MyMedR

Minimally invasive image-guided removal of retrobulbar intraconal foreign body

Vairavan N, Tajunisah I, Subrayan V, Waran V

Orbit, 2009;28(6):442-3.

PMID: 19929682 DOI: 10.3109/01676830903103365

Surgical approaches are becoming increasingly minimally invasive, without compromising either safety or ease. Penetrating ocular foreign bodies has traditionally been approached either by intraocular or supraorbital access. We successfully attempted a minimally invasive approach to remove a retrobulbar foreign body under computer-assisted image guidance in a 19-year-old man involved in an industrial mishap.

Fulltext Endoscopic orbital decompression for optic neuropathy in thyroid ophthalmopathy

Tang IP, Prepageran N, Subrayan V, Tajunisah I

Med J Malaysia, 2008 Oct;63(4):337-8.

PMID: 19385499 MyJurnal

Optic neuropathy, an uncommon manifestation occurs in 5% of patients with Graves' ophthalmopathy. Its outcome is good if early and proper treatment given. We reported a 49 years old male patient of Graves' disease with bilateral optic neuropathy. He underwent bilateral transnasal endoscopic orbital decompression with marked improvement of visual acuity bilaterally. The preoperative visual acuity was 6/36 in his right eye and 6/60 in his left eye. Two days after operation, his visual acuity was 6/12 in his right eye and 6/24 in his left eye. Transnasal endoscopic orbital decompression is a choice of treatment in optic neuropathy in thyroid ophthalmopathy after trial of corticosteroids.

Silent sinus syndrome due to a maxillary mucocele

Tan TY, Shashinder S, Subrayan V, Krishnan G

Auris Nasus Larynx, 2008 Jun;35(2):285-7.

PMID: 18024042

Silent sinus syndrome is a rare clinical condition in which patients present with spontaneous enophthalmos and hypoglobus secondary to collapse of orbital floor due to chronic subclinical maxillary sinusitis. It is postulated that obstruction of the osteomeatal complex lead to negative antrum pressure which causes the maxillary sinus atelectasis.

Purtscher retinopathy as an initial presentation of thrombotic thrombocytopenic purpura

Tajunisah I, Patel DK, Subrayan V

J Thromb Thrombolysis, 2010 Jul;30(1):112-3.

PMID: 19834784 DOI: 10.1007/s11239-009-0399-y

Central corneal thickness measurements with different imaging devices and ultrasound pachymetry

Tai LY, Khaw KW, Ng CM, Subrayan V

Cornea, 2013 Jun;32(6):766-71.

PMID: 23095499 DOI: 10.1097/ICO.0b013e318269938d

The aim of this study was to compare 4 methods of central corneal thickness (CCT) measurements in terms of their agreement, repeatability, and measurement time.

Assessment of polymerase chain reaction in the detection of pseudomonas aeruginosa in contact lens-induced severe infectious keratitis

Subrayan V, Peyman M, Lek Yap S, Mohamed Ali NA, Devi S

Eye Contact Lens, 2010 Jul;36(4):201-3.

PMID: 20531205 DOI: 10.1097/ICL.0b013e3181e3efa3

PURPOSE: The aim of this study is to evaluate the role of real-time polymerase chain reaction (PCR) and conventional bacterial culture methods in the detection of Pseudomonas aeruginosa in contact lens-induced severe, partially treated corneal ulcers referred to a tertiary center.
METHODS: The study duration was 6 months. All patients with contact lens-related corneal ulcer, requiring admission during the study period were recruited. Samples from corneal scrapings were simultaneously sent at the time of admission for PCR and culture testing. An in-house real-time PCR was developed to detect the P. aeruginosa lasA gene. The results of PCR and culture were compared using McNemar's chi2 test.
RESULTS: Ten patients were recruited. The mean age was 33 years (20-45 years). All the patients had contact lens-related keratitis (>4 mm) of which eight (80%) were found positive for P. aeruginosa by PCR or culture. There was no significant difference between PCR and culture in detecting P. aeruginosa (P<0.05).
CONCLUSIONS: PCR is, at least, as good as conventional cultures in detecting P. aeruginosa. It is a rapid assay as compared with culture, and early detection enables prompt treatment thus reducing the destructive effect of the organism on the cornea.

Intravitreal bevacizumab for radiation-induced cystoid macular oedema in patients with nasopharyngeal carcinoma: a clinical series

Subrayan V, Khaw KW, Peyman M, Koay AC, Tajunisah I

Ophthalmologica, 2013;229(4):208-11.

PMID: 23548379 DOI: 10.1159/000348630

To evaluate the outcome of intravitreal bevacizumab in the treatment of radiation-induced cystoid macular oedema among patients who underwent external beam radiotherapy for nasopharyngeal carcinoma.

Ocular trauma injuries: a 1-year surveillance study in the University of Malaya Medical Centre, Malaysia. 2008

Soong TK, Koh A, Subrayan V, Loo AV

Graefes Arch Clin Exp Ophthalmol, 2011 Dec;249(12):1755-60.

PMID: 20607549 DOI: 10.1007/s00417-010-1444-4

PURPOSE: To describe the epidemiology of ocular injuries presenting to the University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia.

DESIGN: Prospective analysis of all ocular trauma injuries presenting to the Department of Ophthalmology in UMMC from 1 January 2008 to 31 December 2008.

PARTICIPANTS: A total of 603 eyes of 546 patients were recruited for the study.

METHODS: All patients presenting to the department with ocular trauma injuries were assessed by an ophthalmologist. Data on the type and source of injury, demographic profile of the patients, and clinical presentation were documented using a uniform and validated datasheet.

RESULTS: Among eye injury cases, 481 patients (88.1%) were male, with a male-to-female ratio of 7.4:1. Of the patients, 412 (75.5%) were Malaysian while the remaining 134 (24.5%) were of non-Malaysian nationality. The average age was 31.5 years (range 1-81 years). A total of 238 injured eyes (43.6%) were work-related. The common sources of eye trauma include the use of high-powered tools (30.8%), motor vehicle accident (23.1%), and domestic accidents (17.7%). Only six patients (2.5%) reported to having used eye protective device (EPD) at time of their work-related injuries.

CONCLUSIONS: A major cause of preventable ocular injuries in Malaysia was work-related trauma. Ocular injuries can be reduced by the use of eye protection devices and the implementation of appropriate preventive strategies to address each risk factor. Effective training is an integral part of occupational safety and health, which should be made mandatory at the workplace. In addition, there should be a continual assessment of safety and health issues at the workplace. A long-term database of all ocular injuries in Malaysia is recommended, to aid research on a larger scale and the development of new preventive strategies for ocular injuries.

Transvitreal migration of a Toxocara larva resulting in a second chorioretinal granuloma

Sivaratnam D, Subrayan V, Ali NA

Jpn. J. Ophthalmol., 2008 Sep-Oct;52(5):416-417.

PMID: 18991049 DOI: 10.1007/s10384-008-0569-z

Fulltext Association between Ocular Pseudoexfoliation and Sensorineural Hearing Loss

Singham NV, Zahari M, Peyman M, Prepageran N, Subrayan V

J Ophthalmol, 2014;2014:825936.

PMID: 24864196 DOI: 10.1155/2014/825936

Background. Our study aimed to investigate an association between ocular pseudoexfoliation (PXF) and sensorineural hearing loss (SNHL) and to compare them with age and sex matched controls without pseudoexfoliation. Method. This was a case-control study of 123 patients which included 68 cases with PXF (at least one eye) and 55 controls without pseudoexfoliation. Pure-tone audiometry (PTA) was done for these patients at sound frequencies taken as important for speech comprehension, that is, 250 Hertz (Hz), 500 Hz, 1000 Hz, and 2000 Hz. Results. There were 41 patients with pseudoexfoliation syndrome (PXE) and 27 with pseudoexfoliative glaucoma (PXEG). The majority of patients with hearing loss (60%; n = 51) were PXF patients and the remaining 40% (n = 34) were controls. Below average hearing thresholds were significantly higher in the pseudoexfoliation group compared to the control group (P = 0.01; odds ratio (OR), 3.00; 95% confidence interval (CI), 1.25-7.19). However, there was no significant difference in the mean hearing threshold levels between the three groups (PXE, PXEG, and controls) in either ear (ANOVA, right ear: P = 0.46 and left ear P = 0.36). Conclusion. Our study found an association between PXF and SNHL, confirming that PXF can involve organs in the body other than the eye.

An age-adjusted seroprevalence study of Toxoplasma antibody in a Malaysian ophthalmology unit

Singh S, Khang TF, Andiappan H, Nissapatorn V, Subrayan V

Trans R Soc Trop Med Hyg, 2012 May;106(5):322-6.

PMID: 22480791 DOI: 10.1016/j.trstmh.2012.01.009

Toxoplasma gondii is a public health risk in developing countries, especially those located in the tropics. Widespread infection may inflict a substantial burden on state resources, as patients can develop severe neurological defects and ocular diseases that result in lifelong loss of economic independence. We tested sera for IgG antibody from 493 eye patients in Malaysia. Overall age-adjusted seroprevalence was estimated to be 25% (95% CI: [21%, 29%]). We found approximately equal age-adjusted seroprevalence in Chinese (31%; 95% CI: [25%, 38%]) and Malays (29%; 95% CI: [21%, 36%]), followed by Indians (19%; 95% CI: [13%, 25%]). A logistic regression of the odds for T. gondii seroprevalence against age, gender, ethnicity and the occurrence of six types of ocular diseases showed that only age and ethnicity were significant predictors. The odds for T. gondii seroprevalence were 2.7 (95% CI for OR: [1.9, 4.0]) times higher for a patient twice as old as the other, with ethnicity held constant. In Malays, we estimated the odds for T. gondii seroprevalence to be 2.9 (95% CI for OR: [1.8, 4.5]) times higher compared to non-Malays, with age held constant. Previous studies of T. gondii seroprevalence in Malaysia did not explicitly adjust for age, rendering comparisons difficult. Our study highlights the need to adopt a more rigorous epidemiological approach in monitoring T. gondii seroprevalence in Malaysia.

Changes in anterior chamber depth and intraocular pressure after phacoemulsification in eyes with occludable angles

Shin HC, Subrayan V, Tajunisah I

J Cataract Refract Surg, 2010 Aug;36(8):1289-95.

PMID: 20656150 DOI: 10.1016/j.jcrs.2010.02.024

PURPOSE: To evaluate changes in anterior chamber depth (ACD) and intraocular pressure (IOP) after phacoemulsification in eyes with occludable angles and compare the results with those in eyes with normal open angles.
SETTING: Eye Clinic, Ipoh General Hospital, Ipoh, Perak, Malaysia.
METHODS: Patients with nonglaucomatous eyes with open angles or with occludable angles were recruited. Ocular biometric measurements (ACD, axial length [AL], lens thickness and position) and IOP (tonometry) were performed preoperatively and 1 day and 1, 4, 9, and 12 weeks postoperatively.
RESULTS: The open-angle group and occludable-angle group each comprised 35 patients. The occludable-angle group had a shallower ACD, shorter AL, thicker and relatively anterior lens position, and higher IOP preoperatively; postoperatively, there was a significant increase in ACD and a significant reduction in IOP (P

Fulltext Compressive optic neuropathy due to a large Onodi air cell: A case report and literature review

See WYN, Sumugam K, Subrayan V

Allergy Rhinol (Providence), 2016 Jan 01;7(4):223-226.

PMID: 28683249 DOI: 10.2500/ar.2016.7.0178

BACKGROUND: To report an unusual case of compressive optic neuropathy secondary to a large onodi air cell.
METHOD: Case report.
RESULTS: A 50 year-old gentlemen presented to the eye clinic with left eye painless loss of vision for one day. Visual acuity was counting finger in the left eye with a positive relative afferent pupillary defect (RAPD). Dilated left fundus examination revealed a pale optic disc. A computed tomography of orbit and brain showed a large left sphenoid sinus with onodi-cell-like projection on the left superior margin of left optic canal impinging on the left optic nerve. He was referred to the otorhinolaryngology team and subsequently underwent left optic nerve decompression. Post-operatively, his left visual acuity improved to 6/60 with reversal of RAPD.
CONCLUSION: There are many causes of optic neuropathy and compressive optic neuropathy due to large onodi air cell is uncommon. Acute unilateral loss of vision heralds from a multitude of sinister causes and junior residents should be vigilant that onodi air cell pneumotisation could be one of them.

The Effect of Irradiated Riboflavin in Human Tenon's Fibroblast - A Study on Cellular Viability

See WYN, Ismail F, Sheikh Abdul Kadir SH, Subrayan V

Curr Eye Res, 2021 Dec 29.

PMID: 34963422 DOI: 10.1080/02713683.2021.2011326

PURPOSE/ AIM: The main purpose of this work is to study the cellular viability effect of irradiated riboflavin in cultured human tenon fibroblasts.

MATERIALS AND METHODS: The tenon tissue was harvested from a patient undergoing strabismus surgery. The human tenon fibroblast cell culture and isolation were performed according to the standard laboratory cell culturing protocol. The cells were divided into three groups: control, treatment with irradiated and non-irradiated riboflavin. There were five different concentrations (0.00156%, 0.003125%, 0.00625%, 0.0125%, 0.025%) in each group of riboflavin. The fibroblasts were treated with riboflavin and the cellular viability was assessed at 24-hour and 48-hour post treatment with MTT 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyl tetrazolium bromide colorimetric assay. The absorbance values were analysed using Magellan microplate reader data analysis. A triplicate of readings was taken. The data were presented as mean ± standard deviation of the triplicates. Statistical analysis was performed with Statistical Package for Social Sciences (SPSS) analysis version 23.

RESULTS: Irradiated riboflavin caused a concentration-dependent cell death in human tenon fibroblast cell culture (p

Diabetes and pachymetry changes in pregnancy

Santiagu F, Bakhtiari A, Iqbal T, Khaliddin N, Lansingh VC, Subrayan V

Int Ophthalmol, 2018 Oct;38(5):2069-2076.

PMID: 28879527 DOI: 10.1007/s10792-017-0701-5

BACKGROUND: Purpose of this study is to evaluate changes in the central corneal thickness (CCT) in patients during the third trimester and postpartum phases of normal pregnancy, pregestational diabetes mellitus (DM), and gestational diabetes mellitus (GDM).
METHODS: This was a prospective study. Patients that fulfilled the inclusion criteria were recruited from the obstetric clinic. They were grouped into normal pregnancy, pregestational DM, and GDM. Ophthalmic assessment and haematological investigations were done during the third trimester (after 28 weeks of gestation) and in the postpartum phase (6 weeks postpartum).
RESULTS: A total of 192 pregnant patients were recruited for this study. Out of the 192 patients, only 143 of them came back for their follow-up 6 weeks postpartum. A total of 70 (36.5%) normal pregnancy patients, 51 (26.6%) DM patients, and 71 (36.9%) GDM patients were included in this prospective study. Our study showed that the CCT decreased postpartum in all three groups. Patients in all three groups did not have significantly different CCT during the third trimester of pregnancy and postpartum phase. However, patients who had thicker CCT irrespective of the grouping during the third trimester also had a thicker CCT post-delivery (p value <0.001). However, these changes did not appear to affect refractive error and visual acuity.
CONCLUSIONS: Diabetes mellitus during pregnancy did not appear to influence the CCT.
Study site: Obstetrics clinic, University Malaya Medical Center (UMMC), Kuala Lumpur, Malaysia

Intravitreal bevacizumab: a viable treatment for bilateral central retinal vein occlusion with serous macular detachment secondary to Waldenström macroglobulinaemia

Ratanam M, Ngim YS, Khalidin N, Subrayan V

Br J Haematol, 2015 Aug;170(3):431-4.

PMID: 25640801 DOI: 10.1111/bjh.13307

Accutome PachPen handheld ultrasonic pachymeter: intraobserver repeatability and interobserver reproducibility by personnel of different training grades

Peyman M, Tai LY, Khaw KW, Ng CM, Win MM, Subrayan V

Int Ophthalmol, 2015 Oct;35(5):651-5.

PMID: 25189684 DOI: 10.1007/s10792-014-9989-6

To assess the intra-observer repeatability and inter-observer reproducibility of central corneal thickness (CCT) measurements of PachPen (Accutome, Inc., Pennsylvania, USA), a hand-held, portable ultrasonic pachymeter when used by an ophthalmic nurse compared to an ophthalmologist. Ophthalmology Clinic, University of Malaya Medical Center In this prospective study, CCT was measured in 184 eyes of 92 healthy subjects, first by a corneal surgeon experienced in ultrasound pachymetry (Observer 1) followed by an ophthalmic nurse new to the procedure (Observer 2). Nine measurements were obtained from each eye by each observer, independently. Measurements were compared between the observers. Coefficients of repeatability and reproducibility were calculated. The Bland-Altman plot was used to assess agreement between observers. Mean age of the study population was 54.3 ± 15.2 years old and consisted of 43.5% male. Mean CCT as measured by Observers 1 and 2 were 528.3 ± 32.9 and 530.7 ± 33.3 µm, respectively. Observer 1 showed higher repeatability of measurements compared to that of Observer 2 (coefficient of repeatability 3.46 vs. 5.55%). The measurements by both observers showed high correlation (0.96) and good agreement (mean difference -2.4 µm; 95% limits of agreement -21.4, 16.7 µm). Coefficient of reproducibility of measurements between observers was 5.08%. Accutome PachPen hand-held ultrasound pachymeters gives excellent intra-observer repeatability and inter-observer reproducibility by personnel of different training grades.

Irreversible blindness following intravenous streptokinase

Peyman M, Subrayan V

JAMA Ophthalmol, 2013 Oct;131(10):1368-9.

PMID: 23929315 DOI: 10.1001/jamaophthalmol.2013.4489

Fulltext Optic nerve involvement as a first manifestation of acute lymphoblastic leukaemia after remission

Peyman M, Hieng TL, Subrayan V

BMJ Case Rep, 2011;2011.

PMID: 22698906 DOI: 10.1136/bcr.11.2010.3517

Fulltext Iris mammillations in two female siblings with congenital adrenal hyperplasia

Peyman M, Ong MJ, Iqbal T, Subrayan V

BMJ Case Rep, 2010;2010.

PMID: 22802477 DOI: 10.1136/bcr.08.2010.3266

Iris mammillations are dark brown, smooth, mound- or dome-shaped protuberances that are typically found on the anterior iris surface and are presumed to be congenital in origin. This congenital anomaly is usually unilateral and can be hereditary or sporadic. Lisch nodules in neurofibromatosis, tapioca melanoma of the iris, inflammatory iris granulomata and Cogan-Reese syndrome should be considered in the differential diagnosis. In this case report, the authors present a case of a bilateral iris mammillations in two siblings with congenital adrenal hyperplasia (CAH). To our knowledge, this is the first case where bilateral iris mammilations have been found to be associated with a systemic condition. Iris mammillations can be considered as one of the clinical signs in CAH in view of the pathogenesis discussed. Detailed ocular examination in CAH may reveal an increased incidence.

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