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1.  Health resource utilization and the economic burden of patients with wet age-related macular degeneration in Thailand 
AIM
To determine healthcare resource utilization and the economic burden associated with wet age-related macular degeneration (AMD) in Thailand
METHODS
This study included patients diagnosed with wet AMD that were 60 years old or older, and had best corrected visual acuity (BCVA) measured at least two times during the follow-up period. We excluded patients having other eye diseases. Two separate sub-studies were conducted. The first sub-study was a retrospective cohort study; electronic medical charts were reviewed to estimate the direct medical costs. The second sub-study was a cross-sectional survey estimating the direct non-medical costs based on face-to-face interviews using a structured questionnaire. For the first sub-study, direct medical costs, including the cost of drugs, laboratory, procedures, and other treatments were obtained. For the second sub-study, direct non-medical costs, e.g. transportation, food, accessories, home renovation, and caregiver costs, were obtained from face-to-face interviews with patients and/or caregivers.
RESULTS
For the first sub-study, sixty-four medical records were reviewed. The annual average number of medical visits was 11.1±6.0. The average direct medical costs were $3 604±4 530 per year. No statistically-significant differences of the average direct medical costs among the BCVA groups were detected (P=0.98). Drug costs accounted for 77% of total direct medical costs. For direct non-medical costs, 67 patients were included. Forty-eight patients (71.6%) required the accompaniment of a person during the out-patient visit. Seventeen patients (25.4%) required a caregiver at home. The average direct non-medical cost was $2 927±6 560 per year. There were no statistically-significant differences in the average costs among the BCVA groups (P=0.74). Care-giver cost accounted for 87% of direct non-medical costs.
CONCLUSION
Our study indicates that wet AMD is associated with a substantial economic burden, especially concerning drug and care-giver costs.
doi:10.3980/j.issn.2222-3959.2014.01.27
PMCID: PMC3949476  PMID: 24634881
age-related macular degeneration; health resource utilization; costs; Thailand
2.  Photoreceptor disruption in central serous chorioretinopathy treated by half-dose photodynamic therapy 
Background
To evaluate photoreceptor disruption in patients with central serous chorioretinopathy (CSC) treated by half-dose photodynamic therapy (PDT).
Methods
A total of 29 patients with symptomatic CSC were recruited and underwent half-dose verteporfin PDT covering the leakage sites as observed via fundus fluorescein angiography. The primary outcome was the percentage of patients with the presence of photoreceptor disruption, and the secondary outcome was the correlation between photoreceptor disruption and visual results at the 1-year follow-up.
Results
Photoreceptor disruption was identified in 13 eyes (44.8%) 12 months after treatment. Twenty-seven patients experienced best-corrected visual acuity (BCVA) improvement after PDT, while two patients showed stable BCVA. The mean BCVA in patients with photoreceptor disruption at the baseline and every follow-up visit was significantly lower than that of patients without photoreceptor disruption. However, there was no correlation between the presence or absence of photoreceptor disruption and the improvement of visual acuity because the BCVA gain at the last follow-up visit between the two groups was not significant (P = 0.69). No potential ocular complication was encountered in the study.
Conclusion
Photoreceptor disruption was found in about 45% of CSC patients treated by PDT, which ultimately resulted in poor visual outcomes. However, a half-dose PDT might not affect or modify the photoreceptor function because it gave the same pattern of visual recovery in patients with and without photoreceptor cell loss.
doi:10.2147/OPTH.S39584
PMCID: PMC3548438  PMID: 23345962
photoreceptor disruption; central serous chorioretinopathy; photodynamic therapy
3.  High-dose antioxidants for central serous chorioretinopathy; The randomized placebo-controlled study 
BMC Ophthalmology  2012;12:20.
Background
To determine the efficacy of high-dose antioxidants in the acute stage of central serous chorioretinopathy (CSC).
Methods
This was a randomized placebo-controlled study. The patients with acute CSC (onset within 6 weeks) were randomized to receive either high-dose antioxidant tablets (study group A) or placebo tablets (control group B) for 3 months or until the complete resolution of subretinal fluid. After 3 months, additional treatment with laser or photodynamic therapy (PDT) was considered if any fluorescein leakage persisted. The outcomes measured were the changes in visual acuity (VA) and central macular thickness (CMT), the number of patients with subretinal fluid at each follow-up time, the number of patients with fluorescein leakage at the end of the 3rd month and patients who received additional treatments.
Results
Fifty-one of 58 patients (88%) completed the follow-up criteria. The baseline demographic data were comparable in both groups. At the end of the 3rd month, the VA and CMT showed no statistical difference between the groups but the patients in group A has less fluorescein leakage and additional treatments than in group B (p = 0.027 and 0.03).
Conclusion
The high-dose antioxidants for acute CSC did not show any benefits in VA and CMT. However, the drugs might decrease the chance for fluorescein leakage and additional treatments at the end of the 3rd month.
doi:10.1186/1471-2415-12-20
PMCID: PMC3410804  PMID: 22800086
Antioxidants; Central serous chorioretinopathy
4.  Electrophysiologic changes after intravitreal ranibizumab injection for the treatment of choroidal neovascular membrane (CNVM) 
Purpose:
To determine the pattern of electroretinographic change after an intravitreal ranibizumab (Lucentis®) injection for the treatment of choroidal neovascular membrane (CNVM).
Patients and methods:
A prospective interventional case series of patients treated by intravitreal ranibizumab injection. Best corrected visual acuity, optical coherence tomography (OCT), and multifocal electroretinography (mfERG) were assessed prior to treatment, and 2 weeks, 1 and 3 months after treatment. Primary outcome was the functional change in amplitude and implicit time by mfERG and secondary outcome was the structural change in macular thickness by optical coherence tomography (OCT).
Results:
Twenty-six eyes from 25 consecutive patients were enrolled. At 3 months after treatment, the mean visual acuity (VA) improved from 1.06 to 0.84 logMAR (P = 0.034) and the mean macular thickness decreased from 389.7 to 264.4 microns (P = 0.003). The mean implicit time of the central zone showed an improvement at 3 months after treatment when compared with the response at baseline (P = 0.024) and at 1 month (P = 0.013) but the mean amplitude showed no significant change. In subgroup analysis, the eyes with initial visual acuity (VA) ≥ 20/200 had a significant improvement in mean implicit time of the peripheral zone at 2 weeks after treatment (P = 0.028). The OCT revealed a significant decrease (P < 0.003) in macular thickness at 1 and 3 months postoperatively.
Conclusion:
The mean implicit time of the central zone improved significantly at 3 months after treatment, whereas the mean amplitude showed no significant change. The macular thickness decreased significantly after the treatment, while VA improved to a lesser extent.
doi:10.2147/OPTH.S19485
PMCID: PMC3096619  PMID: 21607026
choroidal neovascular membrane (CNVM); intravitreal injection; multifocal electroretinography (mfERG); optical coherence tomography (OCT); ranibizumab

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