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Optic Nerve Infiltration in Systemic Metastatic Retinal Lymphoma (SMRL): Multimodal Imaging and Challenges in Diagnosis

Mohd Fauzi Yap MFB, Mohd Zain A, Tumain NR, Palaniappan S, Nasaruddin RA, Md Din N

Ocul Immunol Inflamm, 2020 Sep 24.
PMID: 32967510 DOI: 10.1080/09273948.2020.1800050

A 45-year-old man was diagnosed with diffuse large B-cell lymphoma stage IV which was confirmed by celiac lymph node biopsy. He subsequently completed six cycles of R-CHOP chemotherapy. Six months later, he presented with panuveitis OU with positive relative afferent pupillary defect OD. OCT revealed hyper-reflective lesions and irregularity of the retinal pigment epithelium OU. Fundus fluorescein angiogram shows hyper-auto fluorescence and granular changes on the retina. A month later, he developed swollen optic disc OD and hemorrhagic retinitis OU and treated as presumed CMV retinitis. Anti-TB was started after a positive Mantoux test. He finally consented for a vitreous biopsy which showed atypical lymphoid cells highly suggestive for vitreoretinal lymphoma and subsequently received intravitreal methotrexate OU.
CONCLUSION: Optic nerve infiltration in systemic metastatic retinal lymphoma may have initial occult signs but with profound visual loss. Ocular infections like CMV retinitis and tuberculosis may mask and delay the diagnosis in immunocompromised patients.

Matched MeSH terms: Eye Infections
Development and formulation of Moringa oleifera standardised leaf extract film dressing for wound healing application

Chin CY, Jalil J, Ng PY, Ng SF

J Ethnopharmacol, 2018 Feb 15;212:188-199.
PMID: 29080829 DOI: 10.1016/j.jep.2017.10.016

ETHNOPHARMACOLOGICAL RELEVANCE: M.oleifera is a medicinal plant traditionally used for skin sores, sore throat and eye infections. Recently, the wound healing property of the leaves of M. oleifera was has been well demonstrated experimentally in both in vivo and in vitro models. However, there is a lack of research which focuses on formulating M.oleifera into a functional wound dressing. In this study, the M.oleifera leaf standardized aqueous extract with highest potency in vitro migration was formulated into a film for wound healing application.
MATERIALS AND METHODS: Firstly, M. oleifera leaf were extracted in various solvents (aqueous, 50%, 70% and 100% ethanolic extracts) and standardized by reference standards using UHPLC technique. The extracts were then tested for cell migration and proliferation using HDF and HEK cell lines. M. oleifera leaf aqueous extract was then incorporated into alginate-pectin (SA-PC) based film dressing. The film dressings were characterized for the physicochemical properties and the bioactives release from the M. oleifera leaf extract loaded film dressing was also investigated using Franz diffusion cells.
RESULTS: All extracts were found to contain vicenin-2, chlorogenic acid, gallic acid, quercetin, kaempferol, rosmarinic acid and rutin. Among all M. oleifera extracts, aqueous standardized leaf extracts showed the highest human dermal fibroblast and human keratinocytes cells proliferation and migration properties. Among the film formulations, SA-PC (3% w/v) composite film dressing containing M. oleifera aqueous leaf extract was found to possess optimal physicochemical properties as wound dressing.
CONCLUSION: A potentially applicable wound dressing formulated as an alginate-pectin film containing aqueous extracts of M. oleifera has been developed. The dressing would be suitable for wounds with moderate exudates.

Matched MeSH terms: Eye Infections
Fulltext Rare Kodamaea ohmeri keratitis following a trivial vegetative trauma

Saud Al-Abbas AH, Ling JL, Muhammed J, Hussein A

BMJ Case Rep, 2019 Jun 22;12(6).
PMID: 31229985 DOI: 10.1136/bcr-2019-229660

Kodamaea ohmeri keratitis is an opportunistic pathogen seen in patients who have undergone invasive procedures and immunocompromised state. It has been identified in septicemia patients, resulting in mortality. To the best of our knowledge, we identified the first case of K. ohmeri keratitis following an injury with vegetative material. A 57-year-old woman with underlying, poorly controlled diabetes mellitus was gardening when a tree leaf accidentally poked her in the eye. Two weeks later, the patient presented with right eye pain, redness and progressive blurring of vision due to a traumatised right cornea. Slit-lamp examination showed a small inferior paracentral corneal stromal infiltrate with overlying epithelial defect. A corneal scraping sample yielded K. ohmeri from Analytical Profile Index (API) 20C yeast identification system. She was treated with intensive topical amphotericin B and fluconazole. After 6 weeks of treatment, the keratitis resolved with faint scar tissue, and her visual acuity improved.

Matched MeSH terms: Eye Infections, Fungal/drug therapy*
Herpes Zoster Ophthalmicus with Orbital Apex Syndrome-Difference in Outcomes and Literature Review

Lim JJ, Ong YM, Wan Zalina MZ, Choo MM

Ocul Immunol Inflamm, 2018;26(2):187-193.
PMID: 28622058 DOI: 10.1080/09273948.2017.1327604
Matched MeSH terms: Eye Infections, Viral/diagnosis*; Eye Infections, Viral/drug therapy; Eye Infections, Viral/virology
Fulltext Non-tuberculous mycobacterial ocular infection masquerading as choroidal tumour - a diagnostic conundrum

Yeap KC, Sivagurunathan PD, Raman P, Khalid KHM

GMS Ophthalmol Cases, 2019;9:Doc25.
PMID: 31355123 DOI: 10.3205/oc000114

Purpose: To report a rare case of non-tuberculous mycobacterial (NTM) choroiditis masquerading as choroidal tumour, where the initial diagnosis was masked by keratitis. Casedescription: A 57-year-old heroin chaser with a pre-existing left eye blindness due to past blunt trauma presented with diffuse bacterial keratitis on the same side. Systemic examination revealed multiple non-tender cervical lymphadenopathies. B-scan ultrasonography showed a hyperechoic choroidal mass with surrounding exudative retinal detachment, resembling a choroidal tumour. However, computed tomography (CT) and magnetic resonance imaging (MRI) scan findings were suggestive of inflammatory choroidal changes. Inflammatory markers were significantly raised and infective screening was positive for HIV and Hepatitis C. Tuberculosis workup was normal. In view of intractable pain, evisceration was done and his vitreous humour was sent for polymerase chain reaction (PCR). It was reported to be positive for Mycobacterium Fortuitum. Conclusion: NTM ocular infections are rare, challenging to diagnose, and potentially sight threatening. Early recognition and prompt treatment is life and vision saving.

Matched MeSH terms: Eye Infections
Fulltext Some experiences in ophthalmology

Lowther AH

Journal of the Malaya Branch of the British Medical Association, 1938;2(3):144-64.

Matched MeSH terms: Eye Infections
Fulltext Conjunctiva Necrosis Following Subconjunctival Amphotericin B Injection in Fungal Keratitis

Han Shu T, Hussein A, Kursiah MR

Cureus, 2019 Sep 05;11(9):e5580.
PMID: 31695999 DOI: 10.7759/cureus.5580

A 30-year-old Bangladeshi gentleman presented with history of sand entering his left eye and was diagnosed as having fungal keratitis by private ophthalmologist. He was treated with three doses of conventional subconjunctival amphotericin B injections (1.5 mg of amphotericin B and 1.2 mg of deoxycholate) over the inferior bulbar conjunctiva and topical antibiotics. Subsequently, he developed conjunctival necrosis over the site of injections and there was no clinical improvement of the keratitis. He was then treated with intensive antifungal and antibiotics eye drops. Debridement of epithelial plug was done and he was given intracameral amphotericin B injection. There was gradual improvement observed then with conjunctival epithelialization. The conjunctival tissue was completely healed after three months along with the corneal ulcer. Subconjunctival injection of Amphotericin B (AMB) may be considered as an adjunct therapy in severe fungal keratitis to address the issue of compliance. Close monitoring is needed due to its known complication of scleritis, scleral thinning and conjunctival necrosis. Liposomal AMB which is known to cause less toxicity given via subconjunctival injection in human subjects needs to be further studied.

Matched MeSH terms: Eye Infections, Fungal
Fulltext Specific detection of fungal pathogens by 18S rRNA gene PCR in microbial keratitis

Embong Z, Wan Hitam WH, Yean CY, Rashid NH, Kamarudin B, Abidin SK, et al.

BMC Ophthalmol, 2008;8:7.
PMID: 18445283 DOI: 10.1186/1471-2415-8-7

The sensitivity and specificity of 18S rRNA polymerase chain reaction (PCR) in the detection of fungal aetiology of microbial keratitis was determined in thirty patients with clinical diagnosis of microbial keratitis.

Matched MeSH terms: Eye Infections, Fungal/diagnosis*
Fulltext The use of preserved bovine pericardium for emergency temporizing graft in corneal perforation

Koay AC, Yew YH, Ngo CT, Loo VP, Intan G, Chua CN

Med J Malaysia, 2008 Dec;63(5):421-2.
PMID: 19803308 MyJurnal

Corneal perforation is an ocular emergency that requires early intervention to avoid permanent visual loss from endophthalmitis or irreversible structural changes. Although tectonic keratoplasty is the best choice for patching a large perforation, a donor cornea is not always immediately available. Consequently, an alternative material is required while awaiting a donor cornea. We report the use of preserved bovine pericardium as a temporizing graft to maintain the ocular integrity in two patients with corneal perforation.

Matched MeSH terms: Eye Infections, Fungal/surgery
Fulltext Delayed onset porous polyethylene implant-related inflammation after orbital blowout fracture repair: four case reports

Aryasit O, Ng DS, Goh ASC, Woo KI, Kim YD

BMC Ophthalmol, 2016 Jul 07;16:94.
PMID: 27387333 DOI: 10.1186/s12886-016-0287-0

BACKGROUND: Porous polyethylene implants are commonly used in orbital blowout fracture repair because of purported biocompatibility, durability, and low frequency of complications. Delayed inflammation related to porous polyethylene sheet implants is very rare and no case series of this condition have been reported.
CASE PRESENTATION: This is a retrospective review of clinical presentations, radiographic findings, histopathological findings, treatments, and outcomes of patients who developed delayed complications in orbital blowout fracture repair using porous polyethylene sheets. Four male patients were included with a mean age of 49 years (range 35-69 years). Blowout fracture repair was complicated with implant-related inflammation 10 months, 2 years, 3 years, and 8 years after surgery. Chronic and subacute orbital inflammatory signs were noted in two patients and acute fulminant orbital inflammation was found in two patients. Three patients developed peri-implant abscesses and one patient had a soft tissue mass around the implant. All patients underwent implant removal and two of these patients with paranasal sinusitis had sinus surgery. Histopathological findings revealed chronic inflammatory changes with fibrosis, and one patient had foreign body granuloma with culture positive Staphylococcus aureus.
CONCLUSIONS: Delayed complications with porous polyethylene sheets used in orbital blowout fracture repair may occur many years following the initial surgery in immunocompetent patients. Low-grade or fulminant inflammation could complicate blowout fracture repair related with the implant.

Matched MeSH terms: Eye Infections, Bacterial/etiology
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.

Matched MeSH terms: Eye Infections, Bacterial/diagnosis*; Eye Infections, Bacterial/drug therapy; Eye Infections, Bacterial/microbiology
Hemorrhagic Descemet Membrane Detachment Following Syphilitic Interstitial Keratitis

Höllhumer R, Zairani Mz A, Watson S

Cornea, 2016 Sep;35(9):1255-6.
PMID: 27227396 DOI: 10.1097/ICO.0000000000000889

PURPOSE: Syphilitic interstitial keratitis is a stromal inflammatory disease with characteristic secondary vascularization. This case illustrates a late complication of hemorrhagic Descemet membrane detachment.
METHODS: Case report.
RESULTS: The patient presented with painless sudden visual loss and progressive shallowing of the anterior chamber caused by hemorrhagic Descemet membrane detachment. She had corneal neovascularization and a positive syphilis serology. Owing to the risk of pupil block glaucoma, the patient had surgical drainage of the blood via an ab externo approach.
CONCLUSIONS: This case illustrates a previously unreported complication of syphilitic interstitial keratitis. The patient recovered good visual acuity and had residual pigment deposits in the pre-Descemet interface.

Matched MeSH terms: Eye Infections, Bacterial/diagnosis; Eye Infections, Bacterial/microbiology*; Eye Infections, Bacterial/therapy
Pyogenic Granuloma Formation Following Ahmed Valve Glaucoma Implant

Chendran P, Seng Fai T, Wan Abdul Halim WH, Md Din N

J Glaucoma, 2019 10;28(10):e162-e164.
PMID: 31368915 DOI: 10.1097/IJG.0000000000001334

Ocular pyogenic granuloma is a benign tumor seen after ocular insult secondary to ocular surgeries, trauma or infection. Although benign, intervention is sometimes necessary. Previous authors have reported pyogenic granuloma formation following oculoplastic surgeries. We report a pyogenic granuloma after an Ahmed glaucoma valve implantation. A 65-year-old gentleman presented with right eye redness associated with pain and swelling ~2 months after Ahmed glaucoma valve implantation. Examination found a sessile growth on the tube extruding puss with signs of endophthalmitis. The glaucoma drainage device was explanted and culture results grew Staphylococcus aureus. This article discusses the formation of pyogenic granuloma on a glaucoma drainage device and its management.

Matched MeSH terms: Eye Infections, Bacterial/diagnosis; Eye Infections, Bacterial/drug therapy; Eye Infections, Bacterial/microbiology*
Fulltext Relationship between Routine Handling Practices with Potential Pathogenic Bacteria Isolated from Contact Lenses Among Students in UiTM Negeri Sembilan

Adam Zafdri Md Zali, Rashidah Iberahim

Journal of Academia Universiti Teknologi MARA Negeri Sembilan, 2021;9(1):106-116.
MyJurnal

Pseudomonas aeruginosa and Staphylococcus aureus are types of bacteria known to cause bacterial keratitis. Pseudomonas aeruginosa causes bacterial keratitis by adhering to the surface of the contact lenses, when the P. aeruginosa are in contact with the eye, resulting in infectious keratitis. As for Staphylococcus aureus, when there is a predisposing factor such as wearing expired or extended use of contact lenses (contact lenses that can be used continually for up to one week even while sleeping) weaken the individual defences and leads to the development of bacterial keratitis. Both bacteria are capable to infect eye cornea and lead to bacterial keratitis through contact lenses wearer. The findings of this study provide information on the importance of routine practices in handling contact lenses to help reduce the incidence of bacterial keratitis caused by wear contact lenses in an individual. The side effect of wearing contact lenses such as redness of the eye and keratitis due to the infection by pathogenic bacteria which comes from the behavior and low hygiene level management of individual had led the study to create awareness to contact lenses wearer. In this study, 25 soft and hard contact lenses with purposed for colored or toric contact lenses were obtained among UiTM Negeri Sembilan students. The users required to answer the questionnaire form regarding the type, behavior, and routine practices of their contact lenses. Pathogenic bacteria were isolated using the cotton swab technique and cultured on nutrient broth. The streak technique was used to cultured bacteria from broth to nutrient agar, blood agar, and MacConkey agar. Later, the identification of bacteria was carried out using biochemical tests and microscopic observation. From the laboratory results, 84% of the tested contact lenses contained pathogenic bacteria on their surface. These findings concluded that the presences of pathogenic microorganisms on the contact lenses used closely related to the behavior in handling and hygenic practices level by the contact lenses users.

Matched MeSH terms: Eye Infections, Bacterial
Cladosporium cladosporioides keratomycosis: a case report

Chew FLM, Subrayan V, Chong PP, Goh MC, Ng KP

Jpn. J. Ophthalmol., 2009 Nov;53(6):657-659.
PMID: 20020251 DOI: 10.1007/s10384-009-0722-3
Matched MeSH terms: Eye Infections, Fungal/diagnosis; Eye Infections, Fungal/drug therapy; Eye Infections, Fungal/microbiology*
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
Matched MeSH terms: Eye Infections, Parasitic/diagnosis; Eye Infections, Parasitic/parasitology*; Eye Infections, Parasitic/therapy
Fulltext Refractory Scedosporium apiospermum Keratitis Successfully Treated with Combination of Amphotericin B and Voriconazole

Fadzillah MT, Ishak SR, Ibrahim M

Case Rep Ophthalmol Med, 2013;2013:413953.
PMID: 23509650 DOI: 10.1155/2013/413953

Aim. To report a case of refractory fungal keratitis caused by Scedosporium apiospermum. Methods. Interventional case report. Results. A 47-year-old Malay housewife presented with left eye cornea ulcer as her first presentation of diabetes mellitus. There was no history of ocular trauma, contact lens used, or cornea foreign body. Scedosporium apiospermum was isolated from the cornea scrapping. Her cornea ulcer initially responded well to topical Amphotericin B within 3 days but subsequently worsened. Repeat cornea scrapping also yields Scedosporium apiospermum. This refractory keratitis was successfully treated with a combination of topical Amphotericin B and Voriconazole over 6 weeks. Conclusion. Scedosporium apiospermum keratitis is an opportunistic infection, which is difficult to treat despite tight control of diabetes mellitus and intensive antifungal treatment. The infection appeared to have very quick onset but needed long duration of treatment to completely heal. Surgical debridement always plays an important role as a therapeutic procedure as well as establishes the diagnosis through repeat scrapping.

Matched MeSH terms: Eye Infections, Fungal
Fulltext Prevalence and viral load of oncogenic human papillomavirus (HPV) in pterygia in multi-ethnic patients in the Malay Peninsula

Chong PP, Tung CH, Rahman NA, Yajima M, Chin FW, Yeng CL, et al.

Acta Ophthalmol, 2014 Nov;92(7):e569-79.
PMID: 25043991 DOI: 10.1111/aos.12427

The aim of the study was to determine the prevalence of human papillomavirus (HPV) in primary and recurrent pterygia samples collected from different ethnic groups in the equatorial Malay Peninsula.

Matched MeSH terms: Eye Infections, Viral/ethnology; Eye Infections, Viral/virology*
Topical piperacillin/tazobactam for recalcitrant pseudomonas aeruginosa keratitis

Chew FL, Soong TK, Shin HC, Samsudin A, Visvaraja S

J Ocul Pharmacol Ther, 2010 Apr;26(2):219-22.
PMID: 20415627 DOI: 10.1089/jop.2009.0077

To report the treatment of therapy-resistant Pseudomonas aeruginosa keratitis with topical piperacillin/tazobactam.

Matched MeSH terms: Eye Infections, Bacterial/drug therapy*; Eye Infections, Bacterial/physiopathology
Acute retinal necrosis complicating chickenpox in a healthy adult--a case report and review of literature

Tajunisah I, Reddy SC

Compr Ther, 2007;33(1):25-31.
PMID: 17984490

Acute retinal necrosis (ARN) is known to occur in conjunction with primary varicella or chickenpox infection. The majority of ARN cases reported in the literature were of milder form with mild to moderate vitritis, limited retinitis, and rare occurrence of retinal breaks or detachment that responded well to intravenous acyclovir, with or without oral prednisolone. We report a case of unilateral ARN with marked vitritis and retinal necrosis leading to retinal breaks following chickenpox in a 32-year-old healthy lady. This patient was successfully treated with intravenous acyclovir followed by oral acyclovir and orbital floor triamcinolone injections to contain the inflammation with barrier laser therapy to secure the retinal breaks with good visual outcome. This case is unusual in its severity, and to our knowledge, orbital floor triamcinolone therapy was not used earlier to contain ARN inflammation.

Matched MeSH terms: Eye Infections, Viral/drug therapy; Eye Infections, Viral/etiology*

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