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Chanthaburi, Thailand

Objective: To present a new surgical approach for the management of posteriorly dislocated lens by using a combination of 20-gauge (20G) and 23-gauge (23G) pars plana vitrectomy. Design: An interventional case series Methods: This technique was performed on six patients (five men, one woman; mean age, 66.67 years; range, 66-72 years). Two 23G trans-conjunctival sclerotomy ports were created for infusion and illumination along with a 20G sclerotomy port for introducing the vitrectomy probe or fragmatome. Results: This procedure was successfully performed on six eyes. On postoperative day one, the media were clear and the retina could be seen by indirect ophthalmoscopy. Hyphema developed in one eye and resolved within a week. There were no observed cases of retinal tear, wound leakage, hypotony, or endophthalmitis. The post-operative follow-up period ranged from three to twelve months (mean, 8.1 months). By the final visit, two patients had achieved a visual acuity of 20/40 or better, three patients, 20/70, and one patient, 20/200. Conclusion: The combination of 20G and 23G pars plana vitrectomy is an efficacious and safe procedure for management of posteriorly dislocated lens. ©2010 Kongsap, publisher and licensee Dove Medical Press Ltd. Source

Purpose: To evaluate the effectiveness of subconjunctival anesthesia as compared to retrobulbar anesthesia for pain control during manual small-incision cataract surgery (MSICS) performed by third-year residents. Design: A randomized, controlled trial. Patients and methods: A total of 150 patients undergoing routine cataract surgery were randomly assigned to receive either subconjunctival anesthesia (group 1, n = 75) or retrobulbar anesthesia (group 2, n = 75). Third-year residents performed MSICS using the modified Blumenthal technique. Subconjunctival anesthesia was administered by injecting 2% xylocaine with adrenalin into the superior conjunctiva, and retrobulbar anesthesia by injecting 2 mL of 2% xylocaine with adrenalin into the retrobulbar space. We studied the following variables: intraoperative pain score rated on a 100-point visual analog scale (VAS), operative time, and injection and operative complications. Results: A mean age of 69 vs 70 years, an operative time of 47.1 (SD, 9.9) min vs 47.7 (10.9) min, and a median (interquartile range) pain score of 40 (range, 20-70) vs 40 (range, 20-50) were observed in the subconjunctival and the retrobulbar groups, respectively. The injection complication of subconjunctival hemorrhage was significantly higher in the subconjunctival group (25.3%) compared to the retrobulbar group (1.3%). The operative complication rate between groups was not different (P. 0.05). Conclusion: Both, superior subconjunctival anesthesia and retrobulbar anesthesia were effective during MSICS when used in a residency training program. © 2012 Kongsap, publisher and licensee Dove Medical Press Ltd. Source

Prasarnphanich T.,Prapokklao Hospital
Journal of Pediatric Infectious Diseases | Year: 2010

There is a lack of data assessing the accuracy of clinical diagnosis of influenza in children. This study aimed to identify the clinical predictors of influenza infections and to validate the use of clinical criteria of influenza-like illness definition for the diagnosis of influenza in children. Virological influenza surveillance was conducted by collecting throat swab specimens for viral culture and clinical data from febrile children with acute respiratory tract infection at Prapokklao Hospital from July 2005 to September 2007. The criteria of influenza-like illness definition was modified for children and defined by the presence of fever > 38°C plus two of the following three symptoms: headache, cough and sore throat. Two hundred and four of 838 specimens (24%) yielded positive results for influenza virus isolates. Influenza A virus infections were more common than influenza B virus infections. In the multivariate analysis positive predictors of influenza infections were cough [odds ratio (OR)=2.07 95% confidence interval (CI)= 1.26-3.39] and age > 5 years old (OR=2.30, 95% CI=1.66-3.19), whereas diarrhea was inversely associated with influenza (OR=0.29, 95% CI=0.12-0.69). Both the World Health Organization criteria (OR=1.82, 95% CI=1.04-3.18) and the modified criteria for children (OR=1.86, 95% CI=1.38-2.56) showed a positive association with influenza infections. World Health Organization criteria showed high sensitivity and negative predictive value but low specificity and positive predictive value. The modified criteria for children showed fair sensitivity and specificity, high negative predictive value but low positive predictive value. According to the average proportion of positive isolates of 24%, influenza should be recognized as an important cause of acute respiratory tract infections in children especially in the endemic season, but the diagnosis of pediatric influenza cannot be established on clinical criteria alone. © 2010 - IOS Press and the authors. All rights reserved. Source

Kongsap P.,Prapokklao Hospital
International Journal of Ophthalmology | Year: 2010

AIM: To report the short-and medium-term outcomes of sutureless large-incision manual cataract extraction using the Kongsap (SLIMCE-K) technique. METHODS: This prospective study included 73 eyes of 73 patients who underwent cataract surgery performed by using the SLIMCE-K technique. The postoperative visualacuity , intraoperative and postoperative complications, and endothelial cell loss were evaluated. A follow-up visit, at least 6 months after the surgery , was included in the study . RESULTS: All patients had improved visual acuity after surgery . Uncorrected visual acuity (UCVA) was 6/18 or better in 55 eyes (75.3 %) at 1 week postoperatively and in 64 eyes (87.6%) at 6 weeks postoperatively (P=0.09). The best corrected visual acuity (BCVA) was 6/18 or better in 67 eyes (91.8%) at 1 week postoperatively and in 70 eyes (95.9%) at 6 weeks postoperatively . The results remained stable at 3 months and 6 months postoperatively . No significant intraoperative complications were encountered. The endothelial cell loss was 4.8% at the 3 -month follow -up examination. CONCLUSION: When performed by an experienced surgeon, SLIMCE-K is a safe and effective procedure that can be perform ed independent of phacoem ulsification machines. It can be used in any nuclear grading of cataract hardness that is common in developing countries. © International Journal of Ophthalmology Press. Source

Kongsap P.,Prapokklao Hospital
International Journal of Ophthalmology | Year: 2011

AIM: To compare the efficacy and visual results of the modified Blumenthal and Ruit techniques for manual small-incision cataract surgery (MSICS). METHODS: This was a prospective, non-randomized comparison of 129 patients with senile cataracts scheduled to undergo routine cataract surgery via either a superior scleral tunnel incision, i. e., the Blumenthal technique (group 1, n = 64) or a temporal scleral tunnel incision, i. e., the Ruit technique (group 2, n = 65). MSICS and intraocular lens implantation were performed through an unsutured 6.5- to 7.0-mm scleral tunnel incision. Uncorrected and corrected visual acuity, intraoperative and postoperative complications, and surgically induced astigmatism calculated by simple subtraction were compared. Patients were examined 1 day, 1 week, 1 month, and 3 months after surgery. RESULTS: Both groups achieved good visual outcomes with minor complications. Three months after surgery, the corrected visual acuity was 0.73 in the Blumenthal group and 0.69 in the Ruit group (P = 0.29). The average (SD) postoperative astigmatism was 0.87 (0.62) diopter (D) for the Blumenthal group and 0.86 (0.62) D for the Ruit group. The mean (SD) surgically induced astigmatism was 0.55 (0.45) D and 0.50 (0.44) D for the Blumenthal and Ruit groups, respectively (P = 0.52). Common complications were minimal hyphema and corneal edema. There was no statistically significant difference in the complication rate between the groups (P > 0.05). CONCLUSION: In MSICS, both the Blumenthal and Ruit techniques achieve good visual outcomes, with low complication rates. Source

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