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Exploring bedside clinical features of parkinsonism: A focus on differential diagnosis

Bhidayasiri R, Rattanachaisit W, Phokaewvarangkul O, Lim TT, Fernandez HH

Parkinsonism Relat Disord, 2019 Feb;59:74-81.
PMID: 30502095 DOI: 10.1016/j.parkreldis.2018.11.005

The proper diagnosis of parkinsonian disorders usually involves three steps: identifying core features of parkinsonism; excluding other causes; and collating supportive evidence based on clinical signs or investigations. While the recognition of cardinal parkinsonian features is usually straightforward, the appreciation of clinical features suggestive of specific parkinsonian disorders can be challenging, and often requires greater experience and skills. In this review, we outline the clinical features that are relevant to the differential diagnosis of common neurodegenerative parkinsonian disorders, including Parkinson's disease, multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration. We aim to make this process relatable to clinicians-in-practice, therefore, have categorised the list of clinical features into groups according to the typical sequence on how clinicians would elicit them during the examination, starting with observation of facial expression and clinical signs of the face, spotting eye movement abnormalities, examination of tremors and jerky limb movements, and finally, examination of posture and gait dysfunction. This review is not intended to be comprehensive. Rather, we have focused on the most common clinical signs that are potentially key to making the correct diagnosis and those that do not require special skills or training for interpretation. Evidence is also provided, where available, such as diagnostic criteria, consensus statements, clinicopathological studies or large multi-centre registries. Pitfalls are also discussed when relevant to the diagnosis. While no clinical signs are pathognomonic for certain parkinsonian disorders, certain clinical clues may assist in narrowing a differential diagnosis and tailoring focused investigations for the individual patient.

Matched MeSH terms: Eye Movements
Pyogenic Granuloma Formation Following Ahmed Valve Glaucoma Implant

Chendran P, Seng Fai T, Wan Abdul Halim WH, Md Din N

J Glaucoma, 2019 10;28(10):e162-e164.
PMID: 31368915 DOI: 10.1097/IJG.0000000000001334

Ocular pyogenic granuloma is a benign tumor seen after ocular insult secondary to ocular surgeries, trauma or infection. Although benign, intervention is sometimes necessary. Previous authors have reported pyogenic granuloma formation following oculoplastic surgeries. We report a pyogenic granuloma after an Ahmed glaucoma valve implantation. A 65-year-old gentleman presented with right eye redness associated with pain and swelling ~2 months after Ahmed glaucoma valve implantation. Examination found a sessile growth on the tube extruding puss with signs of endophthalmitis. The glaucoma drainage device was explanted and culture results grew Staphylococcus aureus. This article discusses the formation of pyogenic granuloma on a glaucoma drainage device and its management.

Matched MeSH terms: Eye Infections, Bacterial/diagnosis; Eye Infections, Bacterial/drug therapy; Eye Infections, Bacterial/microbiology*
Fulltext Severe Orbital Myiasis Caused by Chrysomya bezziana: A Case Report

Ng YS, Gan YK, Tupang L

Turk J Ophthalmol, 2021 Feb 25;51(1):62-65.
PMID: 33631919 DOI: 10.4274/tjo.galenos.2020.00225

An 88-year-old woman was brought to the hospital immediately after her neighbours noticed that she was bleeding from her right eye. On examination, her right eye was phthisic with maggot infestation of her right orbit. Over a hundred live maggots were extracted using forceps. Computed tomography scan revealed the infestation was confined to the right orbit. The patient underwent exenteration of the right orbit under general anaesthesia. The species was identified by an entomologist as Chrysomya bezziana, which has aggressive larvae that eat living tissue. This case report demonstrates that orbital myiasis caused by C. bezziana poses a very real risk of intracranial invasion as they feed on living tissues. Adjacent tissue destruction can be very rapid and definitive treatment involves urgent removal of its larvae via surgical debridement. To our knowledge, we are reporting the first case of orbital myiasis from a patient in Malaysia. Therefore, our case report may be helpful in the management of similar case of orbital myiasis.

Matched MeSH terms: Eye
How do Asians perceive Caucasian eyes? Electrophysiological correlates of perceiving racial differences from the eyes region of the face

Yong MH, Lim XL, Schaefer A

Neurosci Lett, 2020 02 16;720:134759.
PMID: 31952988 DOI: 10.1016/j.neulet.2020.134759

Past research has found that several brain event-related potentials (ERPs) were sensitive to the perception of ethnic differences displayed on human faces. This body of research suggests that the phenomenon of "race perception" involves a cascade of cognitive processes that includes both automatic and overt attentional mechanisms. However, most of these studies used stimuli depicting whole faces rather than stimuli depicting separate facial features. Therefore, it is still largely unknown if ERP responses to racial differences are the result of a holistic processing of the whole face, or whether they can be accounted for by the perception of single facial features. To address this issue, we examined whether a single facial feature, the eyes region, can provide sufficient information to trigger known ERP correlates of race perception such as the P2, the N400 and the Late Positive Complex (LPC). Specifically, we showed pictures depicting only the eyes region of Caucasian and Asian faces to a sample of Asian participants. We found that the P2 was larger for other-race (OR) compared to same-race (SR) eyes, and that the N400 was larger for SR compared to OR eyes. The effects on the P2 may suggest an enhanced vigilance response to OR eyes whereas the N400 effect could reflect a signal of familiarity triggered by SR eyes. These results indicate that a specific facial feature, the eyes region, can account for known effects of race perception on early brain potentials. Our findings also indicate that well-known early neural correlates of race perception can be triggered in the absence of a holistic processing of the whole face.

Matched MeSH terms: Eye
Fulltext The effect of smartphone usage on accommodation status

Wiki Safarina Narawi, Shaz’ Ain Razak, Nahdiyah Azman

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):244-247.
MyJurnal

Introduction: Usage of smartphones have increased rapidly because of its importance in our daily life. This led to an increase in incidence of ocular problems among smartphone users. This research was conducted to determine the effect of smartphone usage on accommodation status. Methods: A cross-sectional study was conducted among young adults aged 19 to 30 years old in Management and Science University, Shah Alam. All subjects were asked to use smartphone for 20 minutes. The symptoms and accommodation status were evaluated before and after the smartphone usage. Results: Total subjects showed the mean age of 23.60 ± 2.77 years, 50% (n = 20) were males and 50% (n = 20) were females. The mean smartphone usage per day was 8.60 ± 2.80) hours. After 20 minutes of smartphone usage, subjects complained of tired eyes (92.50%), dry eyes (90.00%), blurred vision (87.50%), and headache (82.50%). Paired t-test showed significant reduction in amplitude of accommodation, monocularly from 9.9 ± 1.9 D to 8.76 ± 2.50 D (p = 0.00), and binocularly from 12.01 ± 1.95 D to 10.96 ± 2.16 D (p = 0.00); monoc- ular accommodative facility from 13.93 ± 3.13 cpm to 11.10 ± 4.32 cpm (p = 0.00) and binocular accommodative facility from 12.70 ± 3.57 cpm to 9.70 ± 4.21 cpm (p = 0.00); positive relative accommodation from -2.72 ± 0.87 D to -2.13 ± 1.28 D (p = 0.00) and increase in lag of accommodation from 0.4 ± 0.26 D to 0.93 ± 0.48 D (p = 0.00). Conclusion: This study shows that there were significance changes on accommodation status after 20 minutes of smartphone usage which can lead to weakness of accommodation.

Matched MeSH terms: Dry Eye Syndromes
Fulltext Human coronaviruses: ophthalmic manifestations

Abdul-Kadir MA, Lim LT

BMJ Open Ophthalmol, 2020;5(1):e000630.
PMID: 33195813 DOI: 10.1136/bmjophth-2020-000630

The 2019 novel coronavirus which causes severe acute respiratory syndrome (SARS) known as SARS-CoV-2 still remains as a global pandemic since its discovery and continues to spread across the world, given how highly contagious the virus is. We reviewed various articles that explore eye involvement in COVID-19 and other human coronaviruses, its human manifestations in comparison to animal studies and potential mechanism of viral entry into the eye surface. Evidence of animal studies depicted various complications of coronaviruses infection into the eyes, in both anterior and posterior segments of the eye. Conjunctival inflammation remains uncommon in association with COVID-19, with other ophthalmic findings. The risk of transmission via the ocular surface remains likely low, though it is inarguably present based on preliminary finding of viral load in ocular samples and expression of ACE2 on the ocular surface. Testing the tears sample for diagnosing SARS-CoV-2 was unreliable due to limitations of the testing kits and conflicting evidence of the viral titre in the ocular samples. Further larger, more precise and specific studies are required to allow us to better understand the pattern of virulence underlying the associations of SARS-CoV-2 in the eye despite its rare occurrence. This review article aims to enhance better awareness among clinicians regarding ocular manifestations associated with COVID-19 and necessary precautions should be implemented to minimise the risk of person-to-person especially in the nosocomial setting.

Matched MeSH terms: Eye
Fulltext Patterns of visual field defects in Malay population with myopic eyes

Rab’ie Rusdi, Mohd Zaki Awg Isa

Malaysian Journal of Medicine and Health Sciences, 2020;16(101):101-105.
MyJurnal

Introduction: Myopia is an emerging vision problem that causes public health and economic burden worldwide and associated with increased risk to many ocular conditions leading to blindness. This study aimed to evaluate patterns of visual field defects in Malay population with myopia. Methods: A retrospective study was conducted between January 2018 until June 2018 at MSU Eye Centre and data was obtained from patient records of Malay subjects with myopia and free from any ocular and systemic diseases. The spherical equivalent (SE) of the refractive errors and the global indices (mean deviation, MD and pattern of standard deviation, PSD) of OCULUS Twinfield® 2 with SPARK strategy were recorded for this study. Results: A total of 90 eyes with the mean age of 29.16 (SD: 10.27) years old and SE (M= -2.92 D, SD:2.94 D) were selected. The mean of MD was -1.71 dB (SD 3.95 dB) and PSD was 1.81 dB (SD:1.82 dB) respectively. Significant differences was found in MD (p=0.012) and PSD (p=0.01) between the three groups. The localised field defect was observed in the moderate to high myopic eyes in all quadrants (p=0.01) for PP2, and also more prevalent pattern found in all quadrants for PP1 except at superior quadrant (p=0.08). Conclu- sions: There is a localised visual field defect found in a higher degree of myopia particularly at temporal, nasal and inferior quadrants. Thus, the visual field test is recommended as a routine procedure in moderate to high myopic eyes and need to be interpreted with caution.

Matched MeSH terms: Eye
Fulltext Recurrent chalazia secondary to bortezomib

Fatin Hanisah, F., Rona Asnida, N., Jemaima, C.H.

Medicine & Health, 2018;13(2):217-222.
MyJurnal

Few cases of chalazia secondary to bortezomib are reported in literature. However, it is not a recognized ocular adverse effect. We hereby report a case of recurrent chalazia secondary to bortezomib. A 40-year-old male with light chain myeloma on ten weeks of chemotherapy with bortezomib was treated for left eye inflamed chalazion with bilateral meibominitis. Severe chalazia persisted despite treatment, which necessitated cessation of chemotherapy. The patient’s condition improved on oral doxycycline and chemotherapy was recommenced but his chalazia recurred, necessitating incision and curretage. His chalazia responded to oral azithromycin without further cessation of chemotherapy. Bortezomib’s association with chalazia has been characterized as a possible adverse drug reaction according to the World Health organization classification, and its recognization as an established adverse reaction to will allow earlier identification and appropriate co-management of the patient.

Matched MeSH terms: Eye
Fulltext The consistency of retinal image size measurement using smartphone application

Nura Syahiera Ibrahim, Firdaus Yusuf @ Alias, Norsham Ahmad

Malaysian Journal of Medicine and Health Sciences, 2020;16(3):15-20.
MyJurnal

Introduction: Unequal retinal image size (RIS) or aniseikonia is usually related with anisometropia. Higher dif- ferences of RIS may manifest symptoms such as dizziness, headache or disorientation. In worst case might cause suppression that leads to amblyopia. Current study aims to evaluate the consistency of aniseikonia measurement in Smart Optometry smartphone application among myopic, hyperopic, and astigmatic simulated anisometropia and real anisometropia groups. Methods: Fifteen real anisometropes (refractive error; -0.50 until -6.00 diopters; D) and fifteen emmetropes (refractive error: -0.25 until +0.50D) were recruited. Real anisometropes wore their habitual spectacle correction while each emmetropes were fitted using soft contact lenses of +4.00DS, -4.00DS and -4.00DC with base curve 8.6 and total diameter 14.2mm in random order to mimic myopic-, hyperopic- and astigmat- ic-anisometropia before testing. Participants with any ocular disease and binocular vision problem were excluded. The consistency of aniseikonia measurement was determined in two visits, separated by at least 24-hour interval. Three repetitive measurements were taken in each visit. Results: Independent t-test and paired t-test showed that real and simulated anisometropia gave insignificant aniseikonia percentage, p>0.05. ICC findings revealed moder- ate-to-good agreement for all simulated and real groups. Bland Altman analysis between two visits exhibited good agreement among all simulated group; myopic (mean difference 0.2047; 95%CI:-1.1386-1.549), hyperopic (mean difference 0.2200; 95%CI:-0.9286-1.3686) and astigmatic (mean difference 0.2533; 95%CI:-0.7114-1.2180). Real anisometropes demonstrated good agreement with bias value of 0.2247(95%CI:-0.9162-1.3656) using Bland Altman plot. Conclusion: Smart Optometry application provides consistent measurement of aniseikonia regardless any types of anisometropia.

Matched MeSH terms: Eye; Eyeglasses
Fulltext Relationship between Routine Handling Practices with Potential Pathogenic Bacteria Isolated from Contact Lenses Among Students in UiTM Negeri Sembilan

Adam Zafdri Md Zali, Rashidah Iberahim

Journal of Academia Universiti Teknologi MARA Negeri Sembilan, 2021;9(1):106-116.
MyJurnal

Pseudomonas aeruginosa and Staphylococcus aureus are types of bacteria known to cause bacterial keratitis. Pseudomonas aeruginosa causes bacterial keratitis by adhering to the surface of the contact lenses, when the P. aeruginosa are in contact with the eye, resulting in infectious keratitis. As for Staphylococcus aureus, when there is a predisposing factor such as wearing expired or extended use of contact lenses (contact lenses that can be used continually for up to one week even while sleeping) weaken the individual defences and leads to the development of bacterial keratitis. Both bacteria are capable to infect eye cornea and lead to bacterial keratitis through contact lenses wearer. The findings of this study provide information on the importance of routine practices in handling contact lenses to help reduce the incidence of bacterial keratitis caused by wear contact lenses in an individual. The side effect of wearing contact lenses such as redness of the eye and keratitis due to the infection by pathogenic bacteria which comes from the behavior and low hygiene level management of individual had led the study to create awareness to contact lenses wearer. In this study, 25 soft and hard contact lenses with purposed for colored or toric contact lenses were obtained among UiTM Negeri Sembilan students. The users required to answer the questionnaire form regarding the type, behavior, and routine practices of their contact lenses. Pathogenic bacteria were isolated using the cotton swab technique and cultured on nutrient broth. The streak technique was used to cultured bacteria from broth to nutrient agar, blood agar, and MacConkey agar. Later, the identification of bacteria was carried out using biochemical tests and microscopic observation. From the laboratory results, 84% of the tested contact lenses contained pathogenic bacteria on their surface. These findings concluded that the presences of pathogenic microorganisms on the contact lenses used closely related to the behavior in handling and hygenic practices level by the contact lenses users.

Matched MeSH terms: Eye Infections, Bacterial
Fulltext Study of the pattern of cell phone usage associated with side effects among university students: case study in a Malaysian university

Sohayla M. Attalla, Nur Syamimi Syuhada bt Safiee, Sakinah Ruhi

Malaysian Journal of Medicine and Health Sciences, 2020;16(107):8-12.
MyJurnal

Introduction: Cell phone is a device that has been used almost every day for all age groups. It connects everyone and everything around the world as it provides various social platforms. However, not many people realized that cell phone is a source of non-ionizing electromagnetic waves that can be associated with various physical effects. Therefore, the aim of this research is to identify the physical side effects associated with exposure to the electromagnetic waves emitted by cell phone use and to detect if these effects are associated with specific pattern of use. Methods: A cross-sectional study was conducted on 166 participants randomly selected from university students. Results: showed that those suffering side effects associated with cell phone usage are usually using more than one cell phone (79%) since about 5 – 10 years (41.9%) for more than 5 hours daily (65.7%) for entertainment (34.3%) and
making about 1-5 calls daily (41%) with average call duration 1 – 30 min (56.2%). 66.7% of them started using cell phone at age 7 – 12 years old, mostly handheld (61%), at their right side (40%), at all times of the day (64.8%). Most common side effects associated with cell phone usage include ear pain (52.4%), headache (79.5%), fatigue, anxiety or insomnia (57.8%), tremors and eye pain beside statistically significant (P

Matched MeSH terms: Eye Pain
Ocular surface disease in psoriatic patients in a developing country

Goh Y, Kwan Z, Han WH, Iqbal T, Yahya F, Khang TF, et al.

Int Ophthalmol, 2021 Jun;41(6):2139-2147.
PMID: 33788072 DOI: 10.1007/s10792-021-01771-8

PURPOSE: To evaluate ocular surface changes among patients with psoriasis in Malaysia, a developing country in Southeast Asia.
METHODS: An interdisciplinary case-control study (60 psoriasis patients and 40 control subjects) to look at the differences in ocular surface manifestations between patients with psoriasis and a group of age-, gender- and ethnicity-matched healthy controls.
RESULTS: One hundred and twenty eyes of 60 patients with psoriasis and 80 eyes of 40 healthy controls without psoriasis were included in the study. Mild-to-moderate psoriasis was found in 42 patients (70%), while 18 patients (30%) had severe psoriasis. Psoriatic arthritis was found in 19 patients (32%). Of the 60 psoriatic patients, the prevalence of ocular involvement was 65% (39/60), in which 32% (19/60) had dry eyes, 27% (16/60) had lid margin abnormalities, 33% (20/60) had cataract, and one had history of anterior uveitis. Compared to controls, ocular surface of psoriatic patients showed more eyelid margin abnormalities, higher meibomian gland loss and lower tear film break-up time. The estimated odds ratio for dry eyes in the psoriasis group was 2.2 (95% CI: 0.8-6.9).
CONCLUSION: Ocular surface disorders encompassing eyelid margin abnormalities, meibomian gland loss and tear dysfunction occur at an earlier and higher rate among psoriatic patients.

Matched MeSH terms: Dry Eye Syndromes
Fulltext Rapid anterior capsular contraction after phacoemulsification surgery in a patient with retinitis pigmentosa

Jin-Poi T, Shatriah I, Khairy-Shamel ST, Zunaina E

Clin Ophthalmol, 2013;7:839-42.
PMID: 23674886 DOI: 10.2147/OPTH.S42122

A decrease in the anterior capsule opening after cataract surgery has been observed in eyes with weakened lens zonules. It commonly occurs in diabetes mellitus, uveitis, pseudoexfoliation syndrome, high myopia, and elderly patients. Herein, we report the case of a middle-aged man with advanced retinitis pigmentosa who developed a rapid contraction of the anterior capsule after an uneventful phacoemulsification surgery that resulted in severe visual loss during the early postoperative period.

Matched MeSH terms: Eye
Fulltext Intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage

Abdul-Salim I, Embong Z, Khairy-Shamel ST, Raja-Azmi MN

Clin Ophthalmol, 2013;7:703-6.
PMID: 23589678 DOI: 10.2147/OPTH.S42208

Herein, we report our experience in treating extensive traumatic submacular hemorrhage with a single dose of intravitreal ranibizumab. A 23-year-old healthy Malay man presented with a progressive reduction of central vision in the left eye of 2 days' duration following a history of blunt trauma. Visual acuity was reduced to counting fingers. Examination revealed infero-temporal subconjunctival hemorrhage, traumatic anterior uveitis, and an extensive sub-macular hemorrhage with suspicion of a choroidal rupture in the affected eye. He was initially treated conservatively with topical prednisolone acetate 1%. The subconjunctival hemorrhage and anterior uveitis resolved but his vision remained poor with minimal resolution of the submacular hemorrhage at 1 week follow-up (day 12 post-trauma). In view of the poor resolution of submacular hemorrhage, he was treated with a single dose of 0.5 mg intravitreal ranibizumab at day 20 post-trauma. At 4 weeks post-intravitreal ranibizumab, there was an improvement in visual acuity (from counting fingers to 6/45) and complete resolution of the submacular hemorrhage with presence of a choroidal rupture scar temporal to the fovea, which was not seen clearly at presentation due to obscuration by blood. His visual acuity further improved to 6/18 at 3 months post-trauma. Although this single case had a favorable outcome, a large population cohort study is needed to establish the effectiveness of intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage.

Matched MeSH terms: Eye Injuries
Fulltext Diabetic retinopathy and the effect of pregnancy

Mallika P, Tan AK, Aziz S, Asokumaran T, Syed Alwi SAR, Intan G

Malays Fam Physician, 2010;5(1):2-5.
PMID: 25606177 MyJurnal

Pregnancy is associated with increased risk of development and progression of diabetic retinopathy (DR). Although pregnancy does not have any long term effect on DR, progression of retinopathy changes occur in 50%-70% of cases. The greatest risk of worsening occurs during the second trimester and persists as long as 12 months postpartum. The other factors found to be associated with its progression include duration of the diabetes, severity of retinopathy at conception, hyperglycaemic control, anaemia and progression of coexisting hypertension. Because of the increased risk of progression of the disease in pregnancy, conception should be delayed till the ocular disease is treated and stabilized and laser photocoagulation should be promptly instituted in all cases of severe non-proliferative retinopathy and should not be delayed till the patient develops early proliferative changes. Good diabetic control before and during pregnancy can help prevent this increase in the progression and serious vision loss.

Matched MeSH terms: Eye
Fulltext The importance of ophthalmic signs in the diagnosis of suprasellar meningioma - a case report

Tan AK, Mallika P, Md Aziz S, Asokumaran T, Intan G

Malays Fam Physician, 2009;4(1):26-29.
PMID: 25606155 MyJurnal

A forty-two year old lady presented with gradual, painless, progressive blurring of vision of her left eye for four months. There were no other associated ocular or systemic complaints. Examination showed decreased visual acuity in both eyes and a pale optic disc on the left side. Visual field examination revealed a temporal field defect of the right eye which aroused the suspicion of an intracranial mass lesion. MRI of her brain revealed a suprasellar meningioma. We would like to emphasize the importance of visual field examination of both eyes in patients presenting with unilateral loss of vision.

Matched MeSH terms: Eye
Fulltext Enucleation for haemophthalmus secondary to choroidal neovascularisation in polypoidal choroidal vasculopathy: a therapeutic and diagnostic dilemma

Azmi NA, Ahem A, Mustapha M, Bastion MC

BMJ Case Rep, 2016 Sep 28;2016.
PMID: 27681348 DOI: 10.1136/bcr-2016-215987

We report a case of enucleation for painful blind eye secondary to recurrent bleeding from choroidal neovascularisation in an eye that was irradiated following presumed metastatic breast carcinoma to the choroid. A 58-year-old woman with a history of treated breast malignancy presented with haemophthalmus and intractable glaucoma in the right eye. One year previously she had presented with right vitreous haemorrhage with subretinal mass that had been irradiated given her history of breast carcinoma. Following irradiation, vitrectomy was performed to clear the blood. Intraoperative and postoperative angiography findings suggested a diagnosis of breakthrough bleeding secondary to polypoidal choroidal vasculopathy. At this presentation, however, the intraocular bleeding was recurrent resulting in elevated intraocular pressure and pain. Despite repeat surgery and medical therapy, the eye had to be enucleated. Histopathology showed choroidal neovascularisation.

Matched MeSH terms: Eye Hemorrhage
Fulltext Clinical Profile and Visual Outcome of Ocular Bartonellosis in Malaysia

Tan CL, Fhun LC, Tai EL, Abdul Gani NH, Muhammed J, Tuan Jaafar TN, et al.

J Trop Med, 2017;2017:7946123.
PMID: 28265290 DOI: 10.1155/2017/7946123

Background. Ocular bartonellosis can present in various ways, with variable visual outcome. There is limited data on ocular bartonellosis in Malaysia. Objective. We aim to describe the clinical presentation and visual outcome of ocular bartonellosis in Malaysia. Materials and Methods. This was a retrospective review of patients treated for ocular bartonellosis in two ophthalmology centers in Malaysia between January 2013 and December 2015. The diagnosis was based on clinical features, supported by a positive Bartonella spp. serology. Results. Of the 19 patients in our series, females were predominant (63.2%). The mean age was 29.3 years. The majority (63.2%) had unilateral involvement. Five patients (26.3%) had a history of contact with cats. Neuroretinitis was the most common presentation (62.5%). Azithromycin was the antibiotic of choice (42.1%). Concurrent systemic corticosteroids were used in approximately 60% of cases. The presenting visual acuity was worse than 6/18 in approximately 60% of eyes; on final review, 76.9% of eyes had a visual acuity better than 6/18. Conclusion. Ocular bartonellosis tends to present with neuroretinitis. Azithromycin is a viable option for treatment. Systemic corticosteroids may be considered in those with poor visual acuity on presentation.

Matched MeSH terms: Eye
Fulltext Retrospective review of the adjunctive use of pre- operative ranibizumab “lucentistm” in the surgical management of diabetic retinopathy in a tertiary referral hospital in Malaysia

Bastion, M.L.C., Siti Aishah, S., Aida Zairani, M.Z., Barkeh, H.J.

Medicine & Health, 2010;5(2):93-102.
MyJurnal

A retrospective case series review was conducted to determine the pre-operative role and safety of pre-operative adjunctive anti-vascular endothelial growth factor (anti- VEGF) agent ranibizumab “LUCENTISTM” in patients with diabetic retinopathy requiring vitrectomy. The study involved twenty consecutive eyes of sixteen patients (age range: 46-72 years; mean 57.5 years) which received intravitreal injection of 0.5 - 1 mg of ranibizumab 3 to 8 days (mean 4.4 days) prior to vitrectomy for diabetic retinopathy. There were no local or systemic post-injection complications. Indications for vitrectomy were retinal detachment (RD) [n=11; 3 combined tractional (TRD) - rhegmatogenous RD (RRD), 8 TRD], TRD with vitreous haemorrhage (VH) (n=3) ,VH (n=8) and vitreomacular traction syndrome (n=1). Inclusion criteria include all consecutive eyes of diabetic patients requiring vitrectomy receiving a first pre-operative injection of anti- VEGF. Pre-operative visual acuity (VA) ranged from 6/36 to light perception. All eyes had minimal to moderate intraoperative bleeding. Post-operative VH in eyes without tamponade or gas tamponade was nil (n=1), mild (n=13) or moderate (n=1). Silicone filled eyes had nil (n=1), moderate (n=3) or severe haemorrhages (n=1). Post-operative VA was unchanged (n=2) (10%), improved (n = 14) (70%) or worsened (n=4). VA was 2/60 or better (n=15) to no light perception (n=1). Two eyes achieved 6/12 or better vision (10%). Ten eyes (50%) had 6/36 or better vision. In conclusion, pre-operative intravitreal ranibizumab is safe and useful in diabetic vitrectomy and appears to help with perioperative bleeding leading to improvement in vision.

Matched MeSH terms: Eye
Fulltext Protein and microbial determinations on worn contact lenses cleaned conventionally using the Lens2® automatic lens cleaner

Haliza Abdul Mutalib, Ahmad Rohi Ghazali, Noor Suhailah Ali

Jurnal Sains Kesihatan Malaysia, 2008;6(1):11-21.
MyJurnal

The accumulation of tear film proteins as well as microbes colonization onto worn contact lenses can be eliminated conventionally by mechanical rubbing during the cleaning process. Lens2® functions in rotation manner to loosen the deposits on the contact lens and has antimicrobial coating to keep lenses away from contamination. The objective of this study was to determine the efficiency of Lens2® to remove deposited protein and reduce microbial contamination compared to conventional method. Twenty-eight subjects each wore a pair of contact lens FDA Group 1 (Polymacon, SoftLens® 38, Bausch & Lomb) for one month and cleaned them using multipurpose solution (COMPLETE® MoisturePLUSTM, Advanced Medical Optics) separately using two different methods. The right lens was cleaned conventionally while the left lens were cleaned using the Lens2®. The control group of thirteen subjects each wore a pair of contact lens for the same period and cleaned both conventionally. These lenses and its cases were then analyzed for protein deposition using Bichinchoninic Acid Assay (BCA) Kit (Sigma, USA) in 96-well plate. Microbial contamination was determined by culturing the samples on nutrient agar for bacteria and fungi and non-nutrient agar for amoeba isolation. The mean of total protein on control lenses (17.014 ± 13.246 µg/mL) was not significantly different from those on the Lens2® (21.623 ± 19.127 µg/mL). There were also low growth numbers of amoeba in each group of samples. Interestingly, there were no growths of amoeba from all Lens2® samples collected. There was also low growth numbers of bacteria in each sample group whereby Lens2® had the lowest growth of bacteria. No growth of fungi was obtained from all samples. The automatic lens cleaner, Lens2® was found to be as efficient as the conventional cleaning method. However, the Lens2® has additional advantage because of its antimicrobial material and need shorter time in the cleaning process as well as easy and effective.

Matched MeSH terms: Eye Proteins

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