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Introduction: A cross-sectional study was conducted to determine the associations of socio-demographic factors, eating behaviours, fast food purchasing by parents for family meals, and availability of neighbourhood fast-food outlets with BMI-for-age z-score (BAZ) among adolescents. Methods: Through multi-stage stratified cluster sampling method, a total of 420 adolescents from five selected public secondary schools participated in the current study. Data on socio-demographic factors, eating behaviours, and parent’s purchases of fast food were obtained through selfadministered questionnaires. The availability of fast-food outlets was assessed using Geographic Information System (GIS). Body weight and height of the adolescents were measured. Results: The prevalence of overweight, obesity, thinness and severe thinness among adolescents in the present study were 17.6%, 15.5%, 3.1% and 0.7%, respectively. The current findings showed that a higher monthly household income (rs =0.12, p=0.02) and less purchases of fast food by parents for family meals (rs =-0.11, p=0.03) were significantly associated with higher BAZ of the adolescents. However, there were no significant associations between eating outside of home, eating at fast-food restaurants, buying delivery fast food, and availability of neighbourhood fast-food outlets with BAZ. Multiple linear regression showed that less purchases of fast food by parents for family meals significantly contributed towards higher BAZ (β=−0.25, p=0.02). Conclusion: A higher household income and less fast food purchasing by parents were associated with higher BAZ. Fast food purchasing of adolescents were not associated with BAZ. Therefore, an appropriate obesity intervention programme should focus on adolescents and their parents from middle- and high-income households in Labuan.

Burkitt lymphoma is a rare and aggressive tumour which predominantly affects children. We report a case of Stage IV Burkitt lymphoma (non-endemic type) in a 5-year-old immunocompetent Malay child who initially presented with left upper eyelid swelling. Clinical examination revealed a soft solid swelling over the left upper lid, extending temporally up to the lacrimal gland. Computed tomography (CT) scan showed a homogenous mass of soft tissue density with intracranial and left orbital involvement. Incisional biopsy of the mass revealed histological changes suggestive of B lymphoblastic lymphoma or leukemia. She was treated with 6 cycles of chemotherapy. Post chemotherapy, the left temporal and upper eye lid swelling subsided. Clinicians need to be on alert when encountering children with eyelid swelling, as this could be an initial presenting feature of Burkitt lymphoma without other systemic symptoms. A delay in diagnosis can lead to aggressive orbital involvement followed by permanent visual loss.

There are various causes that can lead to compressive optic neuropathy. We present here orbital apex cyst as an unusual cause of compressive optic neuropathy in a 49-year-old male. He presented with 2 weeks painless loss of vision in the left eye with left-sided headache. He had had left functional endoscopic sinus surgery for left nasal polyps 4 years earlier. Magnetic resonance imaging of brain and orbit revealed a left discrete orbital nodule, possibly orbital cyst or mucocele, which was compressing on the left optic nerve. Left eye vision improved markedly from hand movement to 6/36 pinhole 6/18 after initiation of intravenous dexamethasone. A subsequent endoscopic endonasal left optic nerve decompression found the orbital nodule lesion to be an orbital cyst. Marsupialization was performed instead of excision, as the cyst ruptured intraoperatively. Postoperative vision improved to 6/7.5 with normal optic nerve function postoperatively. Possible cause of orbital apex cyst is discussed.

PURPOSE To study the prevalence of second eye cataract surgery (SECS), trend in time interval between subsequent surgeries over the years, and factors associated with SECS utilization among patients who underwent cataract surgeries in the Ministry of Health (MOH), Malaysia. DESIGN Secondary cross-sectional analysis of the Malaysian National Eye Database (NED) data. METHODS The Malaysian Cataract Surgery Registry collected data on patients who had cataract surgery from 2002-2004 and 2007-2012. Data collected included demography, operative events, time interval between 2 surgeries, and postoperative visual outcomes. Descriptive analysis was performed. RESULTS Total surgeries increased from 11,954 in 2002 to 30,265 in 2012 with a proportionate increase in SECS (30.7% in 2002 to 34.3% in 2012). Poor vision (

Aim: to study the prevalence, demographics, clinical and histolopathological features of orbital tumors biopsied in Hospital Serdang, a national Oculoplastic referral centre in Malaysia. Methods: A retrospective, observational study on all the consecutive orbital biopsies performed in Hospital Serdang from January 2008 to December 2014. Outcome measurement includes demographic data and histological diagnosis of biopsied orbital lesions. Results: Among a total of 136 cases, there is slight male preponderence (59.6%). Malay is the commonest racial group (58.8%) followed by Chinese (32.4%). Lymphoproliferative lesion is the most common category (34.6%) followed by inflammatory (10.3%) and lacrimal lesion (9.6%). Benign lymphoid hyperplasia (16.9%) and Non Hodgkin lymphoma(BHL) (16.2%) were the most common histology diagnosis. Those with benign lymphoid hyperplasia developed at a younger age (mean 56 years) compared to those with Non Hodgkin Lymphoma (60.6 years old). Benign lymphoid hyperplasia occurred at a same frequency at orbit and lacrimal gland whilst those NHL were mostly located within the orbit. Lymphoproliferative disorders are more common among male and Chinese. Our patients develop cavernous haemangioma, pleomorphic adenoma and solitary fibrous tumor at an earlier age than Western counterparts. Benign orbital lesions whilst being more common, may be associated with significant visual and orbital comorbidities. Conclusions: Lymphoproliferative lesions occur at a higher occurrence among Souteast Asian patients, especially among Chinese and male. Our patients also develop cavernous haemangioma, pleomorphic adenoma and solitary fibrous tumor at an earlier age compared to their Western counterparts. There is ethnic difference among different orbital pathologies. Delayed presentation of benign orbital lesions lead to significant morbidity and sometimes exenteration. Financial restraints may hinder clinicians in developing countries to obtain precise histological diagnosis.

Magnetic spheroid manipulation can be carried out in hanging drops to generate distinctly structured heterotypic microtissues through sequential addition of cells or spheroid to homotypic spheroids. These spheroids can also be incorporated in a droplet-based assay to screen for therapeutic efficacy in prolonged studies. This simple and versatile technique can offer potential benefits in tissue engineering and drug screening applications. ASTAR (Agency for Sci., Tech. and Research, S’pore) NMRC (Natl Medical Research Council, S’pore)

Purpose of review There have been many reports in recent literature concerning the use of scanning laser polarimetry, Heidelberg retinal tomography and optical coherence topography in assessing the optic nerve and peripapillary nerve fibre layer. It is important to assess the validity of new equipment and see whether this has improved our understanding of the disease. There are also reports about possible association of nonarteritic anterior ischaemic optic neuropathy with cataract surgery and phosphodiesterase type-5 inhibitors. This review attempts to look at some of the techniques used and possible associations with nonarteritic anterior ischaemic optic neuropathy. Recent findings Scanning laser polarimetry, Heidelberg retinal tomography and optical coherence tomography have been helpful in quantifying optic nerve and peripapillary retinal nerve fibre layer defects, with different efficacy and limitations. Although these confirm the damage to retinal nerve fibre layer beyond what is detected by standard visual field examination, the effect of cataract surgery and phosphodiesterase type-5 inhibitors remains to be further studied on a larger scale. The few experimental treatments for nonarteritic anterior ischaemic optic neuropathy also need further confirmatory studies. Summary More studies are required to evaluate the benefits of new imaging methods. The availability of a primate model may provide clues to assessing experimental treatments for nonarteritic anterior ischaemic optic neuropathy.

Purpose To review the clinical features and outcomes of pars plana vitrectomy (PPV) in patients with retained lens fragments after phacoemulsification and compare the results with those in previous studies. Setting Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom. Methods This retrospective chart review comprised 82 consecutive eyes of 82 patients who had vitrectomy for retained lens material after phacoemulsification between January 2000 and June 2006. Data on demographics, preexisting eye conditions, cataract surgery details, findings at presentation, interval between phacoemulsification and vitrectomy, details of vitrectomy, details of follow-up visits, and postoperative complications were collected. Results The incidence of raised intraocular pressure (IOP) was 46.3%. Anterior vitrectomy was associated with a lower incidence of increased IOP (P = .006). There was no association between late vitrectomy and a worse visual outcome. There was a much lower rate of complications than in other studies; the incidence of retinal detachment and of cystoid macular edema was 4.9%, and there were no cases of endophthalmitis. Conclusion The incidence of raised IOP in patients who had anterior vitrectomy at the time of cataract surgery was low. The visual outcomes were good, and the incidence of complications was low irrespective of the timing of the PPV.

To evaluate the long-term outcome of involutional entropion repair by means of a combined procedure of lateral tarsal strip and Quickert everting sutures.Noncomparative interventional case series of patients who underwent a combined procedure of lateral tarsal strip and Quickert sutures for treatment of involutional entropion between September 1999 and September 2002. Of 75 patients who underwent surgery, 36 were followed for at least 2 years. At the 2-year clinical examination, patient comfort, complications, recurrence rates, overcorrection, and cosmetic appearance were assessed.The average age of the 36 patients was 76.67 years. There were 5 bilateral cases, for a total of 41 eyelids. Nine eyelids underwent the procedure to correct recurrent entropion. The recurrence rate was 0% at 1 month after surgery, 2 of 41(4.9%) at 6 months, and 5 of 41 (12.2%) at 2 years. The recurrence rate after a primary procedure was 3 of 32 (9.4%), and, after a failed previous procedure, 2 of 9 (22.2%). There were no cases of secondary ectropion, and all patients were happy with their cosmetic appearance.A combined lateral tarsal strip and Quickert sutures procedure is effective, simple, and addresses all of the factors that contribute to involutional entropion formation, with a good long-term success rate and cosmetic outcome.

We report here a rare case of simultaneous onset of preseptal cellulitis in twins. The absence of any infection in three other siblings during this period would suggest that the twins may not have developed simultaneous lid infection by sheer coincidence. The authors discuss the possible mechanism and emphasize the need for close surveillance of the twin of an index case with ocular infection.

We report an HIV-positive patient who developed a unilateral retinitis and subsequent intracranial lesions. The finding of Epstein Barr virus (EBV) DNA at a > 1-log greater concentration in the vitreous compared to blood raised the possibility of a primary CNS non-Hodgkin's lymphoma, which was subsequently confirmed on brain biopsy. EBV DNA quantification acted as a diagnostic marker that led to a change in the management of our patient.

We report three cases of partial spontaneous canthal cross union, a rare complication in cases where Hughes flaps are used to reconstruct lower eyelid defects that also involve the canthi. All cases of spontaneous cross union were identified within 2 months of uneventful division of Hughes’ flap. Two cases were successfully divided with good aesthetic results although one patient was not keen on surgery, as it was aesthetically acceptable to him. The postulated mechanism was either the proximity of the divided nonepithelial margins or the failure to trim the residual upper eyelid tarsoconjunctival remnant. We recommended adequate trimming of the residual upper eyelid tarsoconjunctival remnant and an early postoperative review to prevent adhesions from developing.

Oxidative DNA damage may play an important role in the human carcinogenic process. Recently, we reported a case of bladder cancer among 4, 4'-methylenebis (2-chloroaniline) (MBOCA)-exposed workers. By measuring the plasma level of 8-hydroxydeoxyguanosine (8-OHdG), we investigated the association between oxidative DNA damage and MBOCA exposure. In addition, we examined the effects of different confounders on the plasma level of 8-OHdG. We undertook a cross-sectional survey at four MBOCA-producing factories in Taiwan (158 subjects). Plasma 8-OHdG levels and urinary MBOCA concentrations were measured by liquid chromatography coupled with tandem mass spectrometry (LC/MS/MS). Personal characteristics were collected by questionnaire. The workers were classified according to their job titles as exposed (n=57) or unexposed (n=101) groups as well as classified according to urinary MBOCA levels as high urinary MBOCA (20 microg/g creatinine) (n=45) or low urinary MBOCA (n=108) groups. Neither the MBOCA-exposed workers nor the high urinary MBOCA workers had a significant increase in the mean plasma 8-OHdG level, even after adjustment for potential confounders. Age and gender were significantly positively correlated with plasma 8-OHdG levels. Smokers among high urinary MBOCA workers also had significantly higher 8-OHdG levels than non-smokers among high urinary MBOCA workers. Our study provides evidence that smoking rather than MBOCA exposure induces elevation of plasma 8-OHdG levels among workers exposed to MBOCA, indicating that oxidative DNA damage does not play an important role in the carcinogenic processes of MBOCA.

We report an unusual case of unilateral spontaneous lens dislocation in a 52-year-old woman with a posterior polar cataract. We postulate that the increasing lens size secondary to nuclear sclerosis may have exerted pressure on a thinned posterior capsule, causing the capsule to rupture spontaneously. The unusual weak posterior capsule in posterior polar cataract is a well-recognized risk factor in phacoemulsification surgery. We believe this is the first report case of spontaneous lens dislocation secondary to posterior capsule rupture in posterior polar cataract.

Objective: We sought to find out whether birth weight of less than1251 g or gestational age less than 30 weeks could provide a safe and efficient screening criteria of detecting treatable retinopathy of prematurity (ROP). Methods: Infants either with a birth weight less than 1500 g or gestational age less than 32 weeks were screened for ROP during an 8-year period. Results: In our study, the incidence of ROP was 36 of 187 (19.3%) infants. Although there was a slight increase in the number of infants screened over the years, the incidence of ROP of any stage remained stable. The maximum stage of ROP reached was stage 1 in 10 of187 (5.3%), stage 2 in 8 of 187 (4.3%), and stage 3 in 18 of 187 (9.6%) infants. Among those with stage 3 disease, threshold ROP was present in 16 of 18 (88.9%). All infants with threshold ROP had a BW less than 1100 g and gestational age less than or equal to 28 weeks. Significantly fewer babies (105/187, or 56%) would have been examined had inclusion criteria of a birth weight of less than 1251 g and gestational age less than30 weeks been applied. In addition, 31% (134/437) of screening examinations could have been avoided. Conclusions: Our study suggests that a birth weight of less than 1251 g and gestational age less than 30 weeks can be safely and efficiently used to screen infants without missing a diagnosis of sight-threatening ROP in our catchment population.

To report a case of spontaneous lens dislocation following pupillary dilatation during preoperative assessment for cataract surgery. Our patient had been punched on the left side of the face 40 years ago but throughout this period the patient’s vision had remained normal and ophthalmic evaluation by opticians had also been normal on multiple visits. He was referred to our clinic for cataract assessment. Detailed ophthalmic evaluation, including pupillary dilatation with fundus evaluation,had revealed no evidence of anterior or posterior segment trauma. He presented 1 week later with lens dislocation. The dislocated lens was successfully removed. We recommend that caution be exercised (even in the presence of normal ophthalmic evaluation) when dilating patients with an apparently trivial/or old history of trauma to the face.