AIM: To report the treatment of macular oedema secondary to idiopathic retinitis, vasculitis, aneurysrns,and neuroretinitis (IRVAN) with intravitreal triamcinolone.METHODS: Case report.RESULTS: A patient diagnosed with IRVAN with visual loss secondary to macular oedema. The macular oedema and her visual acuity was improved dramatically with the administration of intravitreal triamcinolone.CONCLUSION: Previous reports recommend treatment of IRVAN with panretinal photocoagulation, vitrectomy,systemic and periocular steroids. Our case shows that intravitreal triamcinolone appears to be a safe and effective treatment for macular oedema and vasculitis secondary to IRVAN.

AIM:To determine tear function tests values,Schirmer Ⅰ test(S Ⅰt),tear film break-up time(TBUT)in patients with pterygium.METHODS:A total of 100 eyes(50 with primary pterygium and 50 without pterygium)of 50 patients who fulfilled the inclusion criteria were evaluated for S Ⅰt and TBUT.RESULTS:The mean S Ⅰ t value in eyes with pterygium was 19.6±11.6(range 1-40)mm and in control eyes without pterygium was 17.2±10.6(range 1-35)mm.S Ⅰ tresults were abnormal in 20 eyes(40%)with pterygium and in 21 eyes(42%)without pterygium(control);the difference was not statistically significant(P= 0.75).The difference between the groups was not statistically significant(f= 1.453,P=0.15).The TBUT in eyes with pterygium was 7.4±5.1(range 2-20)seconds and in control eyes without pterygium was 13.4±6.1(range 2-25)seconds.The difference between the groups was statistically significant(f = 8.029,P＜0.01).The TBUT was abnormal in 39 eyes(78%)with pterygium and in 16 control eyes(32%);the difference was statistically significant(P＜0.01).CONCLUSION:There was no significant difference in S Ⅰ t in eyes with pterygium compared to eyes without pterygium.There is reduction of TBUT in eyes with pterygium.

Otitis externa is an infection of the external auditory canal. It rarely results in facial palsy except in severe cases such as necrotizing otitis externa, which is a life-threatening invasive infection of the external auditory canal. Early recognition with prompt and appropriate treatment of necrotizing otitis externa is crucial to prevent more sinister complications. Here we report a case of an elderly gentleman who presented with otitis externa and developed facial palsy a month later. We identified possible problems that may have led to the complication so that such an occurrence can be prevented in the future.

In the study, we used oil palm residues (empty fruit bunch, EFB) as raw material to produce cellulosic ethanol by pretreatment, enzymatic hydrolysis and fermentation. Firstly, the pretreatment of EFB with alkali, alkali/hydrogen peroxide and the effects on the components and enzymatic hydrolysis of cellulose were studied. The results show that dilute alkali was the suitable pretreatment method and the conditions were first to soak the substrate with 1% sodium hydroxide with a solid-liquid ratio of 1:10 at 40 degrees C for 24 h, and then subjected to 121 degrees C for 30 min. Under the conditions, EFB solid recovery was 74.09%, and glucan, xylan and lignin content were 44.08%, 25.74% and 13.89%, respectively. After separated with alkali solution, the pretreated EFB was washed and hydrolyzed for 72 h with 5% substrate concentration and 30 FPU/g dry mass (DM) enzyme loading, and the conversion of glucan and xylan reached 84.44% and 89.28%, respectively. We further investigated the effects of substrate concentration and enzyme loading on enzymatic hydrolysis and ethanol batch simultaneous saccharification and fermentation (SSF). The results show that when enzyme loading was 30 FPU/g DM and substrate concentration was increased from 5% to 25%, ethanol concentration were 9.76 g/L and 35.25 g/L after 72 h fermentation with Saccharomyces cerevisiae (inoculum size 5%, V/V), which was 79.09% and 56.96% of ethanol theory yield.
Alkalies ; chemistry ; Biofuels ; Ethanol ; metabolism ; Fermentation ; Lignin ; chemistry ; Palm Oil ; Plant Oils

A 2-year-old girl who was under genetic follow up for developmental delay and dysmorphism was accidentally found to have bilateral optic disc swelling during screening examination. She showed response to optokinetic drum examination and the anterior segment examination was unremarkable. Optic disc swellings were seen in both eyes. Lumbar puncture shows high opening pressure of 50 cm H2O with unremarkable CSF analysis. MRI of brain was done and showed features in keeping with mild cerebral atrophy, with no evidence of hydrocephalus or space occupying lesion. She was diagnosed with idiopathic intracranial hypertension and oral acetazolamide 125mg bd was commenced. However, papilloedema persist despite medical therapy. Ventriculoperitonel shunt was inserted to reduce the csf pressure. This case report highlights the importance of considering idiopathic intracranial hypertension as a cause of optic disc swelling in pre-pubertal children because delay in diagnosis and treatment may permanently affect visual function especially in children.

Introduction: The aim of this study was to compare the visual outcomes of phacoemulsification with intraocular lens implantation (IOL) surgery in patients with and without diabetes mellitus (DM) in Malaysia over a 12-year period and to identify factors that may contribute to poor visual outcome. Materials and Methods: Data was retrieved from the webbased Malaysian Cataract Surgery Registry (CSR). Perioperative data for cataract surgery performed from 2007- 2018 were analysed. Inclusion criteria were age ≥40 years, phacoemulsification and IOL and senile cataract. Combined surgeries, surgeries performed by trainees and ocular comorbidities were excluded. Post-operative Best-Corrected Visual Acuity (BCVA) were compared. Factors affecting poor visual outcomes among those with DM were analysed using multivariate logistic regression to produce adjusted odds ratio (OR) for variables of interest. Results: Total number of cases between 2007-2018 was 442,858, of whom 179,210 qualified for our analysis. DM group consisted of 72,087 cases (40.2%). There were 94.5% cases in DM group and 95.0% from non-DM group who achieved BCVA ≥6/12 (p<0.001). Among patients with DM, advanced age (70-79 years old, OR: 2.54, 95% Confidence Interva, 95%CI: 1.91, 3.40; 80-89 years old, OR: 5.50, 95%CI: 4.02, 7.51), ≥90 years, OR: 9.77, 95%CI: 4.18, 22.81), poor preoperative presenting visual acuity [<6/18–6/60] (OR: 2.40, 95%CI: 1.84, 3.14) and <6/60-3/60 (OR: 3.00, 95%CI: 2.24, 4.02), <3/60 (OR 3.63, 95%CI: 2.77, 4.74)], presence of intraoperative complication (OR 2.24, 95%CI: 1.86, 2.71) and presence of postoperative complication (OR 5.21, 95%CI: 2.97, 9.16) were significant factors for poor visual outcome. Conclusions: Visual outcomes following phacoemulsification with IOL implantation surgery among cases with DM were poorer compared to cases without DM. Risk factors for poor visual outcomes among cases with DM were identified.