MyMedR

An unusual presentation of gestational thrombocytopenia

Lim CC, Patel DK, Bakhtiari A, Subrayan V

Platelets, 2013;24(6):498-9.

PMID: 22994680 DOI: 10.3109/09537104.2012.724484

Thrombocytopenia is classically defined as a platelet count of less than 150 000/µl. Counts from 100 000 to 150 000/µl are considered mildly depressed, 50 000 to 100 000/µl moderately depressed, and less than 50 000/µl severely depressed. Thrombocytopenia occurs in about 10% of pregnant women. Gestational thrombocytopenia (GT) is a diagnosis of exclusion and considered the most prevalent cause of thrombocytopenia in pregnancy. GT accounts for almost 75% of cases of thrombocytopenia in pregnancy. The cause of GT is unclear, although existing studies denote the possibility of accelerated platelet consumption and the increased plasma volume during pregnancy. The presence of antiplatelet antibodies is not specific to GT. The degree of thrombocytopenia in GT is usually mild to moderate, usually remaining greater than 70 000/µl. Patients are asymptomatic with no evidence of bleeding and rarely preconception history of thrombocytopenia. The platelet count returns to normal within 2-12 weeks post partum. We wish to report a unique case of GT presenting as blurred vision due to retinal hemorrhages.

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 Agreement analysis of LENSTAR with other techniques of biometry

Jasvinder S, Khang TF, Sarinder KK, Loo VP, Subrayan V

Eye (Lond), 2011 Jun;25(6):717-24.

PMID: 21394115 DOI: 10.1038/eye.2011.28

To assess the agreement of the optical low-coherence reflectometry (OLCR) device LENSTAR LS900 with partial coherence interferometry (PCI) device IOLMaster and applanation and immersion ultrasound biometry.

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.

Endogenous Cushing syndrome from an ectopic adrenocorticotropic hormone production as a rare cause of ocular hypertension

Khaw KW, Jalaludin MY, Suhaimi H, Harun F, Subrayan V

J AAPOS, 2010 Aug;14(4):356-7.

PMID: 20637667 DOI: 10.1016/j.jaapos.2010.04.009

Ocular hypertension caused by endogenous Cushing syndrome from an ectopic adrenocorticotropic hormone-producing tumor is rare. We report an 11-year-old boy who presented with intraocular pressures (IOPs) of 50 mm Hg in both eyes. Surgical resection of the tumor was performed with subsequent normalization of serum cortisol and IOP levels.

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.

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

Primary herpes virus keratitis after penetrating keratoplasty

Hassan M, Patel DK, Subrayan V

Ann Ophthalmol (Skokie), 2009;41(3-4):203-5.

PMID: 20214058

We present a case of a newly acquired herpetic infection in the graft after penetrating keratoplasty.

Fulltext Acute angle closure glaucoma resulting from myelodysplasia

Ang GS, Tey A, Ng WS, Subrayan V

Med J Malaysia, 2007 Aug;62(3):259-60.

PMID: 18246923

Patients with bleeding diatheses can present in a variety of clinical situations. When these patients manifest with ocular complications, their management can be challenging. We describe a case of acute angle closure glaucoma secondary to subretinal haemorrhage, with myelodysplasia as a predisposing factor.

Colloid cyst of third ventricle mimicking normal tension glaucoma

Patel DK, Ali NA, Iqbal T, Subrayan V

Ann Ophthalmol (Skokie), 2008;40(3-4):177-9.

PMID: 19230359

Colloid cysts are rare intracranial tumors most commonly found in the third ventricle. We present a case of colloid cyst of the third ventricle that manifested as bilateral advance optic disc cupping, superior hemifield defects in the visual fields and normal intraocular pressure.

Role of Angiography in Systemic Lupus Erythematosus-Induced Choroiditis

Lee KR, Peng LY, Iqbal TB, Subrayan V

Ocul Immunol Inflamm, 2018;26(8):1146-1149.

PMID: 28362518 DOI: 10.1080/09273948.2017.1298821

PURPOSE: To report a case of systemic lupus erythematosus-induced choroidal vasculitis.

METHODS: A 34-year-old woman with a long-standing history of systemic lupus erythematosus had a sudden painless loss of vision in the right eye over 12 hours. Ocular examination revealed a visual acuity of counting fingers of 1 foot on the right eye and 20/20 on the left. There was a relative afferent pupillary defect on the right side with a pink, distinct optic disk margin.

RESULTS: Optical coherence tomography of the macula and fundus fluorescein angiogram for the eyes were normal. The MRI brain and orbit with the cerebral MRA did not show signs of optic neuritis or occipital vasculitic changes. However, the indocyanine green angiography revealed patches of ill-defined areas of choroidal hypofluorescence in the early- to mid-phase in the macula region.

CONCLUSION: ICGA becomes the crucial tool in unmasking the presence of choroidal vasculitis.

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.

Fulltext A rare occurrence of epithelial inclusion iris cyst after phacoemulsification

Kuganasan S, Voon Loo A, Subrayan V

Clin Exp Optom, 2015 Jan;98(1):97-8.

PMID: 25545950 DOI: 10.1111/cxo.12235

Fulltext Extramedullary plasmacytoma of the eyelid: a case report and review of literature

Lim CC, Soong TK, Chuah KC, Subrayan V

Clin Exp Optom, 2013 May;96(3):349-51.

PMID: 22970978 DOI: 10.1111/j.1444-0938.2012.00797.x

Primary extramedullary plasmacytomas of the eyelid are rare with only five other cases reported in the literature. A 43-year-old Chinese man presented with painless swelling of the left lower eyelid that developed over the past two years. An incisional biopsy and histopathological analysis of the lesion revealed a primary extramedullary plasmacytoma of the eyelid. The tumour was completely excised. There has been no tumour recurrence over the last five years. This tumour should be among those considered when encountering an atypical adnexal lesion. A systemic examination, relevant clinical investigations, as well as life-long monitoring are essential for these patients due to the strong association of extramedullary plasmacytoma with multiple myeloma. When a lesion can be completely resected, surgery provides similar results to radiotherapy.

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

Reproducibility of choroidal thickness measurements in subjects on 3 spectral domain optical coherence tomography machines

Koay CL, Quo MJ, Subrayan V

Int Ophthalmol, 2017 Jun;37(3):655-671.

PMID: 27558260 DOI: 10.1007/s10792-016-0306-4

The purpose of this study was to investigate the reproducibility of choroidal thickness measurements in normal subjects on 3 spectral domain optical coherence tomography instruments, namely: Zeiss Cirrus HD-OCT (Carl Zeiss Meditec Inc., Dublin, CA), Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany), and Optovue RTVue (Optovue Inc., Fremont, CA). This cross-sectional non-interventional study was performed in a single institution. Images were obtained in 47 eyes of 47 healthy volunteers which age ranged between 23 and 72 without ocular pathology. All subjects were imaged on the fovea using Cirrus HD 1-line raster, Spectralis enhanced depth imaging, and RTVue retina-cross. The choroid was measured subfoveally and at intervals of 500 µm from the fovea nasally and temporally up to 2500 µm. Paired t test, modified Bland-Altman plot, and Pearson's correlation were used to compare the results. There is no significant difference between the systems for any measurement within 2500 µm either side of the fovea for most points. Inter-observer correlation was strong for RTVue, and moderate in both Cirrus and Spectralis.

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.

Identification of potential serum metabolic biomarkers for patient with keratoconus using untargeted metabolomics approach

Daphne Teh AL, Jayapalan JJ, Loke MF, Wan Abdul Kadir AJ, Subrayan V

Exp Eye Res, 2021 10;211:108734.

PMID: 34428458 DOI: 10.1016/j.exer.2021.108734

This study aimed to investigate the metabolite differences between patients with keratoconus and control subjects and identify potential serum biomarkers for keratoconus using a non-targeted metabolomics approach. Venous blood samples were obtained from patients with keratoconus (n = 20) as well as from age-, gender- and race-matched control subjects (n = 20). Metabolites extracted from serum were separated and analyzed by liquid chromatography/quadrupole time-of-flight mass spectrometer. Processing of raw data and analysis of the data files was performed using Agilent Mass Hunter Qualitative software. The identified metabolites were subjected to a principal component and hierarchical cluster analysis. Appropriate statistical tests were used to analyze the metabolomic profiling data. Together, the analysis revealed that the dehydroepiandrosterone sulfate from the steroidal hormone synthesis pathway was significantly upregulated in patients with keratoconus (p

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

I think I have double vision? Or not? Internuclear Ophthalmoplegia following right lacunar infarct

Lee HN, Subrayan V

Med J Malaysia, 2021 Nov;76(6):950-952.

PMID: 34806694

Internuclear Ophthalmoplegia (INO) is an inability of the ipsilateral adduction with a contralateral horizontal abducting saccade on attempted gaze to the contra-lesion side. Injury to the medial longitudinal fasciculus (MLF) will obstruct the signalling pathway between the ipsilateral abducens nucleus and the contralateral medial rectus muscle. Infarction accounts for 38% of INO cases with mostly being unilateral (87%), followed by demyelination (34%), which mostly being bilateral (73%). Lacunar infarct is the most common ischemic stroke. INO can be easily missed due to its subtle presentation with no complaints from the patients. A full cranial nerves assessment, includes the extraocular muscles movement, is important. Ischemic and demyelinating INO typically recover. We present here of a case of INO following right lacunar infarct in a 72-year-old Malay woman. She had hypertensive crisis due to missed medications. Her blood pressure was well controlled throughout the hospital admission and finally she was discharged home with continuation of care at her primary facility.

Displaying publications 21 - 40 of 56 in total