Central retinal vein occlusion (CRVO) is a common retinal vascular disorder with potentially blinding
complications.The authors reported a 51-year-old male who presented with blurred vision in right eye for
2 weeks. Visual acuity was 6/200 and fundus showed sign of central retinal vein occlusion. There were no
explainable causes from patientûs history, physical examination and investigations except history of 6-year
testosterone undecanoate 80 mg per day ingestion from andropausal clinic. The patient was treated with
discontinuing testosterone, intravitreous bevacizumab 1.25 mg and 6-month warfarin ingestion. Visual acuity
continuously improved, being 20/30 after 1 year. Oral testosterone supplement might be the most explainable
cause of CRVO in this patient. However, co-incidence canût be excluded. Further study should be performed.
Thai J Ophthalmol 2010; July-December 24(2): 127-132.
Keywords: CRVO, androgen, testosterone, thrombosis, bevacizumab
Efficacy of Intravitreal Bevacizumab Injection for the Treatment of Proliferative Diabetic Retinopathy: A Pilot Study
Purpose: To evaluate the efficacy of intravitreal bevacizumab on persistent or new retinal neovascularizations
(NV) in proliferative diabetic retinopathy (PDR) after full panretinal photocoagulation (PRP).
Methods: This interventional case series included 8 eyes of 8 patients with PDR who had persistent or new
retinal NV after full PRP. Patients underwent Snellen visual acuity testing, measurement of intraocular pressure,
ophthalmoscopic examination and fundus photography at baseline and follow-up visits. After intravitreal
injection of 1.25 mg/0.05 ml of bevaciumab, the first ophthalmoscopic examination was performed within
1 day and repeated at 1 week, 3 months and 6 months.
Results: All 8 patients recruited to this study had type II diabetes for a mean period of 12.13 years. Only 4
patients had good glycemic control (HbA1C < 6.5). After a single dose of bevacizumab, complete resolution
of retinal NV was found in 6 patients (75%) at 3 months. The reinjection was required in 2 patients at 2 and
3 months due to the occurring of new retinal NV. After 6 months follow-up period, all patients had complete
resolution of retinal NV. Visual improvement was demonstrated in all patients after treatment. Adverse events
were detected in 2 patients (25%). Two patients had minimal subconjunctival hemorrhage and one patient
also had mild anterior uveitis.
Conclusion: Intravitreal bevacizumab injection seemed to be a safe and effective adjunctive therapy to PRP
in the treatment of PDR with recurrent or persistent retinal NV after full PRP. Large clinical trials are needed
to evaluate alternative dosing (multiple and/or periodic injection) and further assess the efficacy and safety
of intravitreal bevacizumab as an adjunctive therapy in management of PDR. Thai J Ophthalmol 2010; July-
December 24(2): 120-126.
Keywords: bevacizumab, Avastin, proliferative diabetic retinopathy, retinal neovascularization
Detection of Glaucomatous Optic Neuropathy in Early Glaucoma Using Moorfields Regression Analysis (MRA) and Glaucoma Probability Score (GPS) in Confocal Laser Scanning Ophthalmoscopy
Objective: To estimate the ability of Moorfields Regression Analysis (MRA) and Glaucoma Probability Score
(GPS) in confocal scanning laser ophthalmoscopy (Heidelberg Retina Tomography, HRT 3) for detecting
early glaucoma in Songklanagarind Hospital
Design: Retrospective study.
Materials and Methods: Charts of early POAG patients were reviewed. All subjects underwent complete
ophthalmologic examination. The standard achromatic perimetry (SITA 24-2 or 30-2) and HRT were examined
within 6 months apart. Early POAG was defined as glaucomatous optic neuropathy and visual field defect by
SAP with MD score between -0.01 to -7.00 Db. çOut side normal limité of MRA and GPS was considered
abnormal for confocal scanning laser ophthalmoscopy examination.
Results: Fifty (80 eyes) early glaucoma patients were eligible for the study (19 males, 31 females). Mean age
was 59.3+15.0 years. Mean MD score was - 4.19+1.7Db. Forty-three of eighty eyes had abnormal MRA and
56 eyes had abnormal GPS. The sensitivity of GPS was 70.0% and for MRA was 53.7%.
Conclusion: GPS showed greater sensitivity than MRA for detection of glaucomatous optic neuropathy in
early POAG patients. This may due to variability of contour line placement for MRA. Thai J Ophthalmol
2010; July-December 24(2): 114-119.
Keywords: Early primary open angle glaucoma, Confocal laser scanning ophthalmoscopy, Moorefields
Regression Analysis (MRA), Glaucoma Probability score (GPS)
Objective: To review ophthalmology consultation while patients were admitted with various conditions in
aspects of general characteristics, the reasonability and the system of caring these patients.
Design: A retrospective study.
Methods: Reviewed inpatient medical records consulted to ophthalmology department from February 2009
through May 2009
Results: 303 patients were consulted to ophthalmology unit in 4 months of study. Most of them were from
department of Internal Medicine, Pediatrics, and General surgery. The most common reason for consultation
was helping in part of diagnosis 88 (29.2%), the second was screening for retinopathy including diabetic
retinopathy, chloroquine maculopathy, cytomegalovirus retinopathy, retinopathy of prematurity 76 (27.1%)
the third was new developing eye problems during hospitalization 44 (15.7%). The consultations were
reasonable for inpatient consultation as emergency, urgency, ot necessary conditions 148 (52.9%) while the
other 133 (47.5%) should be appointed for out-patient department instead.
Conclusion: Ophthalmologic evaluation, diagnosis, and treatment are sometimes hard for non-ophthalmologists.
However, understanding characteristics of eye problems required for urgency or non-urgency conditions is
valued for determination to consult as inpatient setting that is more time-consuming or as out-patient. The
data evaluated in this study is helpful for the general physicians, and the ophthalmology residents, leading to
quality and cost-effectiveness of inpatient consultation system. Thai J Ophthalmol 2010; July-December
Purpose: To determine the efficacy of intracameral bevacizumab injection in regression of iris neovascularization
(NVI) and control of intraocular pressure (IOP) in neovascular glaucoma (NVG).
Design: Prospective, consecutive study
Methods: 20 eyes of 20 patients diagnosed with NVI and NVG were included. All patients had complete eye
examination including IOP measurement and anterior segment photography. Bevacizumab (0.1 mg/0.04 ml)
was injected intracamerally in each patient. Patients were examined at 1, 2, and 4 weeks post-injection. Each
patient had a repeat injection at one week if NVI persisted in at least 2 quadrants.
Results: NVI was regressed partially at one week and significantly at two weeks following intracameral
bevacizumab injections. Mean IOP was significantly lowered at 1, 2, and 4 weeks post injection. No signs of
corneal endothelial toxicity were observed on slit-lamp examination. IOP of 2 eyes with open angle was
controlled with topical medication. Trabeculectomy with mitomycin C was necessary for the other 18 eyes.
Conclusions: The intracameral bevacizumab injection was effective in regression of iris neovascularization.
It may help in controlling IOP in eyes with open-angle NVG and impede progression of PAS in those eyes.
Thai J Ophthalmol 2010; July-December 24(2): 95-100.
Keywords: Neovascular glaucoma, Iris neovascularization, Bevacizumab
Objective: A study was conducted to evaluate multifocal contact lens patterns available in Thailand in
Materials and Methods: A prospective study was conducted on sixty healthy eye presbyopes who had
astigmatism < 0.75 diopter, and who had given consent to participate in the trial. The subjects were
evaluated on their distance and near vision, stereopsis, and for dominant and non-dominant eyes. Monthly
replacement soft multifocal contact lenses (Frequency˙ 55 Multifocal) available in Thailand were introduced
to the subjects; the distance lens (D lens) was applied to the dominant eye and the near lens (N lens) was
applied to the non-dominant eye. The subjects were categorized into 3 groups (20 subjects each) based on
distance vision: group 1 were myopic presbyopes and applied D lens + N lens, and D lens + D lens; group
2 were hyperopes and applied D lens + N lens, D lens + D lens, and N lens + N lens, and group 3 were
emmetropes and applied D lens + N lens, N lens + N lens, and only N lens. They were assigned to use the
lenses 1 to 2 weeks for each pattern. Their vision was compared among each pattern based on best
Results: Group 1 revealed statistical significance only in the near vision (p<0.05), in which the pattern D lens
+ N lens was better than D lens + D lens. Group 2 showed data for both the distance and near visions were
statistically significant (p<0.05), for the distance vision the N lens + N lens was the worst pattern, while the
D lens + D lens was the worst pattern for the near vision. Group 3 indicated statistical significance only in the
distance vision (p<0.05), for which using only N lens was the best pattern, while the N lens + N lens was the
worst pattern. Stereopsis indicated no statistical significance for any pattern in all groups. However, stereopsis
decreased from the best corrected vision by 59.38%.
Discussion: Myopic and hyperopic presbyopes should apply the D lens + N lens, while emmetropic presbyopes
should apply only N lens. Thai J Ophthalmol 2010; July-December 24(2): 86-94.
Keywords: multifocal contact lens, presbyopia, dominant eye, non-dominant eye
Objective: To compare the change of corneal endothelium in patients undergoing pterygium excision with
conjunctival autograft and with or without adjunctive mitomycin C (MMC).
Design: Prospective randomized study.
Methods: A prospective study in pterygium patients who were operated with or without MMC in Ramathibodi
hospital during April 2009 - September 2009. Patientsû age, gender, corneal endothelial cell density,
polymegethism, and pleomorphism at preoperative period, 1 month, and 3 months post operation were
recorded. The results were analysed by paired t-test. Recurrence and complication were observed until
January 2010. Recurrence was analysed by Fisherûs exact test.
Results: There were 18 eyes of 18 patients included in this study, 9 eyes were operated with adjunctive
MMC and 9 eyes without MMC. There were no statistical significance in corneal endothelial cell density (P
= 0.366, 0.950, and 0.703 respectively), polymegethism (P = 0.587, 0.258, and 0.116 respectively) and
pleomorphism (P = 0.566, 0.217, and 0.345 respectively) of preoperative period, 1 month and 3 months post
operation in the two groups. Recurrences were found in 2 eyes (22.22%) of control group at the 3rd month
(P=0.470, Fisherûs exact test). No serious complication was found in either group.
Conclusions: Effects on corneal endothelium in pterygium excision and conjunctival autograft with or
without MMC did not differ significantly. There was no statistical significance in recurrence rate between
MMC and control groups. Thai J Ophthalmol 2010; July-December 24(2): 79-85.
Keywords: Pterygium excision, Conjunctival autograft, Corneal endothelial cell density, Polymegethism,
Pleomorphism, Mitomycin C.