Towards Vision 2020 -Trends of Cataract Surgery in Melaka Hospital, A Malaysian Tertiary Center: 2007-2014.

Background Cataract surgery which is the only scientific method to treat cataracts has evolved from large incisions of intracapsular cataract excision to extracapsular cataract exicison and now modern day phacoemulsification. Anaesthesia too has progressed from general anaesthesia to local and topical anaesthesia. A variety of intraocular lenses are available ranging from rigid to foldable, multifocal and toric. Day care surgeries are becoming the norm these days. Objective Cataract surgery has advanced with new techniques and modalities. We studied the trends of cataract surgery and outcomes over the years. Method We performed secondary data analysis (National Eye Database) of cataract surgery patients in Hospital Melaka (2007 - 2014). Result Most patients were 60-69 years (mean 65.0 years). Primary cataract rose (p<0.05) but there was no difference in laterality and first or second eye (p>0.05). More patients presented with Hypertension and Diabetes (p<0.05). Pterygium encroaching the cornea showed a rise (p<0.05). Phacoemulsification (80.8%) showed a rise while Extracapsular Cataract Extraction (ECCE) (15.4%) declined (p<0.05). More Specialists operated and fewer combined surgeries were performed (p<0.001). Type of anaesthesia did not change (p>0.05). Operative complications reduced (p<0.001). Anterior chamber, scleral fixated and foldable intraocular lenses usage reduced (p<0.05). There was no change in pre-operative visual acuity (p>0.05) but postoperative vision showed a rise in good outcomes (p<0.05). Conclusion Melaka Hospital shows a rise in phacoemulsification and a decline in Extracapsular Cataract Extraction. More patients presented with primary cataracts. More Specialists operated and there was a reduction in intraoperative and postoperative complications. Post-operative visual outcomes showed a remarkable improvement. This improvement is in keeping with the aim of improved vision for all by 2020.

Effects of Bauxite and Alumina Exposure on Incidence of Cancer - Meta-analysis.

Bauxite is an ore from which Aluminium is produced. Malaysia, once the leading producer of bauxite has reduced production as mining activity has caused community outrage. Due to concerns about health concerns, rising pollution and environmental hazards, the government has revoked the licenses of bauxite miners. We therefore did a meta-analysis to assess the relationship between exposure to Bauxite and Alumina with incidence of various types of cancers. Bauxite mines and alumina refineries. Individuals of all ages exposed to Bauxite and Alumina. Exposure to bauxite and alumina. Incidence due to overall cancers and specific types of cancers. Exposure to bauxite and alumina did not cause variations in incidence of overall cancer and specific types of cancer such as cancer of lip, cancer of the oral cavity and pharynx, cancer of digestive organs and others. We conclude that there is no evidence that bauxite or alumina exposure cause increase incidence of cancer but due to the small number of studies included in this review, we recommend more cohort studies to be done in future.

Cataract Surgery Incidence Trends in a Tertiary Public Hospital in Malaysia.

Background Since cataract is the leading cause of blindness and no study has been done on the surgical incidence trends, we conducted this research in Melaka. Objective To describe incidences of cataract surgery according to basic demographic variables and types of surgery performed. Method Using the National Eye Database (NED), we performed descriptive statistics calculating incidence rates per 1,000 population by demographic features and types of cataract operations to look at the trends of surgeries in the population. Statistics for population were obtained from the department of statistics. Result From 2007-2010, 6270 patients mostly 60-69 years underwent cataract surgery. Phacoemulsification (78.2%) was the commonest surgery performed. The annual incidence rate of cataract surgery reduced from 2.05 per 1000 population in 2007 to 2.02 per 1000 population in 2010 (p<0.05). Incidence rates for those aged 60 and above rose while for those aged below nine years it declined. Indians had the highest incidence rates followed by Chinese and Malays per 1000 population. Females had a higher incidence rate although there was a declining trend over the years. Conclusion Cataract surgery rates showed a decline. Public health education and awareness on detection and operating upon cataracts should be increased and especially targeted towards vulnerable groups such as women, individuals of Indian ethnicity and those aged 50 years and above.

Visual outcome following posterior capsule rupture during phacoemulsification in a tertiary care hospital in Malaysia.

PURPOSE: To analyse the visual outcomes of cases with posterior capsule rupture (PCR) compared to those without PCR following phacoemulsification. The occurrence of posterior capsule rupture during phacoemulsification surgery for cataract can have serious implications in the visual recovery. However, recognition of PCR and proper management can yield a successful visual outcome. This study analysed the visual outcomes of cases with PCR compared to those without PCR. METHODS: This is a case-control study. All patients who underwent cataract surgery from 2011 to 2012 in Hospital Melaka were traced from the National Eye Database (NED) of Malaysia. The visual outcomes were classified as good, borderline and poor as per WHO guidelines. The data was analysed with SPSS version 12 IBM. RESULTS: Out of 80.4% (2519) of eyes that had undergone phacoemulsification (PHACO) type of surgery, 3.06% (77 cases) had posterior capsule rupture complication. There was no significant difference in the visual outcome of borderline between cases with PCR and cases without PCR (Odds Ratio (OR) 0.989; 95% Confidence Interval (CI) 0.382- 2.560). However, cases with PCR were significantly less likely to have good vision compared to those without PCR (OR 0.335; 95% CI 0.157-0.714). CONCLUSION: The study reveals that a significant number of patients without PCR had good vision, whereas those with PCR did not get good vision. We would like to suggest meticulous care during phacoemulsification surgery to avoid PCR in order to obtain good visual outcomes.

Outcome of phacoemulsification and extracapsular cataract extraction: A study in a district hospital in Malaysia.

AIM: The aim of the study was to compare the outcomes of phacoemulsification (Phaco) and extracapsular cataract extraction (ECCE) in a district hospital setting. METHODS: A retrospective analysis was done from the medical records of the patients who underwent Phaco and ECCE in Temerloh District Hospital, Pahang state between October 2009 and September 2010. The age, gender and ethnicity of the patients, intraoperative and postoperative complications, and the best corrected visual acuity at the last follow-up visit were noted. Statistical analysis was done using Stata Software Version 11.0. The results of the two procedures were compared. RESULTS: Out of the 179 cataract surgeries performed, 146 cases were Phaco and 33 were ECCE. In our study, 82 were men and 97 were women. The age of patients ranged from 39 to 82 years; majority of the patients (71.3%) were more than 60 years of age. There was a significant association between type of surgery and outcome of visual acuity (p = 0.001). There was no significant association between intraoperative complication and type of surgery (p = 0.166). Postoperative complications of the surgeries were not significantly different. Good visual outcome was noted in 80.1% of eyes operated by Phaco compared to 48.5% of eyes operated by ECCE procedure. CONCLUSION: Since the visual outcome was significantly better in Phaco compared to ECCE procedure (p = 0.001), we recommend that Phaco equipments should be supplied in the district hospitals with adequate facilities for performing intraocular surgery.

Visual outcome in open globe injuries.

OBJECTIVE: To determine the factors affecting the visual outcome in patients with open globe injuries of eye. MATERIALS AND METHODS: In a prospective interventional study of consecutive patients with open globe injuries, the age, gender, place of injury, object causing injury and safety precautions taken were recorded. A detailed examination of the eye was done with a slit-lamp. X-rays of the orbits were taken in order to determine the presence of a foreign body. The injuries were classified as simple or complicated depending on the involvement of the pupil/iris, lens and retina. Finally, post operative best-corrected visual acuity at last follow up was noted. RESULTS: Fifty-two patients (52 eyes) were included in the study. The mean age of patients was 27.25±12.62 years (range 9-73 years). The majority of injuries occurred in the workplace (36.5%); nail (15.4%) and glass (15.4%) were the most common objects causing injury. Of those with good initial visual acuity, 90% maintained good visual outcome. Patients with corneal lacerations of less than 5 mm had significant good visual outcome. The number of corneal lacerations and visual axis involvement did not affect the visual outcome. Those with corneoscleral lacerations had significantly poor visual outcomes compared to those with corneal or scleral lacerations alone. CONCLUSION: Predictors of good visual outcome are good initial visual acuity, a corneal laceration wound of less than 5mm, a deep anterior chamber, and simple lacerations. Age, gender, place of injury, object causing injury, presence of hyphema or intraocular foreign body, and the use of safety precautions did not affect the visual outcome.

Prevalence of eye diseases and visual impairment among the rural population - a case study of temerloh hospital.

OBJECTIVE: To determine the prevalence of eye diseases and visual impairment among new patients at the eye clinic of Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang. METHOD: In this cross-sectional prospective study, 1081 new patients were examined over a period of six months. Age, gender, ethnicity, visual acuity and diagnosis were noted from the medical records. RESULTS: Out of 1081 examined, 607 (56.1%) were males, 783 (72.4%) were Malays. The mean age of patients was 45.2 years (ranging from one month to 91 years). Cataract (248, 22.9%) was the most common eye disease, followed by retinal diseases (124, 11.5%) and ocular trauma (106, 9.8%). Majority of the patients (48) suffering from ocular trauma had foreign body cornea. In 85 premature infants screened for retinopathy, 19 showed different stages of retinopathy of prematurity. Visual impairment was noted in 89 (8.2%) patients, severe visual impairment in 12 (1.1%) and blindness in 35 (3.2%); vision could not be determined in 85 premature infants (7.9%). Cataract was singled out as the cause of severe visual impairment in 11 out of 12 patients. CONCLUSION: Health education at primary health centres and availability of eye specialists in all the district hospitals will facilitate the rehabilitation of visually impaired and blind persons by providing early treatment for eye problems (specifically prescription for spectacles, medical treatment and cataract surgery with intraocular lens implantation).