Bleeding characteristics and mortality outcomes following ST-elevation myocardial infarction thrombolysis:a 5-year analysis in an Asian population

BACKGROUND:Bleeding outcomes are crucial primary safety endpoints in studies involving thrombolytic agents.This study aimed to determine the incidence,characteristics and mortality outcomes of bleeding following ST-elevation myocardial infarction(STEMI)thrombolysis in an Asian population.METHODS:This single-centre retrospective study included all STEMI patients who received thrombolytic therapy from 2016 to 2020 in a Malaysian tertiary hospital.Total population sampling was used in this study.The primary outcome was bleeding events post-thrombolysis,categorised using the Thrombolysis in Myocardial Infarction(TIMI)bleeding criteria.Inferential statistics were used to determine the associations between relevant variables.RESULTS:Data from 941 patients were analysed.A total of 156(16.6%)STEMI patients bled post-thrombolysis.Major,minor,and minimal TIMI occurred in 7(0.7%),17(1.8%),and 132(14.0%)patients,respectively.Age 65 years(P=0.031)and Malaysian Chinese(P=0.008)were associated with a higher incidence of bleeding post-thrombolysis.Conversely,foreigners(P=0.032)and current smoker(P=0.007)were associated with a lower incidence of bleeding.Both TIMI major(P<0.001)and TIMI minor(P<0.001)were associated with a higher incidence of all-cause in-hospital mortality among STEMI patients.TIMI minor bleeding was significantly higher in the streptokinase recipients.The bleeding sites were comparable between streptokinase and tenecteplase recipients,except for a significantly higher incidence of gastrointestinal bleeding in the streptokinase recipients(P=0.027).CONCLUSION:In our Asian population,the incidence of total bleeding events following STEMI thrombolysis is comparable to that previously reported.The development of TIMI major and minor bleeding complications is associated with higher mortality.

Evaluation of Functional and Radiological Outcome of Arthroscopic-Assisted Anatomical Coracoclavicular (CC) and Acromioclavicular (AC) Ligament Reconstruction in Chronic AC Joint Dislocation

Introduction: Acromioclavicular (AC) joint dislocation is a common shoulder injury, comprising 9% - 12% of shoulder girdle injuries. Optimal management remains challenging, with treatment decisions guided by the Rockwood classification system. Controversies surround grade III injuries, necessitating further classification. Non-operative treatment has shown favorable outcomes, while surgical interventions vary. Anatomical coracoclavicular reconstruction (ACCR) has demonstrated biomechanical advantages over traditional methods. Arthroscopic techniques offer advantages, minimizing deltoid detachment and allowing concurrent pathology identification. This study evaluates the outcomes of arthroscopic-assisted ACCR in chronic AC joint dislocation. Surgical Technique: Arthroscopic-assisted ACCR involves meticulous portal placement, tendon graft harvesting, diagnostic arthroscopy, and coracoid exposure. The clavicle tunnels were made to mimic the conoid and trapezoid ligament positions, using FibreTape#2 loop and Dog Bone Button for correct placement against the coracoid base, and passing the semitendinosus graft through to reconstruct the conoid ligament, reduction done and graft follow through for anatomical reconstruction. Methods: A retrospective cohort study at Hospital Kuala Lumpur analyzed 35 patients undergoing arthroscopic-assisted ACCR for Rockwood grade III - V AC joint dislocations. Inclusion criteria encompassed trauma ≥ 3 weeks prior, no prior shoulder injuries, and ≥12-month follow-up. Functional and radiological assessments utilized ASES scores and coracoclavicular distances, respectively. Statistical analysis employed descriptive statistics and logistic regression. Results: The mean age was 38.9 years (SD 11.26), and 34 of 35 patients were male. Grade IV injuries were predominant (37.1%). Waiting time for surgery averaged 234.9 days. Functional improvement was substantial postoperatively (ASES: 55.5 to 88.9). Radiological outcomes demonstrated reduced coracoclavicular distances and maintained reduction. No significant correlation was observed between injury grade and outcomes. Conclusion: Arthroscopic-assisted ACCR for chronic AC joint dislocation yields significant functional and radiological improvement, irrespective of injury grade. Waiting time for surgery exhibits minor impact on outcomes, emphasizing the procedure’s efficacy. Concomitant injuries do not impede success, highlighting the versatility of this approach in managing shoulder instability. The study contributes valuable insights into the nuanced management of chronic AC joint dislocations and supports the adoption of arthroscopic-assisted ACCR as a viable treatment option.

Correlation of Hamstring Tendon Size in Pre-Operative MRI Measurement with Intra-Operative Graft Size in Primary Anterior Cruciate Ligament (ACL) Reconstruction

Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation of pre-operative MRI measurement of Hamstring tendons with the intra-operative ACL graft. Thus, it may help surgeons to anticipate the needs for graft augmentation should the final graft size be smaller than expected. Methods: We retrospectively re-viewed 41 cases of ACL reconstructions in which MRI were done pre-operatively, in Hospital Pakar Sultanah Fatimah (HPSF), Muar between January 2019 until December 2022. MRI measurements of Hamstring tendon (semitendinosus: ST, and gracilis) were done by a radiologist, and the in-tra-operative notes were reviewed for the final graft size. Pearson’s correlation coefficients were calculated to determine the relationship between graft size and tendon cross-sectional area. The intraclass correlation (ICC) by using two-way mixed model with type consistency, the reliability based on average measure was 0.41 (95% CI: ?0.10, 0.69). A p-value < 0.05 was considered sig-nificant. Results: Of 105 patients with primary ACL reconstruction done be-tween January 2019 to December 2022, only 41 patients were included in this study. There was fair correlation (p = 0.048) between pre-operative MRI measurement and the graft diameter intra-operatively. The mean of 17.0 mm of combined diameter of ST and gracilis tendon in MRI may results in graft diameter of 8.3 mm. There was also positive correlation between patients’ height and the intra-operative graft size. Conclusion: These results showed good correlation between pre-operative MRI measurement of Hamstring ten-don size with the intra-operative graft size, hence it is a reliable tool to predict the Hamstring autograft size in ACL reconstruction.

Life Threatening Stridor Due to Primary Laryngeal Tuberculosis

Tuberculosis is a potentially serious infectious disease. In otorhinolaryngology practice, lymph node infection is the most common site of predilection followed by the larynx. Laryngeal tuberculosis (LTB) typically presents with dysphagia, odynophagia and hoarseness. We reported a case of primary LTB presenting with acute upper airway obstruction and respiratory distress mimicking acute supraglottitis which requires emergency tracheostomy. Therefore, in acute upper airway obstruction, the appropriate initial investigation should be done to rule out TB to make sure early treatment can be given and it may prevent complications of disease to the patient. .

Eurycoma longifolia Jack in managing idiopathic male infertility

This study investigated the effect of treatment with the proprietary standardized, water-soluble extract of the root of the Malaysian plant, Eurycoma longifolia Jack, which is thought to enhance male fertility with regard to higher semen volumes, sperm concentrations, the percentage of normal sperm morphology and sperm motility in male partners of sub-fertile couples with idiopathic infertility. A total of 350 patients were given 200 mg of the extract daily and follow-up semen analyses were performed every 3 months for 9 months. Of these 350 patients, 75 patients completed one full cycle of 3 months. Follow-up semen analyses in these patients showed significant improvement in all semen parameters. The proprietary extract of Eurycoma longifolia Jack significantly improved the sperm quality in these patients, allowing for 11 （14.7%） spontaneous pregnancies.

The Malaysian cataract surgery registry:incidence and risk factors of postoperative infectious endophthalmitis over a 7-year period

AIM：To report the incidence,risk factors and visual outcomes for postoperative endophthalmitis（POE）based on 7-year data from the Malaysian Ministry of Health Cataract Surgery Registry（MOH CSR）.METHODS：Data was collected from the web-based MOH CSR.All consecutive cataract surgery patients from 1st June 2008 to 31st December 2014 were identified.Exclusion criteria were traumatic cataract or previous ocular surgery.Demographic data,ocular co-morbidities,intraoperative details and postoperative visual acuity（VA）at final ophthalmological follow-up were noted.All eyes were taken for analysis.Subjects with POE were compared against subjects with no POE for risk factor assessment using multiple logistic regressions.RESULTS：A total of 163 503 subjects were screened.The incidence of POE was 0.08%（131/163 503）.Demographic POE risk factors included male gender（OR：2.121,95%CI：1.464-3.015）and renal disease（OR：2.867,95%CI：1.503-5.467）.POE risk increased with secondary causes of cataract（OR：3.562,95%CI：1.740-7.288）,uveitis（OR：11.663,95%CI：4.292-31.693）and diabetic retinopathy（OR：1.720,95%CI：1.078-2.744）.Intraoperative factors reducing POE were shorter surgical time（OR：2.114,95%CI：1.473-3.032）,topical or intracameral anaesthesia（OR：1.823,95%CI：1.278-2.602）,posterior chamber intraocular lens（PCIOL;OR：4.992,95%CI：2.689-9.266）and foldable IOL（OR：2.276,95%CI：1.498-3.457）.POE risk increased with posterior capsule rupture（OR：3.773,95%CI：1.915-7.432）and vitreous loss（OR：3.907,95%CI：1.720-8.873）.Postoperative VA of 6/12 or better was achieved in 15.27%（20/131）subjects with POE.CONCLUSION：This study concurs with other studies regarding POE risk factors.Further strengthening of MOH CSR data collection process will enable deeper analysis and optimization of POE treatment.

Carbon dioxide insufflation during colonoscopy in deeply sedated patients

AIM:To compare the impact of carbon dioxide(CO2) and air insufflation on patient tolerance/safety in deeply sedated patients undergoing colonoscopy.METHODS:Patients referred for colonoscopy were randomized to receive either CO2 or air insufflation during the procedure.Both the colonoscopist and patient were blinded to the type of gas used.During the procedure,insertion and withdrawal times,caecal intubationrates,total sedation given and capnography readings were recorded.The level of sedation and magnitude of patient discomfort during the procedure was assessed by a nurse using a visual analogue scale(VAS)(0-3).Patients then graded their level of discomfort and abdominal bloating using a similar VAS.Complications during and after the procedure were recorded.RESULTS:A total of 142 patients were randomized with 72 in the air arm and 70 in the CO2 arm.Mean age between the two study groups were similar.Insertion time to the caecum was quicker in the CO2 group at 7.3 min vs 9.9 min with air(P = 0.0083).The average withdrawal times were not significantly different between the two groups.Caecal intubation rates were 94.4% and 100% in the air and CO2 groups respectively(P = 0.012).The level of discomfort assessed by the nurse was 0.69(air) and 0.39(CO2)(P = 0.0155) and by the patient 0.82(air) and 0.46(CO2)(P = 0.0228).The level of abdominal bloating was 0.97(air) and 0.36(CO2)(P = 0.001).Capnography readings trended to be higher in the CO2 group at the commencement,caecal intubation,and conclusion of the procedure,even though this was not significantly different when compared to readings obtained during air insufflation.There were no complications in both arms.CONCLUSION:CO2 insufflation during colonoscopy is more efficacious than air,allowing quicker and better cecal intubation rates.Abdominal discomfort and bloating were significantly less with CO2 insufflation.

Coincident Bilateral Atraumatic Hip Fracture in a Young Patient with Renal Osteodystrophy

Bilateral, coincident, atraumatic hip fracture is extremely uncommon and usually occurs secondary to seizures, trauma and metabolic disease including renal osteodystrophy. One of the major types, secondary hyperparathyroidism is associated with high bone turnover due to excess parathyroid hormone and usually seen in a chronic dialysis patient. We reported a 20-year-old woman with end stage renal failure and renal osteodystrophy. She sustained atraumatic right subtrochanteric fracture and left neck of femur fracture (Garden 1), then underwent bilateral long proximal femoral nail. Renal osteodystrophy causes pathological fracture by affecting calcium metabolism that stimulates bone resorptions and leads to osteoporotic bone. The aim of this case report is to discuss the approach and management done to the patient presented to our center. Bilateral long proximal femoral nail (PFN) was chosen, taking into account the patient’s premorbid, age, fracture pattern and potential complications. Careful multidisciplinary team approach led by the orthopaedic surgeon, nephrologist and physical therapist is vital for the patient to achieve good outcome postoperatively, thus reducing morbidity and mortality.

Refractive errors and biometry of primary angle-closure disease in a mixed Malaysian population

AIM： To assess the refractive status, anterior chamber depth （ACD） and axial length （AL） of patients with primary angle-closure disease （PACD）. METHODS： Retrospective cohort. Data was collected from charts of all PACD patients treated from April 2013 to December 2015. Analysis was done on 137 patient charts with complete biometric data. Patient demographics, PACD type, refractive status （spherical equivalent）, ACD and AL were studied. RESULTS： The median age of 137 subjects [53 with primary angle-closure suspects （PACS）, 27 with primary angle- closure （PAC） and 57 with primary angle-closure glaucoma （PACG）] was 68y （range 21-88y）. The majority was Chinese （n=68; 49.6%） and most of them were women （n=75; 54.7%）. The distribution of myopia （n=51; 37.2%） and hyperopia （n=49; 35.8%） was similar. The ACD was shallower in myopes compared to hyperopes （P=-0.02） and emmetropia （P=-0.049） but the AL was not significantly different between groups. There were no patients blind from PACG. CONCLUSION： Both myopia and hyperopia can occur in PACD. Despite a shallower ACD in angle closure myopes, the AL was not different between groups.

Coping Strategies among Parents of Children with Acute Lymphoblastic Leukemia

Background: Having a child with acute lymphoblastic leukemia represents challenges to the family which may impact their quality of life. In such circumstances, parents use various coping strategies to face this stressful situation, and understanding the relation of coping strategies on quality of life among parents of children with acute lymphoblastic leukemia may provide professionals with ideas about how to support them which in turn may improve their quality of life. Aim: The aim of the present study was to assess the correlation between coping strategies and the health related quality of life of parents whose children are suffering from acute lymphoblastic leukemia. Study design: A cross-sectional design using guided self-administered questionnaire by a single researcher was used. Methods: A universal sample consisted of 299 parents of children with acute lymphoblastic leukemia (ALL) was recruited from Hospital Universiti Kebangsaan Malaysia and Kuala Lumpur Institute Pediatrics. The response rate was 98%. The data collection tools were WHOQOL BREF which is the World Health Organization Quality of Life shorter version and Brief COPE questionnaires. Results: The results revealed that half of the parents perceived their health related quality of life as good. The highest scores for parents were reported on the social relationship domain meanwhile the lowest were reported on the environmental health domain. In regard to the coping strategies, it was found that religion was most frequently used while humor was the least to be used. Moreover, there was a significant positive relationship between quality of life of the parents and problem-focused coping style and a significant negative relationship with emotion-focused coping style. Conclusion: On the basis of the finding of present study, an appropriate intervention could be design to include program that promote the use of problem-focused copings such as active coping and planning and discourage the use of emotion-focused copings such as self-blaming to enhance parents’ health related quality of life.

Ratio of Capacitance/BMI Reflects Deficit in Nutritional Concentration While CH2 Reflects Total Nutritional Deficit in CAPD Patients and General Population

Traditionally phase angle was the best predictor in BIA for nutrition and survival in dialysis population. We recently showed that normalized bioimpedance indices are a better risk discriminator for dialysis patients and the general popu-lation. We hereby aimed to explore discriminating factors behind them. Methods: We assessed the body capacitive index (BCI = Capacitance × Height2/Weight);body resistive index (BRI = Resistance × Weight/Height2);and also, CH2 (= Capacitance × Height2) which represents total body capacitive volume in physics. We initially performed BIA for 206 female, 116 male healthy volunteers, followed by, prospective study for 128 CAPD patients (47 diabetes mellitus (DM), 81 non-DM;59 male, 69 female) for >2 years. Results: Moderately good negative correlation of albumin and BCI (r = -0.533, p X2 = 165.6), followed by CH2 (X2 = 140), phase angle (X2 = 59.3) and BRI (X2 = 52.2). Thirty five (27.3%) patients died during the study period (Fatal cause: infection (54%), cardiovascular (26%)). In Cox regression, CH2 ( X24 = 32.4) was the best predictor for all-cause mortality, followed by BCI (X24 = 27.7) and phase angle ( X24 = 19.3). Conclusion: The phase angle was a compound parameter of the body capacity index (BCI) and body resistive index (BRI). BCI has a mod-erately good negative correlation with albumin and this supports its role in reflecting the severity of malnutrition in CAPD patients. CH2 represents total nutrition deficit and thus the major risk indicator for the survival of CAPD pa-tients.

Diagnostic evaluation of optical coherence tomography parameters in normal, preperimetric and perimetric glaucoma patients

AIM: To compare the diagnostic ability of glaucoma parameters measured by the optical coherence tomography(OCT) in normal, preperimetric glaucoma(PPG) and perimetric glaucoma(PG) patients. METHODS: This cross-sectional observational study includes 127 eyes of 127 subjects. Patients were divided into PPG(51 eyes), PG(46 eyes), and normal controls(30 eyes) based on clinical optic disc assessment and Humphrey visual field changes. The Heidelberg Spectralis OCT machine using Glaucoma Module Premium Edition software was used to measure the retinal nerve fiber layer(RNFL) and Bruch’s membrane opening-minimum rim width(BMO-MRW) to assess the optic nerve head and ganglion cell layer(GCL) thickness in the macula. RESULTS: RNFL, MRW, and GCL thickness were all significantly thinner in PG compared to PPG and the normal group. The BMO-MRW parameters showed better specificity(>70%) at 90% specificity compared to both RNFL and GCL parameters to discriminate normal, PPG, and PG patients. All BMO-MRW parameters showed higher area under curves(AUC) compared to RNFL and GCL parameters with the highest AUC observed in the superotemporal sector of the BMO-MRW(AUC=0.819 and and 0.897 between normal and PPG and PG groups respectively).CONCLUSION: While the BMO-MRW best discriminates PPG and PG against normal eyes, GCL parameters poorly differentiate the three groups.

Treatment of diffuse choroidal haemangioma using photodynamic therapy

Dear Editor,I am Dr.Khay Wei Poh from Department of Ophthalmology,Hospital Kuala Lumpur,Malaysia.I write to share a case of diffuse choroidal haemangioma in a child with SturgerWeber syndrome who showed resolution of exudative retinal

Impact of Palm Oil versus Other Oils on Weight Changes: A Systematic Review

Objective: The present review aimed to determine the effect of palm oil versus other oils on changes in body weight or Body Mass Index (BMI). Design: A systematic review was conducted. Studies were identified by database searching (EMBASE, PUBMED, CENTRAL, SCOPUS, PROQUEST, Web of Science [ISI Web of Knowledge], Cumulative Index to Nursing and Allied Health Library (CINAHL Plus), LILAC and ClinicalTrials.gov. Searching, selecting and reporting were done according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) Statement. Setting: Palm oil vs other oils intervention study on weight or BMI changes. Subjects: Individuals participating in palm oil vs other oil intervention study. Results: A total of 182 studies were screened for eligibility, five studies were finally included. Three studies compared the effect of palm oil vs sunflower oil on weight changes and BMI. One study examined the effect of hybrid palm oil vs extra virgin olive oil on weight changes. The last study examined the effect of palm oil vs olive oil vs lard on weight changes. Out of 292 participants in five studies, only one study (Iggman, 2014) had a low risk of bias. In this study, there was no significant difference between the group that received sunflower oil and palm oil (SMD: 0.04, 95% CI: -0.59 to 0.66). Other four studies had unclear risk of bias. Conclusions: Based on the review, there is insufficient evidence to suggest the impact of palm oil intake on weight changes or BMI.

Bell’s Palsy Post COVID-19 Vaccination: A Retrospective Cross-Sectional Study in a Single Tertiary Center

Introduction: Bell’s palsy is an uncommon adverse effect of the COVID-19 vaccine that has been reported in clinical trials. Even though a few studies have linked the vaccination to Bell’s palsy, the actual mechanism is uncertain. Objectives: To describe the demographic data and COVID-19 vaccines-related data with Bell’s palsy in a tertiary centre of Malaysia, Hospital Kuala Lumpur. Methods: A retrospective cross-sectional study was observed among vaccinated recipients who developed Bell’s palsy within 60 days and sought treatment in the Otorhinolaryngology Department Hospital Kuala Lumpur, Malaysia between 1st May 2021 and 30th November 2021. The demographic data, clinical history, and vaccination history were collected from clinical records. The facial paralysis was graded according to the House-Brackmann grading system. Results: A total of 26 patients with a mean age was 38.5 years;higher incidence in younger age, below 60 years old (n = 24), specifically 18 - 30 years old (n = 11). We observed an equal number in relation to gender and onset (after the first or second dose) of facial palsy. Predominantly were Malay (n = 21) and only 6 patients had comorbidities. We found there was no difference in regard to the type of vaccine among Bell’s palsy patients;Pfizer (n = 9), followed by Sinovac (n = 9) and AstraZeneca (n = 8). Conclusion: Bell’s palsy was found to be a possible adverse event of the COVID-19 vaccine. Younger groups were noted as susceptible to this rare adverse effect. However, the benefits of vaccination outweigh the risk of Bell’s palsy, which has a good prognosis. More research with larger samples is needed to determine the true relationship between vaccination and Bell’s palsy.

Capillary Hemangioma of the Nasal Septum: A Rare Case Report

Capillary hemangioma is a congenital malformation of the capillary. It commonly affects the face, eyelids, lips and skin. Adult capillary hemangioma involving the nasal cavity is rare and may be misdiagnosed as polyps or another tumor. This case report illustrated a middle-age adult patient in Malaysia who presents with unilateral nasal obstruction and intermittent epistaxis who later confirmed capillary hemangioma involving the right nasal septum. Endoscopic surgery excision of the hemangioma was successfully performed. There were no known risk factors present in him. A treating doctor in the outpatient clinic seeing symptoms such as unilateral nasal obstruction must consider alternative diagnosis such as hemangioma besides usual diagnosis of polyps.

~etting up a men＇s clinic has never been an easy task. I have done it, and here is my story

Almost a quarter of a century ago, having completed a diploma in reproductive medicine, I was sent to the Monash Medical Research Centreat Prince Henry＇s Hospital in St Kilda, Melbourne, Australia, on a fellowship in clinical andrology and semenology. Professor H. W. Gordon Baker and the present governor of Victoria, Professor David de Kretser. were mv mentors in andrology.

Case Report of Combined Sixth and Twelfth Cranial Nerve Palsy: A Rare Case of Clival Syndrome Arising from Thymoma

Godtfredsen syndrome or clival syndrome is a rare syndrome of abducens and hypoglossal nerve palsies (cranial nerve 6th and 12th respectively) that localizes to a clival mass. There are few reported cases of this clinical presentation. The aim of this case report is to describe this rare manifestation observed in a woman with clival metastases arising from a thymoma. A previously well 34-year-old native lady presented to a district hospital in Sabah, Malaysia, with history of blurring of vision and headache for 1 month. Cranial nerve examination reveals right abducens nerve palsy (right 6th CN) and right hypoglossal nerve palsy (right 12th CN). Initial imaging with CT brain reveals a subtle extra-axial hyperdense mass adjacent to the clivus and a routine chest x-ray reveals a mediastinal mass. Further imaging of thorax showed right anterior mediastinal mass, which then proceeded with Video-Assisted Thoracoscopic Surgery (VATS) guided biopsy. The biopsy result was consistent with the finding of thymoma, type B2. She was then diagnosed with aggressive form of thymoma, which unfortunately has metastasized to the bone, lung, liver and brain. Despite prognosis at the time of diagnosis is guarded, she still opted to undergo chemotherapy. Despite the completion of 6 cycles of chemotherapy, her disease progressed, and she eventually succumbed to the illness. In short, the presence of combined 6th and 12th palsy should alert clinician to the possibility of clival mass or metastases and hence could earlier workup with appropriate imaging can lead to earlier diagnosis and better treatment outcome.

Fenofibrate for the prevention of progression of non-proliferative diabetic retinopathy:review,consensus recommendations and guidance for clinical practice

The prevalence of diabetic retinopathy(DR),and associated morbidity is high in the Asia-Pacific region.Emerging evidence suggests a potential role for fenofibrate in the prevention of progression of DR,especially in patients with cardiovascular risk,and pre-existing mild-to-moderate DR.Fenofibrate has also been found to reduce maculopathy,and the need for laser treatment in these patients.Considering these benefits of fenofibrate,a group of experts from the fields of endocrinology and ophthalmology convened in May 2017,to discuss on the the mechanism of action,and clinical efficacy of fenofibrate in DR.The findings from key clinical studies on fenofibrate in DR were reviewed by the experts,and consensus statements were derived to define the role of fenofibrate in the prevention and treatment of DR.The statements were rated based on the GRADE criteria.An algorithm was also developed for the screening and treatment of DR in patients with type 2 diabetes(T2D),and the place of fenofibrate was defined in the algorithm.The expert recommendations,and the algorithm provided in this review will serve as a guide to the clinicians to reconsider the adjunctive use of fenofibrate for preventing the progression of DR in selected T2D patients.