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Background: Noncompliance can mislead clinicians regarding the efficacy of therapy and result in more aggressive, but inappropriate treatment. Improper techniques used for eye drop instillation frequently occurs in chronic glaucoma patients. The Thai Eye Drop Guide (EDG) device has been developed to ensure precise instillation. However, whether the EDG is more effective than the traditional technique when careful instructions for both techniques are given is still unknown. Objective: To compare success rates of eye drop self-instillation by chronic glaucoma patients using a traditional technique and the EDG when careful instructions for both are given. Methods: Fifty-nine chronic glaucoma patients were instructed to instill eye drops using the EDG or a traditional technique in a randomized sequence. A two week practice period was assigned before groups were crossed-over. The instillation performance was VDO recorded after each practice period. Three criteria of success: time taken to instill an eye drop into the eye; instillation of only one drop; and without the bottle tip touching lids, lashes, periocular tissues, or the other hand, were scored by three independent readers from video-records. The readers were blinded to the sequence to which the patients were randomized. Results: There were no significant differences in success rates between the EDG and traditional technique (61.0% and 66.1% respectively, p = 0.607) and the number of drops dispensed per application (median of 1 drop in both groups, p = 0.89). The time taken to instill eye drops with the EDG was significantly longer than using the traditional technique (median of 19 and 9 s respectively, p < 0.001). Older age (p = 0.049, OR 4.23) and more education (p = 0.025, OR 0.19) were found to be significantly associated with failure of the EDG. Conclusion: EDG is not more effective than a traditional technique in terms of improving dispensing accuracy and decreasing the drops dispensed per application even when careful instructions are given. The results suggest that, if good instructions are provided, experienced glaucoma patients can improve their eye drop instillation performance.

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The RNFL thickness in the morning was higher than in the evening in moderate OSAHS.

Background: Primary angle-closure glaucoma (PACG) is more common among Asians than among Caucasians. Acute primary angle closure (APAC) is a serious associated complication in PACG patients. When conventional treatment fails, Anterior Chamber Paracentesis (ACP) can be performed to decrease IOP. Although slit knives are commonly used for performing ACP, other techniques can also be used to perform this procedure.

Background To report three cases of nontuberculous mycobacterial (NTM) endophthalmitis following multiple ocular surgeries and to review previous literature in order to study the clinical profile, treatment modalities, and visual outcomes among patients with NTM endophthalmitis. Methods Clinical manifestation and management of patients with NTM endophthalmitis in the Department of Ophthalmology, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand were described. In addition, a review of previously reported cases and case series from MEDLINE, EMBASE, and CENTRAL was performed. The clinical information and type of NTM from the previous studies and our cases were summarized. Results We reported three cases of NTM endophthalmitis caused by M. haemophilum, M. fortuitum and M. abscessus and a summarized review of 112 additional cases previously published. Of 115 patients, there were 101 exogenous endophthalmitis (87.8%) and 14 endogenous endophthalmitis (12.2%). The patients’ age ranged from 13 to 89 years with mean of 60.5 ± 17.7 years with no gender predominance. Exogenous endophthalmitis occurred in both healthy and immunocompromised hosts, mainly caused by cataract surgery (67.3%). In contrast, almost all endogenous endophthalmitis patients were immunocompromised. Among all patients, previous history of tuberculosis infection was identified in 4 cases (3.5%). Rapid growing NTMs were responsible for exogenous endophthalmitis, while endogenous endophthalmitis were commonly caused by slow growers. Treatment regimens consisted of macrolides, fluoroquinolones or aminoglycosides, which were continued for up to 12 months. Initial and final vision were generally worse than 6/60. Conclusions NTM endophthalmitis is a serious intraocular infection that leads to irreversible loss of vision. The presentation can mimic a chronic recurrent or persistent intraocular inflammation. History of multiple intraocular surgeries or immune-deficiency in patient with chronic panuveitis should raise the practioner’s suspicion of NTM endophthalmitis. Appropriate diagnosis and treatment are important to optimize visual outcome.

Purpose To determine the characteristics of the patients who preferred using the eye drop guide (EDG) regularly and their opinions toward the guide in order to select the patients for prescribing the EDG appropriately. Patients and Methods Fifty-seven glaucoma patients who completed the primary study, “The effect of ‘eye drop guide’ on the success rate of eye drop self-instillation in glaucoma patients”, were included. Patients’ instillation techniques, routine instillation or using the EDG, were chosen independently. After 4–6 months, they were interviewed about the frequency of EDG use and their rating scores toward the guide in 4 aspects including aiming aids, contamination prevention, reduction of drop waste, and ease of use. The differences in opinion scores between each frequency group and the factors associated with the regularity of EDG use were statistically analyzed. Results Of fifty-seven patients completing the interview, 19.3% used the EDG everyday, while 45.6% had never used the EDG. The nonusers rated significantly lower scores in all aspects (p-value < 0.005). From multivariate analysis, the factors associated with the preference not to use the EDG were administering in supine position (p-value < 0.001, adjusted OR 34.866, 95% CI 4.974–244.412) and more than one eye drop use (p-value = 0.048, adjusted OR 5.280, 95% CI 1.018–27.396). Conclusion The EDG should be selectively prescribed for the particular patients who had one medication and performed instillation in sitting or standing position. Although the regular EDG users tended to have positive opinions on the EDG, their long-term compliance with the guide was underinvestigated.

Objective: To dispense medication in a form of ready to use (RTU) medication was recommended by the standards of Joint Commission International (JCI) and Standard Guidelines of Hospital Pharmacy for preventing the medication error. However, the cost and benefit were questionable. The costs may increase while benefits were unclear. Before making the implementation decision, the cost of investment and benefit between traditional (injectable medication is prepared by nurse) and RTU systems (injectable medication is prepared by pharmacy department) should be evaluated. Methods: This study compared the cost and benefit of injectable medication administration between the traditional system and the RTU system within a large academic hospital. The decision tree was designed to produce comparable data on the hospital's perspective. The time horizon was 10 years thus all costs were discounted at 3% annually. Sensitivity analysis was performed to test the stability of the results. Results: The cost of investment at 10-year intervals of the RTU system was lower than the traditional system by about 18,710,160 baht. The benefit was decreased 19.32 full time equivalents (FTEs) of nurse when compared with the traditional system. The result showed that the five most sensitive variables were number of doses, mixing time per dose (prepared by nurse), space for production, salary and fringe benefits of pharmacists, and mixing time per dose (prepared by pharmacist). Conclusion: The RTU system saved 1,871,016 baht per year and 19.32 FTEs of nurse. Moreover, the RTU system enhanced the opportunity of nurses and pharmacists to play more professional role and promoted the efficient health care system.