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Objective: To report the use of intravitreal (IVT) injections of anti-vascular endothelial growth factor agents (anti-VEGF) and its complications., Material and Method: The authors performed a retrospective review of consecutive patients treated with IVT injection of anti-VEGF between May 2006 and December 2010 at Chiang Mai University Hospital. Demographic data and complications were registered., Results: The present study included 1,006 eyes of 878 patients. Mean age was 60 years (range 1 month to 91 years). Mean follow-up time was 12 months (range 1 month to 54 months). Total injections were 2,077 given as 47, 210, 399, 575, and 846 injection per year between 2006 and 2010, respectively. Anti-VEGF agents were bevacizumab (1,878; 90.42%), ranibizumab (190; 9.15%), and pegaptanib (9; 0.43%). Indications for injection based on primary diagnosis were neovascular macular degeneration (38.5%), diabetic retinopathy (38%), and retinal vein occlusion (15.9%). The incidence of endophthalmitis was 0.048% (1/2,077) for all injections and 0.053% (1/1878)for bevacizumab., Conclusion: The use of IVT injections of anti-VEGF is increasing, especially the use of bevacizumab. Incidence of ocular and systemic complications after IVT injection of anti- VEGF was low with no significant difference among the three anti-VEGFs agents.

Objective: To report a case of bilateral anterior dislocated crystalline lens from water splash during the Songkran festival., Material and Method: A healthy 46-year-old woman with a previous history of having water thrown to her face at the Songkran festival complained of acute bilateral painful visual loss. On examination, visual acuity was 0.1 OD, 0.2 OS, and both eyes revealed anterior dislocated crystalline lens with blood in anterior chamber. Her intraocular pressure (IOP) was 8 mmHg OD and 47 mmHg OS. She was initially treated with medication for controlling IOP and inflammation. Eventually, she underwent pars plana vitrectomy, pars plana lensectomy, and scleral-fixated intraocular lens (SF-IOL) in both eyes., Results: The dislocated lens was successfully removed and visual acuity was 0.7 OD and 0.9 OS at 9 months follow-up., Conclusion: Water splash can be associated with anterior lens dislocation and secondary glaucoma. Awareness, careful examination, and prompt referral to an ophthalmologist can prevent complications and preserve the patient's vision.

Background: Endophthalmitis is one of the most serious complications of ophthalmic surgery, which includes postoperative cataract extraction. Outbreak of acute postoperative endophthalmitis after cataract surgery has been reported in Thailand and other countries., Objective: To describe an outbreak of acute postoperative endophthalmitis after cataract surgery that was referred to Chiang Mai University Hospital during March 2006., Material and Method: Observational case series were made from the records of inpatients and outpatients, who had been referred for treatment of acute postoperative endophthalmitis after cataract surgery at a district hospital in northern Thailand. The surgery was conducted on two consecutive days by volunteer ophthalmologists of a non-profit foundation from Bangkok., Results: In this outbreak, the authors recorded 31 endophthalmitis cases, with 33 eyes (bilateral 2 cases). Of the 33 endophthalmitis eyes, 32 occurred following extracapsular cataract extraction with intraocular lens and one after the secondary intraocular lens implant. Microbiological investigations in the hospital were done with aqueous tapping, vitreous tapping, and vitreous from pars plana vitrectomy. Gram-positive cocci were detected from vitreous tapping in four eyes. Thirty-two cases were managed with intravitreous antibiotics, one with subconjunctival antibiotic only, and all eyes were treated with fortified topical antibiotics. Fifteen eyes underwent pars plana vitrectomy Assessment of visual acuity (VA) before and after treatment showed improvement in 75.8% (25/33), decrease of VA in 9.1% (3/33), while visual acuity remained stable in 15.2% (5/33)., Conclusion: In high-volume cataract surgery, an outbreak of endophthalmitis is always possible. Prompt and appropriate treatment can improve the visual outcome.

Objective: To report three cases of delayed choroidal detachment after treatment with topical prostaglandin analogs., Material and Method: Intervention three case reports. Four eyes of three patients with chronic angle closure glaucoma developed choroidal detachment after using topical prostaglandin analogs., Results: Three patients with chronic angle closure glaucoma developed chroidal detachment in one week, three weeks and two years after using travoprost, bimatoprost and latanoprost respectively. All of them resolved after discontinuation of these medications. All of the eyes that developed chroidal detachment were pseudophakic., Conclusion: Travoprost, bimatoprost and latanoprost may lead to choroidal detachment and hypotony. Pseudophakic patients may be at high risk of the development of chroidal detachment. Topical prostaglandin analogs should be used cautiously in these patients.

Objective: To evaluate the diagnostic value of polymerase chain reaction (PCR) performed on vitreous, aqueous and conjunctiva for the detection of cytomegalovirus in AIDS patients with a clinical diagnosis of cytomegalovirus retinitis., Material and Method: PCR-based assay was used to detect cytomegalovirus DNA in vitreous, aqueous and conjunctival samples from 24 patients with the acquired immunodeficiency syndrome (AIDS) who had untreated clinically diagnosed cytomegalovirus retinitis and from 15 immunocompetent patients, including 11 with retinal detachment, 2 with macular hole and 2 with vitreous hemorrhage., Results: Cytomegalovirus DNA was detected in 16, 9 and 3 of 24 vitreous, aqueous and conjunctival samples, respectively, from patients with AIDS, untreated clinically diagnosis of cytomegalovirus retinitis; and in one patient out of 15 vitreous, aqueous and conjunctival samples from immunocompetent patients with vitreoretinal diseases., Conclusion: The use of PCR in the detection of cytomegalovirus in vitreous, aqueous and conjunctival samples had an equal specificity of 93% and had sensitivity of 67, 37 and 12%, respectively.