The THAI Journal of OPHTHALMOLOGY

A Real-World Evaluation of Optical Coherence Tomography Angiography and Clinical Risk Factors for Mild Non-Proliferative Diabetic Retinopathy

2026-07-31T15:32:20+07:00

Objectives: To evaluate the clinical utility of optical coherence tomography angiography (OCTA) metrics for detecting mild non-proliferative diabetic retinopathy (NPDR) and to identify clinical risk factors associated with mild NPDR.

Methods: This prospective cross-sectional study included patients with type 2 diabetes mellitus (DM). OCTA metrics—including superficial and deep capillary plexus vessel densities (SVD and DVD), ganglion cell complex (GCC) thickness, and foveal avascular zone (FAZ) area—were measured in the parafoveal region using the Optovue Solix OCTA system. Logistic regression analysis adjusted for potential confounders was performed to evaluate associations between OCTA metrics, clinical risk factors, and mild NPDR.

Results: A total of 236 patients were enrolled, including 118 patients without DR and 118 with mild non-proliferative diabetic retinopathy (NPDR). SVD was significantly lower in the mild NPDR group compared to the no DR group (48.37 ± 2.25% vs. 49.22 ± 2.82%, p = 0.011), whereas other OCTA parameters showed no significant differences between groups. In adjusted logistic regression analyses, the presence of mild NPDR was significantly associated with SVD (p < 0.001), DVD (p = 0.003), and age (p = 0.001).

Conclusions: Although SVD was statistically reduced in patients with mild NPDR, the magnitude of difference was not clinically meaningful. Nonetheless, vessel density metrics and age were significantly associated with mild NPDR. While OCTA provides valuable quantitative assessment of retinal microvasculature, its utility as a routine screening tool for mild NPDR remains limited. Clinical fundoscopy continues to be the primary method for diagnosing mild NPDR.

Efficacy and Safety of Intravitreal Ziv-Aflibercept for the Treatment of Patient with Diabetic Macula Edema Refractory to Intravitreal Bevacizumab: A Case Series

2026-02-12T15:04:27+07:00

Purpose: To evaluate the safety and efficacy of intravitreal ziv-aflibercept (IVZ) injection in Thai patients with diabetic macular edema (DME) refractory to intravitreal bevacizumab (IVB).

Materials and Methods: Consecutive patients with refractory DME were treated with three monthly IVZ (1.25 mg/0.05 ml) injections. For patients who responded, a pro-re-nata protocol was used for recurrence or persistent DME, defined as central macular thickness (CMT) > 300 um. Outcome measures included best corrected visual acuity (BCVA), CMT and adverse events at 6 months. Comprehensive ophthalmic exams and optical coherence tomography (OCT) were performed at baseline and follow-up visits.

Results: Seven type 2 diabetic patients, mean age 56.71 ± 5.34 years, were included. The mean number of previous IVB injections was 5.71 ± 2.43. Patients were switched to IVZ 4-5 weeks after their last IVB injection. Mean BCVA improved from 0.46 ± 0.27 logMAR to 0.32 ± 0.17 logMAR (p = 0.018) at 3 months and 0.32 ± 0.13 logMAR (p = 0.001) at 6 months. Mean baseline CMT decreased from 512.71 ± 158.41 µm to 347.86 ± 122.61 µm (p = 0.012) at 3 months and 351.60 ± 117.71 µm (p = 0.029) at 6 months. After three loading injections, 2 eyes were non-responders. The mean number of IVZ injections was 4.6 ± 1.2. No intraocular inflammation, lens opacity progression, elevated
IOP, or retinal detachment was observed. No serious systemic complications were detected.

Conclusions: Intravitreal ziv-aflibercept is a safe and cost-effective treatment for DME refractory to IVB. It offers a valuable alternative, especially in resource-limited settings, but further large-scale, prospective studies are needed to confirm its efficacy and long-term safety

Pseudophakic Rhegmatogenous Retinal Detachment: A Case Series at Sultan Ahmad Shah Medical Centre, Kuantan

2026-03-30T11:42:40+07:00

Purpose: Pseudophakic rhegmatogenous retinal detachment (PRRD) is a sight-threatening condition and one of the most common emergency complications following cataract surgery, requiring prompt surgical intervention. This study aimed to describe the clinical and demographic characteristics of patients with PRRD who presented to the Ophthalmology Clinic at Sultan Ahmad Shah Medical Centre (SASMEC), Kuantan, Malaysia.

Materials and Methods: A retrospective case series was conducted at SASMEC. Electronic medical records from
October 2022 to January 2025 were reviewed to identify patients diagnosed with PRRD. Demographic data, systemic
and ocular comorbidities, presenting symptoms, axial length (AXL), management, and visual outcomes up to 12 months post-treatment were analysed.
Results: Five eyes from five male patients with a mean age of 61.4 years were included in the study.All cases involved macular detachment, with 80% affecting the right eye. Floaters were the most common presenting symptom (80%). All patients had systemic comorbidities, particularly diabetes mellitus, hypertension, and hyperlipidaemia. The mean AXL was 25.3 mm, with most patients demonstrating a long axial length (≥ 25 mm), a known risk factor for PRRD. Four patients underwent pars plana vitrectomy with internal tamponade, and all achieved improvement of at least two Snellen lines at 12 months postoperatively. One patient declined surgery and showed no visual improvement, maintaining poor vision. Only one postoperative complication was reported, which resolved following appropriate management.

Conclusions: PRRD is an uncommon but vision-threatening complication following cataract surgery. In this series,
long axial length, male sex, and systemic comorbidities appeared to be associated risk factors. Prompt diagnosis and
early surgical intervention were associated with better visual outcomes. Strengthening postoperative surveillance and patient education may help reduce PRRD-related visual loss in Malaysia.

Central Serous Chorioretinopathy Coincident with Suprasellar Meningioma: A Case Report

2026-01-27T14:39:53+07:00

A 41-year-old woman with systemic lupus erythematosus (SLE) presented with blurred vision in her right eye for 3 months. A few weeks later, she developed progressive painless visual loss with an involved central area of vision in her right eye. Ophthalmological examination and OCT macula scan revealed serous subretinal fluid in the right macular region. Fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were subsequently
performed a few weeks later. The patient underwent focal laser photocoagulation at an extrafoveal leakage site in the right eye, guided by FFA and ICGA findings. However, her visual function continued to deteriorate. Visual field testing demonstrated a significant bitemporal hemianopic defect. Contrast-enhanced magnetic resonance imaging (MRI) of the brain and orbit revealed a suprasellar mass compressing the optic chiasm, consistent with a meningioma.

This case report describes an SLE patient receiving systemic corticosteroids who developed central serous chorioretinopathy (CSCR) and was subsequently found to have a suprasellar meningioma compressing the optic chiasm.
The concurrence of CSCR and meningioma in this patient is best interpreted as a coincidental coexistence, and no causal association is implied. Although neuroimaging is not routinely indicated for typical CSCR, it should be considered when
visual function is disproportionately poor, when symptoms progress, when perimetry suggests a chiasmal pattern, or when visual impairment persists despite apparent anatomical resolution of subretinal fluid.

Giant Congenital Dacryocystocele Presenting with Globe Displacement: A Rare Cause of Orbital Mass Effect in an Infant

2026-05-01T11:32:26+07:00

Introduction: Congenital dacryocystocele is an uncommon form of lacrimal drainage obstruction in neonates. To the best of our knowledge, globe displacement secondary to a giant congenital dacryocystocele has not been previously reported. We describe a case of a giant congenital dacryocystocele complicated by acute dacryocystitis that produced significant orbital mass effect with globe displacement.

Case report: A 19-day-old female neonate presented with a bluish swelling over the right medial canthal region that had been present since birth. The lesion progressively enlarged and became complicated by acute dacryocystitis.
Intravenous antibiotic therapy improved the inflammation; however, the mass remained enlarged and displaced the globe superotemporally. Computed tomography demonstrated a 17.7 x 14.6 x 16.0 mm cystic lesion at the right medial canthus that was continuous with the nasolacrimal duct and exerted significant mass effect on the globe. Following resolution of the acute infection, nasolacrimal duct probing was performed, resulting in immediate decompression of the dacryocystocele and restoration of the globe to its normal position.

Conclusions: Giant congenital dacryocystoceles can present as a rare cause of orbital mass effect, resulting in globe displacement. Early recognition and timely intervention are essential to prevent serious complications associated with infection and airway obstruction.