Lymphatic filariasis (LF) remains a significant public health challenge in many tropical regions where the disease is endemic. In Malaysia, LF is found in small pockets across the country. Asymptomatic carriers play a critical role in transmission but are often undetected. This report details an investigation of an asymptomatic filariasis reported by local health authorities involving an 83-year-old female patient residing in the Bako area, Sarawak. Despite being immobile due to a stroke, routine screening identified an infection with Brugia malayi through microscopy and a rapid diagnostic test. Interestingly, the patient exhibited no acute or chronic symptoms typically associated with filariasis. Contact tracing among her family members revealed that her son was also infected. Both patients received treatment with diethylcarbamazine (DEC) at a dosage of 6 mg/kg, along with albendazole 400 mg and ivermectin 12 mg. Preventive measures included health education, entomological studies, and the implementation of a ‘Test & Treat Filariasis’ program in the village. By documenting both the index case and a secondary asymptomatic case within the same household, the study provides a strong example of how routine screening and contact tracing can identify hidden sources of infection. This adds significant value to LF elimination strategies and emphasizes the importance of community-level surveillance programs. Coordinated efforts by health authorities, including contact tracing, environmental assessments, and targeted treatment, are essential for controlling the spread of LF and safeguarding public health.

Background: This study aimed to compare the surgical outcomes of pediatric patients with intermittent exotropia who underwent simultaneous eyelid and exotropia surgery and those who underwent exotropia surgery alone. Methods: The medical records of patients aged <18 years who underwent surgery for intermittent exotropia were retrospectively reviewed. The patients were grouped according to whether they underwent simultaneous eyelid surgery. In the simultaneous surgery group, the association between clinical factors, including the type of eyelid procedure, and surgical success was also analyzed. A favorable outcome was defined as an ocular alignment of ≤10 prism diopters (PD) for exodeviation and ≤4 PD for esodeviation at the final follow-up. Results: This study included 118 patients, of whom 31 underwent simultaneous eyelid and exotropia surgery and 87 underwent exotropia surgery alone. Bilateral repair of lower eyelid epiblepharon was the most common eyelid procedure (27/31, 87.1%). Success rates did not differ significantly between the two groups (log-rank test, p=0.291). In the simultaneous surgery group, no clinical factors, including the type of eyelid surgery, were significantly associated with favorable outcomes (all p>0.05). Conclusion Simultaneous eyelid and exotropia surgery produced surgical outcomes comparable to those of exotropia surgery alone, validating the safety and feasibility of the combined procedure in appropriately selected pediatric patients.

Purpose: We evaluated risk factors associated with reoperation following exposed hydroxyapatite orbital implant placement. Methods: We retrospectively analyzed 34 patients (34 eyes) diagnosed with exposed hydroxyapatite orbital implants at our institution between 2008 and 2022; all patients had a minimum follow-up of 12 months. All patients initially received conservative management. However, if symptoms, such as pain, discharge, or progressive exposure persisted, surgery was undertaken. We analyzed several variables, including age, sex, diabetic status, preoperative diagnosis, surgical approach, implant type and size, and exposed implant surface area. Regression analysis was performed to identify variables associated with reoperation. Results: Of the 34 patients (34 eyes), 17 (50.0%) were managed conservatively, whereas 17 (50.0%) required surgical intervention. Regression analysis revealed a significant association between the size of the exposed area and the need for reoperation (p = 0.018); however, other factors did not significantly impact reoperation rates. Receiver operating characteristic curve analysis identified a threshold of 4.5 mm for exposed area size, with an area under the curve of 0.934, sensitivity of 0.882, and specificity of 0.824. Patients categorized into small and large groups based on the 4.5 mm threshold revealed a statistically significant difference in reoperation rates (p < 0.001). Conclusions Our study demonstrates that the size of the exposed area is the single most significant predictor of revision surgery in patients with exposed hydroxyapatite orbital implants. Notably, an exposed area > 4.5 mm was associated with a significantly increased risk of reoperation.

Purpose: To compare clinical characteristics between the poor visual outcome (PVO) and good visual outcome (GVO) groups in culture-proven bacterial keratitis. Methods: A total of 230 cases (44 and 186 eyes in the PVO and GVO groups, respectively) of culture-proven bacterial keratitis, treated between January 2007 and December 2020, were reviewed retrospectively. The PVO group included cases with the final best-corrected visual acuity (BCVA) of less than 0.1 and no improvement compared to the initial BCVA. The remaining cases were included in the GVO group. The microbiological profiles, epidemiology, predisposing factors, and clinical characteristics were compared between the PVO and GVO groups, and the risk factors for PVO were analyzed. Results: Staphylococcus spp. and Pseudomonas spp. were common isolates in both the PVO and GVO groups, with no significant differences in the distribution of isolates. There were no significant differences between the groups in terms of sex, seasonal distribution, corneal trauma, and prior topical steroid use, but contact lens wear was significantly less in the PVO group. Significant risk factors for PVO were age ≥60 years (Z = 4.22, two-proportion Z-test), central corneal lesions (Z = 3.80), epithelial defect size ≥5 mm2 (Z = 3.74), prior ocular surgery (Z = 3.63), hypopyon (Z = 3.42), previous ocular surface disease (Z = 3.32), and diabetes (Z = 3.12). Conclusions In patients with bacterial keratitis, PVO was associated with older age, severe initial corneal findings, previous ocular disease history, and diabetes, but not with the causative pathogen itself.

Purpose: To evaluate the clinical characteristics of patients with intermittent exotropia who exhibited a dramatic decrease in ocular deviation 1 day before surgery. Methods: This study retrospectively enrolled patients with intermittent exotropia who underwent surgery between Decem-ber 2013 and December 2019. Those who exhibited a decrease in ocular alignment ≥10 prism diopters (PD) at the last exam-ination (1 day before surgery) compared with the largest previous angle of deviation were included. A monocular occlusion test was performed to re-confirm the largest angle of ocular deviation. Results: Among 547 patients with intermittent exotropia, 10 (six females; mean age, 8.6 years) exhibited a dramatic de-crease in ocular deviation before impending surgery. The mean largest angle of deviation was 31.0 PD (range, 20 to 50 PD) at distance and 34.5 PD (range, 20 to 55 PD) at near. The mean control scores using the LACTOSE (Look and Cover then Ten Seconds of Observation Scale for Exotropia) scoring system were 2.5 at distance, 1.8 at near, and 4.3 when combined. Mean ocular deviation prior to the impending surgery decreased to 7.4 PD (range, 0 to 10 PD) at distance and 6.2 PD (range, -10 to 10 PD) at near. The largest angle of ocular deviation was re-confirmed using the monocular occlusion test in all patients. All patients underwent surgery as planned, and none exhibited postoperative overcorrection. Conclusions A relatively small number of patients with intermittent exotropia exhibited a dramatic decrease in ocular align-ment 1 day before surgery but demonstrated a relatively better level of control. The monocular occlusion test was helpful in re-confirming the largest angle of ocular deviation.