Anophthalmic socket in retinoblastoma: Exploring complications and risk factors in a tertiary centre in Malaysia.

PURPOSE: To evaluate the complications of anophthalmic socket in retinoblastoma patients at a tertiary centre in Malaysia. DESIGN: Retrospective study. METHODS: Patients who underwent enucleation for retinoblastoma were reviewed from 2004-2020. Details were recorded, including demographics, diagnosis, surgical techniques, implant types, additional therapies, and complications. RESULTS: Of 250 patients with retinoblastoma managed over the period, the anophthalmic sockets of 160 eyes who underwent enucleation were analysed. The mean age at enucleation was 2.03 years (26 days to 9.18 years). The follow-up periods after enucleation range from 5 days to 16.83 years. Porous polyethylene (Medpor) implants were used in 135 patients (84.4%), as were Bioceramic in 9, glass balls in 7, acrylic in 7, dermis fat grafts in 1, and silicone implants (Aurosphere) in 1. The overall complications in our study were 28.8%. Complications seen in the study included implant exposure (12.5%), shallow inferior fornix (10.6%), granuloma formation (3.1%), discharge (2.5%), implant migration (1.9%), ptosis (0.6%), and orbital dystopia (0.6%). Implant exposure is solely found in Medpor, more common in those with donor sclera caps, and exposure times range from 28 days to 11.42 years. The suturing of the Tenon and conjunctiva in separate layers significantly reduced the rate of implant exposure. Six out of seven radiation patients had shallow inferior fornixes. CONCLUSIONS: Long-term post-enucleation complications were not uncommon. Luckily, most had good outcomes, with a few needing surgical intervention. Meticulous suturing technique on the Tenon and conjunctival layer is essential to prevent implant exposure.

Comparison of Weight-Gain-Based Prediction Models for Retinopathy of Prematurity in an Australian Population.

Purpose: Four weight-gain-based algorithms are compared for the prediction of type 1 ROP in an Australian cohort: the weight, insulin-like growth factor, neonatal retinopathy of prematurity (WINROP) algorithm, the Children's Hospital of Philadelphia Retinopathy of Prematurity (CHOPROP), the Colorado Retinopathy of Prematurity (CO-ROP) algorithm, and the postnatal growth, retinopathy of prematurity (G-ROP) algorithm. Methods: A four-year retrospective cohort analysis of infants screened for ROP in a tertiary neonatal intensive care unit in Brisbane, Australia. The main outcome measures were sensitivities, specificities, and positive and negative predictive values. Results: 531 infants were included (mean gestational age 28 + 3). 24 infants (4.5%) developed type 1 ROP. The sensitivities, specificities, and negative predictive values, respectively, for type 1 ROP (95% confidence intervals) were for WINROP 83.3% (61.1-93.3%), 52.3% (47.8-56.7%), and 98.4% (96.1-99.4%); for CHOPROP 100% (86.2-100%), 46.0% (41.7-50,3%), and 100% (98.4-100%); for CO-ROP 100% (86.2-100%), 32.0% (28.0%-36.1%), and 100% (98.3-100%); and for G-ROP 100% (86.2-100%), 28.2% (24.5-32.3%), and 100% (97.4-100%). Of the five infants with persistent nontype 1 ROP that underwent treatment, only CO-ROP was able to successfully identify all. Conclusions: CHOPROP, CO-ROP, and G-ROP performed well in this Australian population. CHOPROP, CO-ROP, and G-ROP would reduce the number of infants requiring examinations by 43.9%, 30.5%, and 26.9%, respectively, compared to current ROP screening guidelines. Weight-gain-based algorithms would be a useful adjunct to the current ROP screening.

Cavernous Sinus Thrombosis and Blindness Complicating Dental Infection.

A 32-year-old gentleman with underlying hypertension presented with left eye ptosis and diplopia for two weeks. He also complained of the left eye progressive blurring of vision. One week of left-sided toothache, headache, and fever preceded these symptoms. He visited a dental clinic for the toothache and was prescribed oral metronidazole before scheduling tooth extraction. However, the disease progressed with ocular symptoms. On examination, his visual acuity was 20/20 on the right and perception to light on the left. The left eye pupil was sluggish, and relative afferent pupillary reflex was positive. There was partial ptosis, mild proptosis, and ophthalmoplegia involving cranial nerve III, IV, and VI over the left. Hypoesthesia over the left V1 region was also present. Bilateral anterior and posterior segments were unremarkable. Blood investigations revealed an elevated total white cell count and C- reactive protein. Hence, an urgent computed tomography of the brain was requested and demonstrated left cavernous sinus thrombosis with diffuse thickening and enhancement extended anteriorly to the left orbital apex. He was admitted for intravenous ceftriaxone and subcutaneous enoxaparin. He was hemodynamically stable and allowed home with new direct anti-coagulants. He sustained the permanent sequelae of a left blind eye and residual cranial nerve palsies despite the treatment.

Descriptive assessment on diabetic retinopathy screening in an awareness programme in Malaysia.

AIM: To determine the prevalence of diabetic retinopathy (DR) among diabetic patients at the primary health clinics in Selangor, Malaysia. METHODS: All diabetic patients were screened in Retinal Disease Awareness Programme (RDAP) and those who had significant DR changes were referred to the hospital for further management. Descriptive analyses were done to determine the prevalence of DR and sociodemographic characteristics among patients with diabetic. Univariate and multivariable analysis using Logistic regression were performed to find association and predictor factors in this screening. RESULTS: A total of 3305 patients aged 40y and above were screened for DR. Of the patients screened, 9% patients were found to have DR and other visual complication such as maculopathy (0.9%), cataract (4.8%) and glaucoma (0.4%). The mean age of patients without retinopathy was 57.82±8.470y and the mean age of patients with DR was 63.93±9.857y. About 61.5% of the patients screened were aged below 60y and 38.5% were aged 60y and above. Majority of the patients screened were women 58.5% and Malay in the age group of 50-59y, while 27% were aged 60-69y. Significant association were found between age, sex, race, visual loss and DR. CONCLUSION: Although the prevalence of DR among patients is not alarming, effective interventions need to be implemented soon to avert a large burden of visual loss from DR.

Time delay and its effect on survival in malaysian patients with non-small cell lung carcinoma.

While evidence indicates that early stage disease has better prognosis, the effect of delay in presentation and treatment of patients with non-small cell lung cancer (NSCLC) on survival is debatable. A retrospective study of 122 Malaysian patients with NSCLC was performed to examine the presentation and treatment delay, and its relation with patient survival. Median (25-75% IQR) interval between onset of symptoms and first hospital consultation (patient delay) and between first hospital consultation and treatment or decision to treat (doctor delay) were 2 (1.0- 5.0) and 1.1 (0.6-2.4) months respectively. The median survival rates in patient delay of <1, 1 to 3, and >3 months were 4.1 (9.9-1.7), 5.1 (10.9-3.2) and 5.7 (12.3-2.1) months respectively (log rank p=0.648), while in doctor delay, <30, 30-60, >60 days, the rates were 4.1 (10.8-1.8), 7.6 (13.7-3.2) and 5.3 (16.0-3.0) months respectively (p=0.557). Most patients presented and were treated in a relatively short time, and delays did not appear to influence survival. This Asian data is consistent with those from Western population, reiterating the need for public health measures that can identify disease early..

Survival in Patients with Non-Small Cell Lung Cancer Who Opted out of Cancer-Specific Therapy.

In Malaysia, many patients opted out of cancer-specific treatment for various reasons. This study was undertaken to investigate the survival rate of patients with stages I to III non-small cell lung cancer (NSCLC) who opted out of treatment, compared with those who accepted treatment. Case records of 119 patients diagnosed with NSCLC between 1996 and 2003 in two urban-based hospitals were retrospectively examined. Survival status was ascertained from follow-up medical clinic records or telephone contact with patients or their next-of-kin. Median (25-75% IQR) survival rate for 79 patients who accepted and 22 patients who opted out of treatment, were 8.6 (16.0-3.7) and 2.2 (3.5-0.8) months respectively [log rank p< 0.001, Kaplan-Meier survival analysis]. Except for proportionately more patients with large cell carcinoma who declined treatment, there was no significant difference between the two groups in relation with age, gender, ethnicity, tumour stage, and time delays between symptom onset and treatment or decision-to-treat. We concluded that there was a small but significant survival benefit in accepting cancer-specific treatment. The findings imply that there is no effective alternative therapy to cancer-specific treatment in improving survival. However, overall prognosis for patients with NSCLC remains dismal.