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Fulltext Topical insulin for healing of diabetic epithelial defects?: A retrospective review of corneal debridement during vitreoretinal surgery in Malaysian patients

Bastion ML, Ling KP

Med J Malaysia, 2013 Jun;68(3):208-16.
PMID: 23749008 MyJurnal

PURPOSE: To investigate whether topical insulin improves healing rate of corneal epithelial erosions induced during vitreoretinal surgery in diabetics.
METHODS: We retrospectively reviewed case notes and serial post-operative photographs of 15 eyes of 14 patients who had corneal epithelial debridement performed during various vitreoretinal surgeries to improve one surgeon's view over a 10 month period in 2010.
RESULTS: Three groups were identified: DTI, comprising diabetics who received topical insulin 1 unit qds postoperatively (n=5); DCT comprising diabetics treated with conventional post-operative medications only (n=5) and NDCT comprising non diabetic patients on conventional post operative therapy (n=5). Only eyes in which the corneal epithelial defect had been serially photographed at time, t= 0, 12, 24, 36, 48, 60, 72 and 120 hours following commencement of topical medications were included. The size of the defect was calculated using local software. DTI eyes had a significantly smaller defect size at t= 24 (p=0.009), 36 (p=0.009), 48 (p=0.015) and 60 hours (p=0.005) compared to DCT eyes and had no statistical difference from NDCT eyes at all times in the Mann Whitney U analysis (p>0.05). In the diabetic operated bilaterally, the insulin treated eye re-epithelialised by 48 hours whereas fellow eye treated conventionally re-epithelialised in 72 hours.
CONCLUSIONS: Topical insulin or insulin eye drops 1 unit qds may be applied to the corneal surface to normalize the rate of healing of epithelial defects in diabetic patients undergoing epithelial debridement to improve the surgeon's view.
Fulltext Accelerated diabetic retinopathy in pregnancy--a real and present danger

Bastion MLC, Barkeh HJ, Muhaya M

Med J Malaysia, 2005 Oct;60(4):502-4.
PMID: 16570717

A 36 year-old Malay lady with diabetes mellitus in pregnancy and poorly controlled hypertension developed rapid progression of diabetic retinopathy from no retinopathy to florid proliferative retinopathy over three months in her right eye. She had subsequent loss of vision due to vitreous haemorrhage in the peri-partum period. She had good final visual acuity with quiescent retinopathy following pars planar vitrectomy. A similar course was avoided in the left eye by timely pan retinal photocoagulation.
Fulltext Multifocal choroiditis: ocular TB or side-effects of anti-TB therapy?

Bastion MLC, Kok HS, Muhaya M

Med J Malaysia, 2004 Dec;59(5):682-4.
PMID: 15889575

A patient with end-stage renal failure secondary to polycystic kidney disease was seen in the Eye Clinic for a corneal abrasion. Incidental fundal examination revealed bilateral multiple, small, raised, pale yellow sub-retinal nodules. Past medical history of inadequately treated pulmonary tuberculosis was obtained. Following initiation of anti-tuberculous therapy, the choroidal lesions resolved.
Study site: Eye clinic, Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
Fulltext Recalcitrant cystoid macular oedema in an eye with ischaemic central retinal vein occlusion - what's next?

Yong MH, Amin A, Mushawiahti M, Bastion ML

Med J Malaysia, 2015 Dec;70(6):358-60.
PMID: 26988210

We report a case of a middle-aged gentleman with recalcitrant macular oedema (RMO) secondary to ischaemic central retinal vein occlusion (CRVO). He was given six injections of intravitreal ranibizumab (anti-VEGF) monthly. However, his visual acuity (VA) deteriorated and the macular oedema worsened. He then received an intravitreal dexamethasone implant eight months post-CRVO. His VA and macular oedema improved dramatically and significantly at first follow-up and remained stable at six months after implant. This case can be a reference for those who treating recalcitrant macular oedema. It shows the effect of an intravitreal dexamathasone implant might have in a patient with RMO due to CRVO. The patient enjoyed improvement of vision, with clinical evidence of reduction in central macular thickness (CMT) and with no serious adverse events after a single injection up to six months post implant.
Outcomes of Subliminal Transscleral Cyclophotocoagulation treatment in glaucoma

Chow JY, Wan Norliza WM, Bastion MC

Med J Malaysia, 2021 03;76(2):236-240.
PMID: 33742635

BACKGROUND: Subliminal transscleral cyclophotocoagulation (SL-TSCPC) is a new alternative therapy to reduce intraocular pressure (IOP) safely and effectively. However, there are few studies regarding SL-TSCPC by Supra 810 laser machine and limited data regarding its effectiveness in moderate severity glaucoma that still has good preservation of vision. This study was conducted to evaluate the outcome of SL-TSPCPC in various types of glaucoma including patients with good vision.
METHODS: A retrospective, non-comparative, analytical case series of all patients who received SL-TSCPC treatment from October 2018 to April 2019 at Hospital Tengku Ampuan Afzan, Pahang, Malaysia. Data was collected during the second week, sixth week, third month and sixth month follow-up. The primary outcome measure gave success rate at six months post-treatment. Secondary measures were changes in visual acuity, mean IOP reduction, mean number of IOP lowering medications reduced and ocular side effects noted during follow-up.
RESULTS: The success rate was 43.8% (seven eyes out of sixteen eyes) at six months post-treatment. The mean IOP reduced from 43.0mmHg±14.8mmHg pre-treatment to 24.7mmHg±12.0mmHg at two weeks post treatment with 42.6% reduction. Subsequently, mean IOP at sixth week, third month and sixth month were 33.8mmHg±16.9mmHg, 35.2mmHg±14.9mmHg, and 29.0mmHg±16.2mmHg respectively. Vision maintained in 13 patients, two patients had improvement in vision however, five patients had deterioration in vision. No serious ocular side effects were noted.
CONCLUSION: Subliminal TSCPC is a safe and alternative method of lowering IOP in moderate to advanced glaucoma over 6 months duration of follow-up. As it has good safety profile and repeatability, it is a good treatment option for patients with uncontrolled glaucoma.
Case series of children with steroid-Induced glaucoma

Lam CS, Umi Kalthum MN, Norshamsiah MD, Bastion M

Malays Fam Physician, 2018;13(3):32-37.
PMID: 30800232

Steroid-induced glaucoma is the most serious complication of the injudicious use of steroids, particularly among children affected by allergic conjunctivitis. This condition is steroid-dependent, and children are commonly being prescribed topical anti-inflammatories, including topical steroids, by general practitioners. Furthermore, topical steroids are also available over the counter, and this availability contributes to overuse without proper monitoring by an ophthalmologist. We present a series of five cases illustrating the devastating effect of unmonitored, long-term use of steroids among children for vernal keratoconjunctivitis. The medications were prescribed initially by general ophthalmologists and were continually bought over the counter by parents. At the presentation to our center, these patients were already compromised visually, exhibiting glaucomatous optic disc changes and high intraocular pressure. The series highlights the optic nerve damage resulting in irreversible visual compromises among children on long-term, topical steroids and the importance of regular monitoring with a low threshold for ophthalmologist referral.
Fulltext The Adjunctive Use of Anti-vascular Endothelial Growth Factor Agents in the Management of Iris Neovascularisation in Malaysia

Bastion ML, Then KY, Faridah HA, Mushawiahti M, Othmaliza O, Wong HS

Med J Malaysia, 2011 Mar;66(1):10-4.
PMID: 23765135 MyJurnal

This retrospective study investigated the role of antivascular endothelial growth factor agents (VEGF), ranibizumab, bevacizumab and pegaptanib sodium in patients with iris neovascularisation (INV), in which 9 eyes received intraocular injections for various ischaemic ocular conditions. Ocular sequelae included recurrence of rubeosis (n=2) and hyphaema (n=2). Systemic complication included one case of cerebrovascular accident. INV regressed in all cases from day one. INV recurrence occurred in 2 cases. The mean intraocular pressure of the study eyes decreased from 25.3 mmHg to 18.3 mmHg at one month. Five eyes are medication free. Visual acuity improved in 5 eyes. Four eyes achieved a Snellen visual acuity of 6/24 or better. We conclude that the use of intraocular anti-VEGF agents are safe and effective for inducing the regression of INV. Patients with multiple systemic risk factors should be counseled on stroke risk.
Revisiting the role of erythropoietin for treatment of ocular disorders

Shirley Ding SL, Leow SN, Munisvaradass R, Koh EH, Bastion ML, Then KY, et al.

Eye (Lond), 2016 Oct;30(10):1293-1309.
PMID: 27285322 DOI: 10.1038/eye.2016.94

Erythropoietin (EPO) is a glycoprotein hormone conventionally thought to be responsible only in producing red blood cells in our body. However, with the discovery of the presence of EPO and EPO receptors in the retinal layers, the EPO seems to have physiological roles in the eye. In this review, we revisit the role of EPO in the eye. We look into the biological role of EPO in the development of the eye and the physiologic roles that it has. Apart from that, we seek to understand the mechanisms and pathways of EPO that contributes to the therapeutic and pathological conditions of the various ocular disorders such as diabetic retinopathy, retinopathy of prematurity, glaucoma, age-related macular degeneration, optic neuritis, and retinal detachment. With these understandings, we discuss the clinical applications of EPO for treatment of ocular disorders, modes of administration, EPO formulations, current clinical trials, and its future directions.
Fulltext Safety and Efficacy of Human Wharton's Jelly-Derived Mesenchymal Stem Cells Therapy for Retinal Degeneration

Leow SN, Luu CD, Hairul Nizam MH, Mok PL, Ruhaslizan R, Wong HS, et al.

PLoS One, 2015;10(6):e0128973.
PMID: 26107378 DOI: 10.1371/journal.pone.0128973

To investigate the safety and efficacy of subretinal injection of human Wharton's Jelly-derived mesenchymal stem cells (hWJ-MSCs) on retinal structure and function in Royal College of Surgeons (RCS) rats.