The THAI Journal of OPHTHALMOLOGY

A Prospective Study on the Outcomes of Manual Small Incision Cataract Surgery (MSICS) Using the Modified Ruit Technique at Nan Hospital

Chupong Issaranarongpan — 2025-07-24

Objective: To study the visual outcomes, post-operative astigmatism, and complications of manual small incision cataract surgery (MSICS) using the Modified Ruit technique in the treatment of cataract patients.

Design: Prospective study

Methods: The medical records of 91 patients (91 eyes) with cataracts who underwent MSICS using a temporal scleral tunnel incision (Ruit’s technique) at Nan Hospital between October 2023 and February 2024 were reviewed. All 91 surgeries were performed by a single surgeon. Out of these 20 eyes (20 patients), four eyes missed the six-week follow-up, one eye was subject to incomplete data, seven eyes underwent combined ocular procedures, and eight eyes had pre-operative vision impairing pathology or previous ocular surgery. Records of 71 patients (71 eyes) with pre-operative, post-operative visual acuity (VA), operative time, intraoperative difficulties, intraoperative complication, post-operative complications, and astigmatism were analyzed in the second and sixth week after surgery.

Results: Seventy-one eyes of 71 patients were treated by MSICS using the Modified Ruit technique. Patients achieved excellent surgical outcomes with low complication rates. The post-operative best-corrected visual acuity (BCVA) results at the sixth-week follow-up were 20/20 to 20/40 in 95.8% (68/71) and 20/50 to 20/70 in 4.2% (3/71). At the sixth week after treatment, the mean post-operative astigmatism was -1.14±0.91D. The findings revealed a small risk of surgical complications, with hyphema being the most frequent intraoperative complication in 12.7% (9/71) of patients. No major surgical complications were found.

Conclusion: MSICS using the Modified Ruit technique is a high-quality procedure that achieves excellent clinical outcomes with a low rate of complications.

Keywords: Modified Ruit technique; Manual small incision cataract surgery

Intracameral anaesthetic mydriatics as adjuvant aids in small pupil cataract surgery to reduce the use of Pupillary Expansion Devices: A randomized prospective cohort study from Central Kerala, India

Merine Paul — 2025-07-24

ABSTRACT:

BACKGROUND:

To determine if Intracameral Anaesthetic Mydriatics (ICAM) can improve

pupillary dilatation in Small Pupil Cataract Surgery (SPCS) and reduce the use

of Pupillary Expansion Devices (PED) in SPCS.

METHODS:

A randomized prospective cohort study of 94 patients who met the inclusion criteria in private hospital setting in Central Kerala. India, were included in the study. Patients were randomized into two groups A and B, with Group A receiving intracameral Phenocaine Plus prior to capsulorhexis and none in Group B. Pupillary measurements were taken at, preoperative, start of surgery, post Phenocaine Plus injection, post Hydro dissection, post Phacoemulsification and post IOL implantation, stages of surgery. The demographic and clinical data collated were subject to statistical analysis.

RESULTS:

Thirty-six (75%) patients in Group A dilated to 6 mm or beyond, prior to capsulorhexis with the use of ICAM. This advantage in pupillary dilation was present in all stages of the surgery at statistically significant levels. The use of PED did not vary significantly between the groups. Group B had more intraoperative complications compared to group A but the difference was not statistically significant.

CONCLUSIONS:

ICAM as an adjuvant in small pupil cataract surgery helps to dilate and

maintain dilation of the pupil at all stages of surgery. ICAM did not

significantly impact the use of PED in this study, however, multicenter studies

with a larger pool of cataract surgeons are required to further explore the lack of

difference.

KEY WORDS:

ICAM, Small Pupil Cataract Surgery, Phenocaine Plus, Pupillary Expansion Devices.

Clinical characteristics, diagnosis, and treatments of pediatric nystagmus

Pittaya Phamonvaechavan — 2025-07-24

Objective: To report the clinical characteristics, types, causes, and management of pediatric nystagmus diagnosed over a 15-year period.

Patients and Methods: A retrospective study was conducted on pediatric patients under the age of 18 years old who were diagnosed with nystagmus at Siriraj Hospital from 2005 to 2019. The patients’ demographic data, characteristics, causes, and treatments of nystagmus were collected.

Results: A total of 328 patients were enrolled. The median age at diagnosis was 1.8 years, with 180 male patients (54.9%). The most prevalent cause was nystagmus associated with retinal and optic nerve abnormalities (42.4%), followed by idiopathic infantile nystagmus syndrome (INS, 17.7%), and nystagmus associated with anterior segment abnormalities (11.6%). Idiopathic INS was more common in Down’s syndrome (37.5%) than in non-Down’s syndrome patients (14.3%). Among the electroretinogram (ERG) results for nystagmus associated with retinal or optic nerve abnormalities, 83.7% were abnormal. Treatments varied by cause, with refractive correction being the most common (40.5%). Nystagmus from central nervous system (CNS) tumors had the highest rate of surgical treatments (42.9%), while nystagmus associated with anterior segment abnormalities often required multimodal treatments (34.2%).

Conclusion: This study offers insights into the characteristics, prevalence, and treatment of pediatric nystagmus within a tertiary care hospital in Thailand. The primary cause identified was nystagmus associated with retinal/optic nerve abnormalities. ERG is recommended in uncertain diagnosis cases or when retinal function is questionable. Treatment modalities are determined by the underlying cause of nystagmus, with refractive correction being the most commonly employed approach across all causes.

Efficacy and Safety of a 2% Dorzolamide/ 0.5% Timolol Fixed-Combination Brand: Mardozia®

Sutee Ananprasert — 2025-07-24

Objective: To evaluate efficacy and safety of Mardozia® (2% Dorzolamide/0.5% Timolol fixed combination) drugs in glaucoma patients, specifically in Thai population.

Methods: The multicenter, prospective, randomized, open label study in POAG, NTG and OHT which used brand name (Cosopt®) with or without PGs at least 3 months then drug washout for one month and switch to generic drug (Mardozia®), total study seven months period. The IOP was measured baseline on branded medication, month 0 and post-switch at month 1, 3 and 6. The questionnaire on the discomfort symptoms and discomfort score for the use of eye drops answered by the patients before baseline on branded medication and month 6 after received.

Results: A total of 60 eyes who receive brand name with or without PGs at least 3 months were enrolled in the study (71.7% female, median age 68.5 years old). At the end of the follow-up month 6 (visit 5) of Mardozia®, mean IOP was 13.82 ± 3.22 mmHg, reduced from baseline 2.7 ± 3.03 mm Hg (14.88%, p < 0.001) and IOP reduction was not significant difference compared with brand name at baseline on branded medication (0.91mmHg) (-5.35%). There was, likewise, significant difference in the discomfort score (P < 0.001).

Conclusion: Mardozia® is effective in reducing IOP for glaucoma patients. The effect was seen significantly since first month and continued until the last follow-up. After the switch, the IOP-lowering effect of the generic drug Mardozia® was comparable to the brand name. Overall safety is better after switching. Patients had less adverse drug reactions and were more comfortable with Mardozia® significantly.

Facial Nerve Innervation of the Orbicularis Oculi Muscle: A Focus on Lower and Medial Region

Atapol Yongvikul — 2025-07-24

In orbital surgery, it is inevitable to interact with the orbicularis oculi muscle. Complications, including difficulties with blinking and closing the eyelids, may arise if the muscle is injured. Although the innervation of the muscle by the facial nerve has been well-defined for centuries, recent literature has examined fine or extrafine branches from the anterior border of the parotid gland to the muscle. Under surgical microscopic examination, two small nerve branches are noted. The first is the lower palpebral branch, which supplies the lower part of the orbicularis oculi. The second is the upper medial palpebral branch, which supplies the medial area of the orbicularis oculi muscle. These small nerves are both clinically and anatomically important.

Methanol induced optic neuropathy: a case report

Siripa Tipparut — 2025-07-24

Methanol induced optic neuropathy is a relatively rare disease that is difficult to diagnose due to unclear patient history. Patients will experience bilateral vision loss, for example, foggy vision. Physical examination reveals decreased visual acuity, possibly with dilated pupils that do not respond to light, and optic disc swelling in the early stages. Currently, there is no standard treatment. Some research suggests that accurate and rapid diagnosis and timely treatment may reduce permanent vision loss in patients. Therefore, awareness of this disease in patients with compatible history is important.