MyMedR

Ocular tuberculosis in Hospital Universiti Sains Malaysia - A case series

Shahidatul-Adha M, Zunaina E, Liza-Sharmini AT, Wan-Hazabbah WH, Shatriah I, Mohtar I, et al.

Ann Med Surg (Lond), 2017 Dec;24:25-30.

PMID: 29062482 DOI: 10.1016/j.amsu.2017.10.003

INTRODUCTION: Ocular tuberculosis (TB) encompasses a broad spectrum of clinical manifestations affecting different structures of the eye. It is caused by Mycobacterium tuberculosis, a great ancient organism that induces various types of diseases and unfavorable outcomes if unrecognized and not well treated.

PURPOSE: To report the clinical profile of 34 ocular TB cases observed during 6 years period in Hospital Universiti Sains Malaysia (HUSM).

METHOD: A retrospective review of medical records from 34 patients diagnosed with ocular TB in HUSM from January 2011 until December 2016.

RESULTS: The mean age was 43 ± 14.6 years old. Both male and female affected in about 1:1 ratio. The majority of subjects were local Malays (91.2%). Risk factors included previous contact with pulmonary TB patients (38.2%), and patients with underlying diabetes mellitus (26.5%). Most patients showed normal chest radiography (79.4%). However they had positive Mantoux test (94.1%) and raised erythrocyte sedimentation rate (ESR) value (58.8%). Uveitis was the most common ocular manifestation of ocular TB (70.6%) while the rare ocular manifestations included optic perineuritis and optic neuritis, orbital apex syndrome, orbital cellulitis, sclerokeratitis, corneal ulcer and conjunctival abscess. All patients responded well to anti-TB treatment, but visual outcome was variable.

CONCLUSIONS: This review shows the diverse entity of ocular TB spectrum in an endemic area. Good clinical response to anti-tuberculous therapy supported the presumed diagnosis of ocular TB in majority of the cases.

Matched MeSH terms: Optic Neuritis

Fulltext Clinical presentation, severity and progression of primary angle closure in malay and chinese patients

Liza-Sharmini AT, Ng GF, Nor-Sharina Y, Khairil Anuar MI, Nik Azlan Z, Azhany Y

Med J Malaysia, 2014 Dec;69(6):245-51.

PMID: 25934953 MyJurnal

OBJECTIVE: To compare the clinical presentation, severity and progression of primary angle closure between Chinese and Malays residing in Malaysia.

METHODS: A comparative retrospective record review study was conducted involving one hundred (200 eyes) Malay and fifty eight (116 eyes) Chinese patients. They were selected from medical records of Hospital Universiti Sains Malaysia, Kelantan and Hospital Pulau Pinang, Penang, Malaysia. The selected patients were re-diagnosed based on the International Society of Geographical and Epidemiological classification. The clinical data on presentation including the presence of systemic diseases were documented. Progression of the disease was based on available reliable visual fields and optic disc changes of patients who have been on follow-up for at least five years.

RESULTS: Malay patients presented at older age (61.4 years SD 8.4) compared to Chinese (60.6 years SD 8.3). There was significant higher baseline Intraocular Pressure (IOP) among Malays (34.7 SD 18.5mmHg) compared to Chinese (30.3 SD 16.7mmHg) (p=0.032). The Chinese patients presented with significantly better visual acuity (p<0.001) and less advanced cup to disc changes (p=0.001) compared to Malays. Malay patients progressed faster than the Chinese. Majority progressed within 1 year of diagnosis. Malays without laser peripheral iridotomy (LPI) have a 4 fold (95% CI 1.4, 10.9) risk of progression. Higher baseline IOP, more advanced visual field defect and absence of LPI was identified as significant predictors associated with progression.

CONCLUSION: The Malays presented with more advanced angle closure glaucoma as compared to the Chinese in Malaysia. Aggressive disease progression was observed in Malays with the onset of optic neuropathy. Effective public awareness and aggressive management is important to prevent blindness in the Malaysian population.

Matched MeSH terms: Optic Neuritis

Fulltext Retinitis punctata albescens presenting with tunnel vision: diagnostic dilemmas

Norhayaty S., Nurul Dalila M.S., Tai, Evelyn L.M., Liza Sharmini A.T., Zunaina E., Azhany Y.

Journal of Biomedical and Clinical Sciences, 2017;2(1):20-22.

MyJurnal

Tunnel vision is a classic sign among patients with advanced glaucoma. However, other conditions such as retinitis pigmentosa, optic neuritis and rod-cone dystrophy may be characterized by similar visual field defects. A 52-year-old lady with a family history of glaucoma presented with bilateral gradual loss of peripheral vision for two years. She claimed to have poor night vision about 20 years prior to this presentation. Her visual acuity was 6/7.5 in both eyes. The anterior chamber depth was moderate bilaterally, with Schaffer grading on gonioscopy of grade I to II. The intraocular pressure was 14 mmHg in both eyes. The optic discs appeared normal. Fundus examination showed scattered hypopigmented changes sparing the fovea. Humphrey visual field test revealed bilateral constricted visual fields. She was diagnosed with retinitis punctata albescens (RPA) based on her symptom of poor night vision, supported by the diffuse hypopigmented changes in her fundi. The management of this condition involves careful counselling regarding the genetic nature of the disease and its progressive course. We discuss this case to illustrate the importance of a thorough history taking and careful fundus examination in the workup of patients presenting with tunnel vision.

Matched MeSH terms: Optic Neuritis

Fulltext Bilateral idiopathic optic perineuritis in a young Malay woman: A case report

Ayesha Mohd Zain, Umi Kalthum Md Noh, Mushawiahti Mustapha, Norshamsiah Md. Din, Bastion, Mae Lynn Catherine

Neurology Asia, 2015;20(4):407-409.

MyJurnal

A 28-year-old Malay woman presented with severe loss of vision in both eyes associated with periocular pain on eye movement. She was completely blind at presentation and examination showed optic discs
swelling. Optic nerve imaging showed ‘doughnut sign’, characteristic of optic perineuritis. Steroid was
given over six months. Visual function improved gradually and was maintained at one year follow-up.
This case highlights the importance of differentiation between optic neuritis and optic perineuritis as
visual recovery depends on prolonged management with corticosteroid in optic perineuritis.

Matched MeSH terms: Optic Neuritis

Fulltext Bilateral optic neuritis in a boy - More than the eyes

Loh MA, Alex Khoo PC, Chong MF

Med J Malaysia, 2016 04;71(2):79-80.

PMID: 27326949

Neuromyelitis optica (NMO) is a rare disorder in children with variable presentation. We report a 7-year-old boy who presented with bilateral retrobulbar optic neuritis and responded very well to treatment. He was also positive for aquaporin 4 (AQP4) antibodies, which is part of an emerging endophenotype within autoimmune neurological disorders in childhood.

Matched MeSH terms: Optic Neuritis/diagnosis*; Optic Neuritis/immunology

Fulltext Mistaken diagnosis of optic neuritis and the possible role of phosphodiasterase-5 inhibitors (Sildenafil/Viagra)

Cullen JF, Chung HW

Med J Malaysia, 2010 Dec;65(4):315-6.

PMID: 21901956

The diagnosis of optic neuritis and particularly retrobulbar optic neuritis when atypical and not responsive to corticosteroid treatment may need to be revised. This is now especially so in male patients who should be questioned regarding their taking a phosphodiasterase-5 inhibitor in particular Viagra. The case history of such a patient is presented who sustained posterior ischaemic optic neuropathy mistaken for retrobulbar neuritis resulting in bilateral severe visual loss.

Matched MeSH terms: Optic Neuritis/chemically induced; Optic Neuritis/diagnosis*

Fulltext Clinical profile and aetiology of optic neuritis in Hospital Universiti Sains Malaysia--5 years review

Ismail S, Wan Hazabbah WH, Muhd-Nor NI, Daud J, Embong Z

Med J Malaysia, 2012 Apr;67(2):159-64.

PMID: 22822635

Although few studies concerning optic neuritis (ON) in Asian countries have been reported, there is no report about ON in Malaysia particularly within the Malay population. We aimed to determine the clinical manifestation, visual outcome and aetiology of ON in Malays, and discussed the literature of ON studies in other Asian populations. This was a retrospective study involving 31 consecutive patients (41 eyes) with ON treated at Hospital Universiti Sains Malaysia commencing from July 2005 till January 2010 with a period of follow-up ranging from 18-60 months. The clinical features, laboratory results, possible aetiology, and visual acuity after one year were analysed. Females were the predominant group. The age of the patients ranged between 3-55 years and peaked between 21-30 years old. 67.7% of the patients had unilateral involvement. Pain on ocular movement was observed in 31.7% of the affected eyes. 73.3% of 41 involved eyes showed visual acuity equal 6/60 or worse on presentation. Paracentral scotoma was the most common visual field defect noted. Optic disc papillitis proved more widespread compared to the retrobulbar type of ON. The aetiology was idiopathic in more than 50%, while the risk of multiple sclerosis was extremely low (3.2%) in our series. 66.0% demonstrating visual acuity improved to 6/12 or better at one year after the attack. 16.1% showed evidence of recurrence during follow-up. In conclusion, the clinical profile and aetiology of ON in Malay patients are comparable to other ON studies reported by other Asian countries.

Matched MeSH terms: Optic Neuritis/etiology*; Optic Neuritis/epidemiology

Fulltext Bilateral optic neuritis with maculopathy: A rare manifestation of dengue fever

Boo YL, Lim SY, Chin PW, Hoo FK

Malays Fam Physician, 2017;12(1):32-34.

PMID: 28503273 MyJurnal

Dengue fever is a common mosquito-borne disease, which is endemic in tropical and subtropical countries. Bilateral optic neuropathy is a relatively unusual dengue-related ocular complication. Here, we present a case of bilateral optic neuritis with maculopathy complicating dengue infection.

Matched MeSH terms: Optic Neuritis

Multiphasic disseminated encephalomyelitis followed by optic neuritis in a child with gluten sensitivity

Ching BH, Mohamed AR, Khoo TB, Ismail HI

Mult Scler, 2015 Aug;21(9):1209-11.

PMID: 26199345 DOI: 10.1177/1352458515593404

Multiphasic disseminated encephalomyelitis (MDEM) followed by optic neuritis (ON) has been described as a new entity in recent years. Gluten encephalopathy has also been recognized as a neurological manifestation of celiac disease. Accurate diagnosis of both is important due to the therapeutic implications. We report a girl presenting with recurrent encephalopathic polyfocal demyelinating episodes followed by optic neuritis, and a clinical history suggestive of gluten sensitivity. She had persistently high ESR, neutrophilia, and tested positive for anti-MOG (myelin oligodendrocyte glycoprotein) antibody. She responded well to methylprednisolone in each relapse, and achieved remission for a year after azathioprine was added.

Matched MeSH terms: Optic Neuritis/complications*

Unusual case of cerebral demyelination and bilateral optic neuritis in an infant with suppurative BCG lymphadenitis

Anandakrishnan P, Khoo TB

BMJ Case Rep, 2018 May 30;2018.

PMID: 29848532 DOI: 10.1136/bcr-2018-224496

Cerebral demyelination and optic neuritis are often seen in children with acute disseminated encephalomyelitis following various infections and immunisations. An eight month old girl presented with a left axillary lymph node swelling and an erythematous lace-like rash over her cheeks and trunk. She then developed acute encephalopathy, bilateral nystagmus, right hemiparesis and left facial nerve palsy. Her electroencephalogram showed an encephalopathic process and visual evoked response study were grossly abnormal. Her MRI brain showed hyperintensities in the midbrain, pons and bilateral cerebellar peduncles. She was treated as postinfectious cerebral demyelination with intravenous antibiotics, methylprednisolone and immunoglobulin. Left axillary lymph node excision biopsy and GeneXpert test detected Mycobacterium tuberculosis complex that prompted initiation of antituberculous therapy. Her chest X-ray and cerebrospinal fluid examinations for tuberculosis were normal. She showed significant recovery after 2 weeks. This case illustrates a rare presentation of cerebral demyelination and bilateral optic neuritis following suppurative BCG lymphadenitis.

Matched MeSH terms: Optic Neuritis/chemically induced*

Paraneoplastic optic neuropathy secondary to adenocarcinoma of the lung

Yap JY, Wan HItam WH, Abdul Halim S, Masnon NA

BMJ Case Rep, 2021 May 12;14(5).

PMID: 33980562 DOI: 10.1136/bcr-2021-242082

We describe an uncommon cause of paraneoplastic optic neuropathy in adenocarcinoma of the lung. A 45-year-old healthy woman presented with seizure and encephalitis, followed by an acute visual loss in both eyes for 1 week. Her visual acuity was no perception of light in the right eye and hand movement in the left eye. There was a generalised restriction of extraocular muscle movements in both eyes. Funduscopy showed a bilateral pale optic disc. A paraneoplastic antigen autoimmune profile showed a positive anti-CV2/CRMP-5 antibody. CT of the thorax revealed the presence of right apical lung mass, confirmed to be adenocarcinoma through a biopsy. She was scheduled for lung lobectomy and chemotherapy. Unfortunately, her health deteriorated and she passed away eventually.

Matched MeSH terms: Optic Neuritis*

Fulltext Myelin Oligodendrocyte Glycoprotein (MOG) Optic Neuritis: A Case Series

Nurul-Ain M, Khairul Kamal ZN, Wan Hitam WH, Abd Munaaim M, Mohd Zaki F

Cureus, 2021 Apr 13;13(4):e14452.

PMID: 33996312 DOI: 10.7759/cureus.14452

Myelin oligodendrocyte glycoprotein (MOG) antibody disease has been recognised as a distinct demyelinating disorder. Optic neuritis has been reported as the most common presentation and manifestation of this spectrum disorder. This is a case series of three MOG optic neuritis patients. Patients involved are female with disease onset ranging between 7- and 37-year-old. Most of these patients experienced symptoms of profound reduced visual acuity with eye pain. All three patients had optic disc swelling upon first presentation and they experienced at least one episode of bilateral simultaneous optic neuritis. Only one patient had demonstrable optic nerve enhancement on magnetic resonance imaging (MRI). Disease was confirmed through positive MOG antibody. Patients typically responded well to intravenous methylprednisolone (IVMP) during acute attack of optic neuritis. However, one patient had suboptimal response to IVMP after multiple relapses. We noted multiple relapses of optic neuritis are common in MOG patients. MOG optic neuritis is a devastating, but treatable condition. Aggressive treatment during acute optic neuritis attack and relapse prevention may favour a good visual prognosis in MOG antibody disease.

Matched MeSH terms: Optic Neuritis

Fulltext Optic neuritis and retinal vasculitis as primary manifestations of systemic lupus erythematosus

Barkeh HJ, Muhaya M

Med J Malaysia, 2002 Dec;57(4):490-2.

PMID: 12733176

Systemic lupus erythematosus (SLE) is a common multisystem disorder. However, retinal vasculitis as a primary manifestation of SLE is uncommon, accounting for only 4% of causes of retinal vasculitis. The postulated mechanism appeared to be vaso-occlusion of the retinal arterioles by thrombosis, with resultant ischaemia. Optic neuropathy in SLE is also rare, with a prevalence of 1%. This is a case report of a young lady who presented to us with retinal vasculitis as her initial presentation of SLE. Interestingly, the pathologic mechanism appeared to be inflammatory and not vaso-occlusive.

Matched MeSH terms: Optic Neuritis/diagnosis*; Optic Neuritis/etiology*; Optic Neuritis/therapy

Fulltext Bilateral optic neuritis in pregnancy

Suraiya MS, Norazlina B, Carmen C, Muhaya M

Med J Malaysia, 2003 Dec;58(5):771-3.

PMID: 15190668

A 25-year old primigravida at 11-weeks period of amenorrhoea presented with bilateral optic neuritis following Varicella Zoster viral (VZV) infection. She was serologically positive for systemic lupus erythematosus but negative for virus. The exact pathogenesis of the patient's severe optic neuritis, adduction and neurological deficit was unknown. The initiation of high dose steroids for optic neuritis was a big clinical dilemma in a pregnant patient with viral infection. The patient was treated with high dose steroids after three days of commencement of antiviral treatment. At 6 months after presentation, her visual acuity in the right eye was 6/36 with perception to light in the left.

Matched MeSH terms: Optic Neuritis/virology*

Fulltext The natural history of optic neuritis in Asian patients: an observational cohort study

Seah, B.H.A., Tow, S.L.C., Ong, K.C.B. Ong, Yang, C.C., Tsai, C.P., Lee, K.H., et al.

Neurology Asia, 2017;22(4):341-348.

MyJurnal

Optic neuritis, which may be a precursor to multiple sclerosis (MS), is an uncommon disease in
Asian patients. The Asian Collaborative Longitudinal Optic Neuritis Epidemiology (ACLONE) is
an observational cohort study that assessed the risk of recurrent optic neuritis and/or progression
of further neurologic events, either MS or neuromyelitis optica (NMO) in Asian patients with firstever
optic neuritis. Secondary aims were to study the presenting characteristics and visual outcome,
and to identify risk factors for development of either MS or NMO. A total of 112 patients (25 men
and 87 women) aged from 12 to 61 years were recruited from Singapore, Taiwan, South Korea and
Malaysia. Of these, 94 (84%) had unilateral optic neuritis, with the right eye involved in 45 patients
and the left eye in 49 patients and the remaining 18 (16%) had bilateral optic neuritis. Follow up
data was available for 104 patients, and patients were followed for a median duration of 25.9 months.
Of these patients, 6 patients were adjudicated to have reached the primary endpoint (composite of
MS/NMO and optic neuritis): 3 patients with recurrent optic neuritis also subsequently experienced
neurologic symptoms, and 3 patients without recurrent eye involvement had neurologic symptoms.
Only one patient was considered to have prototypical MS, the other 5 were diagnosed with NMO,
all with subsequent antibody confirmation. Optic neuritis in Asian patients has significantly different
presenting characteristics from the classic description. However, in the majority of the patients it is
usually a benign disease, with good visual outcome and no further events.

Matched MeSH terms: Optic Neuritis

Fulltext MOG Antibody-Associated Disease with Recurrent Optic Neuritis and Multiple Cranial Neuropathies: A Rare Clinical Phenotype

Razali AM, Zain AM, Din NM, Tan HJ, Ng CF

Neurol India, 2020 3 20;68(2):500-501.

PMID: 32189702 DOI: 10.4103/0028-3886.280641

Matched MeSH terms: Optic Neuritis*

Fulltext Bilateral atypical optic neuritis associated with tuberculosis in an immunocompromised patient

Jaafar J, Hitam WH, Noor RA

Asian Pac J Trop Biomed, 2012 Jul;2(7):586-8.

PMID: 23569976 DOI: 10.1016/S2221-1691(12)60102-6

A 27 year-old lady, presented with sudden loss of vision in the right eye for a week. It was followed by poor vision in the left eye after 3 days. It involved the whole entire visual field and was associated with pain on eye movement. She was diagnosed to have miliary tuberculosis and retroviral disease 4 months ago. She was started on anti-TB since then but defaulted highly active anti-retroviral therapy (HAART). On examination, her visual acuity was no perception of light in the right eye and 6/120 (pinhole 3/60) in the left eye. Anterior segment in both eyes was unremarkable. Funduscopy showed bilateral optic disc swelling with presence of multiple foci of choroiditis in the peripheral retina. The vitreous and retinal vessels were normal. Chest radiography was normal. CT scan of orbit and brain revealed bilateral enhancement of the optic nerve sheath that suggest the diagnosis of bilateral atypical optic neuritis. This patient was managed with infectious disease team. She was started on HAART and anti-TB treatment was continued. She completed anti-TB treatment after 9 months without any serious side effects. During follow up the visual acuity in both eyes was not improved. However, funduscopy showed resolving of disc swelling and choroiditis following treatment.

Matched MeSH terms: Optic Neuritis/drug therapy; Optic Neuritis/etiology*; Optic Neuritis/pathology*

Fulltext Chemotherapy related optic neuritis

Nur, A.S., Jemaima, C.H., Fuad Ismail, Safinaz, M.K.

International Medical Journal Malaysia, 2017;16(2):133-136.

MyJurnal

In children, most cases of optic neuritis are immune-related. Less frequently, it may also be due to
demyelinating disorders. Other secondary causes such as infection of adjacent structures or infiltration are
even rarer. The occurrence of optic neuritis in children on chemotherapy also has not being extensively
reported. We report a case of bilateral optic neuritis in a young girl with subacute visual loss after receiving
systemic chemotherapy for embryonal ovarian carcinoma.

Matched MeSH terms: Optic Neuritis

Pansinusitis causing bilateral optic neuritis in a 9-year-old child

Bashkaran K, Shatriah I, Zunaina E, Bakiah S, Sakinah Z

Orbit, 2009;28(6):377-9.

PMID: 19929663 DOI: 10.3109/01676830903104678

Sinusitis is a rare cause of optic neuritis in children. This case illustrates bilateral optic neuritis in a 9-year-old child caused by pansinusitis. It demands an accurate diagnosis with a prompt management. A proper treatment of sinusitis is essential to prevent this complication.

Matched MeSH terms: Optic Neuritis/diagnosis; Optic Neuritis/drug therapy; Optic Neuritis/etiology*

Fulltext Optic Perineuritis in Neuromyelitis Optica Spectrum Disorder

Kamaluddin NA, Tai E, Wan Hitam WH, Ibrahim M, Samsudin AHZ

Cureus, 2019 Jun 05;11(6):e4834.

PMID: 31404358 DOI: 10.7759/cureus.4834

Optic perineuritis (OPN) involvement in demyelinating disease is rarely encountered. To our knowledge, this is the first reported case of bilateral OPN associated with neuromyelitis optica spectrum disorder (NMOSD). We present a case of a healthy young gentleman who presented with OPN, initially presumed to have a young stroke but later diagnosed to be NMOSD. Early neuroimaging is essential to help distinguish optic neuritis (ON), and prolonged treatment of systemic immunosuppression is the mainstay of treatment.

Matched MeSH terms: Optic Neuritis

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