Dr Chanat NITHITHANAPHAT

Ramathibodi Hospital

Mahidol University

Bangkok, Thailand

'I am very grateful to see many techniques including cataract surgery and PKP.'

'I had a great chance to meet up with many famous ophthalmologists, not only from Asia but also all over the world.’

Keio University School of Medicine, Japan – from 15 May 2017 to 26 May 2017

My inspiration of doing an observership program at Keio university school of medicine is because of a dry eye expert who published many articles, Prof. Kazuo Tsubota. So I decided to contact his secretary, Catherine, via e-mail. She is very accommodating.

I attended his dry eye clinic and observed many kinds of treatment, for example different sizes of punctal plugs, including free-size plugs which can fit to all puncta, many types of tear supplements, or even oral medications such as codeine to relieve pain in dry eye patients. He introduced me to his newly invented moisture chamber glasses for patients whose dryness does not resolve from conventional therapy.

Moreover, I had a valued opportunity to join a new clinic called pain clinic, which runs by Dr. Miki Uchino. There are several patients who suffered from eye pain according to ophthalmic conditions or after refractive surgery and sometime we could not find the causes of them from routine examination. For me, I always say to most of my patients that everything is alright and they do not have to worry. Anyway, they still complain on every visit. She taught me on how to evaluate the whole part of the patient not only their eyes but also their mind. Now I know that I should spend more time to find the real cause of these patients.

With Dr. Yuichi Uchino, I joined his cornea clinic and his operation on the penetrating keratoplasty (PKP) with complicated cataract surgery cases. He is a very careful and generous cornea surgeon. He showed many new drugs and told me how to use them correctly in different patients, such as tranilast in treating recurrent pterygium, diquafosol which recently became available in Thailand, and rebamipide which we do not have yet.

Furthermore, in the operating room with Dr. Shimmura, he always performs every surgery fast even if it is a complicated case. I am very grateful to see many of his techniques including cataract surgery and PKP.

Finally I would like to thank to all the cornea doctors at Keio and Asia Cornea Society for this great opportunity. Hopefully this program will continue for other young cornea ophthalmologists to gain more experience and to bring all the knowledge back to improve quality of life of the patients in their hometowns.

Kyoto Prefectural School of Medicine – From 03 June 2017 to 18 June 2017

In the last two weeks of my observership program, I spent most of my time at Kyoto Prefectural School of Medicine or KPUM. Here, I had a great chance to meet up with many famous ophthalmologists, not only from Asia but also all over the world. There are several clinics relating to the cornea, for examples dry eye clinic, contact lens clinic, Steven-Johnson syndrome (SJS) clinic and cornea and external diseases clinic.

In the dry eye clinic, I joined Dr. Yokoi clinic and discussed with him the patterns of dry eye and how to put the right treatment to each type of dry eye. Also, he introduced me to many new dry eye drugs that we do not yet have in Thailand. In the operating room I observed him performing permanent punctal occlusion using the granulation tissue from the caruncle and closing it tightly with absorbable suture. Moreover, he was an expert in conjunctival resection surgery the treatment of conjunctivochalasis. Even though I had listened to several of his lectures, these could not be compared with meeting him in person.

I had the opportunity to observe Prof. Sotozono and Dr. Inatomi in the cornea clinic. The epidemiology of eye diseases in Japan is different from Thailand. I saw a lot of Avellino corneal dystrophy cases here, which I had never seen in my professional life, and learned that phototherapeutic keratectomy (PTK) is the treatment of choice. Furthermore, I saw many SJS cases, which had a wide range of the disease severity. Besides, their treatments were different from ours too. Prof. Sotozono used large diameter rigid gas-permeable contact lens to protect the ocular surface and the cultivated oral mucosal epithelial transplantation (COMET) in the limbal stem cell deficiency cases. Most of the follow-up patients were doing well after surgery. Dr. Inatomi, who was very fluent in English, helped me understand the patients’ conditions and allowed me to observe his patients closely.

In the operating room at Baptist eye clinic, I watched them perform penetrating keratoplasty (PKP) using the femtosecond laser to excise both the donor and the recipient, which I had never seen before. Even in conventional PKP I could learn some new techniques like continuous sutures to reduce astigmatism and decrease surgical time.

At the contact lens clinic, I was amazed. There were many keratoconus patients, nevertheless, all are in good care of their conditions. There are many different types of rigid gas permeable (RGP) contact lens for them such as different base curves, diameters and even colors. Wearing RGP helped them to get their best vision without receiving any surgery.

Lastly I feel thankful to all of the staff at KPUM especially Prof. Sotozono, Dr. Yokoi, Dr. Inatomi and Yuki, whom I contacted all the time since I was in Thailand. None of these could have happened to me without Asia Cornea Society Santen grant. I am very appreciative of this opportunity and strongly recommend other young cornea ophthalmologist to apply for this delightful program.