Papers by Direk Patikulsila
Journal of the Medical Association of Thailand Chotmaihet Thangphaet, Aug 1, 2008
Background: Endophthalmitis is one of the most serious complications of ophthalmic surgery, which... more 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.
Chiang Mai Medical Journal เชียงใหม่เวชสาร, Sep 29, 2011
We report a young Thai man who came to our department because of blurred vision in the right eye.... more We report a young Thai man who came to our department because of blurred vision in the right eye. Results of ophthalmoscopic examination and fundus fluorescein angiography were consistent with Leber's miliary aneurysms. Focal argon laser photocoagulation was performed and subsequently regression of the aneurysms was observed. Chiang Mai Med Bull 1992; 31:41-45.
Journal of the Medical Association of Thailand Chotmaihet Thangphaet, Jun 1, 2003
To identify the magnitude of ocular complications in HIV infection in Chiang Mai, and determine t... more To identify the magnitude of ocular complications in HIV infection in Chiang Mai, and determine the signs or symptoms that indicate the risk factors for developing ocular complications in HIV-positive patients A prospective study was carried out in newly diagnosed HIV-positive patients seen in the Ocular Infectious Disease Clinic of Maharaj Nakorn Chiang Mai Hospital from March 1, 2000 through February 28, 2001. A complete ophthalmic examination was performed on each patient together with a systemic evaluation of present illness and current medications. Three-hundred and ninety-five HIV-positive patients were seen for ophthalmic evaluation. Of these, 90 were in stage A (asymptomatic), 84 were in stage B (symptomatic), and 221 were in stage C (AIDS). Ocular complications were found in 44.6 per cent of the patients. Cytomegalovirus (CMV) retinitis was the most common ophthalmic complication (33%). Other ocular complications included cotton wool spot (8%), uveitis (4%), optic neuropathy (3%), and keratoconjunctivitis sicca (2%). The clinical presenting symptoms, which were the indicators for ocular complications and CMV retinitis, included chronic cough, oral thrush, chronic diarrhea, weight loss, wasting, and skin disorders. Ocular symptoms, which indicated a high risk of developing CMV retinitis, included flashing, floaters, and scotoma. Ocular complications are common in HIV-positive patients. CMV retinitis, which is a major vision-threatening problem, represented the most common finding. It is recommended that HIV-positive patients should have their eyes examined regularly, particularly when they have the clinical presenting symptoms previously mentioned. The patients should also notice early symptoms of CMV retinitis, which includes flashing, floaters, and scotoma.
Journal of the Medical Association of Thailand Chotmaihet Thangphaet, Nov 1, 2013
To report the use of intravitreal (IVT) injections of anti-vascular endothelial growth factor age... more To report the use of intravitreal (IVT) injections of anti-vascular endothelial growth factor agents (anti-VEGF) and its complications. 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. 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. 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.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2015
To estimate the prevalence and associated factors of age-related macular degeneration (AMD) in Th... more To estimate the prevalence and associated factors of age-related macular degeneration (AMD) in Thailand. This cross-sectional survey was undertaken in 2010. Five provinces were selected and people aged 50 years and over were invited for eye examination. Demographic and health behaviors and data from eye examination equipment were registered. Ophthalmologists graded AMD as early or late based on fundus color photograph and image from optical coherence tomography. Logistic regressions were analyzed to establish associationfactorsfor AMD. Of the 7,043 participants, AMD wasfound in 862 people (12.2%), with more than half (53.1%) found in both eyes. Most cases (94.3%) were early dry, 1.8% early wet, 3.4% late dry, and 0.7% late wet AMD. Factors positively associated with AMD were age (OR 1.03, 95% CI 1.02-1.04), diabetes mellitus (OR 1.20, 95% CI 1.03-1.39), and consumption of yellow vegetable (OR 2.32, 95% CI 1.23-4.39). Factors that conversely associated with AMD were consumption of gr...
Journal of the Medical Association of Thailand Chotmaihet Thangphaet, Nov 1, 2007
To evaluate the effect of photodynamic therapy (PDT) with verteporfin for age-related macular deg... more To evaluate the effect of photodynamic therapy (PDT) with verteporfin for age-related macular degeneration (AMD) and non-AMD in Thais, and compare with the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) and Verteporfin in Photodynamic Therapy (VIP) study. The authors prospectively evaluated all data of 51 eyes of 51 patients who had undergone PDT and accomplished a 1-year follow up. The assessments were divided into two categories: group 1 included three subsets of AMD, and group 2 was non-AMD. The first group classified into three subgroups: group 1A: AMD with subfoveal choroidal neovascularization (CNV) and TAP/VIP compatible with recommendation guidelines characteristics, group 1B: AMD with subfoveal CNV and TAP/VIP incompatible, and group 1C: AMD with non-subfoveal CNV. The measurement outcomes comprised of the baseline characteristics, change in visual acuity, and number of treatments. Thirty-eight eyes had CNV-related AMD and 13 eyes were non-AMD. At the 12-month examination, the mean visual acuity change in group 1A, 1B, 1C had increased 0.19 (p = 0.077), 0.14 (p = 0.076), and 0.24 (p = 0.003), respectively. The number of treatments was 1.8 in group 1A, 2.3 in group 1B, and 1.5 in group 1C. PDT is beneficial to Thai patients with AMD at first year even if they were not compatible with TAP/VIP criteria.
International Ophthalmology, 2015
Purpose: To evaluate the clinical outcome of macular grid laser photocoagulation in the treatment... more Purpose: To evaluate the clinical outcome of macular grid laser photocoagulation in the treatment of diffuse diabetic macular edema and improving visual acuity compare to anatomical improvement by OCT. Methods: In this prospective study included 30 consecutive patients (33 eyes) who were treated by macular grid laser photocoagulation for diffuse diabetic macular edema. Examinations that included slit-lamp exami- nation, assessment of visual acuity and central macular thickness (CMTs) using optical coherence tomogra- phy (OCT) were performed pre-treatment and at 1 month, 3 and 6 months after treatment Results: Mean age of the patients was 58.9 +8.4 years. Mean best-corrected visual acuity (BCVA) for distance (using ETDRS charts) improved from 31.5+14.7 (range, 3-55) pretreatment to 35.2+14.8 (range, 5-55) (P=0.137), 37.2+16.5 (range, 5-65) (P=0.035), 38.6+15.6 (range, 5-60) (P = 0.005) letters at 1 month, 3 months, 6 months after treatment. Six months after treatment, eighteen (54.5%...
Journal of ophthalmology, 2015
Purpose. To determine changes in central subfield (CSF) macular thickness and best corrected visu... more Purpose. To determine changes in central subfield (CSF) macular thickness and best corrected visual acuity (BCVA) following single session, multispot panretinal photocoagulation (PRP). Methods. Forty eyes of 33 patients with newly diagnosed proliferative diabetic retinopathy were treated with single session, 20-millisecond, multispot PRP. Changes in central macular thickness and BCVA at 4- and 12-week follow-up were compared to baseline measurements. Results. Each eye received a mean (SD) of 2,750 (686.7) laser spots. At 4-week follow-up, there was a statistically significant 24.0 μm increase in mean CSF thickness (P = 0.001), with a 17.4 μm increase from baseline at 12-week follow-up (P = 0.002). Mean logMAR BCVA increased by 0.05 logMAR units (P = 0.03) at 4-week follow-up. At 12-week follow-up, BCVA had almost returned to normal with only an increase of 0.02 logMAR units compared to baseline (P = 0.39). Macular edema occurred in 2 eyes (5%) at 12-week follow-up. Conclusions. Macu...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2013
To report the use of intravitreal (IVT) injections of anti-vascular endothelial growth factor age... more To report the use of intravitreal (IVT) injections of anti-vascular endothelial growth factor agents (anti-VEGF) and its complications. 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. 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...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2008
Endophthalmitis is one of the most serious complications of ophthalmic surgery, which includes po... more 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. To describe an outbreak of acute postoperative endophthalmitis after cataract surgery that was referred to Chiang Mai University Hospital during March 2006. 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. 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 int...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2007
To evaluate the effect of photodynamic therapy (PDT) with verteporfin for age-related macular deg... more To evaluate the effect of photodynamic therapy (PDT) with verteporfin for age-related macular degeneration (AMD) and non-AMD in Thais, and compare with the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) and Verteporfin in Photodynamic Therapy (VIP) study. The authors prospectively evaluated all data of 51 eyes of 51 patients who had undergone PDT and accomplished a 1-year follow up. The assessments were divided into two categories: group 1 included three subsets of AMD, and group 2 was non-AMD. The first group classified into three subgroups: group 1A: AMD with subfoveal choroidal neovascularization (CNV) and TAP/VIP compatible with recommendation guidelines characteristics, group 1B: AMD with subfoveal CNV and TAP/VIP incompatible, and group 1C: AMD with non-subfoveal CNV. The measurement outcomes comprised of the baseline characteristics, change in visual acuity, and number of treatments. Thirty-eight eyes had CNV-related AMD and 13 eyes were non-AMD...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2003
Two male patients presented with unilateral blurred vision. A small motile worm was found in the ... more Two male patients presented with unilateral blurred vision. A small motile worm was found in the vitreous cavity in both cases. In one case, another dead, disintegrated worm was noted in the inferior portion of the vitreous cavity. On each eye, vitreous surgery was performed and the worm was removed by an aspirator. Both worms were identified as Angiostrongylus cantonensis. Since both patients had no signs of meningitis, lumbar puncture was not done. Long-term follow-up confirmed the benefit and safety of the vitreous surgery. Fluorescein angiography revealed severe pigmentary alteration, probably from inflammation of the choroid and retina due to subretinal migration of the worm prior to access into the vitreous cavity.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2003
To identify the magnitude of ocular complications in HIV infection in Chiang Mai, and determine t... more To identify the magnitude of ocular complications in HIV infection in Chiang Mai, and determine the signs or symptoms that indicate the risk factors for developing ocular complications in HIV-positive patients A prospective study was carried out in newly diagnosed HIV-positive patients seen in the Ocular Infectious Disease Clinic of Maharaj Nakorn Chiang Mai Hospital from March 1, 2000 through February 28, 2001. A complete ophthalmic examination was performed on each patient together with a systemic evaluation of present illness and current medications. Three-hundred and ninety-five HIV-positive patients were seen for ophthalmic evaluation. Of these, 90 were in stage A (asymptomatic), 84 were in stage B (symptomatic), and 221 were in stage C (AIDS). Ocular complications were found in 44.6 per cent of the patients. Cytomegalovirus (CMV) retinitis was the most common ophthalmic complication (33%). Other ocular complications included cotton wool spot (8%), uveitis (4%), optic neuropath...
Case Reports in Ophthalmology, 2012
To report cases of spontaneous retinal pigment epithelial (RPE) tear complicating serous pigment ... more To report cases of spontaneous retinal pigment epithelial (RPE) tear complicating serous pigment epithelial detachment (PED). The records of 3 Asian patients with spontaneous giant RPE tear were reviewed retrospectively by including clinical presentation, angiography, optical coherence tomography, fundus autofluorescence imaging, and visual outcome. Three patients (4 eyes) were included in this study, with a mean age of 48.3 (42-56) years, and a mean follow-up period of 7.75 (4-18) months. Fundus examination in all patients showed giant RPE tear associated with bullous PED. Two cases had a history of prior corticosteroid use, and 1 had no history of medication use. All 3 patients developed spontaneous resolution of subretinal fluid with no treatment. However, in patients who used corticosteroids, initial progression of the tear and subretinal fluid were observed despite ceasing medication. On subsequent follow-up, an incomplete RPE regeneration was demonstrated by fundus autofluorescence imaging, and choroidal neovascularization developed in 1 patient. Large PED with RPE tear is a rare manifestation. When the fovea is spared, visual prognosis is favorable. No specific treatment is required, but careful choroidal neovascularization monitoring should be performed.
JAMA Ophthalmology, 2014
Cytomegalovirus (CMV) retinitis is a leading cause of blindness in many developing countries, lik... more Cytomegalovirus (CMV) retinitis is a leading cause of blindness in many developing countries, likely the result of inadequate screening. Telemedicine screening for CMV retinitis instituted at the point of care for human immunodeficiency virus (HIV) infection may allow for earlier detection. To determine the diagnostic accuracy of retinal photography in detecting CMV retinitis at the point of HIV care and to characterize the clinical manifestations of CMV retinitis detected through the screening program. We enrolled 103 participants from a population of 258 patients with HIV and a CD4 level of less than 100/μL treated at an HIV clinic in Thailand from June 2010 through June 2012. We captured mosaic fundus photographs through a dilated pupil using a digital fundus camera. An experienced on-site ophthalmologist masked to the results of the fundus images subsequently examined each eye with indirect ophthalmoscopy and recorded the clinical findings on a standardized form. Three remote graders evaluated each image for CMV retinitis. Fundus photography and indirect ophthalmoscopy. Sensitivity and specificity of telemedicine relative to indirect ophthalmoscopy for diagnosis of CMV retinitis and clinical features of CMV retinitis lesions. Sixteen patients (15.5%) were diagnosed as having CMV retinitis, of whom 5 (31%) had bilateral disease. Of the 21 eyes (10.2%) with CMV retinitis, 7 (33%) had visual symptoms. Retinitis lesions occupied less than 10% of the total retinal surface area in 13 of 21 eyes (62%) and did not involve the posterior pole (ie, zone 1) in 15 of 21 eyes (71%). Mean logMAR visual acuity in affected eyes was 0.41 (95% CI, 0.11-0.71; Snellen equivalent, 20/50 [95% CI, 20/25-20/100]). The mean sensitivity for the 3 remote graders in detecting CMV retinitis on fundus photography was 30.2% (95% CI, 10.5%-52.4%), and mean specificity was 99.1% (95% CI, 97.8%-100.0%). The CMV retinitis lesions missed by the remote graders (false-negative findings) were more likely to be small (P = .001) and located in the peripheral retina (P = .04). Patients undergoing screening at a clinic for HIV treatment had less extensive retinitis than patients in recent reports from an ophthalmology clinic. Retinal photography with the camera used in this study was not highly sensitive in detecting CMV retinitis but may identify disease with an immediate threat to vision. Improved accuracy will require a camera that can more easily image the peripheral retina.
Purpose To report the anatomical and visual results of pars plana vitrectomy (PPV) with- out scle... more Purpose To report the anatomical and visual results of pars plana vitrectomy (PPV) with- out scleral buckling which repairs rhegmatogenous retinal detachment (RRD). Methods The authors retrospectively reviewed 41 patients with primary RRD who under- went PPV without scleral buckling repair it between December 1997 and November 2001. Thirty-four patients (34 eyes) followed at least 4 months treatment and were analyzed. The surgical outcome was assessed in terms of a single operation and final anatomical reattach- ment rates, visual results, and complications. Results Of 34 eyes, the reattachment rate was 26 eyes (76.5%) after the first operation and it increased to 30 eyes (88.2%) after repeat procedures. After primary vitrectomy, RRD recurred in 8 eyes (23.5%), due to postoperative proliferative vitreoretinopathy (PVR) in 4 (11.8%) of them, reopened retinal breaks in 3 (8.8%), and a sclerotomy-related retinal dialysis in the other one (2.9%). Of these 8 eyes, 6 underwent reoperation...
Retina, 2007
Purpose: To report a case of an unusually large cavernous hemangioma of the optic disk. Method: C... more Purpose: To report a case of an unusually large cavernous hemangioma of the optic disk. Method: Case report with funduscopic, fluorescein angiography, and magnetic resonance imaging correlations. A 20-year-old woman with no ocular or systemic history was ...
Japanese Journal of Ophthalmology, 2012
Purpose To describe the macular thickness measured by spectral-domain optical coherence tomograph... more Purpose To describe the macular thickness measured by spectral-domain optical coherence tomography (SD-OCT) in healthy eyes of Thai people. Design Prospective cross-sectional study. Methods Three hundred sixty-eight healthy participants underwent a comprehensive ophthalmic examination, including Spectralis SD-OCT scanning, at Chiang Mai University Hospital. The images were obtained over maculae, using a high-speed volumetric raster scan pattern with lines 240 lm apart. Information was collected from both eyes of each person, with only the right one being used unless it was found to be ineligible (in which case the left eye was studied). A mean retinal thickness was calculated based on nine areas that corresponded to the Early Treatment Diabetic Retinopathy Study by OCT mapping software. The relationships between retinal thickness and sex, age, axial length, and spherical equivalence were analyzed. Results The mean age of the subjects was 49.17 ± 17.24 years. The mean central retinal thickness was 259.18 ± 19.08 lm, the mean foveal volume was 0.20 ± 0.02, and the mean total macular volume was 8.59 ± 0.37 mm 3 . Central subfield (CSF) thickness and foveal volume were significantly greater in men than in women (both P \ 0.001). When analyzed for six age groups by ANOVA, the CSF thickness showed no significant difference among the groups, with a P value of 0.280, and foveal volume showed no significant difference among the six groups, with a P value of 0.341. After age adjustment, axial length was correlated positively with the CSF thickness (P \ 0.001, Pearson correlation). Conclusions The normal macular thickness in Thais is thinner than those reported for other populations when measured using the Spectralis SD-OCT. Male gender and axial length were correlated positively with CSF thickness.
International Ophthalmology, 2013
To describe the epidemiology, mechanism of injury, and final visual and anatomical outcomes of pe... more To describe the epidemiology, mechanism of injury, and final visual and anatomical outcomes of pediatric patients with open globe injury. The medical records of patients aged ≤ 16 years diagnosed with open globe injury between January 2006 and December 2010 were retrospectively reviewed. Forty-nine pediatric patients were diagnosed with open globe injury during the study period. Forty-one of the 49 patients (83.7 %) were male. The mean age of the patients was 9.3 ± 4.6 years, with 49 % of the injuries occurring in patients between the ages of 11 and 16 years. Ocular penetration was the most common type of injury (63.3 %), occurring most frequently in the cornea (63.3 %). Wooden objects were the most common cause of injury. Following surgical intervention, 40.8 % of the patients obtained a final visual acuity (VA) of ≥ 6/60. Pars plana vitrectomy was performed in 51 % of cases, with only 36 % of these patients having a final VA of ≥ 6/60. The presence of retinal detachment was the only statistically significant factor (odds ratio 0.05, p < 0.001) that affected VA improvement of more than one line. Corneal penetration was frequently observed in pediatric patients with ocular trauma. Pediatric patients with a retinal detachment were significantly more likely to have a poor final visual outcome than open globe patients whose retina remained attached. Despite prompt surgical intervention, useful vision was preserved in less than half of the patients requiring pars plana vitrectomy.
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Papers by Direk Patikulsila