Lens-induced glaucoma in a tertiary centre in northeast of Malaysia

Lens-induced glaucoma (LIG) is common in developing countries owing to the delay in cataract removal.1,2 In Malaysia, cataract is one of the leading causes of blindness and low vision.3 Although LIG is prevalent in developing countries, it also occurs in developed countries.

Sequelae of neglected senile cataract

Cataract is the most common cause of blindness in the world. An attack of phacolytic and phacomorphic glaucoma as a result of neglected cataract constitutes a medical emergency that must be addressed immediately. Ocular emergencies such as these is challenging for the surgeon with guarded or poor prognosis. We describe the presentation, management and prognosis of three cases of phacomorphic and phacolytic glaucoma. All three patients underwent aggressive management of intraocular pressure. Despite successful cataract operation with implantation of intraocular lens, there was only mild improvement of the vision. Optic nerve and pupil functions were permanently affected following the insult. Phacomorphic and phacolytic glaucoma present a very challenging problem to the surgeon with poor visual outcome. Public health education and awareness are important and health workers should encourage patients with cataract to seek early treatment for better prognosis

Optic disc topography in Malay patients with normal-tension glaucoma and primary open-angle glaucoma

Abdul Rahim Adlina,1,2 Koh Alisa-Victoria,1 Ismail Shatriah,1 Ahmad Tajudin Liza-Sharmini,1 Mt Saad Ahmad2 1Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; 2Department of Ophthalmology, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia Background: There are limited data concerning the optic disc topography in normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG) patients living in Southeast Asian countries. This study aims to compare optic disc parameters in patients with NTG and POAG in Malaysia and to discuss the results in comparison with studies of NTG and POAG in other Asian countries.Methods: This prospective cross-sectional study was performed in two hospitals with glaucoma service in Malaysia from 2010 to 2012. Seventy-seven patients of Malay ethnicity were enrolled in this study, including 32 NTG patients and 45 POAG patients. Using the Heidelberg Retinal Tomograph III, we measured optic disc area, cup area, rim area, cup volume, rim volume, cup-to-disc area ratio, mean cup depth, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness, and retinal nerve fiber layer cross-sectional area. Results: The eyes for NTG patients had significantly larger optic disc areas (2.65 [standard deviation, 0.41] vs 2.40 [standard deviation, 0.36] mm², respectively; P=0.006) and cup areas (1.54 [standard deviation, 0.43] vs 1.32 [standard deviation, 0.40] mm², respectively; P=0.027) compared with the eyes of POAG patients. Comparison of the other parameters between the two groups revealed no significant difference (P>0.050). The moderate and severe NTG patients showed significantly deeper cups and larger disc and cup areas when compared with the moderate and severe POAG patients (P<0.050).Conclusion: The NTG patients in this study have notably larger optic disc and cup areas than the POAG patients. Our observations are consistent with those reported in studies of NTG and POAG patients in Korea. The deeper cups and larger disc and cup areas may serve as indicators of severity when comparing NTG with POAG. However, these findings require verification with IOP and visual field results. Keywords: normal-tension glaucoma, primary open-angle glaucoma, Malay ethnicity, optic disc topography, Heidelberg Retina Topography II

Cyanoacrylate tissue glue for wound repair in early posttrabeculectomy conjunctival bleb leak: a case series

Abdul-Rahim Haslinda, Yaakub Azhany, Rasid Noor-Khairul, Embong Zunaina, Ahmad-Tajudin Liza-Sharmini Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia Abstract: We demonstrated a noninvasive management of early bleb leak following trabeculectomy using cyanoacrylate tissue glue (CATG). Three patients who underwent augmented trabeculectomy with mitomycin C with early bleb leak between January 2009 and June 2010 were reviewed. Case 1 and Case 2 exhibited bleb leak on postoperative Day 1 and Case 3 showed leak on follow-up at postoperative Day 7. Case 1 was successfully sealed with CATG at postoperative Day 3, after failed pressure padding and bandage contact lens. Case 2 was successfully sealed with CATG at postoperative Day 3, after failed pressure padding and conjunctiva flap resuturing. In Case 3, the leaking conjunctival flap was managed with combined techniques of resuturing and applying CATG at postoperative Day 9, after failed pressure padding. During leakage, the intraocular pressure was low (6–8 mmHg) in all three cases, with shallow anterior chamber depth and absence of other complications such as choroidal detachment, hypotony maculopathy, or endophthalmitis. Foreign body sensation was the main complaint following the procedure. No clinical allergy reaction was documented. CATG may serve as a potential adjunctive and effective method in the management of posttrabeculectomy early bleb leak. Keywords: cyanoacrylate tissue glue, bleb leak, trabeculectomy, mitomycin

Severe panuveitis in neuro-Behçet’s disease in Malaysia: a case series

Khairuddin Othman,1 Ahmad Tajudin Liza-Sharmini,1 Mohtar Ibrahim,1 John Tharakan,2 Ryoji Yanai,3 Embong Zunaina1 1Department of Ophthalmology, 2Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; 3Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan Abstract: Behçet’s disease (BD) is a multisystemic disease that is very rare in Malaysia. About 5% of patients develop central nervous system involvement, termed neuro-Behçet’s. Neuro-Behçet’s is one of the most serious causes of long-term morbidity and mortality. We report two cases of neuro-Behçet’s associated with uveitis (ocular BD) highlighting the clinical presentation, diagnostic measurement, and therapeutic management of these cases.Keywords: Behçet’s disease, Behçet’s syndrome, parenchymal neuro-Behçet’s, uveiti

Diffuse unilateral subacute neuroretinitis in a young boy: a case report

FNg Guan-Fook, Abd Aziz Hayati, Mohd Noor Raja-Azmi, Ahmad Tajudin Liza-Sharmini, Wan Hitam Wan-Hazabbah, Embong ZunainaDepartment of Ophthalmology, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MalaysiaAbstract: We report a case of diffuse unilateral subacute neuroretinitis in a young boy with no clinical visualization of nematode. The diagnosis was made based on clinical findings and detection of Toxocara immunoglobulin G by Western blot test. An 11-year-old Malay boy presented with progressive blurring of vision in the left eye for a duration of 1 year. It was associated with intermittent floaters. Visual acuity in the left eye was 6/45 and improved to 6/24 with pinhole. There was positive relative afferent pupillary defect, impaired color vision, and presence of red desaturation in the left eye. There were occasional cells in the anterior chamber with no conjunctiva injection. Posterior segment examination revealed mild-to-moderate vitritis and generalized pigmentary changes of the retina with attenuated vessels. The optic disk was slightly hyperemic with mild edema. There was presence of multiple, focal, gray-white subretinal lesions at the inferior part of the retina. Full blood picture results showed eosinophilia with detection of Toxocara immunoglobulin G by Western blot test. Investigations for other infective causes and connective tissue diseases were negative. The diagnosis of diffuse unilateral subacute neuroretinitis secondary to Toxocara was made based on clinical findings and laboratory results. He was treated with oral albendazole 400 mg daily for 5 days and oral prednisolone 1 mg/kg with tapering doses over 6 weeks. At 1 month follow-up, the inflammation had reduced, and multiple, focal, gray-white subretinal lesions were resolved; however there was no improvement of vision.Keywords: diffuse unilateral subacute neuroretinitis, Toxocara IgG, albendazol

The Effect of Anchovy Sauce on Severity and Progression of Glaucoma

Introduction: Anchovy sauce is a known appetizer in many Asian’s cuisines. Based on the bio-physical content of anchovy sauce, there is a possibility of the frequent consumption can affect severity and progression of glaucoma. The aim of this study was to determine the association of anchovy sauce intake in severity and progression of glaucoma. <div>Methods: A cross-sectional study was conducted involving 91 primary glaucoma patients who were compliance and achieved target intraocular pressure, non-smoker and without a family history of glaucoma. Direct face-to-face interview on the dietary recall of anchovy sauce consumption was conducted between May 2013 and December 2013. The complete ocular examination was performed including intraocular pressure measurement. Hoddap-Parrish-Anderson criterion was used to assess the severity of glaucoma based on the latest reliable and reproducible of two consecutive Humphrey visual fields 24-2. The association between anchovy sauce and glaucoma severity was determined using Fisher’s exact test. Multiple logistic regression analysis was performed to determine the association of anchovy sauce intake with glaucoma progression. </div><div>Results: A total of 46 male and 45 female with primary glaucoma were recruited with a mean age of 66.4 (SD10.1) years old. 56 patients consumed anchovy sauce with 19% occasionally, 44.6% weekly, 16.1% daily and 5.4% in every meal. There was no significant association of anchovy sauce intake with severity and progression of primary glaucoma after a mean of 6.4 years of follow-up.</div><div>Conclusion: Anchovy sauce has potential protective effect against progression and severity of glaucoma. However, it was not reflected in this study due to small sample size and poor quantification of the amount of anchovy sauce as a condiment to the main dish. </div