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Fulltext Lockdown: The Impact on Management of Glaucoma in a Suburban Tertiary Centre in Malaysia

Sidhu JK, Yaakub A, Ahmad Tajudin LS

Cureus, 2023 Jan;15(1):e34412.
PMID: 36874736 DOI: 10.7759/cureus.34412

INTRODUCTION: The COVID-19 pandemic brought the world to a standstill in 2020. Many countries have imposed lockdowns, known as the movement-control order (MCO) in Malaysia, to prevent transmission of the disease.
AIM: The objective of this study is to evaluate the impact of the MCO on the management of glaucoma patients in a suburban tertiary hospital.
METHODOLOGY: We conducted a cross-sectional study of 194 glaucoma patients between June 2020 and August 2020 in the glaucoma clinic at Hospital Universiti Sains Malaysia. We evaluated the patients' treatment, visual acuity, intraocular pressure (IOP) measurements, and potential signs of progression. We compared the results with those of their last clinic visits prior to the MCO.
RESULTS: We studied 94 (48.5%) male and 100 (51.5%) female glaucoma patients with a mean age of 65 ± 13.7. The mean duration between pre-MCO and post-MCO follow-up was 26.4 ± 6.7 weeks. There was a significant increase in the number of patients with deterioration of visual acuity, and one patient lost his vision after the MCO. There was also a significant elevation of the mean IOP of the right eye: pre-MCO, 16.7 ± 7.8 mmHg, compared to post-MCO, 17.7 ± 8.8 mmHg (p = 0.027). The cup-to-disc ratio (CDR) for the right eye increased significantly from pre-MCO, 0.72 ± 0.18, to 0.74 ± 0.19 post-MCO (p < 0.001). However, there were no significant changes in IOP or CDR in the left eye. Twenty-four patients (12.4%) missed medications during the MCO period, and 35 patients (18%) required additional topical medications due to the progression of the disease. Only one patient (0.5%) required admission due to uncontrolled IOP.
CONCLUSION: Lockdown, as a preventive step in the COVID-19 pandemic, indirectly caused the progression of glaucoma and uncontrolled IOP.
Fulltext Optic disc topography of normal tension glaucoma patients in Malaysia

Abdul Rahim A, Ismail S, Ahmad Tajudin LS, Ahmad MS

Med J Malaysia, 2013 Aug;68(4):338-42.
PMID: 24145263 MyJurnal

There are limited data in the literature on the optic disc topography in normal tension glaucoma (NTG) patients in Asian countries, especially in Southeast Asia. This study is aimed at comparing optic disc topography in NTG patients and a control group in Malaysia, and we discuss the literature on NTG studies in other Asian populations. A comparative cross-sectional study was conducted in two hospitals with glaucoma services in Malaysia from November 2010 to February 2012. A total of 109 eyes of 109 Malay patients were included in this study: 32 NTG patients and 77 subjects in the control group. All participants underwent a thorough ocular examination, including visual acuity, subjective refraction, anterior segment and fundus examinations, Humphrey visual field 24-2, intraocular pressure measurement, gonioscopy examination and fundus photography. Optic disc topography was assessed using the Heidelberg Retinal Tomograph III by an identified masked investigator in each hospital. NTG patients had a notably larger disc area (2.65 (0.41) vs 2.19 (0.43) mm(2), respectively), larger cupping (1.54 (0.43) vs 0.63 (0.40) mm(2), respectively), smaller retinal rim areas (1.12 (0.41) vs 1.56 (0.33) mm(2), respectively), higher cup volume (0.47 (0.28) vs 0.11 (0.19) mm(3), respectively), reduced rim volume (0.23 (0.13) vs 0.41 (0.16) mm(3), respectively), higher cup to disc area ratio (0.58 (0.14) vs 0.27 (0.15), respectively), higher linear cup to disc ratio (0.76 (0.09) vs 0.49 (0.17) mm(2), respectively), higher mean cup depth (0.37 (0.09) vs 0.22 (0.09) mm, respectively), higher maximum cup depth (0.77 (0.16) vs 0.59 (0.20) mm, respectively), higher mean of cup shape measure (-0.04 (0.06) vs -0.16 (0.07), respectively), and thinner mean retinal nerve fibre layer thickness (0.15 (0.15) vs 0.24 (0.07) mm, respectively) compared to the control group (p<0.05). In conclusion, most of the optic disc parameters were significantly different in NTG patients compared to healthy individuals in Malaysia. Our findings are comparable to those reported in NTG studies in other Asian countries.
Fulltext Leptomeningeal Carcinomatosis With Optic Nerve Metastasis Secondary to Breast Cancer

Chew C, Wan Hitam WH, Ahmad Tajudin LS

Cureus, 2021 Mar 31;13(3):e14200.
PMID: 33936906 DOI: 10.7759/cureus.14200

Leptomeningeal carcinomatosis (LC) and optic nerve metastasis are uncommon occurrences in breast cancer. We report a rare case of LC with optic nerve infiltration secondary to breast cancer. A 45-year-old lady who was a known case of treated right breast carcinoma six years ago presented with a blurring of vision in both eyes, floaters, and diplopia for one month. She also had recurrent attacks of seizure-like episodes, headache, and vomiting. Examination revealed high blood pressure with tachycardia. Her right eye visual acuity was counting fingers at two feet and 6/36 in the left eye. She had right abducens nerve palsy. Fundoscopy showed bilateral optic disc swelling with pre-retinal, flame-shaped haemorrhages and macular oedema. CT scan of brain and orbit was normal. She was admitted for further investigations. While in the ward, her vision deteriorated further. Her visual acuity in both eyes was at the level of no perception to light. She also developed bilateral abducens nerve palsy and right facial nerve palsy. Subsequently, she started having bilateral hearing loss. There were few episodes of fluctuations in conscious awareness. MRI brain showed mild hydrocephalus. Both optic nerves were thickened and enhanced on T1-weighted and post-gadolinium. Lumbar puncture was performed. There was high opening pressure. Cerebrospinal fluid cytology showed the presence of malignant cells. Family members opted for palliative care in view of poor prognosis. Unfortunately, she succumbed after a month's stay in hospital. Diagnosis of LC and optic nerve infiltration presents a formidable challenge to clinicians especially in the early stages where neuroimaging appears normal and lumbar puncture has high false negatives. Multiple high-volume taps are advised if clinical suspicion of LC is high.
Fulltext Orbital Cellulitis Secondary to Dental Abscess in Children

Abdul Satar H, Yaakub A, Md Shukri N, Ahmad Tajudin LS

Cureus, 2021 Apr 09;13(4):e14392.
PMID: 33981511 DOI: 10.7759/cureus.14392

Paediatric orbital cellulitis is a potential sight- and life-threatening condition. It is a serious infection in children that can result in significant complications, including blindness, cavernous sinus thrombosis, cerebral venous sinus thrombosis, meningitis, subdural empyema, and brain abscess. Of the patients with orbital cellulitis, 17% died from meningitis, and 20% of the survivors had permanent loss of vision. Therefore, the potential for sight- and life-threatening complications makes prompt diagnosis and early treatment very important. We report here a case of a two-year-old girl who presented with a three-day history of left periorbital swelling, preceded by left upper perioral swelling that extended upward to the left cheek and left lower lid and was associated with low-grade fever. The patient had been admitted and was treated as having left preseptal with facial cellulitis; the patient was started on intravenous amoxicillin/clavulanic acid (200 mg three times per day dose), and chloramphenicol ointment was applied to the periorbital area. On day 3, the condition worsened, and dental examination showed multiple dental caries, upper gum swelling and abscess, and mobility of teeth 61 and 62 (two baby teeth). Contrast-enhanced computed tomography (CECT) of the orbit, paranasal, and brain showed a left periosteal abscess collection extending to the inferomedial region of the orbit. Examination and tooth extraction were performed under general anesthesia. The intraoperative results showed the presence of a left upper gum abscess, which was possibly the primary source of infection. Clinical improvement was observed postoperatively. Orbital cellulitis can be a complication of a dental abscess. This case emphasizes the importance of primary tooth care in children. A lack of care can result in fatal complications.
A Woman With Confusion and Blurred Vision

Neoh PF, Tai ELM, Ahmad Tajudin LS

JAMA Ophthalmol, 2018 Feb 15.
PMID: 29450475 DOI: 10.1001/jamaophthalmol.2017.4592
Fulltext Presumptive Rhino-Orbital Mucormycosis Secondary to Corticosteroid Therapy in a Diabetic Patient With COVID-19 Infection

Sidhu JK, Wan Hitam WH, Ahmad Tajudin LS

Cureus, 2023 Feb;15(2):e35199.
PMID: 36968851 DOI: 10.7759/cureus.35199

The coronavirus disease 2019 (COVID-19) pandemic has led to the widespread use of steroids as a life-saving measure. In patients with preexisting diabetes, the therapeutic use of steroids coupled with poorly controlled sugar has led to a surge of mucormycosis. We report a rare case of orbital apex syndrome secondary to mucormycosis post-COVID-19. A 43-year-old female with poorly controlled diabetes mellitus presented with right eye complete ptosis one week post-recovery from COVID-19 infection. During COVID-19 hospitalization, she received a course of dexamethasone. The visual acuity of the right eye was 6/60. She had complete ophthalmoplegia and diplopia in all gazes. There was a positive relative afferent pupillary defect (RAPD) and reduced optic nerve function test in the right eye. MRI showed right ethmoid sinusitis with possible extension to the right orbit and the presence of right perineural optic nerve enhancement. The nasal scope revealed fungal-like thick mucopurulent discharge at the middle meatus. She was clinically diagnosed with rhino-orbital mucormycosis and was started on antifungal for six weeks. Her overall condition improved with 6/6 visual acuity and minimum residual ophthalmoplegia. In conclusion, corticosteroid treatment for COVID-19 infection in diabetic patients causes poor glycemic control and immunosuppression that can lead to secondary infections such as rhino-orbital mucormycosis.
Microvascular endothelial function and primary open angle glaucoma

Mudassar Imran Bukhari S, Yew KK, Thambiraja R, Sulong S, Ghulam Rasool AH, Ahmad Tajudin LS

Ther Adv Ophthalmol, 2019 08 22;11:2515841419868100.
PMID: 31489400 DOI: 10.1177/2515841419868100

Purpose: To determine the role of microvascular endothelial dysfunction as risk factor for primary open angle glaucoma.
Methods: A cross-sectional study was conducted involving 114 Malay patients with POAG seen at the eye clinic of Hospital Universiti Sains Malaysia. Patients aged between 40 and 80 years who were diagnosed with other types of glaucoma, previous glaucoma filtering surgery or other surgeries except uncomplicated cataract surgery and pterygium surgery were excluded. A total of 101 patients who were followed up for dry eyes, age-related cataracts or post cataracts extraction surgery were recruited as control subjects. Those with family history of glaucoma or glaucoma suspect were excluded. Microvascular endothelial function was assessed using laser Doppler fluximetry and the process of iontophoresis. Iontophoresis with acetylcholine (ACh) and sodium nitroprusside (SNP) was used to measure microvascular endothelium-dependent and endothelium-independent vasodilatations, respectively.
Results: In general, POAG patients demonstrated lower ACh% and AChmax values compared with controls. There was significant difference in microvascular endothelial function [ACh%: mean, 95% confidence interval = 503.1 (378.0, 628.3), and AChmax: mean, 95% confidence interval = 36.8 (30.2, 43.5)] between primary open angle glaucoma cases (p
Diagnosis of Ankylosing Spondylitis: Do not let the spine bites the eye

Chew CC, Chin JJ, Wan Hitam WH, Chong MF, Ahmad Tajudin LS

Malays Fam Physician, 2021 Jul 22;16(2):73-77.
PMID: 34386168 DOI: 10.51866/cr1121

Background: A diagnosis of ankylosing spondylitis (AS) is challenging and often delayed despite patients being symptomatic. Low back pain is the most common initial symptom, appearing in the second and third decades of life. Acute anterior uveitis (AAU) occurs much later in the course of the disease, often when the destruction of the spine is already debilitating.
Objective: Here, we report three cases of AS that were diagnosed after the patients developed AAU. Methods: A case series illustrated AAU leading to the diagnosis of AS years after the initial episode of low back pain. A comparison of the clinical presentation, diagnosis, and outcomes was also illustrated.
Result: We report three cases of acute anterior uveitis (AAU)-associated AS diagnosed only after many visits to the primary health care provider with the complaint of chronic low back pain. All three patients had irreversible radiological changes upon diagnosis of AS. The AAU resolved with topical steroids, and one patient developed cataract.
Conclusion: A high index of suspicion of AS in a young adult with chronic back pain before the development of AAU may prevent further functional loss and provide a better prognosis. Diagnosis of AS following AAU is not only associated with dependency but also may rob the vision of a young adult.
Triple Vessel Coronary Artery Disease and Retinal Nerve Fibre Layer Thickness

Neoh YL, Neoh PF, Salleh A, Yusof ZB, Gurusamy B, Ahmad Tajudin LS

Ann Acad Med Singap, 2018 06;47(6):226-229.
PMID: 30019068
Fulltext Genetic Markers PLEKHA7, ABCC5, and KALRN Are Not Associated With the Progression of Primary Angle Closure Glaucoma (PACG) in Malays

Thangavelu L, Che Mat Nor SM, Abd Aziz D, Sulong S, Tin A, Ahmad Tajudin LS

Cureus, 2021 Oct;13(10):e18823.
PMID: 34804680 DOI: 10.7759/cureus.18823

Introduction PLEKHA7, ABCC5, and KALRN have been identified as susceptible genetic markers related to glaucoma. We aimed to investigate the association between the identified susceptible genetic markers PLEKHA7 rs11024102, ABCC5 rs17217796, and KALRN rs1392912 in the progression of primary angle-closure glaucoma (PACG) in Malay patients. Methods For this study, 163 Malay patients with PACG were recruited from April 2015 to April 2017 at Hospital Universiti Sains Malaysia and Hospital Raja Perempuan Zainab II, Kota Bharu. Venesection was performed. DNA was extracted using a commercial DNA extraction kit. The primer was optimized for rs11024102, rs17217796, and rs1392912 of the PLEKHA7, ABCC5, and KALRN genes, respectively. Polymerase chain reaction (PCR) was performed, and PCR products were purified. A DNA sequencer was used to identify polymorphisms. Progression was based on the agreement between the Advanced Glaucoma Intervention Study scoring system and the Hodapp-Parrish and Anderson staging system. The scoring was conducted on two reliable consecutive Humphrey visual fields (HVFs) during the recruitment period and two baseline HVFs obtained when the diagnosis was made. Based on the scoring, patients were grouped into progressed and non-progressed. A chi-square test was used to analyze the association between the genetic markers and the progression of PACG. Results One hundred and sixty-three Malay patients with PACG (58 men and 105 women) were recruited. Twenty-nine patients (18%) had visual field progression of PACG after a mean (SD) follow-up of 6.0 (1.0) years. The minor allele frequencies for PLEKHA7 rs11024102 (G/A), ABCC5 rs17217796 (C/G), and KALRN rs1392912 (A/G) were 0.44, 0.08, and 0.48, respectively. We found that rs11024102 (p=0.828), rs17217796 (p=0.865), and rs1392912 (p=0.684) were not associated with PACG progression in the Malay patients. Conclusion Although PLEKHA7 and ABCC5 were found to be genetic markers associated with the risk of PACG, they played no roles in PACG progression in the Malay population. Moreover, KALRN was not significantly associated with PACG progression. Other susceptible genetic markers may be responsible for PACG progression.
Fulltext Clinical Audit on Badminton-Related Ocular Injuries in a Tertiary Hospital in Malaysia

Mohd Rasidin AH, Muhammad-Ikmal MK, Raja Omar RN, Yaakub A, Ahmad Tajudin LS

Cureus, 2022 Oct;14(10):e30769.
PMID: 36447729 DOI: 10.7759/cureus.30769

Background Badminton-related ocular injuries are among the commonest causes of blunt trauma to the eye, which can lead to significant damage to the ocular structures. This study aimed to assess the clinical presentations, complications, and visual outcomes of patients who sustained ocular injuries related to badminton treated in a single tertiary center in Malaysia. Materials and methods A retrospective clinical audit was conducted in Hospital Universiti Sains Malaysia (HUSM), Malaysia, involving patients diagnosed with ocular injuries related to badminton, either as players or spectators, between January 1, 2003 and December 31, 2017. The demographic data, mechanism of injury, and clinical presentation were recorded. In addition, visual acuity, anterior and posterior segment, and intraocular pressure (IOP) measurements were recorded at the initial presentation and at the present recruitment period. Management at the initial presentation was also obtained and recorded. The final visual outcome and complications were based on the finding of the most recent follow-up. Visual acuity was categorized as follows: mild or no visual impairment (6/18 or better), moderate and severe visual impairment (<6/18 and worse). Results A total of 23 patients (23 eyes) were included in this clinical audit. The average age was 24 years, with a range of 6-56 years, with the highest incidence occurring at the age of 20 years old and younger. The majority of the injuries were sustained during the single-player game. All the injuries were caused by shuttlecock hits. In 18 cases (78%), the trauma was caused by an opponent, in four cases (17%) by a partner, and in one case involving a bystander. Most of the patients in this series were not using any protective eyewear while playing the game 96% (22). Most injuries (22 eyes) involved the anterior segment, with hyphaema as the commonest clinical presentation. The mean IOP at presentation was 23.5 (11.2) mmHg. Angle recession was detected as early as one-week post initial presentation in 17 eyes. Commotio retinae (5 eyes) and vitreous hemorrhage (4 eyes) were the common posterior segment findings. There were eight eyes with visual acuity of worse than 6/18 at the initial presentation, but only three eyes had poor final visual acuity. There was a statistically significant improvement in visual acuity at the last follow-up compared to the initial presentation (Fisher's exact test) (p=0.032). Conclusion Ocular injuries related to badminton is common and cause a detrimental effect on the long-term visual outcome. Traumatic hyphaema and commotio retinae are the most common presenting signs related to poor visual outcomes. Therefore, protective eyewear and promoting awareness of badminton-related ocular injuries are essential to prevent monocular blindness in young adults.
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.

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