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Treatment of macular hole retinal detachment

Lai YK

Br J Ophthalmol, 1990 Apr;74(4):201-2.
PMID: 2337542

Seven patients with macular hole retinal detachment were treated by intravitreal gas injection with or without release of subretinal fluid. Macular buckling, diathermy, cryopexy, or vitrectomy were not used. The patients were placed prone for eight hours a day until the gas had absorbed. In five of the seven patients the retina became reattached within three days and remained reattached with follow-up periods of three to 22 months (average nine months). It is believed that such detachments are due to vitreoretinal traction and the intravitreal gas bubble relieves this traction. This technique is simple, safe, and does not require costly or sophisticated instruments. It has an added advantage in preserving macular function.
Adverse effect of intraoperative phenylephrine 10%: case report

Lai YK

Br J Ophthalmol, 1989 Jun;73(6):468-9.
PMID: 2751981

The case is reported of a patient who suffered severe acute hypertension, cardiac arrhythmia, and myocardial infarction probably as a direct effect of phenylephrine overdose. Instillation of the drops during surgery probably enhanced the systemic absorption of a significant amount of the drug. Therefore it should be used during surgery with caution, especially in elderly patients and those with cardiovascular disease.
Fulltext Perforating eye injuries due to intraocular foreign bodies

Lai YK, Moussa M

Med J Malaysia, 1992 Sep;47(3):212-9.
PMID: 1491647

The results of sixty-four perforating eye injuries with intraocular foreign bodies (IOFB) treated at University Hospital over ten years were reported. Compared to an earlier report we found that the population at risk was the same and consisted of patients under 35 years (70%), males (95.3%) and work related (86%). The commonest causes of IOFB were hand hammer (64.1%) and grass cutting (20.3%). We also noted that while the incidence of cases had increased by 23%, the final visual outcome has improved significantly due to advances in preoperative diagnosis and surgical techniques. Preoperative factors found to have a statistically significant effect on the final visual outcome were the size of the IOFB, poor initial visual acuity, and the presence of the following complications: cataract, iris damage and vitreous haemorrhage. The outcome was also worse in posterior segment IOFBs but this was not statistically significant.
The effectiveness of sub-Tenon's infiltration of local anaesthesia for cataract surgery

Verghese I, Sivaraj R, Lai YK

Aust N Z J Ophthalmol, 1996 May;24(2):117-20.
PMID: 9199741

PURPOSE: To determine if adequate anesthesia and akinesia could be obtained using an inferonasal quadrant sub-Tenons anaesthesia for cataract surgery.
METHODS: The sub-Tenons method of local anaesthesia was used in 50 patients undergoing extracapsular cataract extraction and lens implantation. The technique following was that described by JD Stevens in his study of 50 patients. Posterior sub-Tenons space was approached through a conjunctival incision in the inferonasal quadrant and the anaesthetic solution delivered by an irrigating cannula. The patients were assessed for residual ocular movements just before surgery. Effectiveness of anaesthesia was assessed during surgery using a verbal pain rating score. Scoring was based on the concept of a visual analogue pain score chart.
RESULTS: Total akinesia was obtained in 20% patients and total anaesthesia in 24% patients. The remainder of the patients had adequate akinesia and anaesthesia to proceed with and complete the surgery.
CONCLUSION: This method provides satisfactory anaesthesia for cataract surgery.
Effect of heparin-surface-modified poly(methyl methacrylate) intraocular lenses on the postoperative inflammation in an Asian population

Lai YK, Fan RF

J Cataract Refract Surg, 1996;22 Suppl 1:830-4.
PMID: 9279680

PURPOSE: To compare the efficacy of heparin-surface-modified (HSM), poly(methyl methacrylate) (PMMA) posterior chamber intraocular lenses (IOLs) with that of unmodified PMMA IOLs in reducing postoperative complications caused by inflammatory reactions after extracapsular cataract extraction in an Asian population.
SETTING: Departments of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia, and Tan Tock Seng Hospital, Singapore.
METHODS: In a randomized, double-blind study performed at two centers, 51 patients received an HSM PMMA lens and 48, an unmodified PMMA IOL. Cell and pigment deposits were evaluated by slitlamp at 1 to 6 days, 2 to 3 weeks, and 3 to 6 months postoperatively.
RESULTS: Significantly more eyes with unmodified IOLs had inflammatory cell deposits than those with HSM IOLs at 3 to 6 months (P < .001) and 12 to 14 months (P = .018) postoperatively. The HSM group also had significantly fewer cell deposits per patient at these two follow-ups. Significantly more eyes in the non-HSM group had pigment deposits 3 to 6 months after surgery (P = .049). One year postoperatively, about 85% of patients in both groups had a best corrected visual acuity of 0.5 or better.
CONCLUSION: Heparin surface modification significantly reduced the inflammatory response to PMMA IOLs in an Asian population for at least 12 to 14 months.
Glucose-6-phosphate dehydrogenase deficiency and risk of diabetes: a systematic review and meta-analysis

Lai YK, Lai NM, Lee SW

Ann Hematol, 2017 May;96(5):839-845.
PMID: 28197721 DOI: 10.1007/s00277-017-2945-6

Emerging epidemiological evidence suggests that patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency may have a higher risk of developing diabetes. The aim of the review was to synthesise the evidence on the association between G6PD deficiency and diabetes. A systematic search on Medline, EMBASE, AMED and CENTRAL databases for studies published between January 1966 and September 2016 that assessed the association between G6PD deficiency and diabetes was conducted. This was supplemented by a review of the reference list of retrieved articles. We extracted data on study characteristics, outcomes and performed an assessment on the methodological quality of the studies. A random-effects model was used to compute the summary risk estimates. Fifteen relevant publications involving 949,260 participants were identified, from which seven studies contributed to the meta-analysis. G6PD deficiency was associated with a higher odd of diabetes (odds ratio 2.37, 95% confidence interval 1.50-3.73). The odds ratio of diabetes among men was higher (2.22, 1.31-3.75) compared to women (1.87, 1.12-3.12). This association was broadly consistent in the sensitivity analysis. Current evidence suggests that G6PD deficiency may be a risk factor for diabetes, with higher odds among men compared to women. Further research is needed to determine how G6PD deficiency moderates diabetes.
Fulltext Telemedicine for the management of glycemic control and clinical outcomes of type 1 diabetes mellitus: a systematic review and meta-analysis of randomized controlled studies

Lee SWH, Ooi L, Lai YK

Front Pharmacol, 2017;8:330.
PMID: 28611672 DOI: 10.3389/fphar.2017.00330

Importance: Telemedicine has been shown to be an efficient and effective means of providing care to patients with chronic disease especially in remote and undeserved regions, by improving access to care and reduce healthcare cost. However, the evidence surrounding its applicability in type 1 diabetes remains scarce and conflicting. Objective: To synthesize evidence and quantify the effectiveness of telemedicine interventions for the management of glycemic and clinical outcomes in type 1 diabetes patients, relative to comparator conditions. Data Sources: MEDLINE, EMBASE, Cochrane Library, Web of Science, PsycINFO, and CINAHL were searched for published articles since inception until December 2016. Study Selection: Original articles reporting the results of randomized controlled studies on the effectiveness of telemedicine in people with type 1 diabetes were included. Data Extraction and Synthesis: Two reviewers independently extracted data, assessed quality, and strength of evidence. Interventions were categorized based upon the telemedicine focus (monitoring, education, consultation, case-management, and peer mentoring). Main Outcome and Measure: Absolute change in glycosylated hemoglobin A1c (HbA1c) from baseline to follow-up assessment. Results: A total of 38 studies described in 41 articles were identified. Positive effects on glycemic control were noted with studies examining telemedicine, with a mean reduction of 0.18% at the end of intervention. Studies with longer duration (>6 months) who had recruited patients with a higher baseline HbA1c (≥9%) were associated with larger effects. Telemedicine interventions that involve individualized assessments, audit with feedback and skill building were also more effective in improving glycemic control. However, no benefits were observed on blood pressure, lipids, weight, quality of life, and adverse events. Conclusions and Relevance: There is insufficient evidence to support telemedicine use for glycemic control and other clinically relevant outcome among patients with type 1 diabetes.
Distal technology interventions in people with diabetes: an umbrella review of multiple health outcomes

Chakranon P, Lai YK, Tang YW, Choudhary P, Khunti K, Lee SWH

Diabet Med, 2020 12;37(12):1966-1976.
PMID: 31631398 DOI: 10.1111/dme.14156

AIM: To summarize and evaluate the existing evidence on the effectiveness of distal technology with regard to multiple health outcomes in people with diabetes.
METHODS: We searched PubMed, EMBASE and the Cochrane Database of Systematic Reviews from database inception to 31 August 2018 for systematic reviews and/or meta-analyses of studies that examined the impact of distal technology and reported any clinical or patient-related outcomes among people with type 1 or type 2 diabetes.
RESULTS: The umbrella review identified 95 reviews, including 162 meta-analyses with 46 unique outcomes. Evidence from meta-analyses of randomized controlled studies supports the use of distal technology, especially telehealth and mHealth (healthcare delivered by mobile technology), in people with diabetes for improving HbA1c values by 2-4 mmol/mol (0.2-0.4%). For other health outcomes, such as changes in fasting plasma glucose levels, risk of diabetic ketoacidosis or frequency of severe hypoglycaemia, the evidence was weaker. No evidence was reported for most patient-reported outcomes including quality of life, self-efficacy and medication-taking. The evidence base was poor, with most studies rated as low to very low quality.
CONCLUSION: Distal technologies were associated with a modest improvement in glycaemic control, but it was unclear if they improved major clinical outcomes or were cost-effective in people with diabetes. More robust research to improve wider outcomes in people with diabetes is needed before such technologies can be recommended as part of routine care for any patient group.
Fulltext The global burden of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: A systematic review and meta-analysis

Lee SWH, Chan EMC, Lai YK

Sci Rep, 2017 08 11;7(1):7984.
PMID: 28801563 DOI: 10.1038/s41598-017-06628-8

Benign prostatic hyperplasia is a common non-malignant condition among older men, but the epidemiology is poorly characterised. We summarised and determined the global prevalence of benign prostatic hyperplasia. A systematic search on PubMed, EMBASE and CENTRAL was performed up until 31st July 2016. Studies that described the epidemiology of benign prostatic hyperplasia were included and cumulative plots of prevalence estimates were calculated. A total of 31 prevalence rate estimates from 25 countries were identified. The combined prevalence estimates showed that the lifetime prevalence of BPH was 26.2% (95% CI: 22.8-29.6%). We found that there was an increasing prevalence of BPH with age. However, we found no significant difference between (a) rural, urban or mixed sites, (b) different countries, (c) respondent representativeness. (d) sample size or (e) study quality. We also found no significant change in the prevalence over the past 20 years. While there is substantial variation between sites estimates, results suggest that nearly 1 in 4 men will suffer from BPH over their lifetime. The study revealed there are significant gaps in knowledge, which provides opportunities for future research to further enrich the epidemiological landscape with data.
A Comparison of Once- and Thrice-Weekly Erythropoietin Dosing for the Treatment of Anaemia of Prematurity

Lim CP, Md-Redzuan A, Lai YK, Borhanuddin B, Cheah FC

Ann Acad Med Singap, 2017 10;46(10):395-398.
PMID: 29177368