Descemet stripping endothelial keratoplasty versus penetrating keratoplasty in bullous keratopathy: A 2-year analysis of graft survival and outcomes in a tertiary eye centre in Kuala Lumpur.

INTRODUCTION: This study aims to compare the 2-year graft survival and outcomes of descemet stripping endothelial keratoplasty (DSEK) and penetrating keratoplasty (PK) for the treatment of bullous keratopathy (BK) among multiethnic Malaysia populations treated at a Tertiary Eye Centre in Kuala Lumpur, Malaysia. MATERIALS AND METHODS: This was a retrospective study of BK or Fuchs endothelial dystrophy (FED) patients who underwent DSEK or PK from 2015 to 2019 in Kuala Lumpur Hospital with a minimal post-operative follow-up of 2 years. Outcome measures included best-corrected visual acuity (BCVA), graft survival and complications. A total of 26 DSEK cases and 32 PK cases were included. RESULTS: At 2 years, graft survival rates were quite similar in two groups (DSEK 80.8% vs PK 75%, p=0.765). The mean follow-up period was 35.2 months in DSEK and 31.4 months for PK (p=0.465). The cumulative survival rates were slightly higher in the DSEK group (DSEK 73.1% vs PK 53.1%, p=0.119), but the result was not statistically significant. Postoperative complications were associated with higher graft failure in both groups (p=0.019). DSEK group has better post-operative BCVA (LogMAR DSEK 0.42 vs PK 0.83, p=0.003). CONCLUSION: Similar graft survival rates were observed with both corneal transplant techniques for 2 years among Malaysian patients with BK. Post-operative complications can cause a higher risk of graft failure. DSEK produced better post-operative BCVA compared to PK.

Cultivated oral mucosal epithelial transplantation (COMET) and penetrating keratoplasty in long-standing severe ocular surface injury.

Ocular chemical injury is a true ophthalmic emergency requiring immediate medical intervention. Damages can be devastating and potentially resulting in blindness, corneal perforation and phthisis bulbi. We describe here a successful treatment outcome in a patient who sustained Roper-Hall Grade 4 injury to both eyes. Patient received medical therapy followed by serial ocular surgeries with eventual visual recovery in one eye from counting finger to 6/15 after a decade. In conclusion, after maximum medical therapy, a carefully planned serial surgeries of cultivated oral mucosal epithelial transplantation (COMET) and PK has proven beneficial for this patient with advanced limbal stem cell deficiency (LSCD).

Survival of antibiotic resistant Escherichia coli in vacuumpacked keropok lekor: Food safety alert among SME keropok lekor producers.

The microbiological quality of thirty ready-to-eat (RTE) keropok lekor (a sausage shape Malaysian fish product) was evaluated in comparison to microbiological guidelines for ready to eat foods. The two E. coli isolates were subjected to DNA sequencing, identified and tested for their resistance towards fifteen different antibiotics. The survival and growth of the isolated E. coli strains inoculated in keropok lekor at atmospheric air and vacuum packaging were also evaluated. Results revealed that four samples (13.33%) contained Enterobacteriaceae counts that exceeded the recommended allowable counts of 4.0 log10 CFU/g. Unsatisfactory level of coliforms (< 1.7 log10 CFU/g) was also observed in ten of the samples; two of which contained E. coli (2.1 ± 0.17 and 3.7 ± 0.02 log10 CFU/g), suggesting of poor hygiene and sanitation practices. While the 'Possible E10' E. coli strain was observably resistant towards Nalidixic acid (30µg) alone, B10 E. coli isolate was worryingly resistant towards Ampicillin (10µg), Ceftazidime (30µg), Ciprofloxacin (5µg), Ceftriaxone (30µg), Nalidixic acid (30µg) and Tetracycline (30µg). This study also revealed that the growth and survival of the 'Possible E10' and B10 E. coli strains were not significantly affected by vacuum packaging when stored at both 4°C and 28°C. Therefore, intervention programmes to alert and educate smallmedium enterprisers (SMEs) of keropok lekor producers on food safety as well as potential health risks that can be associated due to inappropriate handling procedures of such product, merits consideration.

Mupirocin resistance among Malaysian isolates of methicillin-resistant Staphylococcus aureus.

Four hundred methicillin-resistant Staphylococcus aureus strains (MRSA) from different geographical areas in Malaysia were tested for mupirocin susceptibility using minimum inhibitory concentration (MIC) determination. The majority of these strains (98.75%) were susceptible to mupirocin with MICs of < or = 4 mg/l. Fifty-percent of these strains had MICs of 0.125 mg/l or less while 90% of the strains had MICs of 1 mg/l or less. Mupirocin resistance was detected in five strains (1.25%) and one of these (0.25%) had an MIC of 64 mg/l and the other four strains (1%), high-level resistance with MICs > 512 mg/l. Even though the rate of mupirocin resistance in MRSA is still low in Malaysia, its presence calls for a strict policy on mupirocin usage in Malaysian hospitals.