Ocular cicatricial pemphigoid (OCP) is a chronic bilateral, blinding, cicatrizing form of conjunctivitis with relapsing and remitting periods. It has strong evidence for an immune type II hypersensitivity that leads to subconjunctival fibrosis and extensive systemic bullae formation. To the best knowledge of the authors, this is the first reported case of direct immunofluorescence (DIF) assay-proven OCP in an elderly Filipino man.

A 68-year-old male presented with bilateral corneal conjunctivalization, symblepharon, ectropion, conjunctival hyperemia testing positive with conjunctival biopsy for basement membrane antibodies with DIF for the left eye, while turning out negative for the right eye. He was managed as a case of OCP, both eyes, and was given topical steroids and antibiotics. Oral Dapsone was started by Dermatology and Rheumatology Services.

OCP is a rare autoimmune and blinding disease. Early diagnosis and prompt treatment are vital as ocular complications permanently affect the quality of life of patients as seen in our patient. DIF assay remains the gold-standard for diagnosis. Systemic immunosuppression is the mainstay of treatment. Adjunctive supportive topical medication may be given to alleviate ocular discomfort. A multidisciplinary approach is essential to provide holistic care to each patient.

OBJECTIVE

Despite being a preventable and treatable condition, central microbial keratitis (CMK) and its complications remain to be a significant cause of vision loss in our country. This study presents the demographic profile, risk factors, etiologies, treatments, and outcomes of CMK in the Philippines.

The study was a two-center, prospective, non-randomized clinical study involving the patients of the External Disease and Cornea Clinics of two tertiary eye referral centers in the Philippines. It was conducted as the Philippine leg of the Asia Cornea Society Infectious Keratitis Study (ASCIKS).1 Patients with a clinical diagnosis of CMK rendered by a cornea specialist, and who signed the consent form, were recruited into the study. They underwent uniform sample collection and culture techniques as described in the ACSIKS. All patients were followed-up for 6 months. Data collected included demographics, risk factors, culture results, management, and treatment outcomes. Descriptive statistics and frequency were used to analyze the data.

A total of 348 patients diagnosed with CMK were included. Trauma (65.5%) among the middle-aged (42.9 ± 17.9 years) male population was the most significant risk factor for development of CMK, followed by contact lens wear (12.9%), prior ocular surgery (6.0%), and ocular surface diseases (3.4%). Bacterial keratitis (53.2%) was still the most common etiology of CMK, followed by fungal keratitis (27.0%), Acanthamoeba keratitis (5.7%), and viral keratitis (2.0%). Aspergillus species (18.3%) were the most common microbial isolates. Pseudomonas species (13.9%) were the most common bacterial isolates. The median time from onset of symptoms to consultation with the study centers was 2 weeks. Medical treatment was enough to treat the infection in 34.8% of cases. Surgical intervention was necessitated in 22.6% with evisceration/enucleation done in 1 out of 3 patients who had surgery.

Bacterial infection remains the most common cause of CMK in the Philippines, followed by fungal infection. Significant risk factors include trauma and contact lens wear. Aspergillus species and Pseudomonas species were the most common fungal and bacterial isolates, respectively. Despite medical treatment, almost a quarter of the cases still required surgical intervention.

Ocular cicatricial pemphigoid (OCP) is a chronic bilateral, blinding, cicatrizing form of conjunctivitis with relapsing and remitting periods. It has strong evidence for an immune type II hypersensitivity that leads to subconjunctival fibrosis and extensive systemic bullae formation. To the best knowledge of the authors, this is the first reported case of direct immunofluorescence (DIF) assay-proven OCP in an elderly Filipino man.

A 68-year-old male presented with bilateral corneal conjunctivalization, symblepharon, ectropion, conjunctival hyperemia testing positive with conjunctival biopsy for basement membrane antibodies with DIF for the left eye, while turning out negative for the right eye. He was managed as a case of OCP, both eyes, and was given topical steroids and antibiotics. Oral Dapsone was started by Dermatology and Rheumatology Services.

OCP is a rare autoimmune and blinding disease. Early diagnosis and prompt treatment are vital as ocular complications permanently affect the quality of life of patients as seen in our patient. DIF assay remains the gold-standard for diagnosis. Systemic immunosuppression is the mainstay of treatment. Adjunctive supportive topical medication may be given to alleviate ocular discomfort. A multidisciplinary approach is essential to provide holistic care to each patient.

INTRODUCTION: Obstructive sleep apnoea (OSA) is common in Singapore, with moderate to severe OSA affecting around 30% of residents. These consensus statements aim to provide scientifically grounded recommendations for the management of OSA, standar-dise the management of OSA in Singapore and promote multidisciplinary collaboration. METHOD: An expert panel, which was convened in 2024, identified several areas of OSA management that require guidance. The expert panel reviewed the current literature and developed consensus statements, which were later independently voted on using a 3-point Likert scale (agree, neutral or disagree). Consensus (total ratings of agree and neutral) was set a priori at ≥80% agreement. Any statement not reaching consensus was excluded. RESULTS: The final consensus included 49 statements that provide guidance on the screening, diagnosis and management of adults with OSA. Additionally, 23 statements on the screening, diagnosis and management of paediatric OSA achieved consensus. These 72 consensus statements considered not only the latest clinical evidence but also the benefits and harms, resource implications, feasibility, acceptability and equity impact of the recommendations. CONCLUSION The statements presented in this paper aim to guide clinicians based on the most updated evidence and collective expert opinion from sleep specialists in Singapore. These recommendations should augment clinical judgement rather than replace it. Management decisions should be individualised, taking into account the patient's clinical characteristics, as well as patient and caregiver concerns and preferences.
Humans ; Sleep Apnea, Obstructive/diagnosis* ; Singapore ; Consensus ; Adult

Background and Objective: Colorectal cancer (CRC) has the third highest incidence in the Philippines. Currently, there is a paucity in literature that is focused on the knowledge, attitudes, and perceptions of Filipinos regarding CRC screening. This is the first study in the Philippines that describes this. Methods: This is a cross-sectional study that validated a 52-item Filipino questionnaire on the knowledge on colorectal cancer, willingness to undergo CRC screening, and perceived benefits and barriers to fecal occult blood test (FOBT) and colonoscopy. The study enrolled household heads more than 20 years of age residing in both urban and rural communities in the Philippines. Results: The UP-PGH CRC KAP (University of the Philippines – Philippine General Hospital Colorectal Cancer Knowledge, Attitudes, and Practices) and Rawl Questionnaire’s validity and internal consistency were established in a pilot study of 30 respondents. A total of 288 respondents were then enrolled to the main study group with a median age of 54.0. Knowledge scores for prognosis and utility of CRC screening were modest (6.3/12 and 8.4/20, respectively). Perceived benefit scores to FOBT and colonoscopy were high (9.9/12 and 13.9/16, respectively).Median scores to barriers to FOBT and colonoscopy were intermediate (22.5/36 and 35.8/60, respectively). Notably, a vast majority (86.1%) were willing to participate in CRC screening programs initiated by the government, and 46.9% agreed to undergo screening tests even as out-of-pocket expense. Conclusion The UP-PGH CRC KAP Questionnaire as well as the Filipino translation of the Rawl Questionnaire are reliable and valid tools in extensively assessing the knowledge of Filipinos on CRC and willingness to undergo screening, as well as the benefits of and barriers to FOBT and colonoscopy. Knowledge scores were modest suggesting that directed educational campaigns and awareness programs can aid in increasing awareness about CRC and its screening. Household income and highest educational attainment were significantly positively correlated with knowledge scores, and perceived benefits of and barriers to CRC screening. Scores were generally comparable between urban and rural communities.
Knowledge ; Attitudes

Pelvic kidneys are anatomical abnormalities that occur when the kidney does not rise from the pelvis during embryogenesis. The majority of cases are asymptomatic, though they are associated with higher risks for traumatic injury, infections, renal calculi, and other urological issues. Because of its advantages of flexion and deflection, retrograde intrarenal surgery (RIRS) employing flexible ureterorenoscopy (fURS) is an alternative treatment method for small- to medium-sized calculi in anatomically aberrant kidneys. Presented here is a case of a 43-year-old male with a renal stone in a pelvic left kidney with the ureter crossing the midlineand is located at the prevertebral region at the level of L4 to S1.

Objectives: This study described the clinical profile of patients with keratoconus at a single tertiary referral hospital. Methods: This was a single-center, retrospective, cross-sectional study that reviewed medical records of patients diagnosed with keratoconus from January 2015 to August 2022. Data on the clinical profile, intervention, and clinical outcomes were collected from the chart review. Results: Forty (40) patients (79 eyes) were included in the study. Majority (98%) had bilateral disease in which 22 (55.5%) were affected asymmetrically. The mean age was 21 years. Most patients (72.5%) were male. Blurring of vision was the chief complaint in all patients. Atopy was present in 23 patients (57.5%). History of vigorous eye rubbing was present in 31 (77.5%). The mean interval from onset of symptoms to consult was 46.4 ± 33.38 months. The mean pinhole corrected distance visual acuity was 0.47 ± 0.41 (Snellen equivalent of 20/59). The average spherical equivalent was -7.48D ± 6.99D. Corneal protrusion on slit-lamp biomicroscopy was seen in 78 eyes (98.7%). Other findings included Fleischer ring (53.2%), Vogt's striae (19.0%), and apical corneal scar (24.0%). Only one eye (1.3%) had no corneal findings. Thirty-nine eyes (49.3%) were classified as advancedsevere keratoconus. Rigid contact lens was planned for 60 eyes (75.9%). Sixty-two eyes (78.5%) were for collagen cross-linking. Deep anterior lamellar keratoplasty was planned in 10 eyes (12.7%) and penetrating keratoplasty in two eyes (2.5%). Conclusion Keratoconus at the Philippine General Hospital was most frequently seen in young males and asymmetrically affects both eyes. Patients consulted relatively late and presented with a more advanced stage of the disease. History of ocular allergy and eye rubbing were significant risk factors. Improving awareness of this condition must be emphasized to detect keratoconus earlier.
Keratoconus ; Cornea ; Demography ; Philippines

Objective: This paper demonstrated the effectiveness of intrastromal injection of levofloxacin 1.5% ophthalmic solution in the management of recalcitrant Gram-positive bacterial keratitis. Methods: This is a report on two cases of recalcitrant bacterial keratitis encountered at the External Diseases and Cornea Clinic of the Department of Ophthalmology and Visual Sciences at the Philippine General Hospital. Results: Two middle-aged females presented with bacterial keratitis unresponsive to previous antibiotic treatment with impending corneal perforation. The Gram stain of the corneal scraping in the first case revealed Gram-positive cocci, while the second case showed encapsulated Gram-positive bacilli and encapsulated Grampositive cocci in chains. In both cases, repeated intrastromal injections of levofloxacin 1.5% in addition to increasing the frequency of topical levofloxacin 1.5% resulted in marked improvement in visual acuity and resolution of deep stromal infiltrates and hypopyon. Conclusion These cases highlighted the utility of intrastromal levofloxacin 1.5% ophthalmic solution in the management of recalcitrant Gram-positive bacterial keratitis.
Fluoroquinolones ; Levofloxacin

Objective: To report a case of acute postoperative endophthalmitis following cataract surgery due to Pseudomonas stutzeri in a healthy elderly male. Methods: This is a case report. Results: A non-hypertensive, non-diabetic male in his late 60s consulted due to eye pain and blurred vision 5 days after an uncomplicated extracapsular cataract extraction with posterior chamber intraocular lens implantation (PCIOL) on his left eye. On examination, the visual acuity was light perception. Slit-lamp examination showed ciliary injection, conjunctival congestion, mild corneal edema with Descemet membrane folds, hazy anterior chamber with fibrin and a 2-millimeter hypopyon, and a visible PCIOL. IOP was 10 mmHg with no leak on Seidel’s test, and there was poor view of the fundus. B-scan ultrasonography showed findings consistent with endophthalmitis. He was given topical, intravitreal, and systemic antibiotics, and emergency vitrectomy was done. The vitreous sample culture revealed Pseudomonas stutzeri. Despite aggressive medical and surgical management, vision loss was not prevented. Conclusion Acute postoperative endophthalmitis from Pseudomonas stutzeri is rare; if not recognized and treated promptly, this complication has devastating outcomes. It may present with a fulminant course regardless of the associated risks for infection. Prevention, early recognition, and timely management can prevent unfavorable visual outcomes.
Endophthalmitis ; Pseudomonas stutzeri

Background and Objective: One of the uses of indocyanine green (ICG) in the surgical field is the evaluation of the anastomotic margins in colorectal surgery. This is of particular importance because fluorescence imaging may aid in detecting vascular compromise, allowing the surgeon to change the resection margin thereby decreasing the chance of an anastomotic leak. To date, there has been no study with its use locally. This study aimed to determine whether the use of ICG can safely identify if the margins of resection are well-vascularized in patients undergoing left-sided colon or rectal surgery, which in turn may reduce anastomotic leak rates. Methods: Through a retrospective study design, the investigators gathered data of patients who underwent left-sided colon or rectal surgery. The groups were divided into those with and without the use of ICG and a comparative data on the anastomotic leak rates were analyzed. Results: Eighty-six (86) patients with similar patient characteristics, tumor staging, and surgical approach were compared. Both the leak rates identified during the initial hospital stay and at 30 days post-operatively were lower in those where ICG was used (p=0.035, p=0.047, respectively) than those where ICG was not used. Conclusion ICG fluorescence imaging may reduce the anastomotic leak rates in patients undergoing colorectal surgery.
indocyanine green ; colon ; rectum ; colorectal surgery ; anastomosis, surgical ; anastomotic leak