Assessment of the Optic Nerve Head Parameters Using Heidelberg Retinal Tomography III in Preterm Children

Background: Variations in optic nerve head morphology and abnormal retinal vascular pattern have been described in preterm children using digital image analysis of fundus photograph, optical coherence tomograph and serial funduscopy. We aimed to compare the optic nerve head parameters in preterm and term Malay children using Heidelberg Retinal Tomograph III. Design: A cross sectional study. Methodology/Principal Findings: Thirty-two preterm Malay children who were born at up to 32 weeks postconception, and 32 term Malay children aged 8–16 years old were recruited into this cross sectional study, which was conducted in the Hospital Universiti Sains Malaysia, Malaysia from January to December 2011. Their optic nerves were scanned and analyzed using a Heidelberg Retinal Tomography (HRT) III (Heidelberg Engineering, Germany). Preterm children showed an increased rim volume (SD) (0.56 (0.26) vs 0.44 (0.18) mm3, respectively), smaller cup shape (SD) (0.18 (0.07) vs 0.25 (0.06) mm, respectively), increased height variation contour (SD) (0.44 (0.14) vs 0.35 (0.08) mm, respectively), and increased cup depth (SD) (0.24 (0.11) vs 0.17 (0.05) mm3, respectively) when compared to their normal peers (p,0.05). There were no significant differences in the mean disc area, cup area, cup to disc ratio or rim area between the preterm and term children (p.0.05) in our study. Conclusions/Significance: Preterm children exhibit different characteristics of optic nerve head parameters with HRT III analysis. Increased cup depth in preterm children suggests a need for close observation and monitoring. It may raise suspicion of pediatric glaucoma when proper documentation of intraocular pressure and clinical funduscopy are unsuccessful in uncooperative children

Syringomyelia presenting with unilateral optic neuropathy: a case report

Purpose: In this case report, we present two cases of syringomyelia with optic neuropathy. Findings: In Case 1, a 36-year-old Malay lady presented to our clinic with acute onset of blurring of vision in her left eye that she experienced since past 1 month. She was diagnosed with syringomyelia 12 years ago and was on conservative management. Her visual acuity was 6/6 in the right eye and counting fingers at 1 m in the left. There was a positive relative afferent pupillary defect in her left eye. Optic nerve functions of her left eye were reduced. Visual field showed a left inferior field defect. Her extraocular muscle movements were full. Magnetic resonance imaging of the brain and spine showed syringomyelia at the level of C2–C6 and T2–T9. Both of her optic nerves were normal. Her condition improved with intravenous and oral corticosteroids. In Case 2, a 44-year-old Malay lady presented to our clinic with a progressive central scotoma in her right eye that she experienced since past 1 month. She had previous history of recurrent episodes of weakness in both of her lower limbs from past 8 months. Visual acuity in her right and left eye was 6/9 and 6/6, respectively. The relative afferent pupillary defect in her right eye was positive. Optic nerve functions of her right eye were affected. Visual field showed a central scotoma in her right eye. Her extraocular muscle movements were full. Fundoscopy of her right eye showed a pale optic disc. Her left eye fundus was normal. Magnetic resonance imaging of the brain and spine showed syringomyelia at T3–T6. Both of her optic nerves were normal. A diagnosis of syringomyelia with right optic atrophy was performed. Her condition improved with intravenous and oral corticosteroids. Conclusion: Optic neuropathy is a rare neuro-ophthalmic manifestation in patients with syringomyelia. Prompt diagnosis and timely management are essential to avoid a poor visual outcome. Intravenous corticosteroids are beneficial in the treatment of early optic neuropathy in syringomyelia

Preseptal cellulitis and cerebral venous sinus thrombosis complication in a patient with diabetes mellitus

This was a rare case of preseptal cellulitis with an unexpected complication by cerebral venous sinus thrombosis. A 73-year-old woman with poorly controlled diabetes mellitus presented with a week history of swelling and redness on the left upper eyelid and right forehead, associated with poor oral intake, lethargy, and fever. She was generally lethargic with poor verbal response. She had cellulitis of the left upper eyelid and right forehead with the left upper eyelid necrosis. Computed tomography venography of the brain revealed thrombosis of the right transverse sinus, right sigmoid sinus, and right internal jugular vein. She later developed left upper eyelid and right forehead abscesses. Incision, drainage, and wound debridement were performed. She was treated with intravenous antibiotics and anticoagulant. After 1 week of treatment, the preseptal and forehead cellulitis had resolved. However, she passed away due to aspiration pneumonia with respiratory failure on day-13 of hospitalization

Comparison of conjunctival impression cytology between glaucoma patients treated with topical timolol maleate 0.5% and topicallatanoprost 0.005%.

Introduction: All topical medications are known to cause conjunctival reactions, and topical antiglaucoma drugs are also no exception. Long term drug induced toxicity to the conjunctiva is postulated to cause filtering bleb scarring and filtration surgery failure. Chronic application of topical timolol maleate 0.5% and topical latanoprost 0.005% had been shown to alter the morphology of the conjunctival ocular surface. Objective: To compare conjunctival surface morphological changes with the use of the topical timolol maleate 0.5% and topicallatanoprost 0.005%. Methodology: Newly diagnosed glaucoma patients who met the selection criteria were randomly divided into two groups. One group treated with topical timolol maleate 0.5%, another group treated with topical latanoprost 0. 005%. Before the treatment was started, the first conjunctival impression cytology was taken. After three months of treatment, the second conjunctival impression cytology was obtained. The changes that occurred between thefrrst and second conjunctival impression cytology in the individual group were analyzed. Conjunctival surface changes that occurred with the use of topical timolol maleate 0.5% were also compared with the conjunctiva surface changes that occurred with the use of topicallatanoprost 0. 005%. Results: There were thirty-nine newly diagnosed glaucoma patients included in this study. Twenty patients were in the Timolol group and nineteen patients in the Latanoprost group. In both groups of patients, there was no change of the conjunctival epithelial cell morphology after three months of anti-glaucoma therapy. However, there was statistically significant reduction of the goblet cell and mucous granule density in both groups of patients after three months of the topical anti-glaucoma therapy (P- value <0.001). By using the independent T -test, there was no significant difference of the goblet cell and mucous granule density between the Timolol group and the Latanoprost group after three months of treatment. Conclusion: This concludes that both timolol maeate 0.5% and topicallatanoprost 0.005% cause great reduction of conjunctival goblet cells and mucous granules within three months of treatment. However, the conjunctival epithelial cell morphology remained normal after three month of treatment in both groups of patients. This study gives evidence that topical timolol maleate 0.5% and topicallatanoprost 0.005% cause morphological changes ofthe conjunctival surface after short term (three months) therapy. However, there was nodifference in the conjunctival morphological changes between the Timolol group and Latanoprost group

Optic neuritis in a child with biotinidase deficiency: case report and literature review

Optic atrophy has often been reported in children with biotinidase deficiency. The visual prognosis is usually poor. This report is of a 6-year-old boy with an early onset of biotinidase deficiency who presented with acute profound visual loss in both eyes. Fundoscopy revealed swollen discs in both eyes, and the imaging was consistent with bilateral optic neuritis. He was treated with systemic corticosteroid, and commenced on oral biotin. The final visual outcome was promising

Factors predicting visual improvement post pars plana vitrectomy for proliferative diabetic retinopathy

誗AIM: To identify factors predicting visual improvement post vitrectomy for sequelae of proliferative diabetic retinopathy (PDR). 誗METHODS: This was a retrospective analysis of pars plana vitrectomy indicated for sequelae of PDR from Jan. to Dec. 2014 in Hospital Sultanah Bahiyah, Alor Star, Kedah, Malaysia. Data collected included patient demographics, baseline visual acuity ( VA ) and post - operative logMAR best corrected VA at 1y. Data analysis was performed with IBM SPSS Statistics Version 22郾0. 誗RESULTS: A total of 103 patients were included. The mean age was 51郾2y. On multivariable analysis, each preoperative positive deviation of 1 logMAR from a baseline VA of 0 logMAR was associated with a post - operative improvement of 0郾859 logMAR (P < 0郾001). Likewise, an attached macula pre - operatively was associated with a 0郾374 (P = 0郾003) logMAR improvement post vitrectomy. Absence of iris neovascularisation and absence of post - operative complications were associated with a post vitrectomy improvement in logMAR by 1郾126 (P = 0郾001) and 0郾377 ( P = 0郾005 ) respectively. Absence of long - acting intraocular tamponade was associated with a 0郾302 (P = 0郾010) improvement of logMAR post vitrectomy. 誗CONCLUSION: Factors associated with visual improvement after vitrectomy are poor pre-operative VA, an attached macula, absence of iris neovascularisation, absence of post - operative complications and abstaining from use of long - acting intraocular tamponade. A thorough understanding of the factors predicting visual improvement will facilitate decision - making in vitreoretinal surgery

Visual electrophy siological tests in obstructive sleep apnoea

AIM:To compare the pattern electroretinogram (PERG) and pattern visual evoked potential ( PVEP ) between obstructive sleep apnoea (OSA) patients and controls. METHODS: This was a prospective cross - sectional study involving 40 OSA patients and 31 control subjects in Hospital Universiti Sains Malaysia. Patients with a confirmed diagnosis of OSA who had no ocular pathology were randomly selected to participate in the study. The apnoea-hypopnoea index (AHI) was obtained from their records and used for stratification of OSA severity. Electrophysiological tests ( PVEP and PERG ) were performed on each patient by a trained technician in the electrophysiology laboratory of the Department of Ophthalmology, USM. The results obtained were recorded as median values. Data analysis was done using IBM Statistics Version 21. 0. RESULTS: Among OSA patients, we observed a significant reduction of the PERG amplitude P50 ( P < 0.001) and the PVEP amplitude P100 (P<0. 001) compared to the control group. OSA patients also had a significant increase in PVEP time to peak P100 (P = 0. 003) and time to peak N75 (P = 0. 004). However, no significant differences were detected in PERG time to peak between OSA patients and controls. There were likewise no significant differences in PVEP or PERG between OSA patients with different disease severity. CONCLUSION: OSA patients have significant abnormalities in PVEP amplitude and time to peak, as well as PERG amplitude. This may reflect subclinical optic nerve dysfunction in OSA. Further research is needed to determine the association between the severity of OSA and the degree of optic nerve dysfunction