MyMedR

Fulltext An Elderly Woman with Unresolved 'Stye' Over her Right Lower Eye Lid

Azhany Y, Nani D

Malays Fam Physician, 2010;5(3):155-6.

Fulltext Microbial profile of culture-proven cases of endophthalmitis in hospital Universiti Sains Malaysia: a 7-year retrospective study

Norhayaty S., Sangeetha, T, Tai, Evelyn L.M., Wan Hazabbah W.H., Zaidah A.R., Azhany Y.

Journal of Biomedical and Clinical Sciences, 2017;2(1):69-73.

MyJurnal

nfectious endophthalmitis is a devastating and potentially sight-threatening condition.The objective is toanalyse the microbiological profile and visual outcome of culture positive endophthalmitis seen in Hospital Universiti Sains Malaysia. All patients with endophthalmitis admitted to Hospital Universiti Sains Malaysia over a 7-year period from January 2007 until December 2013 were recruited into this study. Retrospective review of medical and microbiology records was conducted among patients clinically diagnosed with endophthalmitis in Hospital Universiti Sains Malaysia from January 2007 until December 2013. Sixteen patients were admitted with endophthalmitis during this study period. Seven (43%) were culture-positive, in which five (71%) cases were from vitreous culture and two (29%) from blood specimens. The mean age for culture positive patients of presentation was44 years. The most common bacterial isolate was Pseudomonas spp., while the most common fungus was Candida spp. Other organisms isolated were Fusariumsp., Aspergillus sp., Staphylococcus sp.and Enterococcus sp. The risk factors for culture-positive cases were ocular trauma, corneal keratitis, ocular chemical injury, severe urinary tract infection and retropharyngeal abscess. Only three of the affected eyes could be salvaged. The final visual acuity waspoor in all the culture-positive eyes. Two cases underwent evisceration while one case underwent enucleation. As a conclusion,Culture-positive endophthalmitis in this study were mainly attributed to Pseudomonas spp. and Candida spp. The visual outcome of culture-positive endophthalmitis was poor.

Fulltext Retinitis punctata albescens presenting with tunnel vision: diagnostic dilemmas

Norhayaty S., Nurul Dalila M.S., Tai, Evelyn L.M., Liza Sharmini A.T., Zunaina E., Azhany Y.

Journal of Biomedical and Clinical Sciences, 2017;2(1):20-22.

MyJurnal

Tunnel vision is a classic sign among patients with advanced glaucoma. However, other conditions such as retinitis pigmentosa, optic neuritis and rod-cone dystrophy may be characterized by similar visual field defects. A 52-year-old lady with a family history of glaucoma presented with bilateral gradual loss of peripheral vision for two years. She claimed to have poor night vision about 20 years prior to this presentation. Her visual acuity was 6/7.5 in both eyes. The anterior chamber depth was moderate bilaterally, with Schaffer grading on gonioscopy of grade I to II. The intraocular pressure was 14 mmHg in both eyes. The optic discs appeared normal. Fundus examination showed scattered hypopigmented changes sparing the fovea. Humphrey visual field test revealed bilateral constricted visual fields. She was diagnosed with retinitis punctata albescens (RPA) based on her symptom of poor night vision, supported by the diffuse hypopigmented changes in her fundi. The management of this condition involves careful counselling regarding the genetic nature of the disease and its progressive course. We discuss this case to illustrate the importance of a thorough history taking and careful fundus examination in the workup of patients presenting with tunnel vision.

Fulltext Resolution of exudative retinal detachment and regression of retinal macrocyst post-laser in Coats disease

Munira Y, Zunaina E, Azhany Y

Int Med Case Rep J, 2013;6:37-9.

PMID: 23966803 DOI: 10.2147/IMCRJ.S47769

A 15-year-old boy presented with painless progressive blurring of vision in the right eye for 1 year in duration. His visual acuity in the right eye was hand movement. The right fundus showed presence of extensive subretinal exudates at the posterior pole and a retinal macrocyst at the temporal periphery. It was associated with exudative retinal detachment at the inferior periphery of the retina. Fundus angiography revealed telangiectatic retinal vessels at the superotemporal retina. Based on clinical and angiographic findings, a diagnosis of Coats disease was made. He was treated with retinal laser photocoagulation. There was resolution of the exudative retinal detachment, reduction of subretinal exudates, and regression of the retinal macrocyst with improvement of visual acuity to 1/60 post-laser therapy.

Fulltext An elderly lady with blurring of vision

Azhany Y, Nani D, Zunaina E

Malays Fam Physician, 2012;7(1):43-4.

PMID: 25606247 MyJurnal

Fulltext Purtscher-like retinopathy following valsalva maneuver effect: case report

Nor-Masniwati S, Azhany Y, Zunaina E

J Med Case Rep, 2011;5:338.

PMID: 21806816 DOI: 10.1186/1752-1947-5-338

Purtscher's retinopathy is a rare condition that is noted in cases related to various types of trauma. The characteristic finding in the fundus is the presence of multiple Purtscher flecken. Purtscher-like retinopathy has a similar presentation in the fundus, but without an association with trauma.

Distance vision, near vision and quality of life between preferred emmetropia and residual myopia in monofocal intraocular lens implantation- A Comparative study

Jaafar J, Siti-Khadijah AR, Shaharudin B, Azhany Y

Med J Malaysia, 2021 05;76(3):340-345.

PMID: 34031332

INTRODUCTION: This study was done to evaluate the visual acuity and quality of life in predicted emmetropia (EM) and predicted residual myopia (RM) patients following phacoemulsification with monofocal intraocular lens implantation.

MATERIALS AND METHODS: This prospective comparative study was conducted in the ophthalmology clinic of the Universiti Sains Malaysia Hospital, Kelantan, Malaysia. Overall, 139 patients with senile cataract were randomised into EM and RM groups. At three months post-operatively, patients were assessed for distance and near vision, as well as quality of life using a modified VF-14 questionnaire.

RESULTS: Thirty-six patients (64.3%) in the EM group and 30 patients (52.6%) in the RM group (p = 0.209) showed good distance vision (LogMAR 0.3 or better). Fifty patients (87.7%) in the RM group and 27 patients (48.2%) in the EM group gained significantly higher satisfactory near vision (p < 0.05). The quality of life in both groups was good, with a mean modified VF-14 score of 94.5 (SD 2.68) for the EM group and 95.1 (SD 3.19) for the RM group (p = 0.286). Female patients scored significantly higher than males for total activities (p = 0.010) and distance vision-related activities (p = 0.001). The RM group had significantly better patient satisfaction for near vision-related activities compared to the EM group (p = 0.001). In particular, the item 'reading small print' was significantly better in the RM group (p = 0.003).

CONCLUSION: Patients in the predicted RM group gained more satisfactory near vision than patients in the EM group, with significantly better quality of life for near vision activities.

Fulltext Sequelae of neglected senile cataract

Azhany Y, Hemalatha C, Nani D, Rosediani M, Liza-Sharmini A

Malays Fam Physician, 2013;8(1):33-7.

PMID: 25606266 MyJurnal

Cataract is the most common cause of blindness in the world. An attack of phacolytic and phacomorphic glaucoma as a result of neglected cataract constitutes a medical emergency that must be addressed immediately. Ocular emergencies such as these is challenging for the surgeon with guarded or poor prognosis. We describe the presentation, management and prognosis of three cases of phacomorphic and phacolytic glaucoma. All three patients underwent aggressive management of intraocular pressure. Despite successful cataract operation with implantation of intraocular lens, there was only mild improvement of the vision. Optic nerve and pupil functions were permanently affected following the insult. Phacomorphic and phacolytic glaucoma present a very challenging problem to the surgeon with poor visual outcome. Public health education and awareness are important and health workers should encourage patients with cataract to seek early treatment for better prognosis.

Fulltext Recurrent transient visual loss in a middle aged woman

Chow SY, Draman N, Teh WM, Azhany Y

Malays Fam Physician, 2017;12(3):42-46.

PMID: 29527282 MyJurnal

Visual loss is a common presenting complaint in primary care. We present a case of recurrent transient visual loss in a middle aged woman. Her funduscopy showed bilateral optic disc swelling. We have highlighted the differentiation of bilateral optic disc swelling at the primary care level as the management differs according to the diagnosis.

TUBE VERSUS TRABECULECTOMY IN JUVENILE-ONSET OPEN ANGLE GLAUCOMA - TREATMENT OUTCOMES IN TERTIARY HOSPITALS IN MALAYSIA

Abd H, Ang, Raja N, Norhalwani H, Azhany Y, Liza-Sharmini

Cesk Slov Oftalmol, 2022;78(6):298-303.

PMID: 36543596 DOI: 10.31348/2022/29

AIM OF THE STUDY: To compare the intraocular pressure (IOP) lowering effect and postoperative complications between primary augmented trabeculectomy and glaucoma drainage device (GDD) implantation as primary surgical intervention in patients with juvenile-onset open angle glaucoma (JOAG).

PATIENTS AND METHODS: A retrospective review study involving 20 eyes that underwent primary augmented trabeculectomy with mitomycin (MMC) and 10 eyes GDD implantation in 3 tertiary centres in Malaysia between 1 January 2013 and 31 December 2019. They were followed up for at least 12 months postsurgical intervention. Intraocular pressure (IOP), number of topical IOP lowering medication and complications were evaluated at 1, 3, 6 and 12 months post-intervention. Based on the IOP, the success was divided into complete and partial success, and failure. IOP and postsurgical complications were compared using the Repetitive Measure Analysis of Variance (RM ANOVA) and the Pearson chi-square test.

RESULTS: Both methods were effective in lowering the IOP. Eyes with primary augmented trabeculectomy have significant lower IOP compared to GDD implantation (p = 0.037). There was a higher incidence of postoperative hypotony (30%) in the trabeculectomy group. There was also a significant reduction of mean number of topical pressure-lowering drugs required postoperatively (p = 0.015). Complete success was achieved in 100% of eyes with trabeculectomy and 67% in GDD implantation (p = 0.047).

CONCLUSIONS: Primary augmented trabeculectomy and GDD implantation are good surgical options for the treatment of JOAG. Both methods provide IOP lowering at 1 year. However, trabeculectomy provides better pressure lowering, compared to GDD implantation in patients with JOAG.

Fulltext Intravitreal Anti-vascular Endothelial Growth Factor (Anti-VEGF) Therapy for Valsalva Related Sub-internal Limiting Membrane (Sub-ILM) Macular Haemorrhage: A Case Report

Nur-Najwa S, Zunaina E, Azhany Y

Cureus, 2023 Aug;15(8):e44420.

PMID: 37791179 DOI: 10.7759/cureus.44420

Valsalva retinopathy is an uncommon type of retinopathy that manifests as a rapid and painless vision decline, typically observed in young individuals without prior medical conditions. This condition arises from an elevated pressure within the veins of the eye, causing preretinal haemorrhage with a notable tendency to impact the macula. We describe here a case of valsalva-related sub-internal limiting membrane (sub-ILM) macular haemorrhage which was successfully treated with anti-vascular endothelial growth factor (anti-VEGF). A 27-year-old woman presented with a clinical presentation of a large sub-ILM macular haemorrhage resulting from a valsalva maneuver following a prolonged severe cough. The sub-ILM macular haemorrhage was completely resolved after being treated with three injections of intravitreal ranibizumab with a visual recovery of vision from counting fingers to 20/20 on three month follow-up.

Fulltext Ocular tuberculosis with multiple cerebral abscesses

Nor-Masniwati S, Zunaina E, Azhany Y

Case Rep Ophthalmol Med, 2012;2012:606741.

PMID: 22611511 DOI: 10.1155/2012/606741

A 23-year-old Malay man presented with headache for one-month duration. It was associated with painless blurring of vision of the right eye. He had loss of appetite and reduced weight but no night sweats or hemoptysis. His visual acuity on the right eye was 6/45 and improved to 6/15 with pinhole. Right fundus examination revealed a choroidal tuberculoma located at one disc diameter away from optic disc superiorly with mild vitritis. Systemic examinations revealed no significant finding. Mantoux test reading was 22 mm with erythrocyte sedimentation rate that was 14 mm/h. Other blood investigations were negative with normal chest radiography. The computerized tomography scan of the brain revealed multiple cerebral abscesses. A clinical diagnosis of right ocular tuberculosis with multiple cerebral abscesses was made. He was treated with antituberculosis chemotherapy for one year which divided into intensive phase for three months and maintenance phase for nine months. Cerebral abscesses resolved after three months of antituberculosis drugs and at one-year follow-up, and the choroidal tuberculoma resolved completely with scar formation and significant macular striae.

Fulltext Lens-induced glaucoma in a tertiary centre in northeast of Malaysia

Azhany Y, Norhayati A, Siti Raihan I, Liza Sharmini AT

Malays Fam Physician, 2014;9(2):48-52.

PMID: 25883765 MyJurnal

To determine the clinical presentations, management and outcome of lens-induced glaucoma (LIG) in Hospital Universiti Sains Malaysia.

Fulltext Dengue related maculopathy and foveolitis

Juanarita J, Azmi MN, Azhany Y, Liza-Sharmini AT

Asian Pac J Trop Biomed, 2012 Sep;2(9):755-6.

PMID: 23570008 DOI: 10.1016/S2221-1691(12)60223-8

A 24 year-old Malay lady presented with high grade fever, myalgia, generalized rashes, severe headache and was positive for dengue serology test. Her lowest platelet count was 45 × 10(9) cells/L. She complained of sudden onset of painlessness, profound loss of vision bilaterally 7 days after the onset of fever. On examination, her right eye best corrected vision was 6/30 and left eye was 6/120. Her anterior segment examination was unremarkable. Funduscopy revealed there were multiple retinal haemorrhages found at posterior pole of both fundi and elevation at fovea area with subretinal fluid. Systemic examination revealed normal findings except for residual petechial rashes. She was managed conservatively. Her vision improved tremendously after 2 months. The retinal hemorrhages and foveal elevation showed sign of resolving. Ocular manifestations following dengue fever is rare. However, bilateral visual loss can occur if both fovea are involved.

Fulltext Antiphospholipid syndrome in lupus retinopathy

Ng HK, Chong MF, Azhany Y, Zunaina E

Clin Ophthalmol, 2014;8:2359-63.

PMID: 25473262 DOI: 10.2147/OPTH.S71712

Systemic lupus erythematosus (SLE) is a chronic, multisystem, autoimmune disease that can affect any part of the human body including the eyes. Common blinding ocular manifestations include central retinal artery occlusion (CRAO), central retinal vein occlusion (CRVO), severe vaso-occlusive retinopathy, and optic nerve involvement. Antiphospholipid syndrome (APS) in lupus is usually associated with large vessel occlusions and needs prompt treatment with anticoagulant. We are reporting two cases of APS in SLE patients that presented with CRVO (case 1) and vaso-occlusive lupus retinopathy (case 2). Both cases were positive for antiphospholipid antibody (APA) and were treated with immunosuppression, anticoagulant, and laser treatment. Thus, screening for APA is vital in SLE patients with lupus retinopathy, as prompt treatment with anticoagulants is important to prevent further vascular thrombosis, which worsens the visual prognosis.
Study site: Ophthalmology clinic, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia

Fulltext Purtscher's Retinopathy Following Long Bone Fracture: A Case Report

Mad Isa M, Azhany Y, Alias R, Wan Hitam WH

Cureus, 2024 Jan;16(1):e53087.

PMID: 38414683 DOI: 10.7759/cureus.53087

Purtscher's retinopathy represents an occlusive retinal microvasculopathy that poses a potential threat to vision and is linked to traumatic events. This condition typically manifests in individuals following trauma, commonly associated with long bone fractures, head injuries, or thoracic compression. We report a rare case of unilateral Purtscher's retinopathy after sustaining a long bone fracture. A 27-year-old healthy man sustained an open, comminuted midshaft fracture of the right femur after an alleged motor vehicle accident. On day 3 post trauma, he developed sudden right eye painless reduced vision. Visual acuity in the right eye was 6/12 pinhole 6/12 and the left eye was 6/9 pinhole 6/6. The pupillary reflex was normal in both eyes. Both anterior segments were unremarkable. Fundoscopy showed the presence of multiple cotton wool spots and fleckens in the right eye. Macula optical coherence tomography of the right eye confirmed hyperreflective lesions within the retinal nerve fiber layer. He was diagnosed with Purtscher's retinopathy. The patient was treated conservatively given the fairly good visual acuity. There was complete resolution of fundus lesions with good visual acuity of 6/6 after one month. Ophthalmologic evaluation is crucial in cases of post-traumatic visual impairment, particularly in scenarios involving long bone fractures, to effectively exclude the possibility of Purtscher's retinopathy.

Optic Nerve Metastasis in Lung Adenocarcinoma

Mangalathevi Y, Azhany Y, Wan Hitam WH, Aziz ME

Cureus, 2024 Mar;16(3):e55413.

PMID: 38567233 DOI: 10.7759/cureus.55413

In this article, we report a rare case of an optic nerve metastasis secondary to lung adenocarcinoma. The ocular manifestation was the first clinical sign of the disease, and further investigation led to the diagnosis of the underlying malignancy. A 59-year-old woman presented with progressive blurring of vision in the right eye for the past month. She had been having headaches for the past two weeks and left upper limb weakness for one day. She also had loss of appetite and weight for the past few months. She looked lethargic. On presentation, her bilateral eye vision was 6/18. Both anterior segments were unremarkable. Fundoscopy showed a normal optic disc in both eyes. A nervous system examination showed mild motor sensory impairment over the left upper and lower limbs and also impairment of cranial nerves V and VII. Brain computed tomography was conducted and revealed soft tissue lesions at the lateral aspect of the optic nerve and multiple recent cerebral infarcts. Brain and orbital magnetic resonance imaging showed a metastasis intraconal lesion at the right intraorbital segment of the optic nerve. CT thorax, abdomen, and pelvis were done. The finding revealed carcinoma of the left lung with distant metastasis. The patient's general condition deteriorated in less than two weeks. The family refused further intervention. The patient died three months after the initial presentation.

Fulltext Clinical presentation, severity and progression of primary angle closure in malays

Liza-Sharmini AT, Sharina YN, Dolaboladi AJ, Zaid NA, Azhany Y, Zunaina E

Med J Malaysia, 2014 Feb;69(1):21-6.

PMID: 24814624 MyJurnal

INTRODUCTION: There is limited knowledge on primary angle closure (PAC) in Malays. Understanding the clinical presentation and progression of PAC in Malays is important for prevention of blindness in Southeast Asia.

MATERIAL AND METHODS: A retrospective record review study was conducted on Malay patients seen in the eye clinic of two tertiary hospitals in Kelantan, Malaysia. Based on the available data, Malay patients re-diagnosed as primary angle closure suspect (PACS), primary angle closure (PAC), and primary angle closure glaucoma (PACG) based on the International Society Geographical Epidemiological classification. Clinical data was collected from initial presentation including the presence of acute primary angle closure until at least 5 years follow up. Progression was defined based on gonioscopic changes, vertical cup to disc ratio (VCDR), intraocular pressure (IOP) and Humphrey visual field (HVF) analysis. Progression and severity of PACG was defined based Hodapp-Parrish-Anderson classification on reliable HVF central 24-2 or 30-2 analysis.

RESULTS: A total of 100 patients (200 eyes) with at least 5 years follow up were included. 94 eyes (47%) presented with APAC. During initial presentation, 135 eyes (67.5%) were diagnosed with glaucomatous changes with 91 eyes already blind. After 5 years of follow up, 155 eyes (77.5%) progressed. There was 4 times risk of progression in eyes with PAC (p=0.071) and 16 times risk of progression in PACG (p=0.001). Absence of laser peripheral iridotomy was associated with 10 times the risk of progression.

CONCLUSION: Angle closure is common in Malays. Majority presented with optic neuropathy at the initial presentation and progressed further. Preventive measures including promoting public awareness among Malay population is important to prevent blindness.

Study site: Eye clinic, Hospital Universiti Sains Malaysia and Hospital
Raja Perempuan Zainab II

Fulltext Monsoon and primary acute angle closure in Malaysia

Ch'ng TW, Mosavi SA, Noor Azimah AA, Azlan NZ, Azhany Y, Liza-Sharmini AT

Med J Malaysia, 2013 Oct;68(5):410-4.

PMID: 24632871 MyJurnal

INTRODUCTION: Acute angle closure (AAC) without prompt treatment may lead to optic neuropathy. Environmental factor such as climate change may precipitate pupillary block, the possible mechanism of AAC.

OBJECTIVE: To determine the association of northeast monsoon and incidence of AAC in Malaysia.

MATERIALS AND METHODS: A retrospective study was conducted on AAC patients admitted to two main tertiary hospitals in Kelantan, Malaysia between January 2001 and December 2011. The cumulative number of rainy day, amount of rain, mean cloud cover and 24 hours mean humidity at the estimated day of attack were obtained from the Department of Meteorology, Malaysia.

RESULTS: A total 73 cases of AAC were admitted with mean duration of 4.1SD 2.0 days. More than half have previous history of possibility of AAC. There was higher incidence of AAC during the northeast monsoon (October to March). There was also significant correlation of number of rainy day (r=0.718, p<0.001), amount of rain (r=0.587, p<0.001), cloud cover (r=0.637, p<0.001), mean daily global radiation (r=- 0.596, P<0.001), 24 hours mean temperature (r=-0.298, p=0.015) and 24 hours mean humidity (r=0.508, p<0.001) with cumulative number of admission for AAC for 12 calendar months.

CONCLUSION: Higher incidence of AAC during northeast monsoon suggested the effect of climate as the potential risk factor. Prompt treatment to arrest pupillary block and reduction of the intraocular pressure is important to prevent potential glaucomatous damage. Public awareness of AAC and accessibility to treatment should be part of preparation to face the effect of northeast monsoon.

Lateral rectus myositis mimicking an abducens nerve palsy in a pregnant woman

Haslinda AR, Shatriah I, Azhany Y, Nik-Ahmad-Zuky NL, Yunus R

Ophthalmic Plast Reconstr Surg, 2013 3 28;30(1):e13-5.

PMID: 23531952 DOI: 10.1097/IOP.0b013e31828957ae

Myositis is a rare unknown inflammatory disorder of the skeletal muscle tissue. Generalized inflammatory myopathies, polymyositis, and dermatomyositis have been reported during pregnancy. Isolated orbital myositis in pregnancy has not been previously described in the literature. The authors report a case of left isolated orbital myositis in a primigravida at 38 weeks gestation affecting the patient's left lateral rectus muscle. MRI of the orbit was consistent with the diagnosis. She showed remarkable clinical improvement with oral corticosteroids therapy.

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