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Fulltext Complete recovery of filler-induced visual loss following subcutaneous hyaluronidase injection

Sharudin SN, Ismail MF, Mohamad NF, Vasudevan SK

Neuroophthalmology, 2019 Apr;43(2):102-106.
PMID: 31312234 DOI: 10.1080/01658107.2018.1482358

The rise in popularity of hyaluronic acid (HA) dermal filler injection has caused an exceptional increase in the number of cases of reported irreversible blindness. Here, we reported a case of ischemic optic neuropathy and ophthalmoplegia following subcutaneous HA filler injection with complete visual recovery. A 31-year-old Chinese woman presented with sudden onset of right monocular visual impairment associated with diplopia. Patient had received a hyaluronic acid-containing ﬁller injection for nasal dorsum augmentation twelve hours prior to presentation. Visual acuity of the right eye was counting finger. A right relative afferent pupillary defect was demonstrated with ophthalmoplegia. Humphrey visual field test disclosed a right inferior altitudinal field defect with impairment of colour vision. Computed tomography of the orbit revealed mild enlargement of the right medial and inferior recti muscles. Our patient showed a tremendous improvement of vision after a subcutaneous hyaluronidase injection with complete visual recovery within 2 weeks.
Subfoveal Choroidal Thickness in Pre-eclampsia

Sharudin SN, Saaid R, Samsudin A, Mohamad NF

Optom Vis Sci, 2020 02;97(2):81-85.
PMID: 32011579 DOI: 10.1097/OPX.0000000000001480

SIGNIFICANCE: To our knowledge, this is the first time a study looking at the association between subfoveal choroidal thickness (SFCT) and the parameters affecting the severity of pre-eclampsia has been reported. We provide evidence that SFCT is thicker in pre-eclamptic (PE) patients and speculate on the possible causes.
PURPOSE: The purposes of this study were to compare SFCT in PE, normal pregnant, and nonpregnant women using spectral domain optical coherence tomography and to correlate SFCT with severity of pre-eclampsia.
METHODS: A cross-sectional, observational study was performed. A total of 150 participants were divided into three groups: group 1 (50 PE women), group 2 (50 normal pregnant women), and group 3 (50 nonpregnant healthy women). Subfoveal choroidal thickness was measured using spectral domain optical coherence tomography. Other parameters including mean arterial blood pressure (MABP), central corneal thickness, macular thickness, IOP, ocular perfusion pressure (OPP), and urine protein-to-creatinine ratio were also measured. ANOVA and Pearson correlation analysis were used to look at differences between the groups. P < .05 was considered as statistically significant.
RESULTS: The MABP was higher in group 1 than in groups 2 and 3 (103.0 ± 12.9 vs. 83.2 ± 9.8 vs. 89.5 ± 7.2 mmHg, respectively; all P < .001). The SFCT of the PE group was higher than in groups 2 and 3 (370.7 ± 23.8 vs. 344.5 ± 30.8 vs. 315.8 ± 49.9 μm, respectively; all P < .001). There were no statistically significant differences in central corneal thickness, macular thickness, or IOP between the PE and healthy pregnant groups (all P > .05). The OPP was greater in PE patients (52.8 ± 8.5 vs. 41.9 ± 6.9 vs. 43.4 ± 5.2 mmHg, respectively; both P < .001). The SFCT was positively correlated with MABP (r = 0.464, P < .001), OPP (r = 0.495, P < .001), and urine protein-to-creatinine ratio (r = 0.635, P < .001) in the PE group.
CONCLUSIONS: Subfoveal choroidal thickness is higher in pre-eclampsia and is proportional to established markers of severity of the condition. This parameter might serve as a novel predictive marker for the severity of pre-eclampsia.
Ocular myasthenia gravis and idiopathic orbital inflammatory disease: double the trouble!

Sharudin SN, Govindasamy G, Mohamad NF, Kanesalingam R, Vasudevan SK

Can J Ophthalmol, 2018 04;53(2):e55-e58.
PMID: 29631841 DOI: 10.1016/j.jcjo.2017.07.024
Fulltext Large Vallecula Epiglottica Lipoma: A Rare but Fatal Cause of Dysphagia

Sharudin SN, Thangavelu T, Roslim SN, Hitam S, Mat Baki M

Cureus, 2022 Oct;14(10):e30250.
PMID: 36381797 DOI: 10.7759/cureus.30250

Lipoma is a benign mesenchymal tumor with 13% occurrence in the head and neck region. Despite being the commonest type of tumor, it only accounts for 0.6% of the upper aerodigestive tract. We report a case of a 41-year-old gentleman who presented with progressively worsening dysphagia and a muffled voice. A flexible nasopharyngeal endoscope showed a solitary well-lobulated pedunculated cystic-looking mass occupying the oropharynx arising from the vallecular space and lingual surface of the epiglottis with a partially seen mobile posterior vocal cord. CT of the neck showed a single lesion with fat attenuation in the right vallecula and right lateral lingual epiglottis. The patient underwent endoscopic surgical excision and fully recovered post-operatively. Although rare, lipoma must be considered one of the differential diagnoses of midline laryngeal mass. Therefore, prompt excision needs to be performed to prevent a catastrophic outcome.
Orbitofacial dermatofibrosarcoma protuberans with intranasal extension

Sharudin SN, Tan SW, Mohamad NF, Vasudevan SK, Khairan H, Mun YC, et al.

Orbit, 2018 Jun;37(3):196-200.
PMID: 29058523 DOI: 10.1080/01676830.2017.1383474

A 25-year-old Chinese woman presented with recurrent painless swelling over the left medial canthus region for 3 months and intranasal mass for an indeterminate duration. Initial incision biopsy of the mass was reported as nodular fasciitis but the lesion recurred 3 weeks later. Intraoperative findings during repeat biopsy showed a mass extending from the deep dermal tissue into the anterior orbit and polyp-like nasal mass. Histopathology findings were that of dermatofibrosarcoma protuberans (DFSP). The mass recurred 4 months later without orbital or intranasal recurrence. Wide excision biopsy under frozen section guidance was attempted however; clear surgical margins could not be achieved despite extensive resection. She was subsequently referred for adjuvant radiotherapy. We report an exceptionally rare case of local recurrence of DFSP in an unusual anatomic location. This case was surgically challenging in achieving negative margins, and thus neoadjuvant therapy may improve overall outcome to prevent local relapse.
Fulltext Changing trend of cataract blindness and visual outcomes after cataract surgery in adults aged 50 years and older: findings from the national eye surveys in Malaysia

Salowi MA, Naing NN, Mustafa N, Wan Nawang WR, Sharudin SN, Ngah NF

BMJ Open Ophthalmol, 2024 Aug 12;9(1).
PMID: 39134324 DOI: 10.1136/bmjophth-2024-001732

BACKGROUND/AIMS: Population surveys are required to measure the prevalence of cataract blindness in the community. We conducted simultaneous surveys in two regions in Malaysia in 2023 to estimate the prevalence of untreated cataract, measure the visual outcomes after cataract surgery and compare the results with the survey in 2014.
METHODS: The surveys were done in Eastern and Sarawak administrative regions using the rapid assessment of avoidable blindness technique. It involved a multistage cluster sampling method, each cluster comprising 50 residents aged 50 years and older. The prevalence of cataract was determined through a visual acuity (VA) check and eye examination. The VA of those who had undergone cataract surgery was measured, and the findings were compared with the previous survey.
RESULTS: A total of 9709 subjects, 50 years old and older, were examined (percentages of response were 94.5% and 96.2% for Eastern and Sarawak, respectively). Comparing the current to the previous survey in 2014, the prevalence of cataract at all levels of surgical thresholds (except unilateral VA <6/60 and <6/18 in the Eastern) was reduced. The percentages of cataract surgery visual outcomes with good VA (6/12) were improved, and those with poor VA (<6/60) were reduced in both regions.
CONCLUSION: There was a reduction in cataract prevalence and improved visual outcomes in both regions. These favourable results could be attributed to the surgical performance monitoring initiatives and the community cataract programme implemented soon after the survey in 2014.
Lymphoma with superimposed tuberculosis and fungal infection mimicking parapharyngeal abscess complicated with recurrent neurocardiogenic syncope: a case report

Sharudin SN, Huda Al Firdas AN, Hitam S, Hamid Z, Nordin NJ, Othman N, et al.

Malays J Pathol, 2020 Aug;42(2):287-291.
PMID: 32860384

INTRODUCTION: Lymphoma of parapharyngeal space (PPS) is a rare condition. The clinical presentations may vary and often masquerades as infection or an inflammatory condition. A misdiagnosis will lead to a delay in treatment of the disease. Due to the complex anatomy of PPS, any attributed pressure from masses can lead to a life-threatening event such as cardiac syncope.
CASE REPORT: We report a rare case of PPS B-cell non-Hodgkin lymphoma with superimposed Tuberculosis (TB) and fungal infection that presents with several episodes of syncope and hemodynamic depression.
DISCUSSION: The clinical entities in PPS lesions syncope and its associated syndromes, pathophysiology, and differential diagnosis together with possible managements are further discussed.
A Case Report on Cervicofacial Subcutaneous Emphysema and Its Management: A Unique Presentation of Congenital Defect of the Foramen of Huschke

Sharudin SN, Salahuddin NA, Md Arepen SA, Md Anuar NA, Hassan NE, Hitam S, et al.

Cureus, 2023 Oct;15(10):e47078.
PMID: 38021523 DOI: 10.7759/cureus.47078

Congenital defect to the foramen of Huschke with a manifestation as temporomandibular joint (TMJ) soft tissue herniation in a radiological study is rare. The patient may present with nonspecific symptoms such as otalgia, mandibular joint pain, tinnitus and conductive hearing loss, and scarcely cervicofacial subcutaneous emphysema. Here, we report a patient presented with cervicofacial subcutaneous emphysema secondary to a congenital defect of the foramen of Huschke. A 45-year-old gentleman presented with right-sided neck swelling and right otalgia with a crackling sound over the right ear upon chewing. Examination shows right-sided fullness with subcutaneous emphysema from the zygoma to the upper neck. Otherwise, it is non-tender with no skin changes, and the facial nerve is intact. Otoendoscopy shows erythematous soft tissue bulging of the anterior wall of the right external auditory canal (EAC) upon closing the mouth and prolapsing upon mouth opening. The right tympanic membrane was intact. Contrast-enhanced computer tomography (CECT) of the neck and temporal region revealed extensive cervicofacial subcutaneous emphysema with a bony defect at the anterior wall of the right EAC, indicating fistulous communication between the right EAC and TMJ. The subcutaneous emphysema resolved on the treatment of the right otitis externa. The patient is subjected to a combined approach of open and endoscopic-assisted repair of the anterior EAC wall defect. TMJ herniation into the anterior EAC is rare; however, the patient presentation may vary. CECT is the gold standard for diagnosing and facilitating treatment options. Treatment choice is based on the patient's condition, including conservative or surgical intervention.