Purpose: Worldwide, limited information is available on the psychosocial function and health-related quality of life (HRQoL) in children with congenital ptosis, nor the effect of corrective surgery on these parameters. This study aimed to evaluate the social anxiety and HRQoL of Malaysian children with primary simple unilateral congenital ptosis following ptosis surgery. Methods: A prospective cohort study was conducted among children with primary simple unilateral congenital ptosis and their parent/guardian who attended three tertiary hospitals from 2022 to 2024. The patients and their parents/guardians answered Spence Children’s Anxiety Scale-Social Anxiety and the PedsQL 4.0 Generic Core Scale, at the time of recruitment and 3 months after ptosis surgery. Results: This study involved 45 children, of which 26 (57.8%) were female. At enrollment, 18 (40.0%) had severe ptosis, and 15 (33.3%) had amblyopia. All surgeries were successful, with a mean margin to reflex distance (MRD) 1 and mean intereye MRD1 difference of 4.07 ± 0.62 and 0.29 ± 0.46 mm, respectively. Significant improvements in both social anxiety and HRQoL of children and parent were observed following surgery (p < 0.001). A decrease in intereye MRD1 difference postoperatively was the only significant factor affecting social anxiety of children with ptosis following surgery (p < 0.001). Together with the presence of amblyopia (p < 0.001), the intereye MRD1 difference was found to have a significant impact on the improvement in HRQoL (p = 0.021). Age, sex, and education level of parent/guardians were found to significantly affect the change in social anxiety following ptosis surgery (p < 0.05), while the factor most associated with improvement of parental HRQoL was an improvement in the MRD1 of the ptotic eye (p < 0.001). Conclusions Ptosis surgery significantly improved social anxiety and HRQoL in children with congenital ptosis and their parents/guardians. Psychosocial function should be a consideration when identifying indications for surgery in children with congenital ptosis.

Purpose: Worldwide, limited information is available on the psychosocial function and health-related quality of life (HRQoL) in children with congenital ptosis, nor the effect of corrective surgery on these parameters. This study aimed to evaluate the social anxiety and HRQoL of Malaysian children with primary simple unilateral congenital ptosis following ptosis surgery. Methods: A prospective cohort study was conducted among children with primary simple unilateral congenital ptosis and their parent/guardian who attended three tertiary hospitals from 2022 to 2024. The patients and their parents/guardians answered Spence Children’s Anxiety Scale-Social Anxiety and the PedsQL 4.0 Generic Core Scale, at the time of recruitment and 3 months after ptosis surgery. Results: This study involved 45 children, of which 26 (57.8%) were female. At enrollment, 18 (40.0%) had severe ptosis, and 15 (33.3%) had amblyopia. All surgeries were successful, with a mean margin to reflex distance (MRD) 1 and mean intereye MRD1 difference of 4.07 ± 0.62 and 0.29 ± 0.46 mm, respectively. Significant improvements in both social anxiety and HRQoL of children and parent were observed following surgery (p < 0.001). A decrease in intereye MRD1 difference postoperatively was the only significant factor affecting social anxiety of children with ptosis following surgery (p < 0.001). Together with the presence of amblyopia (p < 0.001), the intereye MRD1 difference was found to have a significant impact on the improvement in HRQoL (p = 0.021). Age, sex, and education level of parent/guardians were found to significantly affect the change in social anxiety following ptosis surgery (p < 0.05), while the factor most associated with improvement of parental HRQoL was an improvement in the MRD1 of the ptotic eye (p < 0.001). Conclusions Ptosis surgery significantly improved social anxiety and HRQoL in children with congenital ptosis and their parents/guardians. Psychosocial function should be a consideration when identifying indications for surgery in children with congenital ptosis.

Purpose: Worldwide, limited information is available on the psychosocial function and health-related quality of life (HRQoL) in children with congenital ptosis, nor the effect of corrective surgery on these parameters. This study aimed to evaluate the social anxiety and HRQoL of Malaysian children with primary simple unilateral congenital ptosis following ptosis surgery. Methods: A prospective cohort study was conducted among children with primary simple unilateral congenital ptosis and their parent/guardian who attended three tertiary hospitals from 2022 to 2024. The patients and their parents/guardians answered Spence Children’s Anxiety Scale-Social Anxiety and the PedsQL 4.0 Generic Core Scale, at the time of recruitment and 3 months after ptosis surgery. Results: This study involved 45 children, of which 26 (57.8%) were female. At enrollment, 18 (40.0%) had severe ptosis, and 15 (33.3%) had amblyopia. All surgeries were successful, with a mean margin to reflex distance (MRD) 1 and mean intereye MRD1 difference of 4.07 ± 0.62 and 0.29 ± 0.46 mm, respectively. Significant improvements in both social anxiety and HRQoL of children and parent were observed following surgery (p < 0.001). A decrease in intereye MRD1 difference postoperatively was the only significant factor affecting social anxiety of children with ptosis following surgery (p < 0.001). Together with the presence of amblyopia (p < 0.001), the intereye MRD1 difference was found to have a significant impact on the improvement in HRQoL (p = 0.021). Age, sex, and education level of parent/guardians were found to significantly affect the change in social anxiety following ptosis surgery (p < 0.05), while the factor most associated with improvement of parental HRQoL was an improvement in the MRD1 of the ptotic eye (p < 0.001). Conclusions Ptosis surgery significantly improved social anxiety and HRQoL in children with congenital ptosis and their parents/guardians. Psychosocial function should be a consideration when identifying indications for surgery in children with congenital ptosis.

Purpose: Worldwide, limited information is available on the psychosocial function and health-related quality of life (HRQoL) in children with congenital ptosis, nor the effect of corrective surgery on these parameters. This study aimed to evaluate the social anxiety and HRQoL of Malaysian children with primary simple unilateral congenital ptosis following ptosis surgery. Methods: A prospective cohort study was conducted among children with primary simple unilateral congenital ptosis and their parent/guardian who attended three tertiary hospitals from 2022 to 2024. The patients and their parents/guardians answered Spence Children’s Anxiety Scale-Social Anxiety and the PedsQL 4.0 Generic Core Scale, at the time of recruitment and 3 months after ptosis surgery. Results: This study involved 45 children, of which 26 (57.8%) were female. At enrollment, 18 (40.0%) had severe ptosis, and 15 (33.3%) had amblyopia. All surgeries were successful, with a mean margin to reflex distance (MRD) 1 and mean intereye MRD1 difference of 4.07 ± 0.62 and 0.29 ± 0.46 mm, respectively. Significant improvements in both social anxiety and HRQoL of children and parent were observed following surgery (p < 0.001). A decrease in intereye MRD1 difference postoperatively was the only significant factor affecting social anxiety of children with ptosis following surgery (p < 0.001). Together with the presence of amblyopia (p < 0.001), the intereye MRD1 difference was found to have a significant impact on the improvement in HRQoL (p = 0.021). Age, sex, and education level of parent/guardians were found to significantly affect the change in social anxiety following ptosis surgery (p < 0.05), while the factor most associated with improvement of parental HRQoL was an improvement in the MRD1 of the ptotic eye (p < 0.001). Conclusions Ptosis surgery significantly improved social anxiety and HRQoL in children with congenital ptosis and their parents/guardians. Psychosocial function should be a consideration when identifying indications for surgery in children with congenital ptosis.

Purpose: Worldwide, limited information is available on the psychosocial function and health-related quality of life (HRQoL) in children with congenital ptosis, nor the effect of corrective surgery on these parameters. This study aimed to evaluate the social anxiety and HRQoL of Malaysian children with primary simple unilateral congenital ptosis following ptosis surgery. Methods: A prospective cohort study was conducted among children with primary simple unilateral congenital ptosis and their parent/guardian who attended three tertiary hospitals from 2022 to 2024. The patients and their parents/guardians answered Spence Children’s Anxiety Scale-Social Anxiety and the PedsQL 4.0 Generic Core Scale, at the time of recruitment and 3 months after ptosis surgery. Results: This study involved 45 children, of which 26 (57.8%) were female. At enrollment, 18 (40.0%) had severe ptosis, and 15 (33.3%) had amblyopia. All surgeries were successful, with a mean margin to reflex distance (MRD) 1 and mean intereye MRD1 difference of 4.07 ± 0.62 and 0.29 ± 0.46 mm, respectively. Significant improvements in both social anxiety and HRQoL of children and parent were observed following surgery (p < 0.001). A decrease in intereye MRD1 difference postoperatively was the only significant factor affecting social anxiety of children with ptosis following surgery (p < 0.001). Together with the presence of amblyopia (p < 0.001), the intereye MRD1 difference was found to have a significant impact on the improvement in HRQoL (p = 0.021). Age, sex, and education level of parent/guardians were found to significantly affect the change in social anxiety following ptosis surgery (p < 0.05), while the factor most associated with improvement of parental HRQoL was an improvement in the MRD1 of the ptotic eye (p < 0.001). Conclusions Ptosis surgery significantly improved social anxiety and HRQoL in children with congenital ptosis and their parents/guardians. Psychosocial function should be a consideration when identifying indications for surgery in children with congenital ptosis.

Purpose: Macular edema, serous retinal detachment, and retinal pigment epithelial detachment have been reported in patients with nephrotic syndrome. However, there is limited data about macular thickness in children with nephrotic syndrome. The aim of this study was to compare the mean macular thickness in children with nephrotic syndrome and in a control group and to correlate it with visual acuity and level of proteinuria. Methods: The comparative cross-sectional study included 66 children aged 6 to 17 years with nephrotic syndrome and healthy control seen in two tertiary centers in Malaysia. We recorded demographic data, as well as visual acuity, level of proteinuria, and the mean macular thicknesses in both groups. The mean macular thickness was measured using Stratus optical coherence tomography according to nine areas of the Early Treatment Diabetic Retinopathy Study map. Results: The mean foveal thickness was 238.15 ± 22.98 µm for children with nephrotic syndrome and 237.01 ± 22.60 µm for the control group. There was no significant difference in the mean macular thickness between the groups (p = 0.843). A significant correlation with visual acuity was observed in the superior outer macula (r = –0.41, p = 0.019), the nasal outer macula (r = –0.41, p = 0.019), and the inferior outer macula (r = –0.40, p = 0.021). There was no significant correlation between the mean macular thickness and level of proteinuria (p = 0.338), although those with higher levels of proteinuria demonstrated a trend towards increased macular thickness. Conclusions The mean macular thickness in children with nephrotic syndrome was similar to that of healthy children. A significant correlation between the mean thickness of the outer macular layer and the presenting visual acuity was observed. There was no correlation between the mean macular thickness and the level of proteinuria.

Purpose: There are limited data from Asian countries regarding retinal thickness in children with type 1 diabetes mellitus (T1DM). This study aimed to compare the macular and retinal nerve fiber layer (RNFL) parameters between diabetic children without retinopathy and non-diabetic healthy children. We also evaluated the factors associated with RNFL thickness in children with T1DM. Methods: A comparative cross-sectional study was conducted among children with T1DM and healthy children aged 7 to 17 years old in Hospital Universiti Sains Malaysia from 2017 to 2019. Children with retinal disease or glaucoma were excluded. Macular and RNFL thicknesses were measured using spectral-domain optical coherence tomography. Demographic information, duration of diabetes, blood pressure, body mass index, visual acuity, and retinal examination findings were documented. Glycosylated hemoglobin levels, renal function, and blood lipid levels were also collected. Results: Forty-one children with T1DM and 80 age- and sex-matched children were enrolled. Both sexes were affected. Mean duration of diabetes mellitus was 3.66 years. The mean glycated hemoglobin levels in the T1DM group was 9.99%. The mean macular and RNFL thicknesses in children with T1DM were 277.56 (15.82) µm and 98.85 (12.05) µm, respectively. Children with T1DM had a significantly thinner average macula, superior outer macula, nasal outer macula, mean RNFL, and inferior RNFL thickness compared to controls (p < 0.05). There was a significant association between nephropathy and the mean RNFL thickness. Conclusions Children with T1DM had significantly decreased mean macular and RNFL thicknesses. Nephropathy is associated with an increased RNFL thickness.

Purpose: There are limited data from Asian countries regarding retinal thickness in children with type 1 diabetes mellitus (T1DM). This study aimed to compare the macular and retinal nerve fiber layer (RNFL) parameters between diabetic children without retinopathy and non-diabetic healthy children. We also evaluated the factors associated with RNFL thickness in children with T1DM. Methods: A comparative cross-sectional study was conducted among children with T1DM and healthy children aged 7 to 17 years old in Hospital Universiti Sains Malaysia from 2017 to 2019. Children with retinal disease or glaucoma were excluded. Macular and RNFL thicknesses were measured using spectral-domain optical coherence tomography. Demographic information, duration of diabetes, blood pressure, body mass index, visual acuity, and retinal examination findings were documented. Glycosylated hemoglobin levels, renal function, and blood lipid levels were also collected. Results: Forty-one children with T1DM and 80 age- and sex-matched children were enrolled. Both sexes were affected. Mean duration of diabetes mellitus was 3.66 years. The mean glycated hemoglobin levels in the T1DM group was 9.99%. The mean macular and RNFL thicknesses in children with T1DM were 277.56 (15.82) µm and 98.85 (12.05) µm, respectively. Children with T1DM had a significantly thinner average macula, superior outer macula, nasal outer macula, mean RNFL, and inferior RNFL thickness compared to controls (p < 0.05). There was a significant association between nephropathy and the mean RNFL thickness. Conclusions Children with T1DM had significantly decreased mean macular and RNFL thicknesses. Nephropathy is associated with an increased RNFL thickness.

ABSTRACT Kimura disease (KD) is a rare chronic inflammatory disorder of unknown aetiology that primarily affects the head and neck region with lymph node involvement. Young to middle-aged adult Asian males are predominantly affected. The most common presentation is painless subcutaneous swelling in the head and neck region, while proptosis or orbital involvement is very rarely reported. KD shares some features with other inflammatory and neoplastic disorders, including lymphoma; thus, investigations to confirm the diagnosis should not be delayed. Systemic corticosteroids are commonly used to treat KD and show an excellent response; however, the optimal treatment is still uncertain, and KD has a high recurrence rate. We describe the case of a patient with KD who presented with proptosis and post-auricular swelling, which responded well to oral prednisolone treatment.
Kimura Disease ; Exophthalmos

·This study aims to describe the treatment efficacy of supratarsal injection of triamcinolone acetonide and dexamethasone sodium phosphate for paediatric vernal keratoconjuctivitis(VKC) over a 5-year-period in Hospital Universiti Sains Malaysia. Totally 10 patients were treated with this combination injection had clinical improvement by 1mo post injection. The main complication was increased intraocular pressure (4 patients). Four patients had recurrences within 6mo. We concluded that the clinical responsetosupratarsalcombination corticosteroids in VKC is fairly similar to that reported in the literature using a single corticosteroid agent. However, the risk of increased intraocular pressure is higher.