MyMedR

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

Fulltext Bilateral scleromalacia perforans and peripheral corneal thinning in Wegener's granulomatosis

Reddy SC, Tajunisah I, Rohana T

Int J Ophthalmol, 2011;4(4):439-42.

PMID: 22553696 DOI: 10.3980/j.issn.2222-3959.2011.04.22

A rare case of bilateral scleromalacia perforans, bilateral peripheral corneal thinning (contact lens cornea) and unilateral orbital inflammatory disease in a 50 year old female patient with an indolent form Wegener's granulomatosis(WG) involving lungs and sinuses is reported. The patient survived for 12 years after the initial diagnosis of systemic disease. There was perforation of left globe following trauma and no perforation of the right globe till the last follow up of the patient.

Fulltext Correlation of serum insulin like growth factor-I with retinopathy in Malaysian pregnant diabetics

Adzura S, Muhaya M, Normalina M, Zaleha AM, Sharifa Ezat WP, Tajunisah I

Int J Ophthalmol, 2011;4(1):69-72.

PMID: 22553613 DOI: 10.3980/j.issn.2222-3959.2011.01.16

AIM: To study the association of serum insulin-like growth factor-I (IGF-I) with diabetic retinopathy.

METHODS: Serum IGF-1 levels were measured in 25 pregnant diabetic patients and 25 pregnant non-diabetic patients who were matched for age, ethnicity, parity and period of gestation. Fundus examination was performed in both groups at 28, 32 and 36 weeks of gestation.

RESULTS: The serum IGF-I level was significantly elevated in pregnant diabetics compared to pregnant non-diabetics (366±199μg/L vs 184±89μg/L, (P=0.0001) at 24 weeks, 535±251μg/L vs 356±89μg/L, (P=0.007) at 32 weeks and 404±166μg/L vs 264±113μg/L, (P=0.003) at 36 weeks of gestation). The pregnant diabetics with established diabetes had significantly higher IGF-1 level than gestational diabetes at 28, 32 and 36 weeks of gestation. The serum IGF-I level in pregnant diabetics with retinopathy was significantly higher than that in those without retinopathy at all periods of gestation.

CONCLUSION: Increased serum IGF-1 in pregnancy may increase the risks for retinopathy.

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

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

Fulltext The association between various visual function tests and low fragility hip fractures among the elderly: a Malaysian experience

Chew FL, Yong CK, Mas Ayu S, Tajunisah I

Age Ageing, 2010 Mar;39(2):239-45.

PMID: 20065356 DOI: 10.1093/ageing/afp259

BACKGROUND: hip fractures are an increasing source of morbidity and mortality in older people. The role of visual function tests such as visual impairment, stereopsis, contrast sensitivity and visual field defects in low fragility hip fractures in Asian populations is not well understood.
OBJECTIVE: to determine the association between various visual function tests and low fragility hip fractures in an Asian population.
DESIGN: case-control study.
SETTING: University Malaya Medical Centre, Kuala Lumpur, Malaysia.
SUBJECTS: 108 cases aged > or = 55 years admitted with low fragility fractures and 108 controls (matched for age, gender and race).
METHODS: both cases and controls underwent a detailed ophthalmological examination, which included visual acuity, stereopsis, contrast sensitivity and visual field testing.
RESULTS: poorer visual acuity (odds ratio, OR = 4.08; 95% confidence interval, CI: 1.44, 11.51), stereopsis (OR = 3.60, 95% CI: 1.55, 8.38), contrast sensitivity (OR = 3.34, 95% CI: 1.48, 7.57) and visual field defects (OR = 11.60, 95% CI: 5.21, 25.81) increased the risk of fracture. Increased falls were associated with poorer visual acuity (OR = 2.30, 95% CI: 1.04, 5.13), stereopsis (OR = 2.11, 95% CI: 1.03, 4.32), contrast sensitivity (OR = 2.12, 95% CI: 1.05, 4.30) and visual field defects (OR = 3.40, 95% CI: 1.69, 6.86).
CONCLUSION: impaired visual acuity, stereopsis, contrast sensitivity and visual field defects are associated with an increased risk of low fragility hip fractures. We recommend that all patients aged > or = 55 should have an annual ophthalmological examination that includes visual acuity, contrast sensitivity, stereopsis and visual field testing to assess the risks for falls and low fragility fractures.

Fulltext Images in clinical medicine. Retinal detachment in malignant hypertension

Tajunisah I, Patel DK

N Engl J Med, 2009 Aug 27;361(9):899.

PMID: 19710488 DOI: 10.1056/NEJMicm0802683

Fulltext Ophthalmology inpatient consultation: does it make a difference to inpatient management?

Tajunisah I, Azida J, Zurina ZA, Reddy SC

Med J Malaysia, 2009 Jun;64(2):130-3.

PMID: 20058572 MyJurnal

Ophthalmology consultation is one of the commonest requested services for inpatients in a tertiary hospital. A total of 290 ophthalmology consultation requests were received over a period of six months (average 12 consultation requests per week) and from these, 222 patients were examined. The patient demographics, the hospitalization data, type of consultations (screening, new problem, preexisting problem), reasons for consultations and the ophthalmology diagnosis were determined. Out of 290 consultation requests, internal medicine services requested the highest number (95, 32.8%); the commonest type of consultation was screening for eye diseases (161, 55.5%) and the most common reason for consultation was to rule out diabetic retinopathy (125, 43.1%). The top five ophthalmology diagnoses after examination were diabetic retinopathy (45, 20.3%), diabetic retinopathy ruled out (37, 16.6%), conjunctivitis (12, 5.4%), refractive error (11, 4.8%) and normal ocular examination (11, 4.9%). Inpatient ophthalmologic procedures were performed in 146 patients, the commonest of which was retinal laser photocoagulation. A total of 133 (59.9%) inpatients had a change in their management as a result of the ophthalmology consultation.

Acute retinal necrosis by cytomegalovirus in an immunocompetent adult: case report and review of the literature

Tajunisah I, Reddy SC, Tan LH

Int Ophthalmol, 2009 Apr;29(2):85-90.

PMID: 18026692

A rare case of acute retinal necrosis caused by cytomegalovirus in an immunocompetent adult, diagnosed by polymerase chain reaction of vitreous aspirate, with good visual outcome after intravitreal and intravenous ganciclovir and oral prednisolone therapy, is reported. A 50-year-old healthy lady presented with redness and diminution of vision in her right eye of 10 days duration. She had anterior chamber inflammation, marked vitritis, and anterior retinal necrosis in the right eye. Blood and other investigations did not reveal any infectious diseases and HIV testing was negative. The retinal lesions and panuveitis resolved with treatment. Two months later she developed retinal detachment which was treated successfully. The best-corrected vision was 6/12 in the right eye. Seven cases of cytomegalovirus ocular infection in immunocompetent healthy adults, reported in the literature, were reviewed. The different presentations of this disease and the importance of suspecting this causative agent are highlighted.

Fulltext Awareness and knowledge on eye donation among university students

Bharti MK, Reddy SC, Tajunisah I, Ali NA

Med J Malaysia, 2009 Mar;64(1):41-5.

PMID: 19852320 MyJurnal

Four hundred (400) students studying first year Medicine, Dentistry, Laboratory Technology, Pharmacy, Biomedicine and Bioengineering degree courses in the University of Malaya were assessed on their awareness and knowledge on eye donation using an open ended questionnaire. The majority of the students (344, 86%) in this study were aware about eye donation; the awareness was higher in biomedical (77.1%) and medical students (76.7%) compared to the others (55.9%-70.7%). One hundred and eight students (27%) were willing to donate their eyes. Most of the students (376, 94%) did not know about any eye bank in Malaysia. One hundred and sixty (40%) students were aware that whole eye can be removed from the donor and 101 (25.25%) were aware that the cornea can be removed separately. However, only 121 (30.25%) knew that donated eyes were used for corneal grafting. More than half of the students (231, 57.7%) did not know that the donor eye could be stored before transplantation. The results of this study indicate that there is a need to educate the young adults in our society about corneal transplantation so that they can in turn motivate other members of society and their own family members to become eye donors, thus facilitating the availability of donor corneas for corneal transplantation in Malaysia.

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.

Retinal phlebitis associated with autoimmune hemolytic anemia

Chew FL, Tajunisah I

Ocul Immunol Inflamm, 2009 Nov-Dec;17(6):394-5.

PMID: 20001258 DOI: 10.3109/09273940903260204

To describe a case of retinal phlebitis associated with autoimmune hemolytic anemia.

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.

Fulltext Knowledge and practice of contact lens wear and care among medical students of University of Malaya

Tajunisah I, Ophth M, Reddy SC, Phuah SJ

Med J Malaysia, 2008 Aug;63(3):207-10.

PMID: 19248691 MyJurnal

The knowledge related to contact lens wear and practice care of contact lenses among medical students of University of Malaya was assessed through a structured questionnaire. One hundred and twenty-one contact lens wearers participated in this study. Majority of contact lens wearers were females (106, 87.6%); the duration of contact lens wear varied from less than six months to two years or more; 53 (43.8%) cited cosmetic purpose for wearing contact lens; 16 (13.2%) were not removing their contact lenses prior to sleeping at night. Despite 107 (88.4%) were aware of complications of contact lens usage, only 102 (84.3%) were adhering strictly to proper hygiene and contact lens care; and 17 (14%) continued wearing in spite of eye symptoms. Forty seven (38.8%) students sought ophthalmic consultation for eye problems. Improper practice of contact lens wear and care even in educated users such as medical students could increase the risk of complications. Therefore, a need for more education to the consumers is desired.

Reddy SC, Tajunisah I

Ann Ophthalmol (Skokie), 2008;40(1):39-44.

PMID: 18556981

Fifty-six contact lens-related corneal ulcers (central in 32; hypopyon in 24 and stromal abscess in 6) were studied. Culture was positive in 78.9%. Corneal ulcers healed with intense antibiotic therapy in nearly all patients. Increased awareness of lens care/disinfection and frequent replacement of storage cases and solution, and early detection of pathogens and intensive appropriate antibiotic therapy are key points in management.

Fulltext Prevalence of eye diseases and visual impairment in urban population - a study from University of Malaya Medical Centre

Reddy S, Tajunisah I, Low K, Karmila A

Malays Fam Physician, 2008;3(1):25-8.

PMID: 25606108 MyJurnal

One thousand one hundred and sixty-nine (1169) patients were examined in the Eye Clinic of University of Malaya Medical Centre over a period of three weeks to determine the prevalence of eye diseases and visual impairment. Age, gender, race, visual acuity and diagnosis of patients were noted from the case records. Cataract (385, 32.9%) was the most common eye disease seen in our study followed by glaucoma (274, 23.4%). Refractive errors were seen in 126 (10.8%) while diabetic retinopathy was noted in 113 (9.7%) patients. One hundred and fifteen (9.6%) patients had visual impairment and 11 (0.9%) had blindness in our study according to WHO classification of visual impairment. Refractive errors are the most common causes of visual impairment in children, while cataract, glaucoma and diabetic retinopathy account for visual impairment in elderly people. All these eye diseases are treatable and the severe eye conditions may be potentially preventable with early diagnosis.
Study site: Eye Clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Fulltext Bilateral Panuveitis in a Case of Ocular Sarcoidosis

Payman, A.K., Tajunisah, I., Ahmad, F.

International Medical Journal Malaysia, 2008;7(1):0-0.

MyJurnal

Glaucoma is a major cause of permanent visual loss in patients with sarcoid uveitis.In this case glaucoma occurred early in the course of the disease and IOP started to rise up after one month from the initial presentation. Uveitic glaucoma can be extremely difficult to treat; pilocarpine is not normally used in eyes with active inflammation. Patients with uveitis respond poorly to laser trabeculoplasty, and filtering procedures usually fail. Success of modified goniotomy, trabeculectomy and Molteno valve implantation were reported. More drastic therapy, such as cyclodestructive procedures, may be required in the most severe cases. In this case the challenge in preserving the vision. by keeping the balance between the need to control the inflammation and the necessity to avoid the treatment related complications.

Fulltext Dropped nucleus following phacoemulsification cataract surgery

Tajunisah I, Reddy SC

Med J Malaysia, 2007 Dec;62(5):364-7.

PMID: 18705466 MyJurnal

Twenty two cases of dropped nucleus following 1,196 phacoemulsification procedures in cataract surgery were examined retrospectively to determine the incidence, predisposing factors and visual outcomes of this dreaded complication. All the cases underwent pars plana vitrectomy and the lens fragments were removed with phacofragmotome, vitrectomy cutter or delivered through limbus. The incidence of dropped nucleus was 1.84%. The predisposing factors were hard cataracts (13.6%), polar cataracts (9.1%), previously vitrectomized eyes (4.5%) and high myopia (4.5%). The final visual outcome was > or = 6/12 in 10 eyes (45.5%); complications were seen in 5 eyes (22.7%). The interval between initial surgery and vitrectomy, the method of fragment removal and the type of lens implanted, did not influence the final visual outcome.

Diurnal variation of intraocular pressure in suspected glaucoma patients and their outcome

Tajunisah I, Reddy SC, Fathilah J

Graefes Arch Clin Exp Ophthalmol, 2007 Dec;245(12):1851-7.

PMID: 17901971

BACKGROUND: A case-controlled prospective study was conducted to evaluate the diurnal variation of intraocular pressure (IOP); the mean, the amplitude of variation and the peak and trough times of pressure readings in the suspected open-angle glaucoma patients as compared with a control group. We also looked at the outcome of these suspects after diurnal variation of IOP measurements.

METHODS: Diurnal variation of intraocular pressure was measured in 202 eyes of suspected open-angle glaucoma patients and 100 control eyes, at 4-hourly intervals for 24 hours (phasing). Based on the phasing results, optic disc changes and visual field defects, the patients were diagnosed as primary open angle glaucoma (POAG), normal tension glaucoma (NTG), ocular hypertension (OHT), or physiologic cup (PC), or still remained as glaucoma suspects due to inconclusive diagnosis. The last group (glaucoma suspects) was then followed up 6-monthly for their eventual outcome.

RESULTS: The highest percentage of suspected glaucoma patients had peak (maximum) readings in the mid-morning (10-11 A.M.) and trough (minimum) readings after midnight (2-3 A.M.); the highest percentage of control group had peak readings in the late evening (6-7 P.M.) and trough readings after midnight (2-3 A.M.). The mean amplitude of variance was 6 mm Hg in suspected glaucoma group and 4 mm Hg in the control group. After 'phasing', 18.8% of the suspected glaucoma patients were diagnosed as POAG, 16.8% as NTG, 5% as OHT, and 28.7% as physiologic cup; 30.9% remained as glaucoma suspects. After 4 years follow-up, 70% of the glaucoma suspects still remained as glaucoma suspects, 6.7% developed NTG and another 6.7% POAG; 16.6% were normal.

CONCLUSIONS: Serial measurement of IOP ( phasing) in a 24-hour period is still needed, in order not to miss the peak and the trough IOP readings in suspected open-angle glaucoma patients, which helps in better management of glaucoma. Among 30.9% of patients who remained as glaucoma suspects after the initial phasing, 13.4% developed NTG/POAG over a period of 4 years.

Acute retinal necrosis complicating chicken pox in a healthy adult: a case report and review of literature

Tajunisah I, Reddy SC

Ann Ophthalmol (Skokie), 2007;39(1):57-62.

PMID: 17914207

We report a case of unilateral acute retinal necrosis (ARN) with marked vitritis and retinal necrosis leading to retinal breaks following chicken pox successfully treated with intravenous acyclovir followed by oral acyclovir, orbital floor triamcinolone injections to contain the inflammation, and barrier laser therapy to secure the retinal breaks with good visual outcome. This case is unusual in its severity and the novel use orbital floor triamcinolone therapy to contain ARN inflammation.

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