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Fulltext Clinical Profile of Retinal Vein Occlusion in Hospital Universiti Sains Malaysia – 7 Years Review

Rosli Abdul-Hadi, Ibrahim Khairul-Anwar, Hassan Mutasim, Embong Zunaina

Journal of Biomedical and Clinical Sciences, 2020;5(2):1-6.
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To review the clinical profile of retinal vein occlusion (RVO) in Hospital Universiti Sains Malaysia (USM) from 2011 until 2017. This was a retrospective single-centre case series. The medical records of the patients presented to Ophthalmology Clinic with RVO from 2011 to 2017 were reviewed. A total of 24 patients (26 eyes) with a diagnosis of RVO in Hospital USM were reviewed. There was 91.6% of our patients were aged more than 45 years old with predominantly affected male gender (58.3%). Majority of the patients were Malays (87.5%). Hypertension (70.8%), hyperlipidemia (70.8%) and diabetes mellitus (54.2%) were the common systemic comorbidities in RVO patients. Majority of the patients (87.5%) were non-smoker. Based on type of RVO, there were 38.5% central RVO, 26.9% branch RVO, 19.2% macular branch RVO, and 15.4% hemivein occlusion. RVO was bilateral in 2 patients (8.4%). Based on fundus fluorescein angiography, 3 patients (11.5%) showed ischaemic features. Reduce vision (91.6%) was the main presenting symptoms of RVO while intraretinal haemorrhage (100%) and macular oedema (96.2%) were the most common ocular signs found in RVO. There were 16 eyes (61.5%) have visual acuity equal or better than 6/60 at presentation. Patient who had visual acuity equal or better than 6/60 showed promising improvement in visual acuity post treatment. Elderly with multiple comorbidities complaining of worsening of vision should have high index suspicion of RVO. Presenting visual acuity is associated with final visual outcome post treatment.
Fulltext Orbital cellulitis complicated with subperiosteal abscess following post-nasopharyngeal swab for COVID-19: A case report

Abdul-Kadir MA, Rosli AH

Clin Case Rep, 2023 May;11(5):e7324.
PMID: 37180319 DOI: 10.1002/ccr3.7324

KEY CLINICAL MESSAGE: The nasopharyngeal swab for COVID-19 is associated with low risks of severe complications, but it is important to consider the patient's medical history and anatomy of the nasal cavity to ensure safety and accuracy of the test. Orbital complications can occur up to 85% secondary to acute sinusitis, and prompt treatments are crucial, particularly in the pediatric group. A conservative approach is effective for subperiosteal abscess if certain criteria are met, and it is not an absolute indication for immediate surgical intervention. However, timely management of orbital cellulitis is essential for better outcomes.
ABSTRACT: Pre-septal and orbital cellulitis are more commonly seen in children than in adults. The incidence of pediatric orbital cellulitis is 1.6 in 100,000. The impact of COVID-19 has led to the increasing practice of nasopharyngeal swab surveillance. We presented a case of rare pediatric orbital cellulitis complicated with subperiosteal abscess secondary to severe acute sinusitis following a nasopharyngeal swab. A 4-year-old boy was brought in by his mother with increasing painful left eye swelling and redness. Three days prior, the patient developed a fever and mild rhinitis with loss of appetite which raised concerns about COVID-19. He had a nasopharyngeal swab on that same day and tested negative. Clinically, there was marked erythematous and tender periorbital and facial oedema involving the left nasal bridge, maxilla extended to the left upper lip with a deviation of the left nasal tip contralaterally. Computed tomography confirmed left orbital cellulitis with left eye proptosis, fullness of left maxillary and ethmoidal sinuses and left subperiosteal abscess. The patient received empirical antibiotics and surgical intervention promptly and recovered well with improvements in ocular symptoms. The nasal swabbing techniques may vary among practitioners, and it is associated with extremely low risks of severe complications from 0.001% to 0.16%. Whether the swab had aggravated the underlying rhinitis or traumatized the turbinates leading to sinus drainage obstruction; a nasal swab may impose the risk of severe orbital infection in a susceptible pediatric patient. Any health practitioner conducting the nasal swab should be vigilant about this potential complication.
A Rare Occurrence of Isolated Endogenous Escherichia coli Panophthalmitis: A Case Report

Ahmad Fauzi N, Rosli AH, Jabbari AJ

Cureus, 2023 Oct;15(10):e47059.
PMID: 38021653 DOI: 10.7759/cureus.47059

Panophthalmitis is a severe ocular condition that can lead to devastating outcomes, such as evisceration, if not promptly treated. It typically originates endogenously, with urinary tract infection being a common primary source of infection. This report describes a rare case of a 61-year-old Malay patient with left eye panophthalmitis. Ocular culture revealed Escherichia coli, while systemic septic workup yielded negative results. Due to the severity of the ocular condition at presentation and the disproportionate level of pain the patient had, an immunocompromised state was suspected and later the diagnosis of diabetes mellitus was confirmed via laboratory investigation. Despite the delay in presentation, which hindered early intervention, the patient's eyeball was successfully salvaged through a treatment regimen involving three injections of intravitreal antibiotic administered at 48 to 72-hour intervals and a complete course of intravenous antibiotics. This case report highlights the importance of prompt treatment to salvage an eye from evisceration in the case of panophthalmitis.
Ocular Hornet Injury: A Case Report on Corneal Microperforation and Endophthalmitis

Mohd Amin MHA, Rosli AH, Salam A

Cureus, 2024 Jul;16(7):e65515.
PMID: 39188476 DOI: 10.7759/cureus.65515

The lesser-banded hornet (Vespa affinis indosinensis) is a prevalent species in tropical and subtropical regions of Asia, including Malaysia. Its stings can result in local reactions, severe anaphylactic shock, and even death. We report a rare case of corneal microperforation and endophthalmitis following an ocular hornet injury. A 76-year-old farmer was attacked by hornets and suffered multiple stings, including one to his right eye. He developed right eye pain, redness, and visual impairment. Ocular examination revealed right corneal haziness with a retained stinger. Attempts to remove the retained stinger were unsuccessful, as the stinger broke and stayed deep in the corneal tissue layer. Corneal microperforation occurred at the site of the retained stinger. Subsequently, he developed endophthalmitis despite extensive topical and systemic antibiotics. He also required a scleral patch procedure for sclerokeratouveitis. This report highlights the importance of quick and vigilant management to prevent severe complications and preserve vision after a hornet sting injury. Retained stingers pose unique challenges that require specialized interventions. There is a need for continuous research and awareness in the management of ocular hornet injuries, aiming to establish standardized treatment guidelines and improve patient outcomes.
Fulltext A Retrospective Review of Endogenous Endophthalmitis: Three Years of Experience at Sultan Ahmad Shah Medical Centre at International Islamic University Malaysia

Alias NAQ, Abu-Bakar MF, Rosli AH, Jabbari AJ

Cureus, 2024 Jun;16(6):e63175.
PMID: 39070347 DOI: 10.7759/cureus.63175

Introduction Endogenous endophthalmitis is characterized by severe intraocular inflammation caused by the invasion of microorganisms into the anterior and posterior chambers of the eye. It results from hematogenous spread from distant foci of infection. This, in turn, leads to potential vision loss and blindness due to reduced anatomical and functional outcomes. The latest reported prevalence of endogenous endophthalmitis accounts for at least 2-8% of cases of general endophthalmitis which is fairly significant. Purpose This study aimed to analyze the clinical profile of endogenous endophthalmitis presented in the Ophthalmology Clinic, Sultan Ahmad Shah Medical Centre at International Islamic University Malaysia (SASMEC@IIUM). This study includes the patients' demographics, clinical manifestations, causative organism, treatment, and final visual outcome. Methods This is a retrospective case series of endogenous endophthalmitis patients from January 2020 to June 2023. The data were obtained from the patients' medical records in SASMEC@IIUM. Results A total of six patients (six eyes) were diagnosed with endogenous endophthalmitis from January 2020 to June 2023. Four patients (66.6%) were female, with a mean age of 51.6 ± 17.5 years. Presenting visual acuity ranged between 6/21 to hand movement (HM). Five patients (83.3%) presented with reduced vision, while one presented with eye redness (16.6%). Ocular signs included vitritis and retinitis (five eyes, 83.3%), hypopyon (five eyes, 83.3%), injected conjunctiva (five eyes, 83.3%), and eyelid swelling (one eye, 16.6%). The most common primary infection seen was intraabdominal sepsis (three patients, 50%), septic arthritis, hospital-acquired pneumonia (HAP), and urinary tract infection (UTI). Vitreous biopsy was only positive in two patients (33.3%) However, five out of the six patients (83.3%) had positive blood cultures (two Staphylococcus aureus, two Klebsiella pneumoniae and one Pseudomonas aeruginosa). All patients received intravitreal injections and intravenous antibiotics. Only one patient underwent subsequent trans pars plana vitrectomy (TPPV). Final visual acuity ranged from 6/6 to no light perception (NPL). Conclusion In this case series of six patients, we observed a variety of outcomes with similar presentations despite standardized treatment in all patients. Five out of six patients showed poorer visual outcomes and only one patient showed a final visual acuity of 6/6. Therefore, further study with a larger sample size is needed to evaluate the factors associated with the final visual outcome in endogenous endophthalmitis.