Optical and Tectonic Corneal Transplant Outcomes in a Tertiary Hospital in Singapore within the Singapore Corneal Transplant Registry

<p><b>INTRODUCTION</b>This study aimed to describe and compare corneal graft survival and optical outcomes following deep anterior lamellar keratoplasty (DALK) and Descemet's stripping automated endothelial keratoplasty (DSAEK) with penetrating keratoplasty (PK), and to document tectonic success of patch grafts.</p><p><b>MATERIALS AND METHODS</b>This was a retrospective, non-randomised, comparative and descriptive cohort study. A total of 139 eyes that underwent primary keratoplasty between 2000 and 2016 were included, and the following data was extracted: demographics, clinical diagnosis and primary indication, pre- and intraoperative risk factors, postkeratoplasty outcomes, and complications. Optical success was defined as good graft clarity and best corrected visual acuity (BCVA) of 6/12 or better. Graft failure was defined as irreversible corneal oedema and loss of clarity. Tectonic success in patch grafts was defined as tectonic integrity with no repeat tectonic surgical procedure required in the postoperative period.</p><p><b>RESULTS</b>The mean follow-up duration was 3.24 ± 3.47 years in the PK group (n = 16), 1.89 ± 0.86 years in the DALK group (n = 37), 2.36 ± 1.24 years in the DSAEK group (n = 53), and 2.17 ± 1.09 years in the patch graft group (n = 33). The 3-year probabilties of survival for PK, DALK, DSAEK and patch graft were 60.9%, 94.1%, 89.9%, and 67.1%, respectively. The overall percentage of complications was significantly higher for PK (81.3%), compared to DALK (48.6%), DSAEK (49.1%), and patch graft (21.2%). In the PK and DALK groups, 100% achieved DSAEK (49.1%), and patch graft (21.2%). In the PK and DALK groups, 100% achieved BCVA of 6/12 or better, while in the DSAEK group, 96.43% achieved BCVA of 6/12 or better.</p><p><b>CONCLUSION</b>From a similar study cohort of Asian eyes, graft survival was superior and complications were reduced for DALK and DSAEK compared to PK, but optical outcomes were comparable. Graft survival for patch graft was expectedly lower, but the incidence of complications was low.</p>

Myopia in young patients with type 1 diabetes mellitus

<p><b>INTRODUCTION</b>This study aimed to evaluate the proportion of young patients with type 1 diabetes mellitus (T1DM) who have myopia, as well as the risk factors associated with myopia in this group.</p><p><b>METHODS</b>In this cross-sectional study, patients aged < 21 years with T1DM for ≥ 1 year underwent a comprehensive eye examination. Presence of parental myopia, and average hours of near-work and outdoor activity were estimated using a questionnaire. Annualised glycosylated haemoglobin (HbA1c), defined as the mean of the last three HbA1c readings taken over the last year, was calculated. Multivariate analysis using genetic, environmental and diabetes-related factors was done to evaluate risk factors associated with myopia.</p><p><b>RESULTS</b>Of the 146 patients (mean age 12.5 ± 3.6 years) recruited, 66.4% were Chinese and 57.5% were female. Myopia (i.e. spherical equivalent [SE] of -0.50 D or worse) was present in 96 (65.8%) patients. The proportion of patients with myopia increased from 25.0% and 53.6% in those aged < 7.0 years and 7.0-9.9 years, respectively, to 59.2% and 78.4% in those aged 10.0-11.9 years and ≥ 12.0 years, respectively. Higher levels of SE were associated with lower parental myopia (p = 0.024) and higher annualised HbA1c (p = 0.011).</p><p><b>CONCLUSION</b>Compared to the background population, the proportion of myopia in young patients with T1DM was higher in those aged < 10 years but similar in the older age group. Myopia was associated with a history of parental myopia. Environmental risk factors and poor glycaemic control were not related to higher myopia risk.</p>

One-year study of clinical course and natural history of congenital heart disease with defective pulmonary flow

30 children with various types of congenital heart disease and defective pulmonary flow were studied during (1993 -1994) for clinical course and natural history. 15 of them needed repeated hospitalization for hypercyanotic spell, and other complications. The other cases were followed the Cardiac Out-patient, Department of Yangon Children Hospital, North Okkalapa General Hospital and Insein General Hospital. Although there was no mortality, one child had bacterial endocarditis. Another two had learning difficulties. Early diagnosis, prevention and early medical management of hypoxic spell can prevent complications of hypercyanotic spell up to certam level but surgical shunt operation and corrective surgery is the choice of management for defective pulmonary flow.

Essential element contents of surface and artesian well water in Yangon area

A total of 91 samples of water collected from 18 townships within Yangon area comprising 31 numbers of surface wells and 60 numbers of artesian wells were chemically examined. All samples were determined for their concentrations of elements such as iodine, calcium, magnesium, iron, copper and zinc with the corresponding depths of wells. Average iodine contents of water was found to decrease as the depth of well increased. Magnesium concentration was also observed in the same manner as iodine. Calcium concentration was more in surface well water and no difference among artesian wells water. There was no relationship between calcium concentrations and the depths of the wells.

One year study of clinical course on children with hyperkinetic pulmonary hypertension

26 out of 105 children with congenital heart diseases were studied in a period of one year (1992-93) 26 children with hyperkinetic pulmonary hypertension presented in different forms of congenital heart disease (Table 3) and continued in different clinical courses. 5 cases of hyperkinetic pulmonary hypertensions died (Table 4) and the remaining 21 hyperkinetic pulmonary hypertension were under medical care. 10 cases of hyperkinetic pulmonary hypertension were waiting for corrective surgery. Early diagnosis and medical care, can prevent irreversible hyperkinetic pulmonary hypertension, and can bring about a favourable condition for corrective surgery and can even avoid early death.

A study of glucose and insulin profiles in acute viral hepatitis patients

Oral glucose tolerance tests, with 75 gm of glucose load were carried out on 25 patients suffering from acute viral hepatitis including 15 pregnant women and on 25 apparently normal subjects. the mean fasting blood glucose level of hepatitis patients (62.3 - 2.6 mg/dl) was found to be significantly (p<0.01)lower than that of normal subjects (73.6 - 2.0mgdl). After drinking the glucose solution hepatitis patients generally had higher blood glucose levels compared to normal sbjects. Blood glucose and plasma insulin concentration were measured in another 35 acute viral hepatitis patients after an overnight fast, to study the relation between these values and the parameters of liver Function Test. The fastion blood glucose level was found to be inversely correlated to SGOT and SGPT level in these patients.

Squamous cell carcinoma arising in three unusual conditions

Squamous cell carcinoma developed in patients having (1)Lepromatous (Unhealed) Ulcer (2) Snake bite (Unhealed) Ulcer (3) Operated scar in KNOWN DIABETIC (No similar recorded instances of such conditions could be found in the literature.

Unusual case of a lump in the breast

An unusual case of a lump in the breast which turn out to be due to cysticercus cellulose is presented.