MyMedR

Irreversible blindness following intravenous streptokinase

Peyman M, Subrayan V

JAMA Ophthalmol, 2013 Oct;131(10):1368-9.

PMID: 23929315 DOI: 10.1001/jamaophthalmol.2013.4489

Statistical analysis of stereoacuity in ophthalmology research

Peyman A, Peyman M

J Curr Ophthalmol, 2016 Dec;28(4):237.

PMID: 27830212

Tonic Pupil, a Paraneoplastic Neuro-Ophtalmological Disease Associated with Occult Breast Cancer

Peyman A, Kabiri M, Peyman M

Breast J, 2015 Sep-Oct;21(5):543-4.

PMID: 26174775 DOI: 10.1111/tbj.12451

Here, we present a case of tonic pupil associated with occult breast cancer as a paraneoplastic neuro-ophthalmology syndrome. A 45-year-old woman developed progressive photophobia and blurred vision due to unilateral Adie's tonic pupil. Magnetic resonance image of her brain and neurological examination (including deep tendon reflexes) were normal at first visit. Follow-up examinations performed by ophthalmologist every 6 month without any change in her condition. After 2 years, patient discovered a mass in her breast which identified to be malignant after diagnostic procedures. Despite surgical and medical treatment for cancer, no change in the ocular condition was happened.

Fulltext Astigmatic treatment with photorefractive keratectomy: Investigations of non-keratometric ocular astigmatism

Peyman A, Dastborhan Z, Peyman M

J Curr Ophthalmol, 2017 Jun;29(2):98-102.

PMID: 28626818 DOI: 10.1016/j.joco.2016.12.001

PURPOSE: To evaluate the effect of non-keratometric ocular astigmatisms on visual and refractive outcomes after photorefractive keratectomy (PRK) for correction of myopic astigmatisms.

METHODS: Seventy one eyes of 36 subjects were enrolled in this study. Patients underwent PRK for treatment of myopia. Subjects were evaluated for refractive error, keratometry, and visual acuity before and six months after surgery. Pre- and post-op non-keratometric astigmatisms were calculated by vectorial analysis of the difference between the corneal plane refractive astigmatism and keratometric astigmatism. Astigmatic analysis explored the contribution of non-keratometric astigmatisms.

RESULTS: The pre-op spherical equivalent (SE) was -6.27 ± 1.48 with 1.16 ± 1.02 diopters of corneal plane refractive astigmatism and 1.44 ± 0.47 diopters keratometric astigmatism. Post-op values were -0.60 ± 0.85, 0.56 ± 0.47, and 1.06 ± 0.57, respectively, 6 months after surgery. Pre- and post-op non-keratometric astigmatisms were 0.76 ± 0.41 and 0.76 ± 0.46, respectively, (P = 0.976) with significant correlation (r = 0.37, P = 0.002). Pre-op non-keratometric astigmatisms correlated to the pre-op SE (r = -0.25, P = 0.04). Pre-op non-keratometric astigmatisms had significant correlation with keratometric difference vector of astigmatic correction (r = 0.369, P = 0.002). Post-op non-keratometric astigmatisms correlated to keratometric induced astigmatism (r = 0.334, P = 0.006), keratometric index of success (r = 0.571, P

Fulltext Optic nerve involvement as a first manifestation of acute lymphoblastic leukaemia after remission

Peyman M, Hieng TL, Subrayan V

BMJ Case Rep, 2011;2011.

PMID: 22698906 DOI: 10.1136/bcr.11.2010.3517

Fulltext Retinal manifestations of patients with human immunodeficiency virus, a multiethnics study in Malaysia

Loo AV, Sujaya S, Peyman M, Florence S, Subrayan V

Int J Ophthalmol, 2011;4(6):641-3.

PMID: 22553736 DOI: 10.3980/j.issn.2222-3959.2011.06.13

To investigate the fundus findings of patients infected with human immunodeficiency virus (HIV) in correlation to Highly Active Antiretroviral Therapy (HAART) and CD4 count.

Nasal chondroma presenting as hypertelorism

Ismail F, Peyman M, Waran V, Vasudevan S, Subrayan V

Optom Vis Sci, 2015 Apr;92(4 Suppl 1):S33-5.

PMID: 25730333 DOI: 10.1097/OPX.0000000000000528

To report a rare case of nasal chondroma presenting as hypertelorism.

Retinal nerve fiber layer structure abnormalities in schizophrenia and its relationship to disease state: evidence from optical coherence tomography

Lee WW, Tajunisah I, Sharmilla K, Peyman M, Subrayan V

Invest Ophthalmol Vis Sci, 2013 Nov;54(12):7785-92.

PMID: 24135757 DOI: 10.1167/iovs.13-12534

We determined structural retinal nerve fiber layer (RNFL) changes in schizophrenia patients and established if the structural changes were related to the duration of the illness using spectral-domain optical coherence tomography (SD-OCT).

Fulltext Iris mammillations in two female siblings with congenital adrenal hyperplasia

Peyman M, Ong MJ, Iqbal T, Subrayan V

BMJ Case Rep, 2010;2010.

PMID: 22802477 DOI: 10.1136/bcr.08.2010.3266

Iris mammillations are dark brown, smooth, mound- or dome-shaped protuberances that are typically found on the anterior iris surface and are presumed to be congenital in origin. This congenital anomaly is usually unilateral and can be hereditary or sporadic. Lisch nodules in neurofibromatosis, tapioca melanoma of the iris, inflammatory iris granulomata and Cogan-Reese syndrome should be considered in the differential diagnosis. In this case report, the authors present a case of a bilateral iris mammillations in two siblings with congenital adrenal hyperplasia (CAH). To our knowledge, this is the first case where bilateral iris mammilations have been found to be associated with a systemic condition. Iris mammillations can be considered as one of the clinical signs in CAH in view of the pathogenesis discussed. Detailed ocular examination in CAH may reveal an increased incidence.

Scanning laser edema index: a reliable tool to correlate with diabetic retinopathy and systemic risk factors?

Peyman M, Tajunisah I, Loo A, Chuah KC, Subrayan V

J Diabetes Complications, 2012 May-Jun;26(3):210-3.

PMID: 22520399 DOI: 10.1016/j.jdiacomp.2012.03.019

To correlate Heidelberg Retina Tomograph (HRT) derived macular edema (DME) index with severity of diabetic retinopathy and systemic factors. A total of 300 diabetic patients were recruited for the study for each of them a value for the macular edema index was obtained using the HRT II. Patients' age, gender, duration and type of diabetes mellitus, latest HbA1c result and presence or absence of co-morbid factors (hypertension, ischemic heart disease, nephropathy) were recorded together with the stage of diabetic retinopathy. These were correlated with DME. Out of 300 patients, HRT defined macula edema was seen in 68 patients (22.6%). There is a wider and higher range (95% percentile) of macula edema index in the severe non proliferative diabetic retinopathy (NPDR) group. Independent samples t test showed significant difference between the severe NPDR group and no DR group (p<0.001), mild NPDR group (p<0.05) and moderate NPDR group (p<0.05). A higher macula edema index was also found to have a low degree of correlation with more advanced stages of retinopathy (r=0.310; p<0.001). Also nephropathy showed a strong and significant correlation with DME. Hypertension had moderately significant correlation with DME. This study found no correlation between ischemic heart disease and DME. HRT derived scanning laser edema index is a reliable objective tool to evaluate diabetic retinopathy and systemic risk factors.

Fulltext Comparison of OKULIX ray-tracing software with SRK-T and Hoffer-Q formula in intraocular lens power calculation

Ghoreyshi M, Khalilian A, Peyman M, Mohammadinia M, Peyman A

J Curr Ophthalmol, 2018 Mar;30(1):63-67.

PMID: 29564411 DOI: 10.1016/j.joco.2017.06.008

Purpose: To compare the performance of OKULIX ray-tracing software with SRK-T and Hoffer Q formula in intraocular lens (IOL) power calculation in patients presenting with cataract.

Methods: In this prospective study, 104 eyes of 104 patients with cataract who underwent phacoemulsification and IOL implantation were recruited. Three IOL brands were used and for all eyes, IOL power calculation was performed using SRK-T, Hoffer Q formula and also OKULIX ray-tracing software. For all patients, axial length and keratometry data was obtained with IOLMaster 500 device and IOL power was determined using Hoffer Q and SRK-T formula. The IOL powers were also calculated using the OKULIX ray-tracing software combined with CASIA AS-OCT and IOLMaster 500 device. Optically measured axial length of eyes were inserted to OKULIX software from IOLMaster 500 device, and anterior and posterior tomographic and corneal pachymetry data was imported from CASIA AS-OCT into the OKULIX.The performance of each calculation methods was measured by subtracting the predicted postoperative refraction from the postoperative manifest refraction spherical equivalent (MRSE). For each of the 3 methods, the mean absolute prediction error was determined, too.

Results: The mean value absolute prediction error by OKULIX, SRK-T and Hoffer Q formulas, respectively, were 0.42 (±0.03), 0.36 (±0.02) and 0.37 (±0.02). The mean absolute prediction error by OKULIX had no significant difference between three IOL groups (P = 0.96), and it was confirmed that there was no meaningful statistically difference in mean absolute prediction error between the OKULIX, SRK-T and Hoffer Q formula. (P = 0.25). Also in each group of implanted IOLs, all three formulas worked with the same accuracy. The prediction error using OKULIX were within ±0.50 diopter in 63.5% of eyes and within ±1.00 diopter in 94.2% of eyes.

Conclusion: OKULIX ray-tracing IOL power measurements provides reliable and satisfactory postoperative results, which are comparable to other 3rd generation formulas of SRK-T and Hoffer Q.

Fulltext Association between Ocular Pseudoexfoliation and Sensorineural Hearing Loss

Singham NV, Zahari M, Peyman M, Prepageran N, Subrayan V

J Ophthalmol, 2014;2014:825936.

PMID: 24864196 DOI: 10.1155/2014/825936

Background. Our study aimed to investigate an association between ocular pseudoexfoliation (PXF) and sensorineural hearing loss (SNHL) and to compare them with age and sex matched controls without pseudoexfoliation. Method. This was a case-control study of 123 patients which included 68 cases with PXF (at least one eye) and 55 controls without pseudoexfoliation. Pure-tone audiometry (PTA) was done for these patients at sound frequencies taken as important for speech comprehension, that is, 250 Hertz (Hz), 500 Hz, 1000 Hz, and 2000 Hz. Results. There were 41 patients with pseudoexfoliation syndrome (PXE) and 27 with pseudoexfoliative glaucoma (PXEG). The majority of patients with hearing loss (60%; n = 51) were PXF patients and the remaining 40% (n = 34) were controls. Below average hearing thresholds were significantly higher in the pseudoexfoliation group compared to the control group (P = 0.01; odds ratio (OR), 3.00; 95% confidence interval (CI), 1.25-7.19). However, there was no significant difference in the mean hearing threshold levels between the three groups (PXE, PXEG, and controls) in either ear (ANOVA, right ear: P = 0.46 and left ear P = 0.36). Conclusion. Our study found an association between PXF and SNHL, confirming that PXF can involve organs in the body other than the eye.

Fulltext Risk factors for clinically significant macular edema in a multi-ethnics population with type 2 diabetes

Jew OM, Peyman M, Chen TC, Visvaraja S

Int J Ophthalmol, 2012;5(4):499-504.

PMID: 22937513 DOI: 10.3980/j.issn.2222-3959.2012.04.18

AIM: To determine the risk factors of clinically significant macular edema (CSME) in patients with non-proliferative diabetic retinopathy (NPDR) in a multi-ethnics Malaysian population.
METHODS: We performed a case control study in which 150 patients with bilateral NPDR and CSME in either eye were compared to 150 patients with bilateral NPDR and no CSME in both eyes. CSME and NPDR were graded according to Early Treatment of Diabetic Retinopathy Study criteria. Student's t-test, odds ratio and multiple logistic regression analysis were performed to analyze the duration of diabetes, body mass index (BMI), blood pressure(BP), total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides (TG), fasting blood glucose (FBG), HbA1c, full blood count, serum creatinine and proteinuria between the two groups.
RESULTS: Both groups were matched in terms of age, gender and ethnicity. Duration of diabetes, total serum cholesterol, serum LDL, FBG, HbA1c and serum creatinine were significantly higher in the CSME group (P<0.05). The hemoglobin, packed cell volume were significantly lower in the CSME group (p<0.05). There was no significant difference for serum HDL, TG, BMI, systolic and diastolic BP. Multiple logistic regression analysis showed that total serum cholesterol and HbA1c had significantly high odds of developing CSME.
CONCLUSION: HbA1c and total cholesterol are the two most important risk factors associated with CSME in patients with NPDR.
KEYWORDS: clinically significant macular edema; diabetes; risk factors
Study site: Ophthalmology clinic, Hospital Melaka, Malaysia

Accutome PachPen handheld ultrasonic pachymeter: intraobserver repeatability and interobserver reproducibility by personnel of different training grades

Peyman M, Tai LY, Khaw KW, Ng CM, Win MM, Subrayan V

Int Ophthalmol, 2015 Oct;35(5):651-5.

PMID: 25189684 DOI: 10.1007/s10792-014-9989-6

To assess the intra-observer repeatability and inter-observer reproducibility of central corneal thickness (CCT) measurements of PachPen (Accutome, Inc., Pennsylvania, USA), a hand-held, portable ultrasonic pachymeter when used by an ophthalmic nurse compared to an ophthalmologist. Ophthalmology Clinic, University of Malaya Medical Center In this prospective study, CCT was measured in 184 eyes of 92 healthy subjects, first by a corneal surgeon experienced in ultrasound pachymetry (Observer 1) followed by an ophthalmic nurse new to the procedure (Observer 2). Nine measurements were obtained from each eye by each observer, independently. Measurements were compared between the observers. Coefficients of repeatability and reproducibility were calculated. The Bland-Altman plot was used to assess agreement between observers. Mean age of the study population was 54.3 ± 15.2 years old and consisted of 43.5% male. Mean CCT as measured by Observers 1 and 2 were 528.3 ± 32.9 and 530.7 ± 33.3 µm, respectively. Observer 1 showed higher repeatability of measurements compared to that of Observer 2 (coefficient of repeatability 3.46 vs. 5.55%). The measurements by both observers showed high correlation (0.96) and good agreement (mean difference -2.4 µm; 95% limits of agreement -21.4, 16.7 µm). Coefficient of reproducibility of measurements between observers was 5.08%. Accutome PachPen hand-held ultrasound pachymeters gives excellent intra-observer repeatability and inter-observer reproducibility by personnel of different training grades.

3 Tesla magnetic resonance imaging noise in standard head and neck sequence does not cause temporary threshold shift in high frequency

Lim EY, Tang IP, Peyman M, Ramli N, Narayanan P, Rajagopalan R

Eur Arch Otorhinolaryngol, 2015 Nov;272(11):3109-13.

PMID: 25205300 DOI: 10.1007/s00405-014-3232-y

High acoustic noise level is one of the unavoidable side effects of 3 T magnetic resonance imaging (MRI). A case of hearing loss after 3 T MRI has been reported in this institution and hence this study. The objective of this study was to determine whether temporary threshold shift (TTS) in high frequency hearing occurs in patients undergoing 3 T MRI scans of the head and neck. A total of 35 patients undergoing head and neck 3 T MRI for various clinical indications were tested with pure tone audiometry in different frequencies including high frequencies, before and after the MRI scan. Any threshold change from the recorded baseline of 10 dB was considered significant. All patients were fitted with foamed 3 M earplugs before the procedure following the safety guidelines for 3 T MRI. The mean time for MRI procedure was 1,672 s (range 1,040-2,810). The noise dose received by each patient amounted to an average of 3,906.29% (1,415-9,170%). The noise dose was derived from a normograph used by Occupational Noise Surveys. This was calculated using the nomograph of L eq, L EX, noise dose and time. There was no statistically significant difference between the hearing threshold before and after the MRI procedures for all the frequencies (paired t test, P > 0.05). For patients using 3 M foamed earplugs, noise level generated by 3 T MRI during routine clinical sequence did not cause any TTS in high frequency hearing.

Refractive outcomes comparison between the Lenstar LS 900® optical biometry and immersion A-scan ultrasound

Naicker P, Sundralingam S, Peyman M, Juana A, Mohamad NF, Win MM, et al.

Int Ophthalmol, 2015 Aug;35(4):459-66.

PMID: 25024102 DOI: 10.1007/s10792-014-9970-4

To determine the accuracy of intraocular lens (IOL) calculations in eyes undergoing phacoemulsification cataract surgery with IOL implantation using immersion A-scan ultrasound (US) and Lenstar LS 900(®) biometry. In this prospective study, 200 eyes of 200 patients were randomized to undergo either Lenstar LS 900(®) or immersion A-scan US biometry to determine the IOL dioptric power prior to phacoemulsification cataract surgery. Post-operative refractive outcomes of these two groups of patients were compared. The result showed no significant difference between the target spherical equivalent (SE) and the post-operative SE value by the Lenstar LS 900(®) (p value = 0.632) or immersion A-scan US biometry (p value = 0.438) devices. The magnitude of difference between the two biometric devices were not significantly different (p value = 0.868). There was no significant difference in the predicted post-operative refractive outcome between immersion A-scan US biometry and Lenstar LS 900(®). Based on the results, the immersion A-scan US technique is as accurate as Lenstar LS 900(®) in the hands of an experienced operator.

Assessment of polymerase chain reaction in the detection of pseudomonas aeruginosa in contact lens-induced severe infectious keratitis

Subrayan V, Peyman M, Lek Yap S, Mohamed Ali NA, Devi S

Eye Contact Lens, 2010 Jul;36(4):201-3.

PMID: 20531205 DOI: 10.1097/ICL.0b013e3181e3efa3

PURPOSE: The aim of this study is to evaluate the role of real-time polymerase chain reaction (PCR) and conventional bacterial culture methods in the detection of Pseudomonas aeruginosa in contact lens-induced severe, partially treated corneal ulcers referred to a tertiary center.
METHODS: The study duration was 6 months. All patients with contact lens-related corneal ulcer, requiring admission during the study period were recruited. Samples from corneal scrapings were simultaneously sent at the time of admission for PCR and culture testing. An in-house real-time PCR was developed to detect the P. aeruginosa lasA gene. The results of PCR and culture were compared using McNemar's chi2 test.
RESULTS: Ten patients were recruited. The mean age was 33 years (20-45 years). All the patients had contact lens-related keratitis (>4 mm) of which eight (80%) were found positive for P. aeruginosa by PCR or culture. There was no significant difference between PCR and culture in detecting P. aeruginosa (P<0.05).
CONCLUSIONS: PCR is, at least, as good as conventional cultures in detecting P. aeruginosa. It is a rapid assay as compared with culture, and early detection enables prompt treatment thus reducing the destructive effect of the organism on the cornea.

Intravitreal bevacizumab for radiation-induced cystoid macular oedema in patients with nasopharyngeal carcinoma: a clinical series

Subrayan V, Khaw KW, Peyman M, Koay AC, Tajunisah I

Ophthalmologica, 2013;229(4):208-11.

PMID: 23548379 DOI: 10.1159/000348630

To evaluate the outcome of intravitreal bevacizumab in the treatment of radiation-induced cystoid macular oedema among patients who underwent external beam radiotherapy for nasopharyngeal carcinoma.

Neonatal herpes simplex virus type-1 central nervous system disease with acute retinal necrosis

Fong CY, Aye AM, Peyman M, Nor NK, Visvaraja S, Tajunisah I, et al.

Pediatr Infect Dis J, 2014 Apr;33(4):424-6.

PMID: 24378951 DOI: 10.1097/INF.0000000000000137

We report a case of neonatal herpes simplex virus (HSV)-1 central nervous system disease with bilateral acute retinal necrosis (ARN). An infant was presented at 17 days of age with focal seizures. Cerebrospinal fluid polymerase chain reaction was positive for HSV-1 and brain magnetic resonance imaging showed cerebritis. While receiving intravenous acyclovir therapy, the infant developed ARN with vitreous fluid polymerase chain reaction positive for HSV-1 necessitating intravitreal foscarnet therapy. This is the first reported neonatal ARN secondary to HSV-1 and the first ARN case presenting without external ocular or cutaneous signs. Our report highlights that infants with neonatal HSV central nervous system disease should undergo a thorough ophthalmological evaluation to facilitate prompt diagnosis and immediate treatment of this rapidly progressive sight-threatening disease.

Novel use of 3T MRI in assessment of optic nerve volume in glaucoma

Ramli NM, Sidek S, Rahman FA, Peyman M, Zahari M, Rahmat K, et al.

Graefes Arch Clin Exp Ophthalmol, 2014 Jun;252(6):995-1000.

PMID: 24770532 DOI: 10.1007/s00417-014-2622-6

PURPOSE: To measure optic nerve (ON) volume using 3 T magnetic resonance imaging (MRI), to correlate ON volume with retinal nerve fiber layer (RNFL) thickness, and to determine the viability of MRI as an objective tool in distinguishing glaucoma severity.

METHODS: In this cross-sectional study, 30 severe glaucoma patients, 30 mild glaucoma patients and 30 age-matched controls were recruited. All subjects underwent standard automated perimetry, RNFL analysis and 3 T MRI examinations. Glaucoma patients were classified according to the Hodapp-Anderson-Parish classification. Pearson's correlation coefficient was used to correlate ON volume with RNFL, and receiver operating curve (ROC) analysis was performed to determine the sensitivity and specificity of ON volume in detecting glaucoma severity.

RESULTS: Optic nerve volume was significantly lower in both the left and right eyes of the severe glaucoma group (168.70 ± 46.28 mm(3); 167.40 ± 45.36 mm(3)) than in the mild glaucoma group (264.03 ± 78.53 mm(3); 264.76 ± 78.88 mm(3)) and the control group (297.80 ± 71.45 mm(3); 296.56 ± 71.02 mm(3)). Moderate correlation was observed between: RNFL thickness and ON volume (r = 0.51, p <0.001), and in mean deviation of visual field and optic nerve volume (r = 0.60, p

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