Evaluation of Prevalence and Associated Factors of Dry Eye Syndrome among Medical Students Exposed to Visual Display Terminal in Health Campus, Universiti Sains Malaysia

@#Introduction: Dry eye syndrome (DES) has become a public health concern, especially during the COVID-19 pandemic. Medical students are at risk due to an increase in visual display terminal (VDT) exposure given the transition to full-time online lectures. The presence of reduced blink rate and tear film instability in VDT users causes an increase in tear evaporation leading to symptoms of DES. This study helps us to learn about the associated factors of VDT use and DES among the young generation. This study aims to determine the prevalence and associated factors of DES among medical students exposed to VDT at the health campus, Universiti Sains Malaysia (USM). Methods: A cross-sectional study involving 140 undergraduate medical students aged 22 to 29 years old who were VDT users. Factors analysed are age, gender, race and duration of VDT usage. Data collection included both subjective assessment (OSDI questionnaire) and objective assessment (TBUT and Schirmer’s test). Statistical analysis was conducted using Statistical Package for the Social Science (SPSS Inc Version 24). Results were analysed using descriptive analysis and multivariate logistic regression. Results: Most of the medical student cohort was female and Malay. Most of the students use VDT for less than 8 hours. A high incidence of DES was noted among medical students (92.1%). None of the factors showed significant association with positive findings DES by subjective and objective assessment and duration of VDT usage. Conclusion: DES is common among VDT users. This study showed a high prevalence of DES among medical students in USM. The factors analysed did not show a significant association between DES and duration of VDT usage. This study may help to recognize the problem and will raise awareness of their daily practice and implement preventive measures to avoid VDT-related DES.

Clinical characteristics and outcomes of paediatric orbital cellulitis in Hospital Universiti Sains Malaysia: a five-year review.

INTRODUCTION: Limited data is available on paediatric orbital cellulitis in Asia. We aimed to describe demographic data, clinical presentation, predisposing factors, identified microorganisms, choice of antibiotics and management in children with orbital cellulitis treated in a tertiary care centre in Malaysia. METHODS: A retrospective review was performed on children with orbital cellulitis aged below 18 years who were admitted to Hospital Universiti Sains Malaysia, Kelantan, Malaysia, between January 2013 and December 2017. RESULTS: A total of 14 paediatric patients fulfilling the diagnostic criteria for orbital cellulitis were included. Their mean age was 6.5 ± 1.2 years. Boys were more likely to have orbital cellulitis than girls (71.4% vs. 28.6%). Involvement of both eyes was observed in 14.3% of the patients. Sinusitis (28.6%) and upper respiratory tract infection (21.4%) were the most common predisposing causes. Staphylococcus aureus (28.6%) was the leading pathogen. Longer duration of hospitalisation was observed in those infected with methicillin-resistant Staphylococcus aureus and Burkholderia pseudomallei. 10 (71.4%) patients were treated with a combination of two or three antibiotics. In this series, 42.9% had surgical interventions. CONCLUSION: Young boys were found to be more commonly affected by orbital cellulitis than young girls. Staphylococcus aureus was the most common isolated microorganism. Methicillin-resistant Staphylococcus aureus and Burkholderia pseudomallei caused severe infection. Sinusitis and upper respiratory tract infection were the most common predisposing factors. A majority of the children improved with medical treatment alone. Our findings are in slight disagreement with other published reports on paediatric orbital cellulitis, especially from the Asian region.

Rapid anterior capsular contraction after phacoemulsification surgery in a patient with retinitis pigmentosa.

A decrease in the anterior capsule opening after cataract surgery has been observed in eyes with weakened lens zonules. It commonly occurs in diabetes mellitus, uveitis, pseudoexfoliation syndrome, high myopia, and elderly patients. Herein, we report the case of a middle-aged man with advanced retinitis pigmentosa who developed a rapid contraction of the anterior capsule after an uneventful phacoemulsification surgery that resulted in severe visual loss during the early postoperative period.

Intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage.

Herein, we report our experience in treating extensive traumatic submacular hemorrhage with a single dose of intravitreal ranibizumab. A 23-year-old healthy Malay man presented with a progressive reduction of central vision in the left eye of 2 days' duration following a history of blunt trauma. Visual acuity was reduced to counting fingers. Examination revealed infero-temporal subconjunctival hemorrhage, traumatic anterior uveitis, and an extensive sub-macular hemorrhage with suspicion of a choroidal rupture in the affected eye. He was initially treated conservatively with topical prednisolone acetate 1%. The subconjunctival hemorrhage and anterior uveitis resolved but his vision remained poor with minimal resolution of the submacular hemorrhage at 1 week follow-up (day 12 post-trauma). In view of the poor resolution of submacular hemorrhage, he was treated with a single dose of 0.5 mg intravitreal ranibizumab at day 20 post-trauma. At 4 weeks post-intravitreal ranibizumab, there was an improvement in visual acuity (from counting fingers to 6/45) and complete resolution of the submacular hemorrhage with presence of a choroidal rupture scar temporal to the fovea, which was not seen clearly at presentation due to obscuration by blood. His visual acuity further improved to 6/18 at 3 months post-trauma. Although this single case had a favorable outcome, a large population cohort study is needed to establish the effectiveness of intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage.

Spontaneous bilateral anterior lens dislocation in an 8-year-old girl.

The authors describe recurrent lens dislocation into the anterior chamber in a young girl with homocystinuria. The patient's 12-year-old sister died after a cerebrovascular accident caused by the same disease. This report highlights the importance of early dietary restrictions and treatment.

Successful treatment of a refractory stromal fungal keratitis by intrastromal injection of amphotericin B / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To report a successful intrastromal injection of amphotericin B 5mg/L in a refractory fungal keratitis.METHODS: An interventional case report RESULTS: A 48-year-old lady presented with history of redness of the right eye for one week duration followed by decrease in vision and corneal opacity for two days. There was no histow of trauma or foreign body. Examination revealed visual acuity of 6/16 with pinhole of 6/12 of the right eye. The conjunctiva was injected with minimal eye discharge. There was a full thickness stromal abscess at the paracentral area of the cornea. It was irregular,feathery margin with few satellite lesions. There was no epithelial defect noted. Hypopyon level was also seen.The left eye was normal. A presumptive diagnosis of fungal keratitis was entertained. Despite three weeks of intensive treatment with topical amphotericin B every 2 hours and natamycin every 4 hours and antibiotic cover,the lesion showed no sign of resolution. It grew larger and a new focal lesion of stromal abscess appeared at the 12 o'clock position. We decided to proceed with an intrastromal injection of amphotericin B 5mg/L in lieu of therapeutic penetrating keratoplasty. The size of the ulcer was substantially reduced with total disappearance of hypopyon. There was no ocular toxicity observed following the intervention. Patient regained her normal visual acuity of 6/6 after 2 months of intervention.CONCLUSION: An intrastromal injection of amphotericin B 5mg/L provides an alternative method of treating refractory fungal keratitis. It is also shown to be an effective and safe procedure with promising results.

A unilateral mild anterior uveitis due to intralenticular foreign body / 国际眼科杂志(Guoji Yanke Zazhi)

A 25-year man presented with symptom of photophobia and tearing in the right eye for 2 months duration. It was associated with painless gradual reduced vision. There was a history of hammering on a metal object prior to that. Ocular examination revealed signs of mild anterior uveitis due to a retained metallic intralenticular foreign body. Conjunctiva was white. Computed Tomography (CT) scan of the orbit confirmed presence of a single intraocular foreign body. The condition is misleading and can be easily overlooked. A detailed history and clinical examination are mandatory in this misleading situation.