vision. Macular dystrophy was diagnosed based on an Alcian blue-stained pathological specimen., Conclusion: Keratoconus may develop as a result of changes associated with macular dystrophy. Therefore, patients with severely decreased vision should be evaluated for keratoconus to ensure proper management.