Papers by Suthasinee Sinawat
Advanced exudative retinopathy with neovascular glaucoma as the clinical presentation of diabetes mellitus and severe combined hyperlipidemia: a case report
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014
A 50-year-old man presented with bilateralprogressive visual loss for 5 months. Visual acuity was... more A 50-year-old man presented with bilateralprogressive visual loss for 5 months. Visual acuity was reduced to countingfingers in the right eye and light perception in the left. Although neovascularizations were detected in the angles of the eyes, neovascular glaucoma and rubeosis iridis were demonstrated only in the left. Fundus examination showed bilateral advanced exudative retinopathy in both eyes. Severe attenuated retinal arteries and enlarged cupping with disc pallor were observed in the left eye. Generalized eruptive xanthomas were found on the back and extremities. Extreme dyslipidemia (serum cholesterol 1311 mg/dl and triglycerides 6356 mg/dl) and diabetes mellitus (fasting plasma glucose 325 mg/dl and HbA1 c 12.1%) were first diagnosed. The serum lipid profiles and glucose levels were dramatically decreased within a month after treatment with subcutaneous insulin injections and oral hypolipidemic agents; notwithstanding, his vision was not significantly improved, even after...
Normal Multifocal Electroretinograms Study in Srinagarind Hospital: A pilot Study
Background and objective: Multifocal electroretinograms (mfERG) measures and records electrical a... more Background and objective: Multifocal electroretinograms (mfERG) measures and records electrical activity of  macula. Currently,VERIS system isused more worldwide than RETIscan system. mfERG used in Srinagarind hospital is RETIscansystem,but normal values innortheastern populationhaveneverbeen studied before. The authors aim to study baseline database of northeastern population. Method : 30 of 120 normal subjects (240 eyes) were categorized intoeach age groups; 10-20, 21-40, 41-60 and >60years-old.Complete ocular examination and mfERG were performed. Results: 38 subjects were male and82subjectswere female. Mean age were 18.1±2.2 , 29.9±4.3 , 50.4±4.3 and 64. 3± 3.8 years-old.Best corrected visual acuity of 110 subjects were 6/6, significant lens opacity was detected in 10 subjects. Refractive error was demonstrated between -3.25 to+3.50 PD.Average latency and amplitude of N1were20.92±0.55ms. and 34.42±3.03 nV/deg2. Average latency and amplitude of P1 were39.48±0.5 ms.and 79.89±3.1...
Clinical Ophthalmology, 2013
Background: To characterize the causative pathogens and the visual outcomes among patients with e... more Background: To characterize the causative pathogens and the visual outcomes among patients with endophthalmitis at a large referral center in northeastern Thailand. Methods: All cases of infectious endophthalmitis treated between 1983 and 2007 were reviewed retrospectively. The patient data – including age, sex, history of ocular injuries, previous treatment and duration of the symptoms – were recorded. The ocular examination included affected side, anterior chamber reaction, vitreous haze, and presence of intraocular foreign bodies. Smears and cultures were prepared from anterior chamber paracentesis and/ or vitreous tapping. Intraocular antibiotics were administered at the time of anterior chamber paracentesis and/or vitreous tapping. Vitrectomy and/or lensectomy were performed when indicated. Initial visual acuity before treatment and the final best-corrected vision were compared. Results: A total of 420 cases of endophthalmitis were reviewed: 181 cases (43.1%) had ocular trauma ...
Journal of the Medical Association of Thailand , 2011
A 47-year-old Thai female with underlying Sweet's syndrome and disseminated non-tuberculous m... more A 47-year-old Thai female with underlying Sweet's syndrome and disseminated non-tuberculous mycobacterial infection presented with a history of blurred vision on both eyes after being lost to follow-up for eight months. The visual acuity was hand motion on the right eye and counting finger on the left eye. There was moderate inflammation in the anterior chamber and vitreous cavity. Multiple foci of round chorioretinitis were found throughout the fundus on both eyes. The patient denied intravitreous tapping and antibiotic injection. Nevertheless, specimens from several sites were collected for culture and sensitivity test. The result of the culture and sensitivity test revealed rapidly growing mycobacteria on specimens taken from the right inguinal lymph node. The presented case may demonstrate the rare event of bilateral endogenous endophthalmitis with chorioretinitis arising from non-tuberculous mycobacterial infection. The pattern of chorioretinitis demonstrated by the present...
Objective : To evaluate the anatomic closure rate and visual outcome in patients undergoing PPV w... more Objective : To evaluate the anatomic closure rate and visual outcome in patients undergoing PPV with ILM peeling 1DD and 2 DD for treatment of large FTMH and identify the predictive factors determining surgical success. Method : This study was a Randomized Clinical Controlled Trial. Forty six patients with large FTMH (>500 µm) were randomized to ILM peeling 1 DD or 2 DD in addition to PPV. Primary outcome was BCVA at 6 months after surgery. Secondary outcomes include closure rate, complication and identify factors predicting surgical success. Preoperative, intraoperative, and postoperative variables were evaluated. Result : Thirty five  patients (76.09%) completed the 6-month follow-up. 27 (77.14%) were females and 8 (22.86%) were males. The average age of patients was 59.7 ± 14 years old. Duration of symptom was detected 10.63±8.36 months preoperatively. The size of macular hole was 643.20±118.96 µm. The baseline characteristics were not significantly different between the two g...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2005
OBJECTIVES To evaluate the result of a surgical technique to insert and secure a standard posteri... more OBJECTIVES To evaluate the result of a surgical technique to insert and secure a standard posterior chamber lens through a simple limbal incision in eyes that had no capsular support or whose capsule was inadvertently ruptured during extracapsular cataract extraction. MATERIAL AND METHOD Retrospective review of the medical records of patients who underwent translimbal fixation of posterior chamber lenses according to age, gender, preoperative visual acuity, postoperative visual acuity, follow-up period and any complications, especially those that may be related to the surgical technique. RESULTS Twelve patients were recruited in the present study. The patents' age ranged from 31 to 77 years, with a mean of 62.58 years. There were 9 male and 3 female patients. The preoperative visual acuity ranged from hand motion to counting fingers, and the postoperative visual acuity ranged from 6/6 to 6/24 except one patient who had postoperative visual acuity of counting fingers due to a pre...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2010
OBJECTIVE To compare the clinical efficacy and systemic side effects of2.5% and 10%phenylephrinef... more OBJECTIVE To compare the clinical efficacy and systemic side effects of2.5% and 10%phenylephrinefor mydriasis in diabetic patient with darkly pigmented irides. MATERIAL AND METHOD A prospective randomized double-blind controlled trial was conducted. One hundred diabetic patients were randomly allocated into 2.5% and 10% phenylephrine groups by block randomization. Pupil diameter, blood pressure and heart rate were measured before and after eye drop instillations. RESULTS The mean pupil diameters after instillation in the right eye were 7.05 +/- 0.71 mm (2.5% phenylephrine group) and 7.40 +/- 0.72 mm (10% phenylephrine group, p = 0.02) and in the left eye were 7.05 +/- 0.72 mm (2.5% phenylephrine group) and 7.39 +/- 0.72 mm (10% phenylephrine group, p = 0.02). There was no clinically significant difference in mean heart rate, mean systolic and diastolic blood pressure. CONCLUSION In diabetic patients with darkly pigmented irides, 10% phenylephrine is more effective than 2.5% phenylep...
Advanced exudative retinopathy with neovascular glaucoma as the clinical presentation of diabetes mellitus and severe combined hyperlipidemia: a case report
UNLABELLED A 50-year-old man presented with bilateralprogressive visual loss for 5 months. Visual... more UNLABELLED A 50-year-old man presented with bilateralprogressive visual loss for 5 months. Visual acuity was reduced to countingfingers in the right eye and light perception in the left. Although neovascularizations were detected in the angles of the eyes, neovascular glaucoma and rubeosis iridis were demonstrated only in the left. Fundus examination showed bilateral advanced exudative retinopathy in both eyes. Severe attenuated retinal arteries and enlarged cupping with disc pallor were observed in the left eye. Generalized eruptive xanthomas were found on the back and extremities. Extreme dyslipidemia (serum cholesterol 1311 mg/dl and triglycerides 6356 mg/dl) and diabetes mellitus (fasting plasma glucose 325 mg/dl and HbA1 c 12.1%) were first diagnosed. The serum lipid profiles and glucose levels were dramatically decreased within a month after treatment with subcutaneous insulin injections and oral hypolipidemic agents; notwithstanding, his vision was not significantly improved,...
Analysis of eye health in the Thai population
OBJECTIVE To assess national eye health as a baseline for improving medical education, services a... more OBJECTIVE To assess national eye health as a baseline for improving medical education, services and research. MATERIAL AND METHOD Information on eye illness among out- and in-patients was based on hospital claims from the three national health insurance schemes in 2010. The data were analyzed by age groups. RESULTS In 2010, 4,982,025 out-patient visits and 187,080 in-patient admissions were reported. The five most common outpatient eye conditions were disorders of the (1) conjunctiva (H10-H13) (2) eyelid, lacrimal system and orbit (H00-H06) (3) lens (H25-28) (4) sclera, cornea, iris and ciliary body (H15-H22) and (5) glaucoma (H40-H42). The five most common inpatient eye diseases were (1) disorders of lens (H25-H28) (2) conjunctiva (H10-H13) (3) sclera, cornea, iris and ciliary body (H15-H22) (4) choroid and retina (H30-H35) and (5) glaucoma (H40-H42). CONCLUSION Information on the most frequent eye diseases-including the types and frequency of high risk conditions, the diseases cau...
Clinical characteristics of full thickness macular holes that closed without surgery
Purpose To ascertain the anatomic factors that help achieve non-surgical sealing in full thicknes... more Purpose To ascertain the anatomic factors that help achieve non-surgical sealing in full thickness macular hole (FTMH). Methods Retrospective collaborative study of FTMH that closed without surgical intervention. Results A total of 78 patients (mean age 57.9 years) included 18 patients with blunt ocular trauma, 18 patients that received topical or intravitreal therapies and 42 patients with idiopathic FTMH. Mean±SD of the initial corrected visual acuity (VA) in logMAR improved from 0.65±0.54 to 0.34±0.45 (p<0.001) at a mean follow-up of 33.8±37.1 months. FTMH reopened in seven eyes (9.0%) after a mean of 8.6 months. Vitreomacular traction was noted in 12 eyes (15.8%), perifoveal posterior vitreous detachment in 42 (53.8%), foveal epiretinal membrane in 10 (12.8%), cystoid macular oedema (CME) in 49 (62.8%) and subretinal fluid (SRF) in 20 (25.6%). By multivariate analysis, initial VA correlated to the height (p<0.001) and narrowest diameter of the hole (p<0.001) while final...
Spontaneous bilateral retinal pigment epithelium rips with good visual acuity
Retinalpigment epithelium (RPE) rips commonly occur in retinochoroidal disorders including age-re... more Retinalpigment epithelium (RPE) rips commonly occur in retinochoroidal disorders including age-related macular degeneration, idiopathic polypoid alchoroidal vasculopathy, central serous chorioretinopathy, high myopia andchoroidal neovascularization. Most patients have unilateral involvement and poor visual prognosis. A 55-year-old female presented with decreased vision in her right eye for one week. Her best-corrected visual acuity was 6/12 in the right eye and 6/6-2 in the left. Fundus examination revealed a large juxtafoveal RPE rip in the right eye and multiple small pigment epithelium detachments in the left. No abnormal hyperfluorescent lesions were detected byfundus angiography. High-doseoral antioxidant was prescribed. A pigment epithelium detachment (PED) in the left eye grew larger over the follow-up period. Ultimately, a RPE rip also occurred in the left eye in the 17th week offollow-up. Her best-corrected visual acuity was 6/9. Although reinvestigation was done, no other ...
OBJECTIVE To study the effect of cataract on electroretinographic responses. MATERIAL AND METHOD ... more OBJECTIVE To study the effect of cataract on electroretinographic responses. MATERIAL AND METHOD Thirty subjects with dense cataracts underwent electroretinogram (ERG) recordings before and after cataract surgery, using RETIport32 (Roland Instruments, Germany). The degree of cataract was classified according to the Lens Opacities Classification System III (LOCS III). No significant eye diseases were noted in all subjects. Following the International Society for Clinical Electrophysiology of Vision (ISCEV), scotopic, mesopic, photopic, oscillatorypotentials and 30 Hz flicker ERG responses were recorded. The mean amplitudes of a- and b-waves, pre and post-cataract surgery were analyzed using the paired t-test. RESULTS Following cataract surgery, most of the ERG responses were slightly increased but the difference was not statistically significant. However, the mesopic b-wave amplitude was decreased significantly after cataract surgery. CONCLUSION Most of the ERG waves after cataract s...
Clin Ophthalmol, 2021
Purpose To evaluate anatomical and visual outcomes of pars plana vitrectomy (PPV) with internal l... more Purpose To evaluate anatomical and visual outcomes of pars plana vitrectomy (PPV) with internal limiting membrane peeling (ILMP) in large idiopathic full-thickness macular holes (FTMH). Predictive factors also formed part of the study. Patients and Methods A retrospective review of medical charts and optical coherence tomography images of patients with large idiopathic FTMH (≥400 µm) was conducted. Results One hundred and fifty-eight eyes of 155 patients with a mean age of 62.94±7.50 years were included in the study. Mean preoperative visual acuity (VA) was 1.26±0.36 logMAR. Mean preoperative minimum linear diameter (MLD) and basal linear diameter (BLD) were 644.89±136.85 µm and 1208.11±307.14 µm, respectively. At 12 weeks postoperative follow-up, FTMH closure rate was 61.39% and mean postoperative BCVA was 0.92±0.36 logMAR. Multivariate logistic regression analyses showed the anatomical outcome was significantly associated with BLD ≤1200 µm, preoperative vitreomacular interface (VM...
OBJECTIVES To evaluate the surgical outcome for patients with rhegmatogenous retinal detachment a... more OBJECTIVES To evaluate the surgical outcome for patients with rhegmatogenous retinal detachment and to find out the factors influencing the anatomic reattachment and visual results. MATERIAL AND METHOD Retrospective review of the medical records of patients for the following details: age, sex, time to diagnosis, time to surgery, phakic status, types, numbers and locations of the retinal breaks, macular status, presence of proliferative vitreoretinopathy (PVR), types of surgical procedures, anatomic reattachment and visual improvement. RESULTS Two hundred and twelve patients were surgically treated by pneumatic retinopexy, scleral buckling, pars plana vitrectomy or combined procedures. Initial anatomic reattachment was found in 157 cases (74.06%) and final reattachment in 193 cases (91.04%). Several factors including age, phakic status, number of the retinal breaks, macular detachment, PVR and types of surgical procedures have been identified to have a correlation with the anatomic s...
J Med Assoc Thai, 2013
Jacobsen syndrome is a rare contiguous gene syndrome caused by partial deletion of the long arm o... more Jacobsen syndrome is a rare contiguous gene syndrome caused by partial deletion of the long arm of chromosome 11. The typical clinical manifestations include physical growth retardation, mental retardation,facial dysmorphisms, congenital heart disease, thrombocytopenia, or pancytopenia. A Thai-Australian girl was born with multiple abnormalities. Typical features and her karyotype, 46, XX, del(ll) (q23-qter), confirmed Jacobson syndrome. She had many uncommon findings including upslanting palpebral fissures, tortuousity of retinal vessels and hypogammaglobulinemia. In addition, this case also presented with protein C deficiency, which has not been reported previously in Jacobsen syndrome. The patient was treated with phototherapy, intravenous antibiotic injection, and platelet transfusion in neonatal period. Cranioplasty was performed for prevention of the increased intracranial pressure at three months of age. Surgical correction for strabismus was in the treatment plan.
Clinical Ophthalmology
Objective: To study the visual outcomes and identify the predictive factors for visual outcomes i... more Objective: To study the visual outcomes and identify the predictive factors for visual outcomes in patients with eye injuries and retained intraocular foreign bodies (IOFBs). Patients and Methods: The medical records of 359 consecutive patients with eye injuries and retained IOFBs were retrospectively reviewed during 2009-2018. Demographic data, clinical findings, treatment and visual outcomes were studied. Univariate and multivariate analyses were used to identify the predictive factors. Results: Most of the patients were male and the average age was 36.4 years old. The three most common causes of eye injuries were grass trimming (25.07%), chiseling (23.12%) and hammering (13.93%). Most of the patients (79.39%) presented with poor initial bestcorrected visual acuity (BCVA) (<3/60). Pars plana vitrectomy with IOFB removal was done in 273 eyes (76.04%). After treatment, eyes with poor BCVA (<3/60) decreased from 79.39% to 62.95% and eyes with good BCVA (≥3/60) increased from 20.61% to 37.05%. Poor initial best-corrected visual acuity (odds ratio 23.39, P<0.001), rhegmatogenous retinal detachment (odds ratio 9.91, P<0.001) and the presence of infectious endophthalmitis (odds ratio 2.06, P=0.02) were statistically significant predictive factors for poor visual outcome. Conclusion: Most patients with eye injuries and IOFBs usually have poor final BCVA. Poor presenting BCVA, retinal detachment and endophthalmitis are significant predictive factors for poor visual outcomes. These factors can be used to inform the visual prognosis and plan prompt surgical intervention for the patients. Causes of IOFBs were mostly work-related and could be preventable. Education and activation of using appropriate protective safety glasses during work are necessary to avoid serious eye injuries and blindness.
Comparative study of 1 DD and 2 DD radius conventional internal limiting membrane peeling in large idiopathic full-thickness macular holes: a randomized controlled trial
Eye
Clinical Ophthalmology
Objective: To compare the efficacy of oral spironolactone treatment versus conservative treatment... more Objective: To compare the efficacy of oral spironolactone treatment versus conservative treatment for patients with persistent central serous chorioretinopathy (CSC) in real-life practice. Design: Retrospective comparative study. Patients and Methods: Medical records and retinal images of 62 patients with nonresolving CSC were reviewed. Twenty-one patients received oral spironolactone (50 mg/ day) while 41 patients received conservative treatment. Primary outcome was proportion of eyes with complete resolution of subretinal fluid (SRF) within 6 months. Secondary outcome measures included changes in SRF height, central macular thickness (CMT), lesion size and best-corrected visual acuity (BCVA). The occurrence of drug side effect was also assessed. Results: There was no significant difference in demographic data, clinical characteristics, optical coherence tomography parameters and leaking patterns in fluorescein fundus angiography between two groups. Complete resolution of SRF was significantly higher and faster in the spironolactone group than the conservative treatment group (p=0.03). Although significant anatomical improvement in SRF height, CMT and lesion size were observed in both groups (p < 0.001), final BCVA was improved significantly in only the spironolactone group (p < 0.05). The recurrence of SRF after complete resolution was observed in 4/12 eyes (33.33%) in the treatment group. None of the patients experienced any side effects of spironolactone. Conclusion: Oral spironolactone (50 mg/day) could achieve both significant anatomical and visual improvement, while the significant visual gain could not be provided with the conservative treatment. Spironolactone should be considered as an alternative treatment option in non-resolving CSC patients who cannot afford the PDT treatment.
Clinical Ophthalmology
Objective: To determine factors affecting visual outcomes after treatment of infectious endophtha... more Objective: To determine factors affecting visual outcomes after treatment of infectious endophthalmitis during 2012-2016 at a large referral eye center in northeastern Thailand. Patients and methods: Medical charts of patients with a diagnosis of infectious endophthalmitis including demographic data, types of endophthalmitis, causative organisms, methods of treatment, anatomical, and functional outcomes were retrospectively reviewed. Factors associated with improved visual outcomes were analyzed. Results: Four hundred and eleven patients (417 eyes) were recruited for the study. The three most common types were post-traumatic (44.53%), post-operative (31.87%), and endogenous endophthalmitis (17.52%). Vitreous cultures revealed causative organisms in 41.25%. Most common Gram-positive organisms were coagulase-negative Staphylococcus 30% (36/120), Bacillus spp. 20% (24/120), and Streptococcus pneumoniae 18.33% (20/120). Most common Gram-negatives were Pseudomonas spp. 24.32% (9/37), Klebsiella spp. 24.32% (9/37), and Enterobacter spp. 16.21% (6/37). Methods of treatment were medical treatment (18.71%) and surgical treatment (81.29%), including pars plana vitrectomy with or without silicone oil tamponade (62.59%) and destructive surgery (18.71%). After treatment, visual improvement was noted in 44.6%, stable vision in 18.47%, and worse vision in 36.93%. Factors associated with improved visual outcomes were post-operative endophthalmitis (P,0.001), coagulasenegative Staphylococcus (P=0.003), and initial visual acuity before treatment of hand motion or better (P=0.017). Conclusion: Most infectious endophthalmitis patients were post-traumatic, post-operative, and endogenous. The most common method of treatment was pars plana vitrectomy. Treatment could improve visual outcomes and at least stabilize the vision in 63.07%. Factors associated with improved visual outcomes were types of endophthalmitis, causative organisms, and initial visual acuity before treatment.
Clinical Ophthalmology
Objective: To study silicone oil (SO) emulsification, anatomic and visual outcome after complicat... more Objective: To study silicone oil (SO) emulsification, anatomic and visual outcome after complicated retinal detachment surgery by pars plana vitrectomy (PPV) with intraocular SO tamponade, comparing between low and high viscosity SO. Design: Randomized, double-blinded, controlled trial. Patients and Methods: Patients with complicated retinal detachment who had been surgically treated by PPV and intraocular SO tamponade were randomly divided into low viscosity (Group 1) or high viscosity (Group 2). Main Outcome Measures were rate of silicone oil emulsification, anatomic retinal reattachment and visual outcome, assessed at 1,3,6,9 and 12 months. Results: One hundred patients were divided into 50 patients in each group. The rate of silicone oil emulsification in Group 1 (63.64%) was higher than Group 2 (40%), but the difference was not statistically significant (p = 0.08). Rates of anatomic retinal reattachment were 88% in Group 1 and 90% in Group 2 (p = 0.76). For functional visual outcome, final best-corrected visual acuity (BCVA) at Month 12 compared with the baseline BCVA was improved vision 52% in Group 1 and 58% in Group 2 (p = 0.82). Conclusion: SO emulsification rate in low viscosity group is non-significantly higher than high viscosity group, but results in a comparable reattachment rate and final visual recovery. Emulsification in both groups is detected at as early as 1 month and mostly within 3 months. We recommend using either low or high viscosity SO in complicated retinal detachment surgery and removing it as early as possible to prevent the consequent serious complications. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02988583.
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Papers by Suthasinee Sinawat