Waste production from phacoemulsification surgery.

PURPOSE: To determine the amount of waste produced from phacoemulsification surgeries and ways to curtail the problem. SETTING: Miri Hospital, Sarawak, Malaysia. DESIGN: Prospective study. METHODS: Phacoemulsification surgery cases were included in this study; nonphacoemulsification surgeries were excluded. The waste was subdivided into 3 main categories, general waste, clinical waste, and sharps. The waste produced by ophthalmologists and trainees was accounted for separately. The mean weight of waste per case was obtained by dividing the total weight of waste produced with the total number of cases. RESULTS: The total waste produced from a total of 203 cases of phacoemulsification surgeries was 167.965 kg, of which, 95.063 kg (56.6%) were clinical waste, 63.197 kg (37.6%) were general waste, and 9.705 kg (5.8%) were sharps; 32.193 kg (50.9%) out of the general waste pool were recyclable waste products. The mean waste production per case of phacoemulsification surgery for an ophthalmologist was 0.814 kg, 1.086 kg per case for a trainee. A case of phacoemulsification surgery would produce 0.282 kg of carbon dioxide equivalents in the setup based on the recyclable general waste. CONCLUSIONS: The average waste produced per case of phacoemulsification surgery in Miri Hospital was 0.827 kg. After excluding the recyclable material, the average waste produced per case was 0.669 kg. Following the 3 R's principles (reduce, reuse, and recycle) in the handling of waste production might reduce environmental impact.

Spectrum of Microbial Keratitis Encountered in the Tropics.

PURPOSE: To report the predisposing factors, microorganisms, antibiotic sensitivity associated with bacterial keratitis, and treatment outcomes in Miri, Borneo which has a tropical climate. METHODS: This is a retrospective study on patients presenting with microbial keratitis in Miri, Sarawak, Borneo over a 7-year period from January 1, 2010 until December 31, 2016. Demographic data, predisposing factors, culture and sensitivity results together with treatment outcomes were studied. RESULTS: There were a total of 221 cases treated as microbial keratitis with a peak age group of 21 to 30 years. The predisposing factors were trauma (49.3%), improper contact lens usage (29.1%), ocular surface diseases (5.9%), ocular surgeries (0.9%), drugs (1.8%), and other factors (19.0%). Occupational injuries among oil palm plantation workers was the leading cause within the trauma cohort (28.8%). Corneal scraping was performed in 189 cases, 61.4% of them yielded positive cultures. The cultures demonstrated that 49.1% were of bacterial origin, 46.6% were fungal, and 4.3% showed mixed growth. The most common bacteria isolated was Pseudomonas aeruginosa, which was sensitive toward ceftazidime and gentamicin antibiotics. One hundred ninety-two cases (86.9%) were treated with purely topical medication, whereas 29 cases (13.1%) required further interventions. CONCLUSION: The commonest predisposing factor for microbial keratitis was trauma. With the nearby oil palm industries, we report a corresponding increase of incidence in fungal keratitis at our center. Culture and sensitivity reports from corneal scrapings are essential in treatment guidance; however, more than a third of the microbial keratitis cases studied were culture-negative. The organisms cultured reflect the profile expected in tropical climates. Fortunately, there was no increase in resistance rates observed for the commonly used antibiotics.

BMI, BP, Visual Acuity and Hearing Status of Special Olympics Athletes in Sarawak

Special Olympics (SO) Inc. is an organization for people with intellectual disability (ID) to actively engaging in Olympic-type sport and participating in competition. Special Olympic Inc. provides Healthy Athletes Programme(HAP®) in screening and providing health education to Special Olympic Athletes. Objective To study the body mass index (BMI), blood pressure (BP), visual acuity and hearing status of children and young adult with ID in Special Olympics Sarawak. Methods Health data were collected by trained health professionals under HAP® held in conjunction with Special Olympics Sarawak State Games on 17th and 18th April 2010 in Sibu. Health data collected were athletes’ weight, BMI, BP, ear canal screen and hearing status (oto-acoustic emission, pure tone audiometry), as well as eye health and visual acuity, using guidelines set by HAP®. Results 195 athletes attended the State Games in 2010 of which 138 were screened. Significant number of athletes was considered overweight / obese (31.5% for children and 36.9% for adult). More than 20% of the adult athletes were hypertensive or at risk of hypertension. Sixteen percent of the adult athletes had hearing loss. More than half of the adult and children athletes never had eye checks, and a significant numbers of them had abnormal eye tests results. Conclusions Health screening conducted during the HAP® is a useful screening program in this population. Health data collected can bring awareness to athletes and their family, and corrective measures in hearing and visual impairment can be taken immediately.

The efficacy of timolol in gel-forming solution after morning or evening dosing in Asian glaucomatous patients.

AIMS: The aim of this study was to determine the effectiveness of timolol gel-forming solution as a monotherapy and to compare the efficacy of timolol gel-forming solution morning instillation versus at night application in Asians with newly diagnosed open-angle glaucoma. METHODS: A retrospective, comparative, parallel group study was conducted on 78 eligible patients diagnosed with open-angle glaucoma who received topical timolol gel-forming solution either on morning (AM dosing group; 39 patients) or evening (PM dosing group; 39 patients) as monotherapy treatment. Intraocular pressure was taken at baseline, 1, 3, 6, and 12 months post-treatment. RESULTS: Mean baseline intraocular pressure (IOP) for timolol gel-forming solution in general was 22.7 +/- 6.6 mmHg with the mean IOP reduction of 5.7 +/- 5.3 mmHg (23.1% reduction). The mean IOP reduction of the AM dosing group was 7.5 +/- 5.2 mmHg (31.0% reduction) and 3.9 +/- 4.9 mmHg (15.1% reduction) in the PM dosing group (P = 0.0002). There was a statistically significant difference of IOP reductions between AM and PM dosing group at 1 month (P = 0.041), 3 months (P = 0.037) and 12 months (P = 0.015) post-treatment. Seventy-five percent (24) of good responders was in the AM group and 67.4% (31) of poor responders were patients in the PM group. CONCLUSION: Timolol gel-forming solution is effective in reducing IOP in Asian eyes. Morning dosing was more effective in lowering the IOP compared to evening dosing.