Browsing by Author "N. Tesavibul"

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    Association between Endothelial Cell Density and Corneal Thickness in Transplanted versus Normal Corneas: A retrospective cohort study
    (2020-04-01) N. Tesavibul; B. Chinkulkitnivat; Soeharnila; P. Naranunn; P. Prabhasawat; Suratthani Hospital; Faculty of Medicine, Siriraj Hospital, Mahidol University; Klinik Mata Nusantara
    © JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND. Objective: To investigate the association between endothelial cell density (ECD) and corneal thickness (CT) in patients with clear corneal grafts after penetrating keratoplasty (PKP) and compare the results with normal corneas. Materials and Methods: In the retrospective cohort study, the authors reviewed the medical charts of patients who underwent a PKP and whose grafts remained clear. Abnormal grafts such as those with irregular surfaces, central scarring, secondary guttae, and graft edema were excluded. The demographic data, ECDs, and CTs were recorded and compared with those of normal corneas. The ECDs were measured using corneal microscopy, and the CTs were measured by optical coherence tomography. Results: Ninety-six eyes treated with PKP and 86 normal eyes were enrolled. One hundred four women and 78 men were included with a mean age of 64.0±16.7 and 68.6±14.3 years in the PKP group and normal group, respectively. The mean time after PKP was 3.7±3.1 years (range 0.3 to 12.6 years). The mean CTs did not differ between the two groups, but the mean ECD in the PKP group was significantly less than in the normal group (1,109.2 versus 1,905.4 cells/mm2, p<0.001). The degree of polymegathism was significantly higher in the PKP group, while the degree of pleomorphism was significantly (p<0.001) lower compared to the normal group. Conclusion: When comparing eyes with the same CTs, those treated with PKP had lower ECDs, more polymegathism, and less pleomorphism than normal corneas.
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    Performance profile of sodium hyaluronate in patients with lipid tear deficiency: Randomised, double-blind, controlled, exploratory study
    (2007-01-01) P. Prabhasawat; N. Tesavibul; N. Kasetsuwan; Mahidol University
    Aim: To assess the short-term efficacy of hypotonic 0.18% sodium hyaluronate in patients with evaporative tear-sufficient dry eye due to lipid tear deficiency (LTD). Methods: This was a randomised, double-blind, controlled, exploratory study. A total of 10 patients with dry eye due to LTD were treated as follows: one drop of hypotonic 0.18% sodium hyaluronate in one eye and one drop of isotonic 0.3% hydroxypropyl-methylcellulose (HPMC)/0.1% dextran in the other eye. Non-invasive tear film break-up time (NIBUT) evaluated by using a tear scope with grid pattern and subjective ocular symptoms of dry eye were assessed at 15, 30, 60 and 90 min after instillation. Results: Both sodium hyaluronate and HPMC/dextran caused a significant (p<0.05) improvement in NIBUT and symptoms. Mean (SD) NIBUT in the sodium hyaluronate group was 3.2 (1.0), 6.4 (2.8), 5.5 (1.9), 5.3 (1.3) and 3.9 (1.7) s at 0, 15, 30, 60 and 90 min, respectively, compared with 3.6 (1.9), 5.5 (3.2), 5.0 (1.5), 4.4 (2.2) and 3.5 (1.2) s in the HPMC/dextran group. However, increase in NIBUT was significantly (p<0.05) greater and longer in the sodium hyaluronate group than in the HPMC/dextran group. Conclusion: Treatment with sodium hyaluronate and HPMC/dextran eye drops is useful for treating patients with dry eye due to LTD. However, sodium hyaluronate caused a significantly (p<0.05) greater increase in NIBUT values than HPMC/dextran in such patients.
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    Single and multilayer amniotic membrane transplantation for persistent corneal epithelial defect with and without stromal thinning and perforation
    (2001-12-01) P. Prabhasawat; N. Tesavibul; W. Komolsuradej; Mahidol University; Pramongkutklao Hospital; Metapracharak Hospital
    Aims - To evaluate the efficacy of amniotic membrane transplantation (AMT) in persistent corneal epithelial defect with or without stromal thinning and corneal perforation. Methods - 28 patients (28 eyes) with persistent corneal epithelial defect unresponsive to medical treatment were given preserved human amniotic membrane transplants. The patients were divided into three groups: group A, persistent corneal epithelial defect 10 eyes; group B, epithelial defect with stromal thinning 13 eyes; and group C, corneal perforation five eyes. AMT was performed using one layer in group A and multilayers in group B and C. The causes of persistent epithelial defect were neurotrophic keratopathy (24 eyes), limbal deficiency (six eyes), exposure keratopathy (four eyes), and Mooren's ulcer (one eye). Results - Success was noted in 82.1% (23/28 eyes) in all groups, with 80% (8110 eyes), 84.6% (11113 eyes), and 80% (4/5 eyes) in groups A, B, and C respectively, with a mean follow up of 10.9 months (1-30 months). The mean epithelialisation time after AMT was 2.1 weeks. The healing times of groups B and C are also significantly shorter than group A (p = 0.017 and 0.018, respectively). Corneal stromal thickness was significantly increased in all cases in groups B and C (p = 0.006). Those with corneal perforation in group C were completely healed by multilayer AMT. There was no difference in the epitheliallsation time between successful cases treated by a single operation (17 eyes) or repeated operation (six eyes). Vision improved in 18.9% (8/28 eyes) and worsened as a result of cataract formation in 2.3% (1/28 eyes). Failure was noted in 17.9% (5128 eyes), because of corneal infection (two eyes), neurotrophic keratopathy with and without limbal deficiency (two eyes), and intractable corneal perforation (one eye). No patient developed major immediate postoperative complications or graft rejection. Conclusion - Amniotic membrane can successfully treat refractory corneal epithelial defect by promoting epithelial healing and thus prevent corneal perforation. It can be used as a treatment for corneal perforation by restoring corneal stromal thickness so that emergency penetrating keratoplasty can be avoided.