MyMedR

Fulltext Ocular Jarisch-Herxheimer Reaction in the Treatment of Ocular Syphilis: A Case Report and Review of the Literature

Abd Manan N, Musa AA, Lott PW, Zahari M, Tajunisah I

Cureus, 2023 Jan;15(1):e33696.

PMID: 36788917 DOI: 10.7759/cureus.33696

Jarisch-Herxheimer reaction (JHR) is a transient clinical phenomenon in patients with syphilis who receive antibiotic treatment. A 31-year-old man with an underlying HIV infection presented with worsening vision in the right eye two days after being treated with oral doxycycline for presumed left-eye neuroretinitis. Prior history revealed two episodes of penile discharge and ulcers that were not investigated. Examination showed bilateral optic disc swelling with right eye placoid chorioretinitis around the macula. Optical coherence tomography (OCT) demonstrated right macular edema and left macular thinning. Blood investigations confirmed syphilis infection. Subsequently, the patient was scheduled for a contrasted brain CT with oral steroid coverage due to underlying allergies. His vision incidentally improved soon after the short course of steroids. Repeated OCT demonstrated marked improvement of right macular edema, which we believe was secondary to JHR initiated by the earlier doxycycline treatment. Following oral steroid addition, improvement in vision and ocular findings were seen. At six-month post-treatment, there was right macular atrophy as a sequela of the macular edema. Ophthalmologists should be aware of ocular-related JHR complications, particularly in potentiating macular atrophy following macular edema upon initiating antibiotic treatment in syphilitic disease.

Fulltext Case Report: Spectrum of interesting ocular manifestations following COVID-19 vaccination: a case series of real-world presentations

Tajunisah I, Tan SS, Effendi-Tenang I, Samsudin A, Ling KP, Tan WY, et al.

Front Cell Infect Microbiol, 2023;13:1243055.

PMID: 37790912 DOI: 10.3389/fcimb.2023.1243055

PURPOSE: We report the ocular findings that patients experienced after receiving the coronavirus disease 2019 (COVID-19) vaccination in three different eye centers in Malaysia.

OBSERVATIONS: A total of four cases were reported. Three patients received the Pfizer-BioNTech vaccine, while the other received the Oxford AstraZeneca type. Ocular symptoms occurred after the first vaccine dose in two patients and after the second vaccine dose in the other two. Three out of four patients required active treatment for their vision complications postvaccination. The first patient had acute-onset retinal pigment epitheliitis within 3 h of vaccination and was treated conservatively. The second patient developed unilateral choroidal neovascularization 3 days after vaccination and required intravitreal antivascular endothelial growth factor injection. The third patient presented with bilateral acute multifocal placoid pigment epitheliopathy a week after vaccination and responded to intravenous methylprednisolone. The fourth patient presented with herpes zoster infection and unilateral anterior nongranulomatous uveitis 2 weeks after vaccination and was treated with oral acyclovir and topical corticosteroids. All patients reported some amount of visual recovery.

CONCLUSIONS AND IMPORTANCE: Visual symptoms and various ocular adverse events can occur following COVID-19 vaccination, which warrants further investigation and urgent intervention if necessary. We would suggest patients receiving the COVID-19 vaccination be aware of possible ocular complications and report any symptoms, regardless of severity.

A comparative analysis of avoidable causes of childhood blindness in Malaysia with low income, middle income and high income countries

Koay CL, Patel DK, Tajunisah I, Subrayan V, Lansingh VC

Int Ophthalmol, 2015 Apr;35(2):201-7.

PMID: 24652461 DOI: 10.1007/s10792-014-9932-x

To determine the avoidable causes of childhood blindness in Malaysia and to compare this to other middle income countries, low income countries and high income countries. Data were obtained from a school of the blind study by Patel et al. and analysed for avoidable causes of childhood blindness. Six other studies with previously published data on childhood blindness in Bangladesh, Ethiopia, Nigeria, Indonesia, China and the United Kingdom were reviewed for avoidable causes. Comparisons of data and limitations of the studies are described. Prevalence of avoidable causes of childhood blindness in Malaysia is 50.5 % of all the cases of childhood blindness, whilst in the poor income countries such as Bangladesh, Ethiopia, Nigeria and Indonesia, the prevalence was in excess of 60 %. China had a low prevalence, but this is largely due to the fact that most schools were urban, and thus did not represent the situation of the country. High income countries had the lowest prevalence of avoidable childhood blindness. In middle income countries, such as Malaysia, cataract and retinopathy of prematurity are the main causes of avoidable childhood blindness. Low income countries continue to struggle with infections such as measles and nutritional deficiencies, such as vitamin A, both of which are the main contributors to childhood blindness. In high income countries, such as the United Kingdom, these problems are almost non-existent.

The trend of retinopathy of prematurity in Malaysia from 1992 to 2001 based on a nationwide blind schools study

Chang KM, Patel DK, Tajunisah I, Subrayan V

Asia Pac J Public Health, 2015 Mar;27(2):217-24.

PMID: 22887807 DOI: 10.1177/1010539512455047

Retinopathy of prematurity (ROP) is one of the most important causes of childhood blindness worldwide. The trend of ROP in Malaysia was unclear because there was no national registry before 2002. The purpose of this study is to analyze ROP students of different ages in the schools for the blind in Malaysia in order to evaluate the trend of ROP from 1992 to 2001. Data were obtained from a previous survey of 24 blind schools. It was found that 78 students or 17.4% were blind/severely visual impaired as a result of ROP. There was a significant surge in the number of ROP students who were born in 1994 when the use of synthetic surfactants was first introduced in Malaysia; otherwise there was no increasing trend in the number of students with ROP. However, the percentage of ROP in total was increasing, which indicates that ROP is becoming a more important cause of childhood blindness in this country.

Neonatal herpes simplex virus type-1 central nervous system disease with acute retinal necrosis

Fong CY, Aye AM, Peyman M, Nor NK, Visvaraja S, Tajunisah I, et al.

Pediatr Infect Dis J, 2014 Apr;33(4):424-6.

PMID: 24378951 DOI: 10.1097/INF.0000000000000137

We report a case of neonatal herpes simplex virus (HSV)-1 central nervous system disease with bilateral acute retinal necrosis (ARN). An infant was presented at 17 days of age with focal seizures. Cerebrospinal fluid polymerase chain reaction was positive for HSV-1 and brain magnetic resonance imaging showed cerebritis. While receiving intravenous acyclovir therapy, the infant developed ARN with vitreous fluid polymerase chain reaction positive for HSV-1 necessitating intravitreal foscarnet therapy. This is the first reported neonatal ARN secondary to HSV-1 and the first ARN case presenting without external ocular or cutaneous signs. Our report highlights that infants with neonatal HSV central nervous system disease should undergo a thorough ophthalmological evaluation to facilitate prompt diagnosis and immediate treatment of this rapidly progressive sight-threatening disease.

Retinal nerve fiber layer structure abnormalities in schizophrenia and its relationship to disease state: evidence from optical coherence tomography

Lee WW, Tajunisah I, Sharmilla K, Peyman M, Subrayan V

Invest Ophthalmol Vis Sci, 2013 Nov;54(12):7785-92.

PMID: 24135757 DOI: 10.1167/iovs.13-12534

We determined structural retinal nerve fiber layer (RNFL) changes in schizophrenia patients and established if the structural changes were related to the duration of the illness using spectral-domain optical coherence tomography (SD-OCT).

Malignant hypertension with papilledema

Tajunisah I, Patel DK

J Emerg Med, 2013 Jan;44(1):164-5.

PMID: 21820265 DOI: 10.1016/j.jemermed.2011.05.042

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.

Fulltext Attenuated levels of pro-inflammatory markers in diabetic retinopathy patients undergoing treatment with antihyperglycemic and antihypertensive drugs

Ng ZX, Chua KH, Tajunisah I, Pendek R, Kuppusamy UR

Clinics (Sao Paulo), 2013;68(2):185-93.

PMID: 23525314 DOI: 10.6061/clinics/2013(02)oa11

OBJECTIVE: This study aimed to assess the circulating levels of activated nuclear factor kappa B p65 and monocyte chemotactic protein-1 in diabetic retinopathy patients who were taking antihyperglycemic and antihypertensive drugs.

METHODS: In total, 235 healthy controls and 371 Type 2 diabetic patients [171 without retinopathy (DNR) and 200 patients with retinopathy (diabetic retinopathy)] were recruited for this study. Plasma and the nuclear fraction of peripheral blood mononuclear cells were isolated for the quantification of the monocyte chemotactic protein-1 and nuclear factor kappa B p65 levels, respectively.

RESULTS: Non-medicated diabetic retinopathy patients had significantly higher levels of activated nuclear factor kappa B p65 and plasma monocyte chemotactic protein-1 than DNR patients. Diabetic retinopathy patients who were taking antihyperglycemic and antihypertensive drugs showed significant reductions in both the nuclear factor kappa B p65 and monocyte chemotactic protein-1 levels compared with the non-medicated patients.

CONCLUSION: This study demonstrated the significant attenuation of both the nuclear factor kappa B p65 and circulating monocyte chemotactic protein-1 levels in diabetic retinopathy patients taking antihyperglycemic and antihypertensive drugs.

Fulltext Lack of association between Gly82Ser, 1704G/T and 2184A/G of RAGE gene polymorphisms and retinopathy susceptibility in Malaysian diabetic patients

Ng ZX, Kuppusamy UR, Poh R, Tajunisah I, Koay AC, Fong KC, et al.

Genet. Mol. Res., 2012 Mar 01;11(1):455-61.

PMID: 22427038 DOI: 10.4238/2012.March.1.2

Diabetic retinopathy is the most common diabetic eye disease, occurring in about 60% of type 2 diabetic patients. Other than known clinical risk factors, the influence of genes has been suggested as part of the development of diabetic retinopathy. We investigated the association of Gly82Ser, 1704G/T and 2184A/G polymorphisms in the RAGE gene with retinopathy in type 2 diabetic patients in Malaysia. Ninety-eight unrelated retinopathy patients and 185 unrelated healthy controls from all over Malaysia were recruited in this study. The allele and genotype frequencies of the three gene polymorphisms were investigated using PCR-RFLP. The allele frequency of the three polymorphisms did not differ significantly between the control and the retinopathy group (P > 0.05). Analysis of the frequency of GA+AA, GT+TT and AG+GG in the retinopathy group did not reveal significant differences (P > 0.05) compared to the control group. We conclude that RAGE gene Gly82Ser, 1704G/T and 2184A/G polymorphisms are not associated with retinopathy development in the Malaysian population.

Association analysis of -429T/C and -374T/A polymorphisms of receptor of advanced glycation end products (RAGE) gene in Malaysian with type 2 diabetic retinopathy

Ng ZX, Kuppusamy UR, Tajunisah I, Fong KC, Chua KH

Diabetes Res Clin Pract, 2012 Mar;95(3):372-7.

PMID: 22154374 DOI: 10.1016/j.diabres.2011.11.005

Conflicting results have been reported in different populations on the association between two particular RAGE gene polymorphisms (-429T/C and -374T/A) and retinopathy in diabetic patients. Therefore this study was designed to assess the association between both gene polymorphisms with retinopathy in Malaysian diabetic patients. A total of 342 type 2 diabetic patients [171 without retinopathy (DNR) and 171 with retinopathy (DR)] and 235 healthy controls were included in this study. Genomic DNA was obtained from blood samples and the screening for the gene polymorphisms was done using polymerase chain reaction-restriction fragment length polymorphism approach. Overall, the genotype distribution for both polymorphisms was not statistically different (p>0.05) among the control, DNR and DR groups. The -429C minor allele frequency of DR group (12.0%) was not significantly different (p>0.05) when compared to DNR group (16.1%) and healthy controls (11.3%). The -374A allele frequency also did not differ significantly between the control and DNR (p>0.05), control and DR (p>0.05) as well as DNR and DR groups (p>0.05). This is the first study report on RAGE gene polymorphism in Malaysian DR patients. In conclusion, -429T/C and -374T/A polymorphisms in the promoter region of RAGE gene were not associated with Malaysian type 2 DR patients.

Fulltext 2245G/A polymorphism of the receptor for advanced glycation end-products (RAGE) gene is associated with diabetic retinopathy in the Malaysian population

Ng ZX, Kuppusamy UR, Tajunisah I, Fong KC, Koay AC, Chua KH

Br J Ophthalmol, 2012 Feb;96(2):289-92.

PMID: 22116960 DOI: 10.1136/bjophthalmol-2011-300658

The receptor for advanced glycation end-products (RAGE) has been implicated in the pathogenesis of diabetic microvascular complications. The aim of this study was to investigate the association between 2245G/A gene polymorphism of the RAGE gene and retinopathy in Malaysian type 2 diabetic patients.

Investigation of SLC2A1 26177A/G gene polymorphism via high resolution melting curve analysis in Malaysian patients with diabetic retinopathy

Ng ZX, Kuppusamy UR, Tajunisah I, Fong KC, Chua KH

J Diabetes Complications, 2012 Sep-Oct;26(5):388-92.

PMID: 22795339 DOI: 10.1016/j.jdiacomp.2012.05.014

PURPOSE:
In this study, we aimed to investigate the possible association between SLC2A1 26177A/G polymorphism and diabetic retinopathy (DR) in Malaysian patients with type 2 diabetes.

METHODS:
Genomic DNA was extracted from 211 Malaysian type 2 diabetic patients (100 without retinopathy [DNR], 111 with retinopathy) and 165 healthy controls. A high resolution melting assay developed in this study was used to detect SLC2A1 26177A/G polymorphism followed by statistical analysis.

RESULTS:
A statistically significant difference in 26177G minor allele frequency between healthy controls (19.7 %) and total patient group (26.1 %) (p<0.05, Odd ratio = 1.437, 95% Confidence interval = 1.015-2.035) as well as between healthy controls (19.7 %) and DNR patients (27.5%) (p<0.05, Odd ratio = 1.546, 95% Confidence interval = 1.024-2.336) was shown in this study. However, when compared between DR and DNR patients, there was no significant difference (p>0.05).

CONCLUSIONS:
This is the first study which shows that SLC2A1 26177G allele is associated with type 2 diabetes in Malaysian population but not with DR.

Scanning laser edema index: a reliable tool to correlate with diabetic retinopathy and systemic risk factors?

Peyman M, Tajunisah I, Loo A, Chuah KC, Subrayan V

J Diabetes Complications, 2012 May-Jun;26(3):210-3.

PMID: 22520399 DOI: 10.1016/j.jdiacomp.2012.03.019

To correlate Heidelberg Retina Tomograph (HRT) derived macular edema (DME) index with severity of diabetic retinopathy and systemic factors. A total of 300 diabetic patients were recruited for the study for each of them a value for the macular edema index was obtained using the HRT II. Patients' age, gender, duration and type of diabetes mellitus, latest HbA1c result and presence or absence of co-morbid factors (hypertension, ischemic heart disease, nephropathy) were recorded together with the stage of diabetic retinopathy. These were correlated with DME. Out of 300 patients, HRT defined macula edema was seen in 68 patients (22.6%). There is a wider and higher range (95% percentile) of macula edema index in the severe non proliferative diabetic retinopathy (NPDR) group. Independent samples t test showed significant difference between the severe NPDR group and no DR group (p<0.001), mild NPDR group (p<0.05) and moderate NPDR group (p<0.05). A higher macula edema index was also found to have a low degree of correlation with more advanced stages of retinopathy (r=0.310; p<0.001). Also nephropathy showed a strong and significant correlation with DME. Hypertension had moderately significant correlation with DME. This study found no correlation between ischemic heart disease and DME. HRT derived scanning laser edema index is a reliable objective tool to evaluate diabetic retinopathy and systemic risk factors.

Combined optic neuropathy and central retinal artery occlusion in presumed ocular tuberculosis without detectable systemic infection

Ooi YL, Tai LY, Subrayan V, Tajunisah I

Ocul Immunol Inflamm, 2011 Oct;19(5):370-2.

PMID: 21834697 DOI: 10.3109/09273948.2011.594203

To report a rare case of combined optic neuropathy and central retinal artery occlusion in presumed ocular tuberculosis without systemic infection.

Thirupathy A, Tajunisah I

Ocul Immunol Inflamm, 2011 Jun;19(3):156-7.

PMID: 21595530 DOI: 10.3109/09273948.2011.555593

To report a rare case of intermediate uveitis following rubella infection in pregnancy.

Fulltext Childhood blindness and severe visual impairment in Malaysia: a nationwide study

Patel DK, Tajunisah I, Gilbert C, Subrayan V

Eye (Lond), 2011 Apr;25(4):436-42.

PMID: 21350565 DOI: 10.1038/eye.2011.19

To determine the causes of childhood blindness and severe visual impairment (BL/SVI) in schools for the blind in Malaysia.

Valsalva haemorrhagic retinopathy after push-ups

Hassan M, Tajunisah I

Lancet, 2011 Feb 5;377(9764):504.

PMID: 21255827 DOI: 10.1016/S0140-6736(10)60677-0

Fulltext Adverse outcomes in Type I diabetic pregnant women with proliferative diabetic retinopathy

Helen CCT, Tajunisah I, Reddy SC

Int J Ophthalmol, 2011;4(4):443-6.

PMID: 22553697 DOI: 10.3980/j.issn.2222-3959.2011.04.23

AIM: To report maternal and fetal adverse outcomes, in spite of appropriate treatment and regular follow up, in diabetic pregnant women with proliferative diabetic retinopathy.
METHODS: Case series of four young pregnant diabetics aged between 20 and 25 years with type I diabetes mellitus and proliferative diabetic retrinopathy.
RESULTS: The maternal adverse outcomes were abortion in one patient, pre-eclampsia and preterm delivery in one patient, and renal failure requiring dialysis in one patient. The fetal adverse outcomes were neonatal death in one case and premature baby in another case.
CONCLUSION: These cases highlight the fact that diabetic pregnant women should be closely followed up by the obstetricians and physicians when they have proliferative retinopathy. The proliferative diabetic retinopathy should be considered as a part of the assessment when counseling a diabetic woman in antenatal check up and also in the follow up visits during pregnancy.
KEYWORDS: pregnancy; proliferative diabetic retinopathy; type I diabetes mellitus; vitreous haemorrhage
Study site: Eye clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Fulltext Awareness of eye complications and prevalence of retinopathy in the first visit to eye clinic among type 2 diabetic patients

Tajunisah I, Wong P, Tan L, Rokiah P, Reddy S

Int J Ophthalmol, 2011;4(5):519-24.

PMID: 22553714 DOI: 10.3980/j.issn.2222-3959.2011.05.12

AIM: To assess the awareness of eye complications and the prevalence of retinopathy, in the first visit to eye clinic, among type 2 diabetic patients attending a tertiary medical centre in Kuala Lumpur, Malaysia.
METHODS: An investigator-administered questionnaire was given to 137 patients with diabetes undergoing first time eye screening in the eye clinic. This was followed by a detailed fundus examination by a senior ophthalmologist to assess for presence of retinopathy.
RESULTS: Almost 86% of respondents were aware of diabetic eye complications, especially in patients who had achieved tertiary educational level (96.3%). The majority of the patients (78.8%) were referred by their physicians and only 20.4% came on their own initiative. Many of the patients (43.8%) did not know how frequent they should go for an eye check-up and 72.3% did not know what treatments were available. Lack of understanding on diabetic eye diseases (68.6%) was the main barrier for most patients for not coming for eye screening earlier. Despite a high level of awareness, only 21.9% had recorded HbA1c level of <6.5% while 31.4% were under the erroneous assumption of having a good blood sugar control. A total of 29.2% had diabetic retinopathy in their first visit eye testing.
CONCLUSION: In the present study, 29.2% of type 2 diabetic patients had retinopathy in their first time eye testing. Although the awareness of diabetic eye complications was high among first time eye screening patients, the appropriate eye care-seeking behavior was comparatively less and should be rectified to prevent the rise of this sight threatening eye disease.
KEYWORDS: awa-reness; diabetic retinopathy; eye complications; eye screening
Study site: Eye clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

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