Estimates of visual impairment and its causes from the National Eye Survey in Malaysia (NESII).

BACKGROUND: Population-based data on prevalence, causes of blindness and extent of ophthalmological coverage is required for efficient implementation and evaluation of ocular health programs. In view of the scarcity of prevalence data for visual impairment and blindness in Malaysia, this study aims to estimate the prevalence and causes of visual impairment (VI) in the elderly, using Rapid Assessment of Avoidable Blindness (RAAB) survey technique. METHODS: Malaysia was divided into six regions, with each region consisting of 50 clusters. Multistage cluster sampling method was used and each cluster contained 50 residents aged 50 years and above. Eligible subjects were interviewed and pertinent demographic details, barriers to cataract surgery, medical and ocular history was noted. Subjects had visual acuity assessment with tumbling 'E' Snellen optotypes and ocular examination with direct ophthalmoscope. The primary cause of VI was documented. Results were calculated for individual zones and weighted average was used to obtain overall prevalence for the country. Inter-regional and overall prevalence for blindness, severe VI and moderate VI were determined. Causes of VI, cataract surgical coverage and barriers to cataract surgery were assessed. RESULTS: A total of 15,000 subjects were examined with a response rate of 95.3%. The age and gender-adjusted prevalence of blindness, severe visual impairment and moderate visual impairment were 1.2% (95% Confidence Interval: 1.0-1.4%), 1.0% (95%CI: 0.8-1.2%) and 5.9% (5.3-6.5%) respectively. Untreated cataract (58.6%), diabetic retinopathy (10.4%) and glaucoma (6.6%) were the commonest causes of blindness. Overall, 86.3% of the causes of blindness were avoidable. Cataract surgical coverage (CSC) in persons for blindness, severe visual impairment and moderate visual impairment was 90%, 86% and 66% respectively. CONCLUSION: Increased patient education and further expansion of ophthalmological services are required to reduce avoidable blindness even further in Malaysia.

The Malaysian Cataract Surgery Registry: risk Indicators for posterior capsular rupture.

AIM: To identify the risk indicators for posterior capsular rupture (PCR) in the Malaysian Cataract Surgery Registry (CSR). METHODS: Data from the web-based CSR were collected for cataract surgery performed from 2008 to 2013. Data was contributed by 36 Malaysian Ministry of Health public hospitals. Information on patient's age, ethnicity, cause of cataract, ocular and systemic comorbidity, type of cataract surgery performed, local anaesthesia and surgeon's status was noted. Combined procedures and type of hospital admission were recorded. PCR risk indicators were identified using logistic regression analysis to produce adjusted OR for the variables of interest. RESULTS: A total of 150 213 cataract operations were registered with an overall PCR rate of 3.2%. Risk indicators for PCR from multiple logistic regression were advancing age, male gender (95% CI 1.04 to 1.17; OR 1.11), pseudoexfoliation (95% CI 1.02 to 1.82; OR 1.36), phacomorphic lens (95% CI 1.25 to 3.06; OR 1.96), diabetes mellitus (95% CI 1.13 to 1.29; OR 1.20) and renal failure (95% CI 1.09 to 1.55; OR 1.30). Surgical PCR risk factors were combined vitreoretinal surgery (95% CI 2.29 to 3.63; OR 2.88) and less experienced cataract surgeons. Extracapsular cataract extraction (95% CI 0.76 to 0.91; OR 0.83) and kinetic anaesthesia were associated with lower PCR rates. CONCLUSIONS: This study was agreed with other studies for the risk factors of PCR with the exception of local anaesthesia given and type of cataract surgery. Better identification of high-risk patients for PCR decreases intraoperative complications and improves cataract surgical outcomes.

Topical piperacillin/tazobactam for recalcitrant pseudomonas aeruginosa keratitis.

PURPOSE: To report the treatment of therapy-resistant Pseudomonas aeruginosa keratitis with topical piperacillin/tazobactam. METHODS: Retrospective report of 3 cases. RESULTS: Three patients with P. aeruginosa keratitis were unresponsive to various antimicrobials. Resolution of all 3 cases of keratitis occurred upon commencement of topical piperacillin/tazobactam. CONCLUSION: Therapy-resistant P. aeruginosa keratitis acquired from the community is becoming an increasing problem. Topical piperacillin/tazobactam is an option for the treatment of therapy-resistant P. aeruginosa keratitis.

The association between various visual function tests and low fragility hip fractures among the elderly: a Malaysian experience.

BACKGROUND: hip fractures are an increasing source of morbidity and mortality in older people. The role of visual function tests such as visual impairment, stereopsis, contrast sensitivity and visual field defects in low fragility hip fractures in Asian populations is not well understood. OBJECTIVE: to determine the association between various visual function tests and low fragility hip fractures in an Asian population. DESIGN: case-control study. SETTING: University Malaya Medical Centre, Kuala Lumpur, Malaysia. SUBJECTS: 108 cases aged > or = 55 years admitted with low fragility fractures and 108 controls (matched for age, gender and race). METHODS: both cases and controls underwent a detailed ophthalmological examination, which included visual acuity, stereopsis, contrast sensitivity and visual field testing. RESULTS: poorer visual acuity (odds ratio, OR = 4.08; 95% confidence interval, CI: 1.44, 11.51), stereopsis (OR = 3.60, 95% CI: 1.55, 8.38), contrast sensitivity (OR = 3.34, 95% CI: 1.48, 7.57) and visual field defects (OR = 11.60, 95% CI: 5.21, 25.81) increased the risk of fracture. Increased falls were associated with poorer visual acuity (OR = 2.30, 95% CI: 1.04, 5.13), stereopsis (OR = 2.11, 95% CI: 1.03, 4.32), contrast sensitivity (OR = 2.12, 95% CI: 1.05, 4.30) and visual field defects (OR = 3.40, 95% CI: 1.69, 6.86). CONCLUSION: impaired visual acuity, stereopsis, contrast sensitivity and visual field defects are associated with an increased risk of low fragility hip fractures. We recommend that all patients aged > or = 55 should have an annual ophthalmological examination that includes visual acuity, contrast sensitivity, stereopsis and visual field testing to assess the risks for falls and low fragility fractures.

Retinal phlebitis associated with autoimmune hemolytic anemia.

PURPOSE: To describe a case of retinal phlebitis associated with autoimmune hemolytic anemia. DESIGN: Observational case report. METHODS: A 44-year-old Indian man diagnosed with autoimmune hemolytic anemia presented with a 1-week history of blurred vision in both eyes. Fundus biomicroscopy revealed bilateral peripheral retinal venous sheathing and cellophane maculopathy. RESULTS: Fundus fluorescent angiogram showed bilateral late leakage from the peripheral venous arcades and submacular fluid accumulation. The retinal phlebitis resolved following a blood transfusion and administration of systemic steroids. CONCLUSIONS: Retinopathy associated with autoimmune hemolytic anemia is not well known. This is thought to be the first documentation of retinal phlebitis occurring in this condition.

47 XYY and morning glory syndrome--a unique association.

47 XYY syndrome is a sporadic condition in which the human male receives an extra Y chromosome. Few ocular associations have been documented. The authors report the first case of 47 XYY associated with morning glory syndrome, frontonasal meningoencephalocele, and midfacial defects.