Digital image processing software for diagnosing diabetic retinopathy from fundus photograph

Tanapat Ratanapakorn,1 Athiwath Daengphoonphol,2 Nawapak Eua-Anant,2 Yosanan Yospaiboon1 1KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Department of Computer Engineering, Faculty of Engineering, Khon Kaen University, Khon Kaen, Thailand Objective: The aim of this study was to develop automated software for screening and diagnosing diabetic retinopathy (DR) from fundus photograph of patients with diabetes mellitus. Methods: The extraction of clinically significant features to detect pathologies of DR and the severity classification were performed by using MATLAB R2015a with MATLAB Image Processing Toolbox. In addition, the graphic user interface was developed using the MATLAB GUI Toolbox. The accuracy of software was measured by comparing the obtained results to those of the diagnosis by the ophthalmologist. Results: A set of 400 fundus images, containing 21 normal fundus images and 379 DR fundus images (162 non-proliferative DR and 217 proliferative DR), was interpreted by the ophthalmologist as a reference standard. The initial result showed that the sensitivity, specificity and accuracy of this software in detection of DR were 98%, 67% and 96.25%, respectively. However, the accuracy of this software in classifying non-proliferative and proliferative diabetic retinopathy was 66.58%. The average time for processing is 7 seconds for one fundus image.Conclusion: The automated DR screening software was developed by using MATLAB programming and yielded 96.25% accuracy for the detection of DR when compared to that of the diagnosis by the ophthalmologist. It may be a helpful tool for DR screening in the distant rural area where ophthalmologist is not available. Keywords: automated diabetic retinopathy software, diabetic retinopathy screening, fundus photography diagnosis, digital image processin

Subretinal angiostrongyliasis-induced optic neuritis

Suthasinee Sinawat,1 Yosanan Yospaiboon,1 Supat Sinawat21Vitreoretinal Unit, Department of Ophthalmology, 2Department of Physiology, Khon Kaen University, Khon Kaen, ThailandAbstract: A 27-year-old Thai male presented with progressive visual loss and a membrane-like floater in the right eye that had persisted for 1 month. He had a history of eating raw foods, including snails. His initial visual acuity was counting fingers at 1 ft and he had a relative afferent pupillary defect. A movable larva with subretinal tracks was found in the subretinal space near a normal optic disc. Visually evoked potentials showed delayed latency, which indicated secondary retrobulbar optic neuritis. A diode laser was directly applied to the motile worm. The patient was subsequently prescribed oral prednisolone and albendazole. After treatment, his visual acuity was slightly improved at 2/60. Ocular manifestation is a very rare event resulting from parasitic infection. In only 1.1% of angiostrongyliasis cases is an Angiostrongylus cantonensis larva identified in the eye. Ocular angiostrongyliasis with optic neuritis may be secondary to mechanical injury and/or inflammatory reactions. Steroid treatment is recommended, although most patients have only slight visual improvement after treatment.Keywords: Angiostrongylus cantonensis, intraocular, ocular angiostrongyliasis, parasitic infectio

Direct and Dural Carotid Cavernous Sinus Fistulas: Comparison of Clinical Characteristics

Pawasoot Supasai, Kanwasee Kanjana, Yosanan Yospaiboon KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCorrespondence: Yosanan Yospaiboon, KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, 123 Mitraparb Highway, Khon Kaen, 40002, Thailand, Tel +66-4336-3010, Fax +66-4334-8383, Email [email protected]: To compare the clinical characteristics of patients with direct and dural carotid cavernous sinus fistulas (CCFs).Methods: The medical records of 60 patients diagnosed with CCFs were retrospectively reviewed. The collected data included demographic characteristics, clinical findings, and ocular manifestation. The clinical characteristics of the direct and the dural CCFs were compared on head-to-head basis. Logistic regression analysis was used to demonstrate the direction and magnitude of the difference and reported as odds ratio with its 95% confidence interval.Results: There were 28 patients (46.67%) with direct CCFs, and 32 patients (53.33%) with dural CCFs. Patients with direct CCF were mostly male (p=0.023), younger age (p< 0.001), had history of trauma (p< 0.001), and more visual impairment at presentation (p=0.025), when compared to those with dural CCFs. In addition, patients with direct CCF had significantly more chemosis (p=0.005), proptosis (p=0.042), bruit (p< 0.001) and dilated retinal vessels (p=0.008) than those with dural CCF. Thirty patients (50%) had increased intraocular pressure (IOP). Mean IOP of the affected eyes was significantly higher than the unaffected eyes (p< 0.0001). In patients with normal IOP, mean IOP of the affected eyes was also higher than the unaffected eyes (p=0.0027).Conclusion: Patients with direct CCF were younger age, associated with trauma, and more visual impairment at presentation. Chemosis, proptosis, bruit and dilated retinal vessels were detected more in the direct CCF than the dural CCF. Despite normal IOP, affected eyes had significantly higher IOP than the unaffected eyes. Information on these clinical characteristics may be helpful in discrimination of the direct type, which is more urgent for further investigation and treatment.Keywords: direct carotid cavernous fistula, dural carotid cavernous fistula, clinical characteristic

Clinical Risk Score for Prediction of Urgency in Carotid Cavernous Sinus Fistulas

Pawasoot Supasai, Kanwasee Kanjana, Yosanan Yospaiboon KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCorrespondence: Yosanan Yospaiboon, KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, 123 Mitraparb Highway, Khon Kaen, 40002, Thailand, Tel +66-4336-3010, Fax +66-4334-8383, Email [email protected]: To develop a clinical risk score for the prediction of urgency in patients with carotid cavernous sinus fistulas (CCFs) and test for the discriminative ability of the diagnostic prediction.Methods: The medical charts of 60 patients with CCFs were retrospectively reviewed. The clinical characteristics of direct and dural CCFs were analyzed by logistic regression. The clinical risk score was developed from the coefficient in the multivariable regression model and used to predict direct CCFs which were more urgent than the dural type. The score prediction was reported as an area under the receiver operating characteristic (AuROC) curve and 95% confidence interval (95% CI).Results: In a univariable analysis, the clinical characteristics which increased the risk of direct CCFs were age, gender, trauma, underlying diseases, visual acuity (VA) at presentation, bruit, chemosis, and dilated retinal vessels. However, in multivariable analysis, the significant predictors were limited to age, trauma, bruit, underlying diseases and logMAR VA. Regression coefficient of each predictor was converted to a risk score and summation of scores from these predictors for each patient was calculated. The total risk score predicted the urgent direct CCFs correctly with AuROC of 97.77% (95% CI; 93.57, 100).Conclusion: The clinical risk score for the prediction of urgent direct CCFs has been developed and used in the patients with CCFs in our setting. The discriminative ability of the score prediction is high. This simple clinical risk score may help clinicians suspect direct CCFs and urgently refer the patients to have prompt angiography and treatment.Keywords: clinical risk score, cavernous sinus, carotid cavernous fistulas, prediction, urgenc

Successful treatment of Chrysosporium keratitis with voriconazole

Onsiri Thanathanee, Chavakij Bhoomibunchoo,&nbsp;Orapin Anutarapongpan,&nbsp;Olan Suwan-apichon,&nbsp;Yosanan Yospaiboon KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Objective: To report a patient with severe Chrysosporium keratitis successfully treated by voriconazole.Method: Case report.Results: A 37-year-old healthy male presented with irritation, pain and reduced vision in his left eye after mud contamination. Examination demonstrated corneal stromal infiltration, endothelial plaque and hypopyon. Corneal scrapings demonstrated numerous septate hyphae, and specimen cultures were positive for Chrysosporium sp. The lesion did not respond to aggressive topical 5% natamycin, 0.15% topical amphotericin B and oral itraconazole. The patient was then treated by topical 1% voriconazole every hour. Intracameral and intrastromal voriconazole injections (50  &mu;g/0.1  mL) were also undertaken. The keratitis was significantly improved after voriconazole.Conclusion: To the best of the authors&rsquo; knowledge, this is the first report on the use of voriconazole for Chrysosporium keratitis. Voriconazole may be an effective alternative to conventional antifungal agents in some cases of fungal keratitis. It should be considered before shifting to therapeutic keratoplasty. Keywords: Chrysosporium, keratitis, keratoplasty, voriconazol

Systemic abnormalities associated with retinal vein occlusion in young patients

Suthasinee Sinawat,1 Chavisa Bunyavee,2 Tanapat Ratanapakorn,1 Supat Sinawat,3 Wipada Laovirojjanakul,1 Yosanan Yospaiboon1 1KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Department of Ophthalmology, Faculty of Medicine, Nawamindaradhiraj University, Bangkok, Thailand; 3Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Objectives: To study the systemic abnormalities associated with retinal vein occlusion in patients aged &le;50 years with a particular emphasis on atherosclerotic diseases and thrombophilic disorders. Methods: Medical charts of patients, aged &le;50 years whose diagnoses were retinal vein occlusions during the period 1995&ndash;2015 were retrospectively reviewed. The primary outcome was the number of systemic abnormalities associated with these patients. Secondary outcomes included types of retinal vein occlusion and sites of occlusion. Results: Atherosclerotic diseases were the most common systemic abnormalities associated with retinal vein occlusion and accounted for 55.1% of the patients in the study. Hypertension in 27.55%, diabetes mellitus in 16.33%, and 5.1% with dyslipidemia were noted. The number of thrombophilic disorders seemed to be less than expected and were noted in only 5.1%. Other systemic abnormalities included viral hepatitis infection, systemic lupus erythematosus, and acquired immunodeficiency syndrome. Oral contraceptives were used by some patients. Conclusion: Atherosclerotic diseases remained the most commonly associated systemic diseases in the majority of these patients. Approach to these patients should include a screening for hypertension, diabetes mellitus, and lipid abnormalities. Thrombophilia should also be considered where no obvious atherosclerotic diseases are found or if the patient is &lt;40 years old, a history of thrombosis or a family history of thrombosis is possible. Keywords: retinal vein occlusion, systemic diseases, young patients&nbsp

Macular sensitivity after half-dose verteporfin photodynamic therapy in central serous chorioretinopathy

Thuss Sanguansak, Prapapan Pitujaturont, Yosanan Yospaiboon, Suthasinee Sinawat, Tanapat Ratanapakorn, Chavakij Bhoomibunchoo Department of Ophthalmology, Faculty of Medicine, KKU Eye Center, Khon Kaen University, Khon Kaen, Thailand Objective: To study the macular sensitivity after half-dose verteporfin photodynamic therapy in patients with resolved central serous chorioretinopathy using the automated static perimeter.Methods: Prospective consecutive case study of 24 patients with resolved central serous chorioretinopathy was performed. The macular sensitivity was measured using a conventional automated static perimeter with the Swedish interactive threshold algorithm 10-2 and foveal threshold. Best corrected visual acuity, intraocular pressure, fundus examination, macular thickness, and volume were also examined. The mean macular sensitivities of the affected eyes and their normal fellow eyes were calculated and compared. P&lt;0.05 was considered statistically significant.Results: The mean macular sensitivities of the affected eyes were lower than the normal fellow eyes with a statistically significant difference in all areas of the study (P&lt;0.05). Best corrected visual acuity improved significantly from pretreatment (0.26&plusmn;0.3 logMAR) to posttreatment (0.075&plusmn;0.15 logMAR, P&lt;0.05). Macular thicknesses in affected eyes were 230.66&plusmn;67.34 &micro;m and in the normal eyes were 238.33&plusmn;92.26 &micro;m (P=0.68). Macular volumes in affected eyes were 8.77&plusmn;0.49 and in the normal eyes were 8.70&plusmn;0.50 (P=0.60). These findings were not statistically significant.Conclusion: Eyes with resolved central serous chorioretinopathy after half-dose verteporfin photodynamic therapy had lower macular sensitivity than normal fellow eyes. These findings agreed well with the previous microperimetric studies. The conventional automated static perimeter can also be used when a microperimeter is not available. Keywords: macular sensitivity, half-dose photodynamic therapy, automated static perimeter, central serous chorioretinopath

Factors affecting visual outcomes after treatment of infectious endophthalmitis in northeastern Thailand

Yosanan Yospaiboon, Anocha Intarapanich, Wipada Laovirojjanakul, Tanapat Ratanapakorn, Suthasinee Sinawat, Thuss Sanguansak, Chavakij Bhoomibunchoo KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Objective: To determine factors affecting visual outcomes after treatment of infectious endophthalmitis during 2012&ndash;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&lt;0.001), coagulase-negative 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. Keywords: visual outcome, infectious endophthalmitis, prognostic factor

Incidence of and risk factors for chloroquine and hydroxychloroquine retinopathy in Thai rheumatologic patients

Nuanpan Tangtavorn, Yosanan Yospaiboon, Tanapat Ratanapakorn, Suthasinee Sinawat, Thuss Sanguansak, Chavakij Bhoomibunchoo, Wipada Laovirojjanakul KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Objective: To study the incidences of and risk factors for chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy in Thai rheumatologic patients. Methods: A retrospective cohort study of 234 rheumatologic patients receiving either CQ or HCQ was conducted. Patients were divided based on whether or not they developed retinopathy as retinopathy-positive or negative groups. Medical records giving details regarding age, gender, body weight, underlying diseases, daily doses, and cumulative doses of CQ or HCQ were reviewed. CQ and HCQ retinopathy were diagnosed by indirect ophthalmoscopy, Humphrey visual field test, and optical coherence tomography. The main outcome measures were incidences and risk factors of CQ and HCQ retinopathy. Results: The CQ retinopathy was detected in 14 of 173 patients (8.09%) who received CQ for 139&ndash;2,033 days, cumulative doses from 14.3 to 325.1 g, and daily doses from 0.8 to 18.5 mg/kg/d. Their ages ranged from 27 to 65 years. When compared to the CQ retinopathy-negative group, only age, body weight, and cumulative dose showed statistically significant differences. The HCQ retinopathy-positive group was comprised of 2 of 61 patients (3.28%) who received HCQ for 660&ndash;828 days, cumulative doses from 80 to 130 g, and daily dose from 1.9 to 4.4 mg/kg/d. Their ages were 36 and 39 years. Compared to the HCQ retinopathy-negative group, there were no statistically significant differences in studied risk factors. Conclusion: Incidences of and risk factors for CQ and HCQ retinopathy were reported. Since most patients developed retinopathy earlier than 5 years, it is suggested that patients taking long-term CQ or HCQ should undergo ophthalmologic screening annually after the baseline examination. Keywords: chloroquine, hydroxychloroquine, retinopathy, incidence, risk factor