Malaysian Journal of Ophthalmology

Influence of COVID-19 pandemic on the cataract services in a district hospital

James Wen Siang Lim — 2024-07-04

Purpose: In March 2020, COVID-19 was declared a pandemic by the World Health Organization. The COVID-19 pandemic significantly disrupted the healthcare system, including the number of elective ophthalmic procedures conducted worldwide, resulting in a large-scale deferment of cataract surgeries after the Malaysian government recommended to postpone all nonessential elective surgeries to minimise the virus transmission and to augment the hospital resources to cope with a surge in COVID-19 cases. This study assessed the influence and impact of the COVID-19 pandemic on the cataract services in a district hospital.

Study design: Retrospective descriptive analysis.

Methods: This study analysed cataract surgery services in the period between January 1, 2017 and 31 December 31, 2021. Data were extracted from the electronic medical records. The study population was further divided into 3 groups according to the COVID-19 pandemic status: pre-pandemic, lockdown and recovery phase.

Results: A total of 8,125 eyes were included in this study. During the lockdown phase, there was a 42% decline in the number of surgeries done compared to the pre-COVID-19 phase. A higher number of patients (53.5%) presented with severe visual impairment or blindness during the lockdown phase as compared to 40.2% during the pre-COVID-19 phase. The number of lens-related complications was markedly higher (2.58%) during the lockdown phase, as compared to the pre-COVID-19 phase (0.64%). During the end of the recovery phase studied, there was an early increment in the number of surgeries done, surpassing that of the pre-COVID-19 phases.

Conclusion: The COVID-19 pandemic caused a drastic reduction in the number of cataract surgeries performed during the lockdown phase, causing more patients to suffer from avoidable blindness due to cataract, and leading to a higher rate of lens-related complications. An intuitive approach and reorganisation of ophthalmic care services are essential in order to lessen the backlog without causing burnout among healthcare workers.

Improving patient compliance for intravitreal injections during the COVID-19 pandemic

Andrew Zhijian Low — 2024-07-04

Purpose: Intravitreal injections (IVT) of anti-vascular endothelial growth factor are standard treatment procedures in ophthalmology for many retinal diseases. We conducted a full-cycle clinical audit to evaluate patient compliance with IVT in Penang Hospital during the COVID-19 pandemic.

Study design: Full cycle audit.

Methods: A 3-month audit was carried out on patients scheduled to receive IVT in the operation theatre between August and October 2019 (COVID-19 pre-pandemic period). Patient compliance rates were calculated. We set a target of 95% patient compliance rate. Interventional steps taken to improve compliance were carried out from April 2020 to September 2021 (during the Movement Control Order period). A 3-month re-audit was conducted between October and December 2021.

Results: A total of 481 patients were scheduled for IVT, and 50 patients (10.4%) did not present to the appointment. The compliance rate was 89.6%. The reasons for defaulting treatment included multiple hospital visits, transportation issues, cost of transportation, loss of daily wages, and fear of COVID-19 infection. Post-intervention, a total of 895 patients were scheduled for IVT in 3 months. Among these patients, 844 patients completed their IVT appointment, while 51 patients missed the scheduled IVT. The patientsâ€™ compliance rate also rose from 89.6% to 94.3%. There was also an increase of 87.1% in the total number of scheduled IVT as compared to the pre-intervention phase.

Conclusion: These interventions not only increased the number of patients receiving treatment but also improved patientsâ€™ compliance with IVT despite the COVID-19 pandemic. Patients benefited from reduced hospital visits, the cost of follow-up, and the risk of hospital infection.

Endogenous endophthalmitis in a tertiary centre of northern Malaysia: a case series and literature review

Jiah Bou Koay — 2024-06-27

Background: Endogenous endophthalmitis is an uncommon ophthalmological emergency caused by hematogenous spread of infection from a distant focus. It can lead to permanent blindness, panophthalmitis, enucleation, or evisceration. Difficulties are often encountered in making a diagnosis, yielding cultures of causative pathogens and selecting appropriate antibiotics.

Case series: We describe 4 cases treated in Hospital Sultanah Bahiyah from 2021 to 2022. The studied cases belonged to a high-risk group in common with at least 1 predisposing medical condition. Endogenous endophthalmitis was caused by different etiologies and demonstrated various clinical manifestations. Two patients were initially misdiagnosed and later referred to our centre. The identified pathogens were predominantly Gram-negative bacteria, i.e., Klebsiella variicola and Pseudomonas aeruginosa. Magnetic resonance imaging was utilized in 1 patient to help distinguish an infection from a metastatic carcinoma. All patients received intravitreal antibiotics. Two patients underwent vitreoretinal surgery and were able to achieve 2/60 or better postoperatively. One patient required evisceration and another developed phthisis bulbi.

Conclusion: Aggressive screening for occult infection is important to identify the source of infection and guide appropriate antibiotic treatment. Early diagnosis and prompt antimicrobial treatment are crucial to prevent devastating complications.

Symptomatic pigment dispersion with intraocular pressure elevation attributed to intracameral moxifloxacin after open-globe injury

Yamiko Jessica Chanza — 2024-06-27

Background: Intracameral moxifloxacin is commonly used following intraocular surgery to prevent endophthalmitis. Pigment dispersion is a rare complication of moxifloxacin use that has mainly been reported following systemic administration.

Case presentation: We report a case of unilateral pigment dispersion three weeks after open-globe repair with intracameral moxifloxacin presenting with pain, redness, photophobia, elevated intraocular pressure, marked pigment liberation, new iris transillumination defects and pigment deposits on the anterior iris surface.

Conclusion: Symptomatic unilateral pigment dispersion with IOP elevation following intracameral moxifloxacin is a rare entity, but it is a crucial complication for clinicians to be aware of as intracameral antibiotic use following intraocular surgery becomes more frequent.

Acute cerebral venous sinus thrombosis presenting in papilloedema: a case report

Indra Tri Mahayana — 2024-07-04

Background: Papilloedema has several aetiologies, including brain tumours, central nervous system inflammation, cerebral venous thrombosis, cerebral venous sinus thrombosis (CVST), and idiopathic intracranial hypertension. CVST is a rare condition and a form of stroke with an incidence of 5:1,000,000/year.

Case presentation: A 23-year-old female developed impaired vision in her left eye, accompanied by headache, nausea, and vomiting, 5 weeks prior to hospitalization. Visual acuity in the left eye (OS) was 6/12, which improved to 6/9 on pinhole examination, and to 6/6 with S-0.50 and C-0.50 on the 180Â° axis. OS intraocular pressure (IOP) was 14 mmHg. Bilateral funduscopic examination revealed papilloedema, peripapillary venous tortuosity, and macular exudate. Both computerised tomography scan and magnetic resonance angiography examination detected superior sagittal sinus thrombosis.

Conclusion: Acute CVST is a rare condition. A good prognosis depends on early diagnosis and prompt treatment.