There has been a paradigm shift in health service delivery to a more holistic approach, which considers Quality of Life (QoL) and overall functioning. Health-Related Quality of Life (HRQoL) is a multidimensional construct that encompasses physical functioning as well as psychosocial aspects of emotional and social functioning. This study explored factors related to HRQoL in Asian pediatric patients with leukemia in Singapore. The available variables included: age, treatment duration, household income, gender, ethnicity, religion, diagnosis, and phase of treatment. It is hypothesized that the relationships will be significant. In the current study, there were 60 patients (60% males) with leukemia; their ages ranged from 1 to 21 years (Mean = 8.03, Standard Deviation = 4.55). The hypothesis was partially supported. Age had a significant positive relationship with physical functioning, r(60) = 0.28, p < 0.05, physical health, r(60) = 0.28, p < 0.05, and the total HRQoL score, r(60) = 0.29, p < 0.05. Treatment duration had a positive relationship with school functioning, r(60) = 0.28, p < 0.05. All other correlations were statistically non-significant. The effects of the available psychosocial variables of gender, ethnicity, and religion were examined on scores from the Pediatric Quality of Life Inventory (PedsQL). Ethnicity had a significant effect on social functioning, U = 292.00, p < 0.05, r = 0.3 (medium effect size). Specifically, Chinese (Median = 85.00, n = 33) had significantly higher scores on social functioning than others (Median = 70.00, n = 27). The remaining comparisons were statistically non-significant. The current findings added to QoL research, and provided an impetus for more research in the area of HRQoL for children with leukemia in Singapore.

Aim To describe the long-term outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) with an anterior chamber intraocular lens (ACIOL) compared to secondary posterior chamber (PC) IOL. Methods This was a retrospective comparative cohort study. The clinical data of 82 eyes from 82 consecutive patients with pseudophakic (PBK) or aphakic bullous keratopathy (ABK) who either underwent DSAEK with retained or secondary ACIOL (n=23) or DSAEK with IOL exchange and/or secondary PCIOL (retropupillary iris-claw IOL, n=25; intrascleral-fixated IOL, n=29; or sulcus IOL, n=5) were analysed. The main outcome measures were graft survival and complications up to 5 years. Results The graft survival in the secondary PCIOL group was superior than the ACIOL group over 5 years (year 1, 100.0% vs 100.0%; year 3, 94.7% vs 75.0%; year 5, 91.1% vs 60.6%, p=0.022). The presence of an ACIOL was a significant risk factor associated with graft failure (HR, 4.801; 95% CI, 1.406 to 16.396, p=0.012) compared to a secondary PCIOL. There was no significant difference in the rate of graft detachment and elevated intraocular pressure between the groups. There were five cases (9.3%) of IOL subluxation or dislocation in the retropupillary iris-claw and intrascleral-fixated IOL groups. Conclusions Eyes that underwent DSAEK with ACIOL in situ had poorer long-term graft survival compared with those with secondary PCIOL. Intraocular lens exchange was not associated with a higher complication rate. In ABK or PBK eyes with ACIOL, we recommend performing IOL exchange and/or secondary PCIOL implantation combined with endothelial keratoplasty.

Objective: This was a longitudinal study of TCF4 CTG18.1 trinucleotide repeat lengths in 17 patients (27 eyes) diagnosed with Fuchs’ endothelial corneal dystrophy (FECD), and it aimed to correlate the repeat expansion status with disease severity and progression. Design: This was a prospective cohort study looking at FECD clinical progression and TCF4 CTG18.1 repeat length expansion status over time. Methods: A total of 27 eyes from 17 patients diagnosed with FECD were recruited. Only eyes with FECD disease severity of at least Grade 4 on the modified Krachmer clinical grading scale were included; eyes that had previously undergone any form of ocular surgery prior to the first genotyping or during the duration of follow-up were excluded. CTG trinucleotide repeat genotyping was performed on peripheral blood leukocytes at two time points over an average follow-up of 10 years. Over the follow-up period, the FECD progression of each subject was examined using pachymetry, Scheimpflug imaging (Pentacam), and endothelial cell density (ECD) readings, during the baseline visit, yearly thereafter, at the time of repeat CTG18.1 genotyping, and at their latest visit. Main Outcome Measures: The clinical progression of FECD patients was assessed using central corneal thickness (CCT), ECD, and any keratoplasty performed. CTG repeat length was assessed twice over the entire follow-up period. Results: The non-expanded alleles were shown to be stable over the period of follow-up and did not develop any expanded repeats. Repeat expansion did not influence the risk of attaining Threshold Disease, although more patients in the L ≥ 40 group (CTG18.1 repeat sequence of more than or equal to 40 repeats) underwent keratoplasty. Conclusions: Through this study, we found that the CTG18.1 allele lengths of <40 repeats in peripheral blood leukocytes showed minimal change over a 10-year period, and none became an expanded repeat. Hence, a single CTG expansion assessment, performed at any point in a patient’s lifetime, is likely a good representation of genetic risk. Clinicians may use this information to better advise patients on the risk of clinical progression and the best therapeutic strategy.

Training to perform ophthalmic blocks is often done on actual patients by trial and error. Higher complication rates and poor patient experience occur from suboptimal blocks. We assess the efficacy of a novel ophthalmic block simulator via a pilot study. The production process involved 3D-printing and improvisation with readily available materials that provided excellent reproducibility of a real-life experience. A prospective pilot study on ophthalmology trainees in a single centre via a 3-pronged approach before and after a supervised training workshop on the simulator was performed. Outcomes include procedural confidence, competence, accurate needle positioning during peribulbar block and degree of post-procedural akinesia. There were significant improvements in trainee self-ranked confidence (7.57 ± 1.27 to 8.57 ± 1.13, p = 0.018) and competence (7.71 ± 0.95 to 8.43 ± 0.98, p = 0.047) (n = 7). There was improvement in consultant-rated akinesia, competence and confidence (38.1% ± 29.9% to 34.8% ± 20.7% p = 0.766, 7.63 ± 1.51 to 7.90 ± 0.66 p = 0.585, and 7.57±1.64 to 7.80±0.92 p = 0.698) (18 assessments pre-workshop, 20 assessments post-workshop), and mean accuracy in blocks performed on the simulator after training with the simulator (4.17 ± 1.27 to 4.83 ± 0.389, n = 12, p = 0.054) although all these were statistically insignificant. In summary, this is a useful, portable and low-cost ophthalmic block simulator that allows trainees to gain confidence and competence in performing these procedures.

Background/Objectives: To compare the visual outcomes between two extended depth-of-focus intraocular lenses (EDOF IOLs) in an Asian population. Methods: This retrospective single-center study included patients with senile cataract undergoing cataract surgery with implantation of either TECNIS PureSee or AcrySof IQ Vivity IOL. Visual and refractive outcomes such as visual acuity (VA), manifest refraction, and mean refractive spherical equivalent were compared up to post-operative month 6. Contrast sensitivity and defocus curves were evaluated monocularly, as well as binocularly if both eyes had the same IOL implanted. Results: Forty-nine eyes were evaluated—24 implanted with PureSee and 25 implanted with AcrySof IQ Vivity. The follow-up period was 6.4 ± 1.1 months in the PureSee group and 6.4 ± 1.0 months in the Vivity group (p = 1.0). There was no significant difference in postoperative visual outcomes at postoperative month 1 or 6. At post-operative month 6, unaided distance VA was 0.06 ± 0.10 and 0.08 ± 0.14 in the PureSee and Vivity groups, respectively (p = 0.519); unaided intermediate VA was 0.21 ± 0.05 and 0.18 ± 0.09, respectively (p = 0.192); and unaided near VA was 0.38 ± 0.12 and 0.38 ± 0.12, respectively (p = 0.842). Defocus and contrast sensitivity performance were broadly similar, except for Vivity’s defocus being marginally better at 66 cm intermediate distance. At post-operative month 1, 69.2% of Vivity patients (n = 13) and 75.0% of PureSee patients (n = 4) denied haloes or glare. Conclusions: Both EDOF IOLs demonstrated comparable visual performances.