Disruption of white matter integrity and its relationship with cognitive function in non-severe traumatic brain injury

Background

Impairment in cognitive function is a recognized outcome of traumatic brain injury (TBI). However, the degree of impairment has variable relationship with TBI severity and time post injury. The underlying pathology is often due to diffuse axonal injury that has been found even in mild TBI. In this study, we examine the state of white matter putative connectivity in patients with non-severe TBI in the subacute phase, i.e., within 10 weeks of injury and determine its relationship with neuropsychological scores.

Methods

We conducted a case-control prospective study involving 11 male adult patients with non-severe TBI and an age-matched control group of 11 adult male volunteers. Diffusion MRI scanning and neuropsychological tests were administered within 10 weeks post injury. The difference in fractional anisotropy (FA) values between the patient and control groups was examined using tract-based spatial statistics. The FA values that were significantly different between patients and controls were then correlated with neuropsychological tests in the patient group.

Results

Several clusters with peak voxels of significant FA reductions (p < 0.05) in the white matter skeleton were seen in patients compared to the control group. These clusters were located in the superior fronto-occipital fasciculus, superior longitudinal fasciculus, uncinate fasciculus, and cingulum, as well as white matter fibers in the area of genu of corpus callosum, anterior corona radiata, superior corona radiata, anterior thalamic radiation and part of inferior frontal gyrus. Mean global FA magnitude correlated significantly with MAVLT immediate recall scores while matrix reasoning scores correlated positively with FA values in the area of right superior fronto-occipital fasciculus and left anterior corona radiata.

Conclusion

The non-severe TBI patients had abnormally reduced FA values in multiple regions compared to controls that correlated with several measures of executive function during the sub-acute phase of TBI.

White-eyed blowout fracture, child in danger: A case report

A white-eyed blowout fracture is an orbital floor fracture associated with restriction of ocular motility (suggestive of orbital content entrapment) but with minimal or absence of signs of soft tissue trauma. It can lead to significant patient morbidity. This case involved an 8-year-old boy with a white-eyed blowout fracture following facial trauma. He presented with binocular diplopia and a history of recurrent episodes of vomiting after the trauma and was referred to our centre for a suspected head injury. Visual acuity in both eyes was 6/9. Examination showed minimal left periorbital haematoma with left eye motility restriction on superior and medial gaze associated with pain. CT scan of the orbit showed left orbital floor fracture with minimal soft tissue entrapment. He underwent urgent open exploration of the left orbit and release of orbital tissue entrapment. Post-operatively, the left eye motility restriction improved significantly with resolution of diplopia. In conclusion, a high index of suspicion is crucial in diagnosing paediatric white-eyed blowout fractures due to lack of external ocular signs.

Alteration in the Functional Organization of the Default Mode Network Following Closed Non-severe Traumatic Brain Injury

The debilitating effect of traumatic brain injury (TBI) extends years after the initial injury and hampers the recovery process and quality of life. In this study, we explore the functional reorganization of the default mode network (DMN) of those affected with non-severe TBI. Traumatic brain injury (TBI) is a wide-spectrum disease that has heterogeneous effects on its victims and impacts everyday functioning. The functional disruption of the default mode network (DMN) after TBI has been established, but its link to causal effective connectivity remains to be explored. This study investigated the differences in the DMN between healthy participants and mild and moderate TBI, in terms of functional and effective connectivity using resting-state functional magnetic resonance imaging (fMRI). Nineteen non-severe TBI (mean age 30.84 ± 14.56) and twenty-two healthy (HC; mean age 27.23 ± 6.32) participants were recruited for this study. Resting-state fMRI data were obtained at the subacute phase (mean days 40.63 ± 10.14) and analyzed for functional activation and connectivity, independent component analysis, and effective connectivity within and between the DMN. Neuropsychological tests were also performed to assess the cognitive and memory domains. Compared to the HC, the TBI group exhibited lower activation in the thalamus, as well as significant functional hypoconnectivity between DMN and LN. Within the DMN nodes, decreased activations were detected in the left inferior parietal lobule, precuneus, and right superior frontal gyrus. Altered effective connectivities were also observed in the TBI group and were linked to the diminished activation in the left parietal region and precuneus. With regard to intra-DMN connectivity within the TBI group, positive correlations were found in verbal and visual memory with the language network, while a negative correlation was found in the cognitive domain with the visual network. Our results suggested that aberrant activities and functional connectivities within the DMN and with other RSNs were accompanied by the altered effective connectivities in the TBI group. These alterations were associated with impaired cognitive and memory domains in the TBI group, in particular within the language domain. These findings may provide insight for future TBI observational and interventional research.

Interactive Blood Vessel Segmentation from Retinal Fundus Image Based on Canny Edge Detector

Optometrists, ophthalmologists, orthoptists, and other trained medical professionals use fundus photography to monitor the progression of certain eye conditions or diseases. Segmentation of the vessel tree is an essential process of retinal analysis. In this paper, an interactive blood vessel segmentation from retinal fundus image based on Canny edge detection is proposed. Semi-automated segmentation of specific vessels can be done by simply moving the cursor across a particular vessel. The pre-processing stage includes the green color channel extraction, applying Contrast Limited Adaptive Histogram Equalization (CLAHE), and retinal outline removal. After that, the edge detection techniques, which are based on the Canny algorithm, will be applied. The vessels will be selected interactively on the developed graphical user interface (GUI). The program will draw out the vessel edges. After that, those vessel edges will be segmented to bring focus on its details or detect the abnormal vessel. This proposed approach is useful because different edge detection parameter settings can be applied to the same image to highlight particular vessels for analysis or presentation.

Sinonasal undifferentiated carcinoma – a rare cause of proptosis in elderly

Sinonasal undifferentiated carcinoma is a rare and extremely aggressive sinonasal tract malignancy. It is a rapidly enlarging tumour and a highly destructive lesion. We hereby report a 71-year-old Malay male with progressive left proptosis for one month, associated with reduced vision in the left eye, intermittent diplopia and anosmia. He was later diagnosed as having sinonasal undifferentiated carcinoma. The patient subsequently underwent a series of radiotherapy and showed improvement following treatment. This case was reported to highlight the importance identifying this entity and emphasise that sinonasal undifferentiated carcinoma should be considered in an elderly patient with proptosis associated with nasal symptoms.

Detection of FZD4, LRP5 and TSPAN12 Genes Variants in Malay Premature Babies with Retinopathy of Prematurity

Purpose:

To determine the mutational analyses of familial exudative vitreoretinopathy (FEVR)-causing genes in Malay patients with retinopathy of prematurity (ROP) to obtain preliminary data for gene alterations in the Malay community.

Methods:

A comparative cross-sectional study involving 86 Malay premature babies (ROP = 41 and non-ROP = 45) was performed from September 2012 to December 2014. Mutation analyses in (FEVR)-causing genes (NDP, FZD4, LRP5, and TSPAN12) were performed using DNA from premature babies using polymerase chain reaction (PCR) and direct sequencing. Sequencing results were confirmed with PCR-Restriction Fragment Length Polymorphism (RFLP).

Results:

We found variants of FZD4, LRP5, and TSPAN12 in this study. One patient from each group showed a non-synonymous alteration in FZD4, c.502C>T (p.P168S). A synonymous variant of LRP5 [c.3357G>A (p.V1119V)] was found in 30 ROP and 28 non-ROP patients. Two variants of TSPAN12, c.765G>T (p.P255P) and c.*39C>T (3′UTR), were also recorded (29 and 21 in ROP, 33 and 26 in non-ROP, respectively). Gestational age and birth weight were found to be significantly associated with ROP (P value < 0.001 and 0.001, respectively).

Conclusion:

Analysis of data obtained from the ROP Malay population will enhance our understanding of these FEVR-causing gene variants. The c.3357G>A (p.V1119V) variant of LRP5, and c.765G>T (p.P255P) and c.*39C>T variants of TSPAN12 could be common polymorphisms in the Malay ethnic group; however, this requires further elucidation. Future studies using larger groups and higher numbers of advanced cases are necessary to evaluate the relationship between FEVR-causing gene variants and the risk of ROP susceptibility in Malaysian infants.

Investigation of natural environmental radioactivity concentration in soil of coastaline area of Ado-Odo/Ota Nigeria and its radiological implications

Natural radioactivity in coastaline area soil of Ado-Odo/Ota has been carried out to ascertain the presence of radionuclides using gamma-ray spectroscopy (HPGe detector). The result showed that U-238, Th-232 and K-40 ranged from 24 ± 7-49 ± 10; 67 ± 6-120 ± 9 and 88 ± 17-139 ± 20 Bqkg^-1 respectively. The radium equivalent for the samples ranged from 132.51 to 230.91 Bqkg^-1 with mean value of 185.89 Bqkg^-1. The mean value for the gamma dose rate for the soil samples was estimated to be 81.32 nGyh^-1. The estimated values of annual effective dose equivalent ranged from 0.61 to 1.07 mSv y^-1. The estimation of alpha index representative (Iα) ranged from 0.12 to 0.24 with mean value of 0.21 while the gamma representative index ranged between 0.465 and 0.810. The activity utilization index of the soil samples ranged from 1.09 to 1.89 with mean value of 1.53. The radiological implication in the study area has shown that the soil samples with gamma dose rate value of 89.99 nGyh^-1, 94.39 nGyh^-1, 97.40 nGyh^-1 and 101.04 nGyh^-1 respectively are higher than the recommended value of 80 nGyh^-1 and may pose health implication for long term exposure.

Assessment of natural radioactivity in various commercial tiles used for building purposes in Nigeria

In this study, we evaluated the activity concentration of natural radionuclides (226Ra, 232Th and 40K) for fifteen (15) different brands of tile samples used for building purposes in Nigeria. The tile samples were analyzed using High purity Germanium gamma detector. The mean activity concentrations of 226Ra, 232Th, and 40K were observed to be 61.1 ± 5.5 Bq/kg, 70.2 ± 6.08 Bq/kg and 514.7 ± 59.8 Bq/kg respectively. Various hazard indices such as absorbed dose rate, external and internal hazard index, annual effective dose rate, Gamma activity Index (Iγ) and Alpha Index (Iα) were calculated. The obtained results showed that the mean radium equivalent activity (Raeq), the absorbed dose rate (D), external and internal hazard index, the annual effective dose (AEDR) equivalent, Gamma activity Index (Iγ) and Alpha Index (Iα) were: 204.42 Bq/kg, 177.61 nGyh-1, 0.55, 0.77, 0.96 mSvyr-1, 0.74 and 0.32 respectively. The average value of radium equivalent obtained in this study is less than that of the recommended value of 370 Bq/kg but the average values of the other radiological hazards for some samples are found to be slightly above international recommended values except Hex, Hin and AEDE which are within the international reference value of unity. The measured concentrations of these radioactive materials were correlated with other previous result obtained from similar tile materials used in other countries and found to be in good agreement with the international standard, however, the tiles are recommended for decoration purposes in Nigeria.

The optimisation of electrokinetic remediation for heavy metals and radioactivity contamination on Holyrood-Lunas soil (acrisol species) in Sri Gading Industrial Area, Batu Pahat, Johor, Malaysia

The optimisation of electrokinetic remediation of an alluvial soil, locally named as Holyrood-Lunas from Sri Gading Industrial Area, Batu Pahat, Johor, Malaysia, had been conducted in this research. This particular soil was chosen due to its relatively high level of background radiation in a range between 139.2 and 539.4 nGy h(-1). As the background radiation is correlated to the amount of parent nuclides, (238)U and (232)Th, hence, a remediation technique, such as electrokinetic, is very useful in reducing these particular concentrations of heavy metal and radionuclides in soils. Several series of electrokinetics experiments were performed in laboratory scale in order to study the influence of certain electrokinetic parameters in soil. The concentration before (pre-electrokinetic) and after the experiment (post-electrokinetic) was determined via X-ray fluorescence (XRF) analysis technique. The best electrokinetic parameter that contributed to the highest achievable concentration removal of heavy metals and radionuclides on each experimental series was incorporated into a final electrokinetic experiment. Here, High Pure Germanium (HPGe) was used for radioactivity elemental analysis. The XRF results suggested that the most optimised electrokinetic parameters for Cr, Ni, Zn, As, Pb, Th and U were 3.0 h, 90 volts, 22.0 cm, plate-shaped electrode by 8 × 8 cm and in 1-D configuration order whereas the selected optimised electrokinetic parameters gave very low reduction of (238)U and (232)Th at 0.23 ± 2.64 and 2.74 ± 23.78 ppm, respectively.

Intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage

Herein, we report our experience in treating extensive traumatic submacular hemorrhage with a single dose of intravitreal ranibizumab. A 23-year-old healthy Malay man presented with a progressive reduction of central vision in the left eye of 2 days’ duration following a history of blunt trauma. Visual acuity was reduced to counting fingers. Examination revealed infero-temporal subconjunctival hemorrhage, traumatic anterior uveitis, and an extensive sub-macular hemorrhage with suspicion of a choroidal rupture in the affected eye. He was initially treated conservatively with topical prednisolone acetate 1%. The subconjunctival hemorrhage and anterior uveitis resolved but his vision remained poor with minimal resolution of the submacular hemorrhage at 1 week follow-up (day 12 post-trauma). In view of the poor resolution of submacular hemorrhage, he was treated with a single dose of 0.5 mg intravitreal ranibizumab at day 20 post-trauma. At 4 weeks post-intravitreal ranibizumab, there was an improvement in visual acuity (from counting fingers to 6/45) and complete resolution of the submacular hemorrhage with presence of a choroidal rupture scar temporal to the fovea, which was not seen clearly at presentation due to obscuration by blood. His visual acuity further improved to 6/18 at 3 months post-trauma. Although this single case had a favorable outcome, a large population cohort study is needed to establish the effectiveness of intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage.

Ultrasonographic findings in eyes with retinopathy of prematurity in malaysia

RetCam is an excellent screening tool for the detection of retinopathy of prematurity (ROP). However, affordability is a barrier when adopting the use of RetCam in developing countries. We aimed to describe different stages of ROP using ultrasonographic B-scan and to evaluate the association between funduscopic examinations and ultrasonographic B-scan findings in premature neonates with ROP in Malaysia. A descriptive cross sectional study was conducted in 90 eyes of 47 premature neonates with different stages of ROP in three tertiary hospitals in Malaysia. Experienced ophthalmologists performed detailed funduscopic examinations using binocular indirect ophthalmoscopy (BIO). A masked examiner performed a 10 MHz ultrasonographic B-scan evaluation with 12 meridian position images within 48 hours of clinical diagnosis. Data from the clinical examination and ultrasonographic findings were collected and analysed. We recruited 37 eyes (41.1%) with stage 1 ROP, 29 eyes (32.3%) with stage 2, 18 eyes (20.0%) with stage 3, and 3 eyes (3.3%) with stages 4 and 5 based on the clinical assessment. Ultrasonography correctly identified 3 (8.1%) stage 1 eyes, 17 (58.6%) stage 2 eyes, 13 (72.2%) stage 3 eyes, and 3 each (100%) of the stage 4 and 5 eyes. There was a significant association between the funduscopic signs and the ultrasound findings for stage 2 ROP and above (Fisher's exact test, p <0.001). In conclusion, all stages of ROP were detected and described with a 10 MHz ultrasonic B-scan system. A significant association was observed between funduscopic signs and ultrasonographic findings in premature Malaysian neonates with stage 2 ROP and above.

Topical cyclosporin as an alternative treatment for vision threatening blepharokeratoconjunctivitis: a case report

Here, a case of vision threatening blepharokeratoconjunctivitis that responded well to topical cyclosporin is reported. A 9-year-old Malay girl with a history of bilateral blepharokeratoconjunctivitis was regularly treated with lid scrubbing using diluted baby shampoo, fusidic acid gel, and topical steroids as well as an intermittent course of oral doxycycline for the past year. She developed acute onset bilateral eye redness associated with poor vision in her right eye. Both eyes showed marked diffuse hyperemic conjunctiva with corneal vascularization. The presence of corneal vascularization obscured the visual axis in the right eye. The condition did not improve with regular intensive lid hygiene using diluted baby shampoo, fusidic acid gel, and topical steroids. She was started on topical cyclosporin A 0.5% every 6 hours. There was a dramatic regression of corneal vascularization after 3 days on topical cyclosporin, with marked improvement in visual acuity. This is a single case in which cyclosporin improved the status of the ocular surface. A large cohort study is required to justify its effectiveness in treating blepharokeratoconjunctivitis and to test its potential as an alternative immunosuppressive agent in comparison to conventional corticosteroids.

Clinical profile and aetiology of optic neuritis in Hospital Universiti Sains Malaysia--5 years review

Although few studies concerning optic neuritis (ON) in Asian countries have been reported, there is no report about ON in Malaysia particularly within the Malay population. We aimed to determine the clinical manifestation, visual outcome and aetiology of ON in Malays, and discussed the literature of ON studies in other Asian populations. This was a retrospective study involving 31 consecutive patients (41 eyes) with ON treated at Hospital Universiti Sains Malaysia commencing from July 2005 till January 2010 with a period of follow-up ranging from 18-60 months. The clinical features, laboratory results, possible aetiology, and visual acuity after one year were analysed. Females were the predominant group. The age of the patients ranged between 3-55 years and peaked between 21-30 years old. 67.7% of the patients had unilateral involvement. Pain on ocular movement was observed in 31.7% of the affected eyes. 73.3% of 41 involved eyes showed visual acuity equal 6/60 or worse on presentation. Paracentral scotoma was the most common visual field defect noted. Optic disc papillitis proved more widespread compared to the retrobulbar type of ON. The aetiology was idiopathic in more than 50%, while the risk of multiple sclerosis was extremely low (3.2%) in our series. 66.0% demonstrating visual acuity improved to 6/12 or better at one year after the attack. 16.1% showed evidence of recurrence during follow-up. In conclusion, the clinical profile and aetiology of ON in Malay patients are comparable to other ON studies reported by other Asian countries.

Orbital apex syndrome after tooth extraction in an immunocompromised patient

A 60 year-old man presented with acute on set of left eye proptosis and ptosis. It was associated with poor vision, eye pain and restriction of eye movement of the same eye after 5 hours post left upper molar tooth extraction. The visual acuity in the left eye was hand movement. There was severe ptosis and proptosis of the left eye. The conjunctiva was chemotic with quite anterior chamber. The pupil was mid dilated and sluggished to light. The ocular movement was restricted in all directions. Fundoscopy of the left eye revealed features of central retinal artery occlusion with hyperaemic disc and subretinal exudates at posterior pole. The right eye appeared normal. Urgent MRI brain and orbit revealed severe left paranasal sinusitis with anterior displacement of the left globe and presence orbital abscess. Patient was managed with Otorhinolaryngology and Neurosurgery teams. He underwent emergency transnasal drainage of abscess. Histopathological examination of unhealthy sinus mucosa showed evidence of fungal infection. However, the culture and sensitivity result was inconclusive. Patient was treated with amphotericin B, ceftriaxone, amoxicillin clavulanate and metronidazole. Patient was detected to have high blood sugar level and was managed accordingly. The proptosis improved with treatment. However, his vision, ptosis and ophthalmoplegia remained static. Assessing the immunocompromised status is important for the management of patient presented as acute orbital apex syndrome to avoid fatal outcome.

Syphilitic uveitis: report of 3 cases

AIM

To evaluate the clinical manifestations and visual outcome of syphilitic uveitis patients.

METHODS

Case series of three patients with syphilitic uveitis who were managed in Hospital USM.

RESULTS

Three patients were diagnosed to have uveitis secondary to Syphilis. All three patients were not known to have syphilis prior to presentation but have positive history of sexual promiscuity. All patients presented with progressive blurring of vision for average of one-month duration. Two of them have association with fever, ocular pain and floaters. Visual acuity at presentation ranges from 6/12 to hand movement. Mild anterior uveitis (non-granulomatous), vitritis and papillitis were presence in all the patients. First patient has multifocal chorioretinitis with exudative retinal detachment. The second patient presented with exudative retinal detachment while the third patient has chorioretinitis only. All the patients were treated with intramuscular benzyl-penicillin 2.4 MU weekly for 4 weeks and two of them received oral doxycycline 200mg twice daily for 3 months. The uveitis responded well to the treatment and two of them showed dramatic visual improvement from 6/120 to 6/21 and 6/12 to 6/6. The one with worse outcome was confirmed to have positive retroviral.

CONCLUSION

Ocular syphilis presented here as non-granulomatous inflammation associated with exudative retinal detachment. Final visual outcome is generally good despite slow improvement after treatment.

Prediction error and accuracy of intraocular lens power calculation in pediatric patient comparing SRK II and Pediatric IOL Calculator

Background

Despite growing number of intraocular lens power calculation formulas, there is no evidence that these formulas have good predictive accuracy in pediatric, whose eyes are still undergoing rapid growth and refractive changes. This study is intended to compare the prediction error and the accuracy of predictability of intraocular lens power calculation in pediatric patients at 3 month post cataract surgery with primary implantation of an intraocular lens using SRK II versus Pediatric IOL Calculator for pediatric intraocular lens calculation. Pediatric IOL Calculator is a modification of SRK II using Holladay algorithm. This program attempts to predict the refraction of a pseudophakic child as he grows, using a Holladay algorithm model. This model is based on refraction measurements of pediatric aphakic eyes. Pediatric IOL Calculator uses computer software for intraocular lens calculation.

Methods

This comparative study consists of 31 eyes (24 patients) that successfully underwent cataract surgery and intraocular lens implantations. All patients were 12 years old and below (range: 4 months to 12 years old). Patients were randomized into 2 groups; SRK II group and Pediatric IOL Calculator group using envelope technique sampling procedure. Intraocular lens power calculations were made using either SRK II or Pediatric IOL Calculator for pediatric intraocular lens calculation based on the printed technique selected for every patient. Thirteen patients were assigned for SRK II group and another 11 patients for Pediatric IOL Calculator group. For SRK II group, the predicted postoperative refraction is based on the patient's axial length and is aimed for emmetropic at the time of surgery. However for Pediatric IOL Calculator group, the predicted postoperative refraction is aimed for emmetropic spherical equivalent at age 2 years old. The postoperative refractive outcome was taken as the spherical equivalent of the refraction at 3 month postoperative follow-up. The data were analysed to compare the mean prediction error and the accuracy of predictability of intraocular lens power calculation between SRK II and Pediatric IOL Calculator.

Results

There were 16 eyes in SRK II group and 15 eyes in Pediatric IOL Calculator group. The mean prediction error in the SRK II group was 1.03 D (SD, 0.69 D) while in Pediatric IOL Calculator group was 1.14 D (SD, 1.19 D). The SRK II group showed lower prediction error of 0.11 D compared to Pediatric IOL Calculator group, but this was not statistically significant (p = 0.74). There were 3 eyes (18.75%) in SRK II group achieved acccurate predictability where the refraction postoperatively was within ± 0.5 D from predicted refraction compared to 7 eyes (46.67%) in the Pediatric IOL Calculator group. However the difference of the accuracy of predictability of postoperative refraction between the two formulas was also not statistically significant (p = 0.097).

Conclusions

The prediction error and the accuracy of predictability of postoperative refraction in pediatric cataract surgery are comparable between SRK II and Pediatric IOL Calculator. The existence of the Pediatric IOL Calculator provides an alternative to the ophthalmologist for intraocular lens calculation in pediatric patients. Relatively small sample size and unequal distribution of patients especially the younger children (less than 3 years) with a short time follow-up (3 months), considering spherical equivalent only.

Spontaneous bilateral anterior lens dislocation in an 8-year-old girl

The authors describe recurrent lens dislocation into the anterior chamber in a young girl with homocystinuria. The patient's 12-year-old sister died after a cerebrovascular accident caused by the same disease. This report highlights the importance of early dietary restrictions and treatment.

Specific detection of fungal pathogens by 18S rRNA gene PCR in microbial keratitis

Background

The sensitivity and specificity of 18S rRNA polymerase chain reaction (PCR) in the detection of fungal aetiology of microbial keratitis was determined in thirty patients with clinical diagnosis of microbial keratitis.

Methods

Corneal scrapings from patients were used for Gram stain, culture and PCR analysis. PCR was performed with primer pairs targeted to the 18S rRNA gene. The result of the PCR was compared with conventional culture and Gram staining method. The PCR positive samples were identified by DNA sequencing of the internal transcribed spacer (ITS) region of the rRNA gene. Main outcome measures were sensitivity and specificity of PCR in the detection of fungus in corneal keratitis.

Results

Combination of microscopy and culture gave a positive result in 11 of 30 samples of microbial keratitis. PCR detected 10 of 11 samples that were positive by conventional method. One of the 19 samples that was negative by conventional method was positive by PCR. Statistical analysis revealed that the PCR to have a sensitivity of 90.9% and specificity of 94.7% in the detection of a fungal aetiology in microbial keratitis.

Conclusion

PCR is a rapid, sensitive and useful method to detect fungal aetiology in microbial keratitis.

Dental infection presenting with ipsilateral parapharyngeal abscess and contralateral orbital cellulitis - a case report

A 43 year-old man presented with pain on the right tooth for three days duration. Computed tomography showed left orbital cellulitis and right parapharyngeal abscess. There was also evidence suggestive of a dental abscess over right upper alveolar region. Magnetic resonance imaging revealed left superior ophthalmic vein thrombosis. Emergency drainage of the right parapharyngeal abscess was performed. Right maxillary molar extraction revealed periapical abscess. Left eye proptosis markedly reduced after initiating heparin.

Gallium scan in diagnosing ocular sarcoidosis

A 40-year-old man presented with floaters and painless progressive blurring of vision in the right eye for one month duration. Visual acuity in the right eye was 6/24. There was mild anterior chamber reaction and vitritis. The optic disc was swollen and elevated with presence of granulomatous lesion in the optic disc head. Blood investigations were unremarkable. Serum angiotensin converting enzyme (ACE) was normal and conjunctival biopsy showed presence of inflammatory cells. B-Scan ultrasound revealed an echo-dense lesion in the optic nerve head. There was increased uptake of the right lacrimal gland and presence of 'Panda sign' with Gallium scan. A diagnosis of right ocular sarcoidosis was made base on the clinical features and Gallium scan.