BackgroundImpairment in cognitive function is a recognized outcome of traumatic brain injury (TBI... more BackgroundImpairment 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.MethodsWe 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...
Optometrists, ophthalmologists, orthoptists, and other trained medical professionals use fundus p... more 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 v...
RetCam is an excellent screening tool for the detection of retinopathy of prematurity (ROP). Howe... more 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,...
Objectives: To describe the clinical presentation of vaso-occlusive changes in hidden presumed oc... more Objectives: To describe the clinical presentation of vaso-occlusive changes in hidden presumed ocular tuberculosis (TB). Methods: Retrospective case review of 3 patients with a diagnosis of presumed ocular TB at Eye Clinic, Hospital Universiti Sains Malaysia. Results: All three patients presented with hazy fundus view in which 2 patients were presented with vitreous hemorrhage (case I & case 3) and one patient was presented with vitritis and vitreous condensation (case 2). Vaso-occlusive changes was noted by post vitrectomy (case l), based on fluorescein fundus angiography (case 2) and after resolving vitreous hemorrhage (case 3). A diagnosis of presumed ocular TB was made based on presence of vaso-occlusive changes (case 1, case 2 & case 3) and supported by positive Mantoux test (case 1 & case 3) and history of contact with pulmonary TB (case 3). Conclusions: Diagnosis of ocular TB requires a high index of suspicion. Early anti TB treatment for suspected ocular TB can give a better...
A white-eyed blowout fracture is an orbital floor fracture associated with restriction of ocular ... more 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,...
We describe a case of antineutrophil cytoplasmic antibody (ANCA)-associated retinal vasculitis in... more We describe a case of antineutrophil cytoplasmic antibody (ANCA)-associated retinal vasculitis in a 21-year-old previously healthy Malay woman, who presented to us with complaints of sudden painless loss of vision in her left eye. Her vision upon presentation was counting fingers and her fundus examination showed retinal vasculitis and ischemic changes. Fundus fluorescein angiography showed leakage from the vasculitic retinal vessels, resulting in macular oedema. All investigations were normal, except that a full blood test showed eosinophilia and an autoimmune screening revealed positive perinuclear staining-ANCA, which led us to diagnose ANCA-associated retinal vasculitis. The patient was comanaged with the rheumatology team. She was started on a high-dose intravenous steroid followed by a tapering dose of an oral steroid. Improvement was noted from the resolution of macular oedema evident on optical coherence tomography of the macula. However, vision remained poor and unchanged.
To review the clinical profile of retinal vein occlusion (RVO) in Hospital Universiti Sains Malay... more 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%) ...
Microbial keratitis is a serious ocular infection. It is often difficult to establish a microbial... more Microbial keratitis is a serious ocular infection. It is often difficult to establish a microbial keratitis that is due to fungal infection. Inadequate therapy and delayed diagnosis of fungal keratitis leads to generally poor visual outcomes. The objective of this study is to determine the sensitivity and specificity of PCR to detect fungal pathogen in microbial keratitis. In this study, a PCR method was compared to the conventional method to detect fungal pathogen in microbial keratitis. The PCR was performed with primers pair F1,R2 and F3,R4 from two consecutive regions in the 18S rRNA gene. Positive result for PCR was considered when there was presence of this amplified target sequence in both primer pairs F1,R2 and F3,R4. A statistical diagnostic test revealed that the PCR has a sensitivity of 90.9% and a specificity of 94.7% to detect fungal pathogen in microbial keratitis. PCR is a rapid, sensitive and a useful method to detect fungal pathogen in microbial keratitis.
A21-year man presented with symptom of photophobia and tearing in the right eye for 2 months dura... more A21-year man presented with symptom of photophobia and tearing in the right eye for 2 months duration. lt was associated with painless gradual reduced vision. There was a history of hammering on a metal object prior to that. Ocular examination revealed signs of mild anterior uveitis due to a retained metallic intralenticular foreign body. Conjunctiva was white. Computed Tomography ( CT) scan of the orbit confirmed presence of a single intraocular foreign body. The condition is misleading and can be easily overlooked. A detailed history and clinical examination are mandatory in this misleading situation.
A 60 year-old man presented with acute on set of left eye proptosis and ptosis. It was associated... more 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 ...
Journal of Pediatric Ophthalmology & Strabismus, 2010
The authors describe recurrent lens dislocation into the anterior chamber in a young girl with ho... more 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.
A 32-year-old lady, diagnosed with anaplastic large cell non-Hodgkin's lymphoma of the medias... more A 32-year-old lady, diagnosed with anaplastic large cell non-Hodgkin's lymphoma of the mediastinum, presented with bilateral floaters and reduced right eye vision 3 years post chemotherapy. Ophthalmic examination revealed bilateral panuveitis with multiple deep seated choroidal lesions in the left eye. Computed tomography scanning of the orbit showed enhancing and bulky optic nerve sheath at the retrobulbar part of both optic nerves. The patient was treated with involved field radiation therapy of the orbit, with cumulative dose of 30Gy. Eight months post radiation therapy, she developed retinal pigment epithelial detachment at the macula and deep chorioretinal degeneration at superotemporal and inferonasal regions of the right fundus. There was evidence of vitreoretinal traction at the margin of chorioretinal degeneration areas, thus barricade lasers were performed in the affected eye. Her visual acuity remains 6,/6 in both eyes. Retinal pigment epithelial detachment is a possi...
Background Alkali injury is one of the most devastating injuries to the eye. It results in perman... more Background Alkali injury is one of the most devastating injuries to the eye. It results in permanent unilateral or bilateral visual impairment. Chemical eye injury is accompanied by an increase in the oxidative stress. Anti-inflammatory and antioxidant agents play a major role in the treatment of chemical eye injuries. The purpose of this study is to evaluate the anti-inflammatory (clinical and histopathological) and antioxidant effects of Tualang honey versus conventional treatment in alkali injury on the eyes of rabbits. Methods A preliminary study was carried out prior to the actual study to establish the alkali chemical injury on rabbit's cornea and we found that alkali chemical injury with 2 N NaOH showed severe clinical inflammatory features. In actual study, alkali injury with 2 N NaOH was induced in the right eye of 10 New Zealand White rabbits' cornea. The rabbits were divided into two groups, Group A was given conventional treatment and Group B was treated with bot...
BackgroundImpairment in cognitive function is a recognized outcome of traumatic brain injury (TBI... more BackgroundImpairment 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.MethodsWe 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...
Optometrists, ophthalmologists, orthoptists, and other trained medical professionals use fundus p... more 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 v...
RetCam is an excellent screening tool for the detection of retinopathy of prematurity (ROP). Howe... more 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,...
Objectives: To describe the clinical presentation of vaso-occlusive changes in hidden presumed oc... more Objectives: To describe the clinical presentation of vaso-occlusive changes in hidden presumed ocular tuberculosis (TB). Methods: Retrospective case review of 3 patients with a diagnosis of presumed ocular TB at Eye Clinic, Hospital Universiti Sains Malaysia. Results: All three patients presented with hazy fundus view in which 2 patients were presented with vitreous hemorrhage (case I & case 3) and one patient was presented with vitritis and vitreous condensation (case 2). Vaso-occlusive changes was noted by post vitrectomy (case l), based on fluorescein fundus angiography (case 2) and after resolving vitreous hemorrhage (case 3). A diagnosis of presumed ocular TB was made based on presence of vaso-occlusive changes (case 1, case 2 & case 3) and supported by positive Mantoux test (case 1 & case 3) and history of contact with pulmonary TB (case 3). Conclusions: Diagnosis of ocular TB requires a high index of suspicion. Early anti TB treatment for suspected ocular TB can give a better...
A white-eyed blowout fracture is an orbital floor fracture associated with restriction of ocular ... more 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,...
We describe a case of antineutrophil cytoplasmic antibody (ANCA)-associated retinal vasculitis in... more We describe a case of antineutrophil cytoplasmic antibody (ANCA)-associated retinal vasculitis in a 21-year-old previously healthy Malay woman, who presented to us with complaints of sudden painless loss of vision in her left eye. Her vision upon presentation was counting fingers and her fundus examination showed retinal vasculitis and ischemic changes. Fundus fluorescein angiography showed leakage from the vasculitic retinal vessels, resulting in macular oedema. All investigations were normal, except that a full blood test showed eosinophilia and an autoimmune screening revealed positive perinuclear staining-ANCA, which led us to diagnose ANCA-associated retinal vasculitis. The patient was comanaged with the rheumatology team. She was started on a high-dose intravenous steroid followed by a tapering dose of an oral steroid. Improvement was noted from the resolution of macular oedema evident on optical coherence tomography of the macula. However, vision remained poor and unchanged.
To review the clinical profile of retinal vein occlusion (RVO) in Hospital Universiti Sains Malay... more 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%) ...
Microbial keratitis is a serious ocular infection. It is often difficult to establish a microbial... more Microbial keratitis is a serious ocular infection. It is often difficult to establish a microbial keratitis that is due to fungal infection. Inadequate therapy and delayed diagnosis of fungal keratitis leads to generally poor visual outcomes. The objective of this study is to determine the sensitivity and specificity of PCR to detect fungal pathogen in microbial keratitis. In this study, a PCR method was compared to the conventional method to detect fungal pathogen in microbial keratitis. The PCR was performed with primers pair F1,R2 and F3,R4 from two consecutive regions in the 18S rRNA gene. Positive result for PCR was considered when there was presence of this amplified target sequence in both primer pairs F1,R2 and F3,R4. A statistical diagnostic test revealed that the PCR has a sensitivity of 90.9% and a specificity of 94.7% to detect fungal pathogen in microbial keratitis. PCR is a rapid, sensitive and a useful method to detect fungal pathogen in microbial keratitis.
A21-year man presented with symptom of photophobia and tearing in the right eye for 2 months dura... more A21-year man presented with symptom of photophobia and tearing in the right eye for 2 months duration. lt was associated with painless gradual reduced vision. There was a history of hammering on a metal object prior to that. Ocular examination revealed signs of mild anterior uveitis due to a retained metallic intralenticular foreign body. Conjunctiva was white. Computed Tomography ( CT) scan of the orbit confirmed presence of a single intraocular foreign body. The condition is misleading and can be easily overlooked. A detailed history and clinical examination are mandatory in this misleading situation.
A 60 year-old man presented with acute on set of left eye proptosis and ptosis. It was associated... more 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 ...
Journal of Pediatric Ophthalmology & Strabismus, 2010
The authors describe recurrent lens dislocation into the anterior chamber in a young girl with ho... more 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.
A 32-year-old lady, diagnosed with anaplastic large cell non-Hodgkin's lymphoma of the medias... more A 32-year-old lady, diagnosed with anaplastic large cell non-Hodgkin's lymphoma of the mediastinum, presented with bilateral floaters and reduced right eye vision 3 years post chemotherapy. Ophthalmic examination revealed bilateral panuveitis with multiple deep seated choroidal lesions in the left eye. Computed tomography scanning of the orbit showed enhancing and bulky optic nerve sheath at the retrobulbar part of both optic nerves. The patient was treated with involved field radiation therapy of the orbit, with cumulative dose of 30Gy. Eight months post radiation therapy, she developed retinal pigment epithelial detachment at the macula and deep chorioretinal degeneration at superotemporal and inferonasal regions of the right fundus. There was evidence of vitreoretinal traction at the margin of chorioretinal degeneration areas, thus barricade lasers were performed in the affected eye. Her visual acuity remains 6,/6 in both eyes. Retinal pigment epithelial detachment is a possi...
Background Alkali injury is one of the most devastating injuries to the eye. It results in perman... more Background Alkali injury is one of the most devastating injuries to the eye. It results in permanent unilateral or bilateral visual impairment. Chemical eye injury is accompanied by an increase in the oxidative stress. Anti-inflammatory and antioxidant agents play a major role in the treatment of chemical eye injuries. The purpose of this study is to evaluate the anti-inflammatory (clinical and histopathological) and antioxidant effects of Tualang honey versus conventional treatment in alkali injury on the eyes of rabbits. Methods A preliminary study was carried out prior to the actual study to establish the alkali chemical injury on rabbit's cornea and we found that alkali chemical injury with 2 N NaOH showed severe clinical inflammatory features. In actual study, alkali injury with 2 N NaOH was induced in the right eye of 10 New Zealand White rabbits' cornea. The rabbits were divided into two groups, Group A was given conventional treatment and Group B was treated with bot...
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