CRC HOSPITAL SHAH ALAM NEWSLETTER VOLUME 1, ISSUE 1 NOVEMBER 2017 In this issue: 2018 Words from the Director HSAS 2 Words from the Head of CRC 2 HSAS Venue: Introduction to CRC 2/19 CRC HSAS EVENTS 2017 3 HOSPITAL SHAH ALAM Ophthalmology Research Day 4-12 2017 Contributions & Achievements 13-17 of HSAS Clinical Audit 18 All rights reserved. © CRC.HSAS 2017 Clinical Research Centre, Hospital Shah Alam, Level 2 Tel: 035526300 (ext-3304/3305) Fax: 03 –55263217 Email: [email protected] 1ST CRC HOSPITAL SHAH ALAM RESEARCH DAY OPHTHALMOLOGY RESEARCH DAY 2017 INCONJUNCTION WITH 6TH SELANGOR RESEARCH WEEK 17TH-18TH August 2017 J m HOSPITAL SHAH ALAM Research Officiated by: Datin Sri Dr. Asmah binti Samat Deputy Director of Medical Development, MOH Winners Free Paper Competition: 1st Place: Poster Competition: Dr Faradatul Aisyah Abdul Aziz Success Rate & Complication of Augmented Trabeculetomy in 1st Place: Hospital Raja Perempuan Zainab II at Dr Chow Kit May 2 years. Anti Gq1b Antibody Syndrome : A Case Series 2nd Place: Dr Goh Hui Yin 2nd Place: Descemet's Stripping Automated Dr Valarmathy Vaiyavari Endothelial Keratoplasty (DSAEK): Recurrent Corneoscleral Cyst – Hospital Sungai Buloh Experience A Rare Occurrence 3rd Place: 3rd Place: Dr Nur Hanis Binti Yusri Dr Jacqueline Ting The Kuala Pilah Cluster Cataract Spontaneous Expulsive Study: The Changing Trend in Patient Suprachoroidal Haemorrhage In Blind Demography. Page 4 Page 5 TOP 10 ABSTRACTS FOR ORAL COMPETITION Comparison of smartphone wireless videography system to the conventional video recording system Successful Use of Intravitreal Tenecteplase for Management of Submacular Haemorrhage - A Case Series for ocular surgery Lee WY, Teh WM, Ling KP, Haslina MA Chan Jan Bond 1, Chong Wern Yih 2,3, Logeswari Krishna 4,5, Shatriah Ismail 2. Department of Ophthalmology, Hospital Sultanah Bahiyah, Alor Setar, Malaysia 1 Department of Ophthalmology, Hospital Shah Alam, Selangor; 2 Department of Ophthalmology, Universiti Sains Malaysia Kampus Kesihatan, Kelantan; 3 Department of Ophthalmology, Hospital Klang, Introduction:Tenecteplase (TNKase) is a recombinant tissue plasminogen activator (rTPA) indicated for acute Selangor; 4 Department of Ophthalmology, Hospital Melaka, Melaka; 5 Department of Ophthalmology, myocardial infarction. Its use in ophthalmology is off-label, but promising. This study was a retrospective Pusat Perubatan Universiti Malaya, Kuala Lumpur. clinical case series of six eyes treated with intravitreal TNKase (50mcg/0.1ml) for submacular haemorrhage of varying causes. We would like to share our experience and patient outcomes of using TNKase. Outcome Introduction: To compare smartphone videography system to conventional video recording technique in measures evaluated include anatomic displacement of submacular blood, change in visual acuity, and terms of video quality and cost effectiveness. possible adverse events. Methodology: This is a pilot, comparative observational study, involving patients from Hospital Tuanku Case Series:Six patients received intravitreal TNKase for submacular haemorrhage secondary to various Ja’afar Seremban ophthalmology department requiring cataract surgery. Ten surgical procedures were underlying pathologies, including idiopathic polypoidal choroidal vasculopathy in four eyes, and ruptured recorded simultaneously using both videography systems, out of which 10 seconds of the video was macroaneurysm and trauma in one eye each. In five of the six cases, TNKase was given in conjunction with sampled and evaluated by 50 medical personnels (doctor vs non-doctor). Both sample videos intravitreal perfluoropropane pneumatic displacement. Complete resolution of blood was achieved in five (conventional video and smartphone) were viewed simultaneously by viewer for 10 seconds and cases, while one developed a breakthrough vitreous haemorrhage. All patients either maintained or subsequently, the assessor graded the video using modified Absolute Category Rating (ACR) labeled as improved on their final visual acuity, except for the one with vitreous haemorrhage requiring vitrectomy. “bad”, “poor”, “fair” , “good”, and ‘excellent” and they were translated to Mean Opinion Score (MOS) Lesson Learnt:Intravitreal TNKase as an adjunctive therapy in displacement of submacular haemorrhage has ranging from 1 to 5. The cost of each videography system was calculated and compared. proven to be safe, with favourable outcome. Result: A total of 27 doctors and 23 non-doctors participated in the study. Smartphone videography had a Discussion/Conclusion:Despite the limited evidence base, we believe that intravitreal TNKase can be used in higher MOS value compared to conventional one in both groups (Doctor 4.1 vs 3.47, p = 0.03 ; non-doctor select patients with submacular haemorrhage to achieve a favourable outcome. Further studies are 4.44 vs 3.83, p <0.001) and combined group (4.22 vs 3.65, p <0.001). Smartphone videography system warranted to determine the efficacy and safety profiles of TNKase, as well as establish appropriate dosing was also cheaper than the conventional. regimens and other ocular routes of administration. Conclusion: Smartphone videography system, offers better video quality & cost effectiveness. It can help hospitals or clinics with no conventional video recording system to record ocular surgery. Pediatric Cataract Surgery in Malaysia- A Review of Visual Outcomes Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK): Hospital Sungai Buloh Experience LIM SEE THENG1, FIONA LEE MIN CHEW2, SURIYA EH QURUT 3, IZZAIFA HASSAN3, SUNDER RAMASAMY3, GOH HUI YIN, K JOHN MATHEN, SHAMALA RETNASABAPATHY JAMALIA RAHMAT3 Department of Ophthalmology, Hospital Sungai Buloh 1 Department of Ophthalmology, Universiti Kebangsaan Malaysia UKM, 2 Department of Ophthalmology, Hospital Selayang, 3 Department of Ophthalmology, Hospital Kuala Lumpur HKL Introduction: Corneal endothelial dysfunction is a significant cause of progressive blurring of vision. Over the past decade, there has been a revolutionary change in the treatment of corneal endothelial disease. Introduction:Outcomes of pediatric cataract surgery vary with cataract complexity, ocular growth, Cornea transplant surgical techniques have been refined to provide patients with faster recovery rate, associated ocular conditions and patient compliance to post-operative visual rehabilitation. Little is known lower corneal graft complications as well as better visual outcome. regarding the visual outcomes of non-traumatic pediatric cataract surgery in Malaysia. This study documents Methodology: This is a single centre, retrospective study conducted from December 2013 to November the visual outcomes of non-traumatic pediatric cataract surgery performed in a tertiary referral center in 2016. A total of sixty eyes of fifty-seven participants with corneal conditions such as pseudophakic bullous Malaysia. keratopathy, Fuch’s endothelial dystrophy and endothelial graft failure after corneal transplant Methodology:Case notes of all patients aged 12 years and below who underwent cataract surgery from underwent DSAEK performed by nine surgeons in Hospital Sungai Buloh. The participants were followed January 2010 to December 2015 in HKL were reviewed. Patients were recruited if they had primary cataract up every six months. The outcome measures studied included best-corrected visual acuity, graft surgery and a minimum of 6 months post-operative follow-up. Data collected included subjects’ attachment success rate and its associated complications. demographic details, past medical conditions and ocular examination findings. Intra-operative and post- Results: There was a significant improvement in the visual outcome of 87% of the participants. 90% of operative ocular findings at 1, 6 months and 1 to 5 years were documented. this surgery had a successful graft attachment rate. The remaining 10% of the participants required graft Results: A total of 111 subjects were recruited. The mean age at diagnosis and at surgery was 29.97(SD: rebubbling. Nine out of the sixty eyes had primary graft failure. Three of the nine patients underwent 32.49) months and 33.14(SD:33.47) months respectively. Males represented 55%(61/111) of subjects. repeat DSAEK and one of them achieved a satisfactory visual outcome of 6/12. Only one eye was Bilateral cataracts were found in 63.1%(70/111) subjects. Congenital cataract represented 78.4%(87/111) of converted to PK as there was a perforation of the donor cornea during microkeratome dissection. the cataracts. Pre-operative mean visual acuity was 1.6 (SD: 1.07) LogMar units. Intra-operative Conclusion: Endothelial keratoplasty is a minimally invasive surgery that offers excellent visual outcome complications were noted in 17% (19/111) subjects. Intraocular lens was implanted in the capsular bag for for patients with corneal endothelial dysfunction. It should be considered as the surgery of choice for 94.6%(105/111) subjects. The mean duration of follow-up was 29.71(SD: 18.78) months. At one month these patients in a suitable healthcare setting. review, 60.3%(67/111) subjects achieved spherical power within 1.0D of targeted refraction. At final review, the mean visual acuity was 0.52(SD:0.47) LogMar units . Conclusions: There is room for improvement to enhance visual outcomes of pediatric cataract surgery in Malaysia. Page 6 Page 7 Words from the Director of Hospital Shah Alam Assalamualaikum, Salam Sejahtera. CRC HSAS Events 2017 It is of paramount important that we as clinicians understand