ABSTRACT
@#Introduction: The aim of this study was to compare the visual outcomes of phacoemulsification with intraocular lens implantation (IOL) surgery in patients with and without diabetes mellitus (DM) in Malaysia over a 12-year period and to identify factors that may contribute to poor visual outcome. Materials and Methods: Data was retrieved from the webbased Malaysian Cataract Surgery Registry (CSR). Perioperative data for cataract surgery performed from 2007- 2018 were analysed. Inclusion criteria were age ≥40 years, phacoemulsification and IOL and senile cataract. Combined surgeries, surgeries performed by trainees and ocular comorbidities were excluded. Post-operative Best-Corrected Visual Acuity (BCVA) were compared. Factors affecting poor visual outcomes among those with DM were analysed using multivariate logistic regression to produce adjusted odds ratio (OR) for variables of interest. Results: Total number of cases between 2007-2018 was 442,858, of whom 179,210 qualified for our analysis. DM group consisted of 72,087 cases (40.2%). There were 94.5% cases in DM group and 95.0% from non-DM group who achieved BCVA ≥6/12 (p<0.001). Among patients with DM, advanced age (70-79 years old, OR: 2.54, 95% Confidence Interva, 95%CI: 1.91, 3.40; 80-89 years old, OR: 5.50, 95%CI: 4.02, 7.51), ≥90 years, OR: 9.77, 95%CI: 4.18, 22.81), poor preoperative presenting visual acuity [<6/18–6/60] (OR: 2.40, 95%CI: 1.84, 3.14) and <6/60-3/60 (OR: 3.00, 95%CI: 2.24, 4.02), <3/60 (OR 3.63, 95%CI: 2.77, 4.74)], presence of intraoperative complication (OR 2.24, 95%CI: 1.86, 2.71) and presence of postoperative complication (OR 5.21, 95%CI: 2.97, 9.16) were significant factors for poor visual outcome. Conclusions: Visual outcomes following phacoemulsification with IOL implantation surgery among cases with DM were poorer compared to cases without DM. Risk factors for poor visual outcomes among cases with DM were identified.
ABSTRACT
@#Objective: The aim of this study was to compare the postoperative refractive outcome after cataract surgery between a hospital-based and an outreach-based cataract service centre. Methods: This study was conducted at the Hospital Selayang (HS), Selangor, Malaysia, a tertiary referral centre and an outreach-based cataract service centre (Pusat Pembedahan Katarak MAIWP, PPKM). Data was sourced from the Cataract Surgery Registry (CSR) in the National Eye Database (NED). Results: A total of 2318 surgeries were analysed. PPKM achieved postoperative refraction outcome within ±1.0D in 94.3% of cases compared with 88.4% in Selayang Hospital. Mean absolute prediction error was also better in PPKM (0.39±0.27D vs. 0.33±0.24D, p<0.001). Multivariate analysis showed that the tertiary hospital, persons of Chinese ethnicity, history of uveitis, previous history of ocular surgery and intraoperative complications as significant independent predictive factors for poor refractive outcomes. Conclusion: The outreach-based cataract service centre, which incorporates streamlined process designs and workflows, achieved superior refractive outcomes within ±1 dioptre after cataract surgery compared to a tertiary hospital.
ABSTRACT
@#The aim of the present study was to evaluate visual functions and retinal morphology of Polypoidal Choroidal Vasculopathy (PCV) patients seen in an AMD referral centre of Malaysia and to further explore association between visual functions and optical coherence tomography (OCT) parameters in PCV eyes. In this single centre, cross sectional study, best corrected distance visual acuity (DVA), near vision acuity (NVA), reading speed (RS), and contrast sensitivity (CS) were measured in naïve PCV eyes. Selective parameters such as integrity of external limiting membrane (ELM), inner segment and outer segment junction (IS-OS), retinal pigment epithelium and Bruch’s membrane (RPE-BM) complex, average retinal thickness (ART) and volume (ARV), central retinal thickness (CT), centre maximum (CTmax) and centre minimum (CTmin) thickness were assessed using spectral-domain OCT. Forty-three new PCV eyes of 42 patients were evaluated. Mean (±SD) DVA, NVA, CS, RS were 0.83 ± 0.35 logMAR, 0.77 ± 0.3 logMAR, 0.69 ±.26 log CS and 59.56 ±14 words per minutes respectively. ART and CT showed good correlation with DVA (r=0.571& 0.546) and CS (r= 0.576 & 0.586). ARV and CTmax showed good correlation with CS (r=0.516 &, 0.513). The mean DVA, NVA and CS between three ELM and IS-OS status were significantly different (p=.002 & .000; p=.012 & .029; p=.005 & .001). In conclusion, present study reports visual functions and OCT characteristics of PCV patients in an AMD referral centre of Malaysia. Many of the quantitative and qualitative OCT parameters showed good association with the visual functions in eyes with PCV.