Dr Patchima CHANTAREN MD.

Department of Ophthalmology,

King Chulalongkorn Memorial Hospital,

Bangkok, Thailand

I have learned a new concept in dry eye diagnosis and treatment (TFOD & TFOT). This also give me a lot more insight in dry eye and tears dynamic which is very very impressive and interesting. The most important thing is that this really expands my knowledge in dry eye and will change my clinical practice in dry eye care.

I receive the ACS-Santen grant to have an observation program in Department of Ophthalmology, Kyoto Prefectural university of Medicine (KPUM) from 4 June - 1 July 2016. It was very impressive and it has been my great experience and opportunity. I have a chance to see many interesting clinical practices which can be listed as the following,

Out patient department

I have seen many OCP and SJS cases which are relatively rare Thailand, I can learn how the doctors give the medical and surgical treatment in SJS clinic and also the usage of the hard CL to improve vision and protect the ocular surface.

I see post COMET/CLET patients who are doing very well and some had repeated surgery. I also see the post KEP, post DMEK, post DSEAK and cornea graft survival after 17 years, this reflects a very good surgical outcome in these patients.

One of the most interesting activity in KPUM is to attend the dry eye clinic. I have learned a new concept in dry eye diagnosis and treatment (TFOD & TFOT). This also give me a lot more insight in dry eye and tears dynamic which is very very impressive and interesting. The most important thing is that this really expands my knowledge in dry eye and will change my clinical practice in dry eye care.

Operating room

I have a chance to see buccal mucosa biopsy for COMET by the dentist, the technique is quite different from my place but it is more simply and easy. Furthermore, I have a chance to see 2 COMET surgery, many DSEAK including Re-DSEAK, combined Phaco with IOL and DSEAK and 1 DMEK. It is my great opportunity to see these surgeries, as in my country the technique are also different. We did not perform COMET in last 7 years, we do CLET using fibrin glue, we use Endoglide for DSEAK (In KPUM, they used Busin glide) and we never perform DMEK.

I am also impressed in conjunctivochalasis surgery, ptosis correction (Fasanella Sarvat procedure) performed by corneal specialist. This emphasises me that corneal specialist is also good and response in oculoplastic conditions related to ocular surface problems.

One more interesting technique I have learned from here is keratoepithelioplasty (KEP). KEP can be used in patient who suffered conjunctival invasion, Mooren ulcer or mild limbal deficiency. I found this technique very useful and I did perform KEP to my patient right after I came back to Thailand. The treatment result is very impressive and my patient is happy now.

LAB

I have less chance to visit the LAB as the endothelial cell culture projected has finished early in this year and was currently inactive. The COMET sheet preparation was conducted in CPC elsewhere. I once visited the culture LAB and saw some cultured endothelial cells. I did not have chance to see limbal epithelial stem cell culture.

However, I have a chance to visit Doshisha University where KPUM has a strong correlation and collaboration with, I can see how the students enjoy the work in the LAB and conduct their own research projects. This is very impressive and surprisingly inspire me to think of being in the LAB and do a basic research or take a PhD program which I used to overlook.

Other

I have very much impression in the electronic medical record (EMR) system. Not only the patient’s information but the investigation (such as wavefront data, corneal topography and OCT) photos and even VDOs are also kept well in the same system. The doctor can also draw a picture , create a graph form the data in the EMR. The flow in OPD is very fast, all the staffs and electronics do their best to make everything simply and quick for the patients.

The cornea topic in every Monday morning is very interesting and I have learned a lot from that, too. Thanks to the doctors’ kindness to present those topics in English, so that I can understand. The KPUM staffs gave me a very warm welcome and great hospitality. They teach me and take care of me the very best. It is such a valuable memory and opportunity for me. And at last, this can not happen without ACS-Santen Grant. Thank you so much ACS committees and secretariat for giving me such a wonderful opportunity. I can say that all the knowledge and experiences I have learned will be transferred to my patients in clinical practice and to my residents and fellows as well.