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Lee HN, Subrayan V. I think I have double vision? Or not? Internuclear Ophthalmoplegia following right lacunar infarct. Med J Malaysia 2021; 76:950-952. [PMID: 34806694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Internuclear Ophthalmoplegia (INO) is an inability of the ipsilateral adduction with a contralateral horizontal abducting saccade on attempted gaze to the contra-lesion side. Injury to the medial longitudinal fasciculus (MLF) will obstruct the signalling pathway between the ipsilateral abducens nucleus and the contralateral medial rectus muscle. Infarction accounts for 38% of INO cases with mostly being unilateral (87%), followed by demyelination (34%), which mostly being bilateral (73%). Lacunar infarct is the most common ischemic stroke. INO can be easily missed due to its subtle presentation with no complaints from the patients. A full cranial nerves assessment, includes the extraocular muscles movement, is important. Ischemic and demyelinating INO typically recover. We present here of a case of INO following right lacunar infarct in a 72-year-old Malay woman. She had hypertensive crisis due to missed medications. Her blood pressure was well controlled throughout the hospital admission and finally she was discharged home with continuation of care at her primary facility.
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Affiliation(s)
- H N Lee
- Sultanah Fatimah Specialist Hopsital, Johor, Malaysia.
| | - V Subrayan
- University Malaya Medical Center, Kuala Lumpur, Malaysia
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Aliff IC, Fazliana I, Tajunisah I, Mimiwati Z, Chandran PA, Subrayan V. Primary Conjunctiva Tuberculosis and Review of Literature. Trop Biomed 2018; 35:26-31. [PMID: 33601773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The causes of chronic conjunctivitis are exhaustive, infection being the commonest. Primary tuberculosis(TB) involving the conjunctiva is rare. History of chronicity, worsening symptoms with steroids and clinical signs of subconjunctiva nodules could point towards the diagnosis of primary conjunctiva tuberculosis especially in endemic countries. Clinicopathological diagnosis is imperative to confirm this diagnosis. We report a case of a young lady who presented with a non-resolving chronic conjunctivitis that was proven to be TB and responded well to anti-tuberculosis treatment.
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Affiliation(s)
- I C Aliff
- Department of Ophthalmology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - I Fazliana
- Department of Ophthalmology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - I Tajunisah
- Department of Ophthalmology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Z Mimiwati
- Department of Ophthalmology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | | | - V Subrayan
- Department of Ophthalmology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Teh D, Azira SA, Hassan M, Loo AVP, Iqbal TB, Subrayan V. Ocular manifestations of dengue fever in University Malaya Medical Centre. Trop Biomed 2016; 33:799-806. [PMID: 33579077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This time-framed study describes the spectrum of ocular manifestations in patients with dengue fever and the association between maculopathy with the stages of dengue fever. This cross sectional prospective study involved 145 dengue inpatients recruited from University Malaya Medical Centre. Observed parameters were stages of dengue infection, abnormal fundus and types of maculopathy. Retinal abnormalities involved the peripheral region in 3 patients (1.03%) and the macula in 13 patients (4.48%). The types of maculopathy encountered were macular oedema 7 (53.8%), cystic appearance 4 (30.8%), macular haemorrhage 1 (7.7%) and yellow spots 1(7.7%). Reduced distance VA, visual scotoma and metamorphopsia and abnormal Amsler grid test correlated with maculopathy, p< 0.05. Maculopathy correlated well with dengue with severe leakage (p= 0.025). Our study found the prevalence of maculopathy in dengue infection to be 4.48% in UMMC. The significant predictors of maculopathy were dengue with severe leakage, visual scotoma, metamorphopsia, distance VA impairment and abnormal Amsler grid test. This study was funded by a University Malaya Grant - URMG no: RP006D-13HTM.
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Affiliation(s)
- D Teh
- Department of Ophthalmology, Faculty of Medicine, University Malaya Jalan Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - S A Azira
- Department of Ophthalmology, Faculty of Medicine, University Malaya Jalan Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - M Hassan
- Department of Ophthalmology, Faculty of Medicine, University Malaya Jalan Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - A V P Loo
- Department of Ophthalmology, Faculty of Medicine, University Malaya Jalan Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - T B Iqbal
- Department of Ophthalmology, Faculty of Medicine, University Malaya Jalan Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - V Subrayan
- Department of Ophthalmology, Faculty of Medicine, University Malaya Jalan Lembah Pantai, 50603 Kuala Lumpur, Malaysia
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Rohan Lee K, Chiang Ling K, Reza Peyman M, Subrayan V. Acute ptosis as the sole presenting symptom of a pulmonary adenocarcinoma. Eur Geriatr Med 2014. [DOI: 10.1016/j.eurger.2014.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Mutations in the PAX6 gene that cause aniridia have been identified in various ethnicities but not in the Malaysian population. Therefore, the objective of this study was to investigate the PAX6 mutation in a Malaysian family with congenital aniridia. In this study, a complete ophthalmic examination was performed on a Dusun ethnic family with aniridia. Genomic DNA was extracted from the peripheral blood of the subjects and screened for the PAX6 gene mutation using polymerase chain reaction amplification high-resolution melting curve analysis (PCR-HRM) followed by confirmation via direct DNA sequencing. A heterozygous G deletion (c.857delG) in exon 7 causing a frame shift in PAX6 was identified in all affected family members. Genotype-phenotype correlation analysis revealed congenital cataract and all affected family members showed a similar spectrum of aniridia with no phenotypic variability but with differences in severity that were age-dependent. In summary, by using a PCR-HRM approach, this study is the first to report a PAX6 mutation in a Malaysian family. This mutation is the cause of the aniridia spectra observed in this family and of congenital cataract.
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Affiliation(s)
- P C Lee
- School of Science and Technology, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu, Sabah, Malaysia
| | - H H Lam
- Department of Ophthalmology, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - S A Ghani
- Department of Ophthalmology, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - V Subrayan
- Department of Ophthalmology, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - K H Chua
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Koay CL, Patel DK, Tajunisah I, Subrayan V, Lansingh VC. A comparative analysis of avoidable causes of childhood blindness in Malaysia with low income, middle income and high income countries. Int Ophthalmol 2014; 35:201-7. [PMID: 24652461 DOI: 10.1007/s10792-014-9932-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 03/08/2014] [Indexed: 11/25/2022]
Abstract
To determine the avoidable causes of childhood blindness in Malaysia and to compare this to other middle income countries, low income countries and high income countries. Data were obtained from a school of the blind study by Patel et al. and analysed for avoidable causes of childhood blindness. Six other studies with previously published data on childhood blindness in Bangladesh, Ethiopia, Nigeria, Indonesia, China and the United Kingdom were reviewed for avoidable causes. Comparisons of data and limitations of the studies are described. Prevalence of avoidable causes of childhood blindness in Malaysia is 50.5 % of all the cases of childhood blindness, whilst in the poor income countries such as Bangladesh, Ethiopia, Nigeria and Indonesia, the prevalence was in excess of 60 %. China had a low prevalence, but this is largely due to the fact that most schools were urban, and thus did not represent the situation of the country. High income countries had the lowest prevalence of avoidable childhood blindness. In middle income countries, such as Malaysia, cataract and retinopathy of prematurity are the main causes of avoidable childhood blindness. Low income countries continue to struggle with infections such as measles and nutritional deficiencies, such as vitamin A, both of which are the main contributors to childhood blindness. In high income countries, such as the United Kingdom, these problems are almost non-existent.
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Affiliation(s)
- C L Koay
- Department of Ophthalmology, Faculty of Medicine, University Malaya, 50603, Kuala Lumpur, Malaysia,
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Loo AVP, Sujaya S, Peyman M, Florence S, Subrayan V. Retinal manifestations of patients with human immunodeficiency virus, a multiethnics study in Malaysia. Int J Ophthalmol 2011; 4:641-3. [PMID: 22553736 DOI: 10.3980/j.issn.2222-3959.2011.06.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 10/10/2011] [Indexed: 11/02/2022] Open
Abstract
AIM To investigate the fundus findings of patients infected with human immunodeficiency virus (HIV) in correlation to Highly Active Antiretroviral Therapy (HAART) and CD4 count. METHODS Two hundred and two patients of the three major races (Chinese, Malay and Indian) in Malaysia were recruited in this population-based cross-sectional study. This consisted of confirmed HIV sero-positive patients with HAART treatment (n=95) or without HAART therapy (n=107) from December 2007 to March 2008. They were further classified into the HIV infected group, AIDS related complex (ARC) group and AIDS group. Each group was then subdivided according to their CD4 count. Clinical fundus findings were recorded. RESULTS Sixty six patients (32.7%) showed presence of fundus manifestation, majority of which was HIV microangiopathy (89%) and the rest being Cytomegalovirus (CMV) retinitis (11%). The most common fundus lesion was cotton wool spot (34%). There was a higher incidence of fundus manifestation in the non HAART group than the HAART group (P=0.04) and in patients with CD4 count less than 200 cells/ml in both groups (P=0.01). The HAART therapy had remarkably reduced the percentage of fundus manifestation by 20% but CD4 count remains the marker for fundus manifestations. There were no significant differences noted in the retinal manifestation among the different races. (ANOVA, P=0.25). CONCLUSION The fundus manifestations were higher in patients with CD4<200 cells/ml and in the non HAART group. Hence the HAART therapy is capable of reducing the incidence of fundus manifestations, however the CD4 count determines the occurrence of fundus manifestations.
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Affiliation(s)
- A V P Loo
- Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia
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Ooi YL, Tai LY, Subrayan V, Tajunisah I. Combined Optic Neuropathy and Central Retinal Artery Occlusion in Presumed Ocular Tuberculosis without Detectable Systemic Infection. Ocul Immunol Inflamm 2011; 19:370-2. [DOI: 10.3109/09273948.2011.594203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tajunisah I, Ong MJ, Patricia AC, Subrayan V. Langerhans Cell Histiocytosis of the Pituitary Gland Presenting as Unilateral Reversible Central Visual Loss and a Contralateral Junctional Scotoma. Neuroophthalmology 2011. [DOI: 10.3109/01658107.2011.561946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
AIM To determine the causes of childhood blindness and severe visual impairment (BL/SVI) in schools for the blind in Malaysia. METHODS All children ≤ 15 years attending 24 schools for the blind throughout the country were examined using the WHO Prevention of Blindness Programme (WHO/PBL) eye examination record for children, and visual loss was classified according to the International Classification of Disease (ICD). RESULTS In all, 469 children were examined, of whom 448 (95.6%) had BL/SVI. The major causes of visual loss were retinal disorders (n=148, 33%; mainly retinopathy of prematurity (n=78, 17.4%)), cataract/pseudophakia/aphakia (n=77, 17.2%), and anomalies affecting the whole globe. (n=86, 19.2%). The major underlying etiology was undetermined (n = 193, 43.1%), followed by hereditary factors, 21.7% (mainly retinal dystrophies), and perinatal factors, 20.5%. More than 34 (7.6%) cases were considered potentially preventable and 192 (42.9%) potentially treatable. CONCLUSION Diseases of the retina are the major cause of visual impairment, with retinopathy of prematurity being an important avoidable cause. This reflects expansion of neonatal services in Malaysia, and improved survival of very low birth weight and preterm babies. Lens-related causes of visual impairment reflect the need to further improve pediatric ophthalmology services in Malaysia.
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Affiliation(s)
- D K Patel
- Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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12
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Affiliation(s)
- I Tajunisah
- Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Abstract
Surgical approaches are becoming increasingly minimally invasive, without compromising either safety or ease. Penetrating ocular foreign bodies has traditionally been approached either by intraocular or supraorbital access. We successfully attempted a minimally invasive approach to remove a retrobulbar foreign body under computer-assisted image guidance in a 19-year-old man involved in an industrial mishap.
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Affiliation(s)
- N Vairavan
- Division of Neurosurgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Tang IP, Prepageran N, Subrayan V, Tajunisah I. Endoscopic orbital decompression for optic neuropathy in thyroid ophthalmopathy. Med J Malaysia 2008; 63:337-338. [PMID: 19385499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Optic neuropathy, an uncommon manifestation occurs in 5% of patients with Graves' ophthalmopathy. Its outcome is good if early and proper treatment given. We reported a 49 years old male patient of Graves' disease with bilateral optic neuropathy. He underwent bilateral transnasal endoscopic orbital decompression with marked improvement of visual acuity bilaterally. The preoperative visual acuity was 6/36 in his right eye and 6/60 in his left eye. Two days after operation, his visual acuity was 6/12 in his right eye and 6/24 in his left eye. Transnasal endoscopic orbital decompression is a choice of treatment in optic neuropathy in thyroid ophthalmopathy after trial of corticosteroids.
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Affiliation(s)
- I P Tang
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Ang GS, Tey A, Ng WS, Subrayan V. Acute angle closure glaucoma resulting from myelodysplasia. Med J Malaysia 2007; 62:259-260. [PMID: 18246923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Patients with bleeding diatheses can present in a variety of clinical situations. When these patients manifest with ocular complications, their management can be challenging. We describe a case of acute angle closure glaucoma secondary to subretinal haemorrhage, with myelodysplasia as a predisposing factor.
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Affiliation(s)
- G S Ang
- Department of Ophthalmology, Raigmore Hospital, Inverness, United Kingdom
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Mulhern MG, Sheikh I, Subrayan V, Gilbert PM, Sneddon KJ. The E-Z(easy) clamp--a new instrument to facilitate medial ectropion repair. Orbit 2005; 24:109-11. [PMID: 16191798 DOI: 10.1080/01676830590926756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The medial spindle/retropunctal diamond procedure is a useful technique to correct medial ectropion. Unfortunately, the procedure is difficult, due to the limited size of the surgical field, the bleeding that is seen when the marginal artery is encountered and because of the ever present risk of damaging the canaliculus. We have developed a clamp that overcomes the anatomical opposition outlined above and at the same time improves access to the surgical field.
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Affiliation(s)
- M G Mulhern
- Corneo Plastic Unit and The F.A.C.E. Clinic, Queen Victoria Hospital NHS Trust, Waterford, Ireland.
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