Thanapong Somkijrungroj

Intraocular device-associated uveitis (IDAU) - which we propose as a more precise alternative to the traditional term "uveitis-glaucoma-hyphema (UGH) syndrome" - is a rare but potentially sight-threatening complication of intraocular device implantation. Elevated intraocular pressure (IOP) is a major driver of visual morbidity in IDAU, but the risk factors that predispose affected patients to IOP elevation remain poorly characterised. We aimed to describe the clinical spectrum of IDAU and to identify independent risk factors for elevated IOP in this population, using the Chulalongkorn University Uveitis Cohort (CU²C) database. This first nested case-control study within the Chulalongkorn University Uveitis Cohort (CU²C) enrolled 375 subjects followed at a tertiary uveitis clinic in Thailand over 8 years (August 2014-June 2022). Cases (n = 30) were IDAU patients with elevated IOP (> 21 mmHg); controls (n = 60) were IDAU patients with normal IOP, sampled at a 1:2 ratio from the same cohort. Univariate and multivariate logistic regression were used to calculate odds ratios (OR) and 95% confidence intervals (CI) for candidate risk factors. We retrospectively identified 90 subjects who developed IDAU. Following a one-to-two case-control ratio, 30 case subjects and 60 control subjects were included. Three factors were significantly associated with high intraocular pressure in IDAU. These included intraocular lens (IOL) malposition (AOR: 8.30, 95% CI 1.25 to 54.76), long eye (AOR: 8.08, 95% CI 1.18 to 55.16) and age (AOR: 1.18, 95% CI 1.07 to 1.31). There was no statistical evidence of effects of hypertension, ruptured posterior capsule, vitrectomized eye, transillumination iris defect (TID), pseudophacodonesis and single-piece IOL in sulcus on high IOP in IDAU. In this first nested case-control study of IDAU, IOL malposition, long axial length (> 25 mm), and older age were independently associated with elevated IOP. These findings should inform clinician awareness and post-operative monitoring strategies for high-risk IDAU patients.

Purpose: To compare patient-reported pain perception between immediate sequential vs delayed sequential bilateral cataract surgery (ISBCS vs DSBCS). Setting: King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Design: Prospective cohort study. Methods: Eligible participants scheduled to undergo ISBCS and DSBCS were consecutively enrolled. Topical anesthesia was administered for all procedures with no sedation used. Pain scores for each eye were assessed separately at 3 timepoints: immediately after surgery, day 1, and day 7 postoperation, using a verbal numeric rating scale from 0 to 10. A linear mixed-effects model was used to analyze the differences in pain scores between the 2 groups and adjusted for covariates, including surgical method, timepoint, operated eye, education level, surgeon experience, and surgical duration. Results: 90 bilateral cataract patients (45 ISBCS and 45 DSBCS) were enrolled. Pain scores on day 0 were low, with medians of 1 (0; 2) for both groups ( P = .476). The linear mixed-effects model revealed no significant impact of surgical methods on pain scores, with a notable decrease in pain levels over time. Surgical duration significantly affected pain, with each minute adding approximately 0.027 to the score. In addition, patients with higher education levels reported higher pain scores. Conclusions: Pain related to cataract surgery was mild and resolved quickly in both ISBCS and DSBCS groups, with no significant differences between surgical methods and operated eyes. The effect of education level on pain perception suggests the importance of good preoperative counseling to set appropriate expectations.

Introduction: Toric intraocular lens (IOL) calculation has traditionally relied on anterior corneal astigmatism (KA), but recent trends emphasize incorporating posterior corneal astigmatism (PCA) and total corneal astigmatism (TCA). However, age-related changes and sex-based differences in PCA and TCA remain inconclusive due to limited sample sizes in previous studies. Methods: We conducted a cross-sectional observational study using biometric measurements obtained with the IOLMaster 700. Patients with warning and failed history of corneal transplant or keratoconus were excluded. The objective was to evaluate age-related changes and sex-based differences in KA, PCA, and TCA among patients undergoing cataract surgery at a tertiary care center in Thailand. Results: A total of 23,932 eyes were analyzed for KA, and 9,546 eyes for PCA and TCA. Data were visualized using double-angle plots. PCA demonstrated a distinctive three-point star distribution, predominantly oriented along the with-the-rule (WTR) axis, with against-the-rule (ATR) astigmatism being rare in younger patients as illustrated in graphical Across KA, PCA, and TCA, the prevalence of ATR astigmatism increased in older age group, while WTR orientation decreased. A marked shift from WTR to ATR orientation was observed at different age thresholds: 60– 65 years for KA, 75– 80 years for PCA, and 55– 65 years for TCA. KA and TCA also exhibited a preferential shift toward superonasal oblique orientation with advancing age—a pattern not observed in PCA. No significant sex-based differences were observed in mean astigmatism vector distributions across age groups. Conclusion: Clinicians should account for age-related shifts in KA, PCA, and TCA when selecting toric IOLs, particularly in patients younger than 55 years. Preoperative counseling should address potential long-term shifts toward ATR orientation, which may influence visual outcomes in patients receiving toric IOLs aligned along other axes. Incorporating these changes into toric IOL formulae may improve patient outcomes. Plain Language Summary: In this study, we examined how the curvature and orientation of the cornea, specifically the anterior (front), posterior (back), and total corneal astigmatism, change with age and whether there are any differences between males and females. Astigmatism is when the cornea is not perfectly round, which can cause blurred vision. For patients undergoing cataract surgery, toric intraocular lenses (IOLs) are often used to correct this condition. Traditionally, surgeons have focused only on the front part of the cornea when planning for toric IOLs, but recent advances highlight the importance of also considering the back surface and total astigmatism of the cornea. By analyzing data from nearly 24,000 eyes, we discovered that astigmatism tends to shift in orientation as people age, from a with-the-rule (WTR) pattern commonly seen in younger patients to an against-the-rule (ATR) pattern in older adults. This shift happens at different ages for different layers of the cornea with changes showing as early as age 55. We also found that this shift often moves toward a nasal side in the front and total corneal surfaces, but not in the posterior surface. Importantly, we did not observe any meaningful differences between males and females. These findings suggest that age plays a significant role in determining astigmatism patterns and should be considered when selecting and aligning toric IOLs, especially for younger patients who may continue to experience changes in corneal shape over time. Discussing these potential future shifts with patients before surgery may help improve satisfaction and long-term visual outcomes.

: Extralymphatic filariasis caused by filaria of zoonotic origins has been frequently reported in Thailand over recent years. Here, we report the first case of ocular filariasis in a 7.5-year-old Thai boy who initially presented with progressive conjunctival redness and blurred vision in his right eye. A small, slender, coiled worm was found and surgically removed from the right anterior chamber. Histopathological examination illustrated predominant eosinophilic inflammation surrounding the parasite, which showed smooth and thin cuticle, prominent lateral chords, flat and broad muscle cells, one intestine, and two reproductive tubes with unsegmented ova, typically characteristic of a female adult Brugia filarial nematode. The parasite was also molecularly identified as B. pahangi, based on mitochondrial cytochrome c oxidase subunit I sequence analysis. The patient was then empirically prescribed albendazole, systemic prednisolone, and topical methylprednisolone. Unfortunately, his vision did not recover after 2 months due to severe maculopathy, most likely resulting from parasitic infestation and subsequent vitreous inflammation. To the best of our knowledge, this is the first case of ocular infestation by B. pahangi with visual complications that occurred outside a filariasis-endemic area of Thailand. Furthermore, this report provides clinical data on preceding cases of B. pahangi filariasis formally reported in southeast Asian countries, including Thailand and Malaysia, which facilitate a better understanding of the epidemiology of this sporadic zoonotic infection for effective disease elimination.

Background: Nowadays, the prevalence of digital device usage has shifted the demands for multifocal intraocular lenses. To accurately capture outcomes, clinical practice must evaluate digital reading performance. We aimed to assess the digital reading performance using a digital device in patients with diffractive multifocal intraocular lenses. Methods: Patients with bilateral diffractive multifocal intraocular lens implantation were included in the study. Monocular and binocular uncorrected and corrected visual acuity was measured using the LogMAR chart and the MNREAD application. Binocular uncorrected defocus curves were obtained using the LogMAR chart at 4m. The reading acuity was measured using the MNREAD application with positive and negative display polarities. The mean digital critical print size (CPS) was recorded using the MNREAD application at 40cm. Results: Our study reported uncorrected distance, intermediate, and near visual acuity were -0.084 ± 0.079, -0.014 ± 0.078, and 0.040 ± 0.081, respectively. The mean reading acuity at three months postoperatively with positive display polarity at 60cm and 40cm was -0.115 ± 0.102 and -0.008 ± 0.083, respectively. The mean digital CPS at three months postoperatively was 0.238 ± 0.100 logMAR. Conclusions: Incorporating digital reading performance measurements provides additional advantages in assessing the effectiveness of bilateral diffractive multifocal intraocular lens implantation.

Purpose of review: This article reviewed and summarized recent published data on ocular imaging findings and treatment of posterior segment manifestations of ocular metastasis. Recent findings: Advanced ocular imaging can help differentiate ocular metastases from other mimicking lesions, including primary intraocular tumors or infections. Recently, case reports have demonstrated the successful use of targeted systemic therapy to achieve local control of vitreous and choroidal metastases. Summary: Metastasis can lead to a wide variety of posterior segment ocular manifestations. The choroid is the most common metastatic site, whereas tumor metastasizing to the retina and optic disc are rare. Patients with possible metastatic eye disease are recommended to undergo extensive investigation to determine the underlying primary cancer and ongoing systemic metastases. Currently, there is no consensus on the treatment strategy. Treatment generally includes systemic chemotherapy in combination with local treatment, such as radiotherapy, laser therapy, or anti-vascular endothelial growth factor (anti-VEGF) treatment.

Trachoma surveillance is typically performed via random sampling of endemic districts. This strategy minimizes bias and allows examination of preschool children, but is also expensive. Surveillance for some other neglected tropical diseases is carried out in schools, which is logistically easier. In the present study, the prevalence of trachomatous inflammation–follicular (TF) from a population-based sample of children from each of 70 communities in Ethiopia was compared with the corresponding school-based estimate, which was calculated for each community by performing examinations in all primary schools in the district. The overall prevalence of TF was 39.1% (95% confidence interval [CI]: 35.0–43.1%) among children aged 1–9 years in the community-based sample and 18.8% (95% CI: 15.9–21.7%) among children in grades 1–3 of the school-based sample. School-based estimates of TF explained 35% of the variation in the community-based prevalences (P < 0.001). When TF prevalence was used as a diagnostic test for detecting a community with > 5% prevalence of ocular chlamydia, the area under the receiver operating characteristic curve was 0.73 (95% CI: 0.60–0.85) for the school-based sample and 0.71 (0.58–0.83) for the community-based sample (P = 0.76). Thus, although school-based monitoring was necessarily biased relative to population-based monitoring of 1- to 9-year olds, the two methods provided a similar amount of information about the community burden of ocular chlamydia in this trachoma-hyperendemic setting. The generalizability of these findings to areas with less prevalent trachoma is unclear.