Retinoblastoma is a rare intraocular malignant tumour more commonly seen in children below five years of age. We presented a rare case of retinoblastoma in an older child. A nine-year-old girl noticed that she had loss of vision OS following a fall at home. Her vision was 6/6 OD and only light perception OS. Examination of the left eye revealed an extensive exudative retinal detachment. Her right eye examination was unremarkable. CT scan showed a left eye intraocular mass with calcification. EUA revealed a mixed endophytic and exophytic mass with extensive exudative retinal detachment. Family members consented to left eye enucleation and histopathological report confirmed the diagnosis of retinoblastoma. Post enucleation, patient is doing well with a prosthetic eye. In conclusion, any unexplained visual loss in children regardless of age warrants a full ophthalmological examination as the possibility of retinoblastoma cannot be ruled out.

Purpose: The prevalence of retinopathy of prematurity (ROP) is higher in developing countries compared to developed countries. There is limited data on vision-related quality of life (VRQoL) among children with severe type of ROP in developing countries. This study evaluated the influence of threshold and prethreshold ROP on VRQoL in Malaysian children. Methods: Multicenter prospective cross-sectional study conducted in three tertiary hospitals in 2018 to 2019. Children less than 7 years old with previous ROP diagnosis were recruited. Patients with systemic comorbidities that affected vision or daily activities were excluded. A parent or guardian completed the Children’s Visual Function Questionnaire (CVFQ) for the assessment of child’s general health, general vision, competence, personality, family impact, and treatment difficulty. Results: Eight were categorized with threshold ROP, 16 with high-risk prethreshold ROP, and 26 with low-risk prethreshold ROP. Fifty age-matched controls were also included. Mean visual acuity in logarithm of the minimum angle of resolution was 0.46 in the threshold, 0.08 in high-risk prethreshold, and 0.01 in low-risk prethreshold subgroups. Threshold ROP was associated with myopia and strabismus, and associated with poor visual acuity compared to prethreshold ROP. Mean total CVFQ score was significantly lower in the ROP group (p < 0.001) compared to the control group. Mean score and all mean subscale scores were significantly lower in the threshold subgroup compared to high-risk and low-risk prethreshold subgroups, with lowest subscale scores on general vision and general health. There was significant association between gestational age, visual acuity of the better eye, family income, and VRQoL (p < 0.05). Conclusions ROP was associated with lower VRQoL in children born prematurely in Malaysia. The threshold ROP group is the most affected. General vision and health domains are their main difficulties encountered. Gestational age, visual acuity of the better eye, and family income affects the VRQoL.

RetCam is an excellent screening tool for the detection of retinopathy of prematurity (ROP). However, affordability is a barrier when adopting the use of RetCam in developing countries. We aimed to describe different stages of ROP using ultrasonographic B-scan and to evaluate the association between funduscopic examinations and ultrasonographic B-scan findings in premature neonates with ROP in Malaysia. A descriptive cross sectional study was conducted in 90 eyes of 47 premature neonates with different stages of ROP in three tertiary hospitals in Malaysia. Experienced ophthalmologists performed detailed funduscopic examinations using binocular indirect ophthalmoscopy (BIO). A masked examiner performed a 10 MHz ultrasonographic B-scan evaluation with 12 meridian position images within 48 hours of clinical diagnosis. Data from the clinical examination and ultrasonographic findings were collected and analysed. We recruited 37 eyes (41.1%) with stage 1 ROP, 29 eyes (32.3%) with stage 2, 18 eyes (20.0%) with stage 3, and 3 eyes (3.3%) with stages 4 and 5 based on the clinical assessment. Ultrasonography correctly identified 3 (8.1%) stage 1 eyes, 17 (58.6%) stage 2 eyes, 13 (72.2%) stage 3 eyes, and 3 each (100%) of the stage 4 and 5 eyes. There was a significant association between the funduscopic signs and the ultrasound findings for stage 2 ROP and above (Fisher’s exact test, p <0.001). In conclusion, all stages of ROP were detected and described with a 10 MHz ultrasonic B-scan system. A significant association was observed between funduscopic signs and ultrasonographic findings in premature Malaysian neonates with stage 2 ROP and above.

Introduction: Little is known regarding the extent of visualimpairment amongst pre-school children in Malaysia.Objective: To determine the prevalence of visual impairmentand amblyopia in Malaysian preschool children.Methodology: A cross-sectional, population-based studywas conducted on children aged four to six years from 51participating kindergartens in the district of Segamat, Johor,Malaysia from 20 March 2016 to 6 April 2016. All subjects hadinitial eye screening consisting of LogMar visual acuity,orthoptics examination and Spot vision screenerassessment. Subjects who failed the initial eye screeningwere invited for a formal eye assessment consisting ofcycloplegic refraction and a comprehensive ocularexamination. Definitions of visual impairment and amblyopiawere based on the Multi-Ethnic Pediatric Eye Disease Studycriteria.Results: A total of 1287 children were recruited. Meansubject age was 5.03 (SD:0.77) and males represented 52.3%of subjects. Subjects by ethnicity were Malay (54.8%),Chinese (27.7%), Indian (15.6%) and Orang Asli (1.9%).Formal eye assessment was required for 221 subjects and88.8% required ophthalmic intervention. Refractive error,representing 95.4% of diagnosed ocular disorders,comprised of astigmatism (84%), myopia (9%) andhypermetropia (6.9%). With-the-rule astigmatism waspresent in 93.4% of the subjects with astigmatism. Visualimpairment was present in 12.5% of our subjects, with 61%having bilateral visual impairment. Of the subjects withvisual impairment, 59.1% had moderate visual impairment.The prevalence of amblyopia was 7.53%, and 66% of theamblyopic subjects had bilateral amblyopia.Conclusion: Our study highlights an urgent need forinitiation of preschool vision screening in Malaysia.

Paediatric cataract surgery is challenging with reported post-operative visual acuity (VA) of 0.3LogMar or better varying between 33% to 68% of patients. OBJECTIVE: The aim is to document the post-operative refraction, VA and complications of non-traumatic pediatric cataract surgery performed in a tertiary referral center in Malaysia.

Objective: To determine the socio-demographic and clinical profile of exotropia surgery outcomes amongst paediatric patients. Methods: This is a descriptive, retrospective, clinical study of surgeries performed between 2014 and 2016 at the Sarawak Heart Centre, Malaysia. Medical records of patients with primary and secondary exotropia were reviewed. The following factors that affected the surgical outcomes were collected: onset age of squint, age at the time of surgery, the interval between diagnosis and surgery, the type of exotropia, visual acuity, presence of amblyopia, previous patching, anisometropia, refractive error, type of surgery, preoperative and postoperative deviation, pre-existing ocular comorbidity and systemic illness. Result: A total of 15 patients were studied with more than two thirds being females. Seven patients had primary exotropia while eight patients had secondary exotropia. Average interval between diagnosis and surgery was 1.3 years (±0.82) for primary exotropia and 1.2 years (±0.84) for secondary exotropia. Average pre-operative angle for primary exotropia was 50.57PD (±10.83) whereas secondary exotropia was 39.38PD (±8.63). Seven patients had successful surgical outcomes of within 10 prism dioptres, five for primary exotropia and two for secondary exotropia. The response to surgery was 3.0PD/mm (±0.59) for primary exotropia and 2.2PD/mm (±0.74) for secondary exotropia. Conclusion: In our study, primary exotropia had larger preoperative angle than secondary exotropia. The response to surgery was positively correlated with the preoperative angle of deviation. Primary exotropia showed better surgical outcome.

Retinoblastoma very rarely presents as vitreous haemorrhage. We are presenting a case of atypical presentation of retinoblastoma in a 3-year-old girl. She initially came with right eye vitreous haemorrhage of unknown cause. B-mode ultrasound showed dense vitreous opacity without evidence of mass. Initial MRI Brain/Orbit was inconclusive. Diagnostic vitrectomy was performed and noted thickened abnormal retina which was suspicious for retinoblastoma. The parents refused for enucleation for diagnostic histopathological examination and opted for conservative management. Repeated MRI Brain/Orbit done six months later showed disease progression through optic nerve involvement and suggestive of retinoblastoma. The parents were re-counselled for enucleation however refused and defaulted. 2 months later, the child was brought back with proptosed and disorganized eye. This time, they agreed for intervention. The patient underwent three cycles of chemoreduction therapy before enucleation. After enucleation, she received six cycles of adjuvant chemotherapy. She was well with no disease recurrence at two-year post treatment.