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Non-arteritic anterior ischaemic optic neuropathy secondary to menorrhagia in a young healthy woman

Koh KL, Sonny Teo KS, Chong MF, Wan Hitam WH

BMJ Case Rep, 2018 Jun 27;2018.
PMID: 29950366 DOI: 10.1136/bcr-2018-225113

Non-arteritic anterior ischaemic optic neuropathy (NAION) may develop due to severe anaemia and hypotension which is seen in acute blood loss. The devastating visual loss is often irreversible. We report a case of NAION in a 20-year-old healthy woman, who presented on the third day of a heavy menstrual cycle with hypovolaemic shock. On day 2 of admission, she had sudden right eye blurring of vision at the superior field on awakening from sleep. Funduscopy revealed a pale and swollen right optic disc. There was a dense right superior altitudinal visual field defect. Her haemoglobin level was low (3.6 g/dL), but she refused blood transfusion due to her religious belief (Jehovah's Witness) and opted for conservative management. She later developed right optic atrophy with persistent visual field defect despite an improved haemoglobin level of 10.5 g/dL.
Fulltext Simultaneous Bilateral Optic Neuritis Following Human Papillomavirus Vaccination in a Young Child

Michael NDB, Tuan Jaffar TN, Hussein A, Wan Hitam WH

Cureus, 2018 Sep 24;10(9):e3352.
PMID: 30510863 DOI: 10.7759/cureus.3352

Vaccination-induced optic neuritis is not common. The development of optic neuritis following various vaccinations have been reported, suggesting a possible association between optic neuritis and vaccination. Of those reported cases, influenza vaccines have been the most common. Although rare, those patients who developed optic neuritis following HPV vaccination also presented with other central nervous system (CNS) demyelinating syndromes, especially following a booster dose. We present a rare case of simultaneous isolated bilateral optic neuritis following the first dose of an HPV vaccination in a young child. She received treatment with a systemic corticosteroid that resulted in a good clinical outcome without developing any demyelinating disease.
Fulltext Evaluation of Optic Nerve Head Parameters and Electro-Physiology Among Breast Cancer Patients on Tamoxifen

Ngoo QZ, Wan Hitam WH, Tan CL, Krishna Bhavaraju VM

Cureus, 2022 Jan;14(1):e21042.
PMID: 35155010 DOI: 10.7759/cureus.21042

Introduction To evaluate if early tamoxifen toxicity can be detected by comparing pre-and post-treatment optic nerve head parameters and visual function using Heidelberg Retinal Tomograph III (HRT III) and Pattern Visual Evoked Potential (Pattern VEP). Method This is a prospective study involving 76 eyes of 38 breast cancer patients treated with tamoxifen in Hospital Universiti Sains Malaysia, Kelantan, Malaysia. These patients were examined by a single doctor and the investigations were done by a single technician. The visual acuity, optic nerve function, visual field, optic nerve head parameters on HRT III and Pattern VEP were assessed. The examination was performed before and three months after treatment initiation. Results There was no tamoxifen ocular toxicity found three months post-treatment with tamoxifen. There was no change in visual acuity and optic nerve function post-treatment initiation. There were no statistically significant changes found in optic nerve head parameters on HRT III and P 100 peak latency and amplitude on Pattern VEP. Conclusion Ocular toxicity is a recognized complication of tamoxifen treatment. Tamoxifen optic neuropathy is a potentially irreversible, visually disabling complication. Tamoxifen ocular toxicity was not found three months after tamoxifen treatment initiation among estrogen receptor (ER)-positive breast cancer patients. No early changes in optic nerve head parameters and P 100 peak latency and amplitude changes were found after three months of treatment. A longer duration of monitoring with HRT III and Pattern VEP may be needed to adequately observe for early, subclinical changes in optic nerve head parameters and visual function among tamoxifen users.
Fulltext Compressive Optic Neuropathy Secondary to Sinonasal Undifferentiated Carcinoma in a Young Male

Hassan MN, Wan Hitam WH, Masnon NA, Govindasamy S, Omar AR

Cureus, 2021 Oct;13(10):e19042.
PMID: 34858739 DOI: 10.7759/cureus.19042

Sinonasal undifferentiated carcinoma (SNUC) is an extremely aggressive malignancy. Extension to the orbit and adjacent structures is common, but isolated visual loss as a presenting symptom is rare. We report a rare case of SNUC with bilateral visual loss as the initial manifestation. A 34-year-old gentleman was presented with acute onset loss of vision in both eyes for one week. It was followed by recurrent headaches and epistaxis. Visual acuity in the right eye was 2/60 and 3/60 in the left eye. Funduscopy showed a bilateral swollen disc. Neuroimaging revealed a large mass in the ethmoidal sinus extended laterally causing compression to recti muscles and the optic nerves. The histopathological examination of nasal tissue biopsy showed features of SNUC with bone and perineural invasion. A diagnosis of SNUC with bilateral compressive optic neuropathy was established. The patient underwent tumor debulking and base of skull reconstruction by the neurosurgical team. This was then followed by chemotherapy and radiotherapy. The patient's right eye visual acuity initially improved to 6/9. However, his both eye vision developed into no light perception during treatment. In conclusion, SNUC is a highly aggressive tumor that may present with acute blindness. Early treatment may save a life, but the visual prognosis is guarded due to extensive optic nerve damage caused by tumor compression.
Fulltext Functional Visual Loss in a Young Patient With Systemic Lupus Erythematosus

Abd Hamid A, Zakaria N, Masnon NA, Muhammed J, Wan Hitam WH

Cureus, 2021 Dec;13(12):e20513.
PMID: 35070550 DOI: 10.7759/cureus.20513

We describe a rare case of a patient with systemic lupus erythematosus (SLE) with functional visual loss (FVL). A 30-year-old female had blindness in the left eye due to multiple episodes of optic neuritis with underlying SLE. She presented with blurred vision in the right eye after an upper respiratory tract infection. The visual acuity in the right eye was 6/24, while the left eye had no light perception. The right eye optic nerve function tests were within normal limits. There was a positive relative afferent pupillary defect in the left eye. Fundoscopy showed left optic atrophy, while the right fundus was normal. The patient was treated according to a diagnosis of right retrobulbar optic neuritis. However, despite a course of intravenous methylprednisolone, her right visual acuity deteriorated to light perception. A magnetic resonance imaging (MRI) scan of the brain and orbit was normal. The visual evoked potential (VEP) in the right eye was also normal. The patient was suspected of having FVL and was referred to a psychiatrist. She was diagnosed with major depressive disorder after a full psychiatric assessment.
Fulltext Comparison of retinal vascular geometry in obese and non-obese children

Tai ELM, Kueh YC, Wan Hitam WH, Wong TY, Shatriah I

PLoS One, 2018;13(2):e0191434.
PMID: 29389952 DOI: 10.1371/journal.pone.0191434

PURPOSE: Childhood obesity is associated with adult cardiometabolic disease. We postulate that the underlying microvascular dysfunction begins in childhood. We thus aimed to compare retinal vascular parameters between obese and non-obese children.
METHODS: This was a cross-sectional study involving 166 children aged 6 to 12 years old in Malaysia. Ocular examination, biometry, retinal photography, blood pressure and body mass index measurement were performed. Participants were divided into two groups; obese and non-obese. Retinal vascular parameters were measured using validated software.
RESULTS: Mean age was 9.58 years. Approximately 51.2% were obese. Obese children had significantly narrower retinal arteriolar caliber (F(1,159) = 6.862, p = 0.010), lower arteriovenous ratio (F(1,159) = 17.412, p < 0.001), higher venular fractal dimension (F(1,159) = 4.313, p = 0.039) and higher venular curvature tortuosity (F(1,158) = 5.166, p = 0.024) than non-obese children, after adjustment for age, gender, blood pressure and axial length.
CONCLUSIONS: Obese children have abnormal retinal vascular geometry. These findings suggest that childhood obesity is characterized by early microvascular abnormalities that precede development of overt disease. Further research is warranted to determine if these parameters represent viable biomarkers for risk stratification in obesity.
Fulltext Simultaneous Oculomotor and Trochlear Nerve Palsy in Herpes Zoster Ophthalmicus

Low KL, Nurul-Ain M, Che Hamzah J, Wan Hitam WH

Cureus, 2022 Oct;14(10):e30755.
PMID: 36447705 DOI: 10.7759/cureus.30755

Simultaneous oculomotor and trochlear nerve palsy in Herpes Zoster Ophthalmicus (HZO) is rare. We report a 78-year-old lady who presented with right ptosis while receiving treatment for HZO keratouveitis. Examination showed crusted vesicular lesions on the right V1 dermatome with right complete ptosis and limited right eye extraocular movement on adduction, supraduction, infraduction, and intorsion. There was mild right eye anterior chamber inflammation, while bilateral fundus examinations were normal. Other neurological and systemic examinations were unremarkable. Neuroimaging was also normal. Corticosteroids treatment was started, in addition to oral acyclovir, given for a total course of six weeks. Her ocular motor cranial neuropathy (OMCN) was partially resolved during the follow-up at one year. OMCN can be an isolated complication of HZO, or it may be associated with other neurological complications. Although recovery for OMCN is anticipated, the patient should be closely monitored for the possibility of developing other devastating neurological complications.
Fulltext Recurrent Optic Neuritis in Paediatric Anti-N-Methyl-D-Aspartate Receptor (Anti-NMDAR) Encephalitis: Case Report and Literature Review

Chan JS, Nurul-Ain M, Mohamad NF, Wan Hitam WH, Thavaratnam LK

Neuroophthalmology, 2022;46(4):258-263.
PMID: 35859635 DOI: 10.1080/01658107.2021.2014892

Optic neuritis associated with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis poses a novel challenge and is recognised as being part of overlapping antibody-associated demyelinating syndromes. We report a case of a 10-year-old girl who first presented with anti-NMDAR encephalitis and later developed four episodes of left optic neuritis. Blurring of vision, pain on eye movement, and headache were the striking features in all episodes of optic neuritis. For each recurrent episode of optic neuritis she was treated with intravenous methylprednisolone, following which visual acuity, colour vision, and visual field improved to normal. Neuroimaging was unremarkable. Myelin oligodendrocyte glycoprotein and aquaporin-4 antibody tests were negative. She developed a relapse of anti-NMDAR encephalitis after recurrent episodes of optic neuritis despite being on azathioprine. Intravenous immunoglobulin and cycles of cyclophosphamide were started, and she has been free from optic neuritis and encephalitis for more than one year since. Optic neuritis and anti-NMDAR encephalitis are reversible with intensive immunotherapy. Early and accurate diagnosis can lead to better management of this condition.
Fulltext Orbital Apex Syndrome Secondary to Huge Primary Ethmoidal Sinus Mucocele: A Case Report

Loh SA, Wan Hitam WH, Ramli RR, Sayuti KA, Sonny Teo KS

Cureus, 2023 Feb;15(2):e34853.
PMID: 36923171 DOI: 10.7759/cureus.34853

Ethmoidal sinus mucoceles are benign expansile lesions that may progressively invade the orbit causing optic nerve compression and its nearby structures. We report a rare case of primary ethmoidal sinus mucocele instigating orbital apex syndrome. A 40-year-old man presented with right eye (RE) progressive blurring of vision with diplopia for 2 weeks. It was preceded by right-sided facial pain for 3 months. Clinical examination revealed RE proptosis with multiple cranial nerves palsy involving right cranial nerves II, III, IV, V, and VI, suggestive of right orbital apex syndrome. Magnetic resonance imaging (MRI) demonstrated right eye proptosis and right ethmoidal mucocele with intracranial and right intraorbital extension compressing the right medial rectus and optic nerve. The patient underwent an uncomplicated endoscopic sinus surgery resulting in a return to normal appearance and function post-operation. Thus, ethmoidal mucoceles are benign and curable with early recognition and intervention.
Fulltext Bilateral Optic Atrophy in a Young Patient With Chronic Anaemia Secondary to End-Stage Renal Disease

Ab Gani NH, Ibrahim M, Wan Hitam WH, Masnon NA, Hassan A

Cureus, 2021 Mar 18;13(3):e13969.
PMID: 33884230 DOI: 10.7759/cureus.13969

End-stage renal disease (ESRD) is associated with a number of serious complications, including increased cardiovascular disease, anaemia and metabolic bone disease. Optic atrophy secondary to chronic anaemia in ESRD is rare. We report a case of bilateral optic atrophy in a young patient with chronic anaemia secondary to ESRD. A 23-year-old lady with ESRD, presented with progressive blurring of vision in her left eye for a period of six months. Visual acuity in the left eye was counting finger and the right eye was 6/6. Left optic nerve functions were significantly reduced. Bilateral anterior segments and intraocular pressure were normal. Funduscopy showed bilateral pale disc with arteriolar attenuation. The infective, autoimmune and demyelinating screening were negative. Serial full blood count indicated low haemoglobin and haematocrit value. The full blood picture revealed normocytic normochromic anaemia. Neuroimaging was normal. The patient was diagnosed as having bilateral optic atrophy secondary to chronic anaemia due to ESRD. Chronic anaemia is a potential cause of optic atrophy in a young patient with chronic disease. Management of anaemia in such cases is crucial to prevent irreversible complications including optic atrophy and blindness.
Fulltext Binasal Field Defect in Non-arteritic Anterior Ischemic Optic Neuropathy

Syed Mohd Khomsah SNH, Muhammed J, Wan Hitam WH, Haron J

Cureus, 2023 Aug;15(8):e43722.
PMID: 37727156 DOI: 10.7759/cureus.43722

Non-arteritic anterior ischemic optic neuropathy (NAION) is the most common cause of optic neuropathy in older adults and is usually associated with an altitudinal visual field defect. Binasal hemianopia is a rare visual field presentation, and most causes are due to ocular pathology instead of brain pathology. It is an infrequent finding in NAION. We report a rare presentation of binasal hemianopia visual field defect in a patient with NAION. This a case of an elderly lady with underlying uncontrolled type 2 diabetes mellitus, hypertension, and dyslipidemia who presented with a sudden onset of painless blurring of vision in the left eye. She had a similar episode of blurred vision involving the other eye two years ago. Her visual acuity was reduced in both eyes. Humphrey visual field showed a binasal field defect. Fundoscopy showed mild hyperemic optic disc swelling in the left eye and a pale disc in the right eye. The CT scan and MRI were normal. She was co-managed with the medical team to control her systemic risk factors. Although NAION is the most common cause of optic neuropathy in older adults, binasal hemianopia is a rare visual field presentation in NAION. The history and assessment from this case add important information toward diagnosing NAION.
Evaluation of Retinal Nerve Fiber Layer and Macular Thickness Pre- and Post-Chemotherapy With Carboplatin and Paclitaxel in Patients With Endometrial and Ovarian Cancer

Chin JJ, Wan Hitam WH, Chong MF, Lee SJ, Yew JM, Ngoo QZ

Cureus, 2023 Aug;15(8):e43943.
PMID: 37746413 DOI: 10.7759/cureus.43943

Background Carboplatin and paclitaxel are two standard chemotherapeutic agents known to cause neurotoxicity. In this study, we aim to evaluate the toxicity of these agents by measuring the peripapillary retinal nerve fiber layer (RNFL) and macular thickness in patients with endometrial and ovarian cancers who are receiving them. Methods A one-year prospective cohort study involving 28 patients who were treated intravenously with carboplatin (200-400 mg/m2) and paclitaxel (175 mg/m2) three-weekly for six cycles was conducted. RNFL and macula thickness were measured using optical coherence tomography (OCT) before the commencement of chemotherapy, after the third cycle, and one month after the sixth cycle. The main outcome measurements were the average RNFL thickness and central subfield thickness of the macula. Results The mean age of the 28 participants was 54.68 years old (standard deviation [SD] 9.03). Eleven had endometrial cancer, while 17 had ovarian cancer. The mean of the average RNFL thickness during baseline pre-chemotherapy was 96.43 µm (SD 11.39). One month after cessation of treatment, the mean RNFL thickness increased to 101.57 µm (SD 13.54). Statistical analysis showed a significant increment in the mean RNFL thickness (p ≤ 0.001), from baseline to after three cycles, and baseline to one month after six cycles of chemotherapy, except the nasal quadrant. The increment of all macular quadrants was statistically significant (p < 0.05) except for central subfield thickness. Conclusion Systemic administration of carboplatin and paclitaxel affected both the peripapillary RNFL and macula thickness. This represents early evidence of subacute subclinical retinal toxicity. OCT can be used as a screening tool to assess peri-chemotherapeutic retinal alterations.
Fulltext A Study on the Central Corneal Thickness of Primary Angle Closure and Primary Angle Closure Glaucoma and Its Effect on Visual Field Progression

Tan HK, Ahmad Tajuddin LS, Lee MY, Ismail S, Wan-Hitam WH

Asia Pac J Ophthalmol (Phila), 2015;4(3):161-5.
PMID: 26065503 DOI: 10.1097/APO.0000000000000058

PURPOSE: To determine the mean central corneal thickness (CCT) and the relationship between the CCT and visual field progression in primary angle closure (PAC) and primary angle closure glaucoma (PACG).
DESIGN: A combined cross-sectional and prospective study on PAC and PACG.
METHODS: A total of 35 eyes were included in the study for each group of normal control, PAC, and PACG patients from eye clinics in Kota Bharu, state of Kelantan, Malaysia, from January 2007 to November 2009. The PAC and PACG patients were divided into thin and thick CCT groups. They were followed up for 12 to 18 months for visual field progression assessment with their mean Advanced Glaucoma Intervention Study (AGIS) score.
RESULTS: The CCT was 516.8 ± 26.0 µm for PAC and 509.7 ± 27.4 µm for PACG. Both were significantly thinner compared with the control group with CCT of 540 ± 27.8 µm (P < 0.001). There was a statistically significant increase in the mean AGIS score after 12.9 ± 1.7 months of follow-up in the thin CCT group for PACG (P = 0.002). However, no significant increase in the mean AGIS score was found for the thick CCT group in PACG and for both thin and thick CCT in PAC.
CONCLUSIONS: The PAC and PACG had statistically significant thinner CCT compared with the controls. Thin CCT was associated with visual field progression based on the mean AGIS score in PACG.
Fulltext A Case Report of Bilateral Optic Perineuritis With Idiopathic Intracranial Hypertension: Challenges in Diagnosis and Management

Shahrudin NH, Muhammed J, Wan Hitam WH, Sapiai NA, Abdul Halim S

Cureus, 2024 Feb;16(2):e54692.
PMID: 38523970 DOI: 10.7759/cureus.54692

Optic perineuritis (OPN) refers to the inflammation of the optic nerve sheath and it is a rare form of idiopathic orbital inflammatory disease. We report a rare case of bilateral OPN in an obese female teenager with idiopathic intracranial hypertension (IIH). She was initially presented with painless bilateral blurring of vision that was progressively worsening for three weeks duration. Visual acuity of both eyes was hand movement with no relative afferent pupillary defect detected. The confrontation visual field test showed central scotoma. Both anterior segments were unremarkable. Fundoscopy showed a swollen optic disc bilaterally, with extensive flame-shaped hemorrhages surrounding the disc area and dot blot hemorrhages in the posterior pole. A magnetic resonance imaging scan of the brain and orbit revealed the presence of bilateral optic nerve sheath enhancement with empty sella turcica. The patient was diagnosed with bilateral OPN with IIH. She received an initial high dose of systemic corticosteroid followed by a slow tapering dose. She was monitored by the neuromedical team for her IIH. She was followed up for about a year. The final best corrected visual acuity in the right eye was 6/36 and the left eye was 6/60. In conclusion, OPN poses challenges in diagnosis and management. This case emphasizes the importance of considering OPN in the differential diagnosis of optic nerve-related symptoms, as prompt recognition and intervention are crucial for favorable outcomes.
Neurofibromatosis Type 2 Presenting with Oculomotor Ophthalmoplegia and Distal Myopathy

Tevaraj JM, Li Min ET, Mohd Noor RA, Yaakub A, Wan Hitam WH

Case Rep Ophthalmol Med, 2016;2016:1701509.
PMID: 27738538

Neurofibromatosis type 2 usually presents with bilateral acoustic schwannomas. We highlight the rare presentation of neurofibromatosis initially involving third nerve. A 23-year-old Malay female presented with left eye drooping of the upper lid and limitation of upward movement for 8 years. It was associated with right-sided body weakness, change in voice, and hearing disturbance in the right ear for the past 2 years. On examination, there was mild ptosis and limitation of movement superiorly in the left eye. Both eyes had posterior subcapsular cataract. Fundoscopy showed generalised optic disc swelling in both eyes. She also had palsy of the right vocal cord, as well as the third and eighth nerve. There was wasting of the distal muscles of her right hand, with right-sided decreased muscle power. Pedunculated cutaneous lesions were noted over her body and scalp. MRI revealed bilateral acoustic and trigeminal schwannomas with multiple extra-axial lesions and intradural extramedullary nodules. Patient was diagnosed with neurofibromatosis type 2 and planned for craniotomy and tumour debulking, but she declined treatment. Neurofibromatosis type 2 may uncommonly present with isolated ophthalmoplegia, so a thorough physical examination and a high index of suspicion are required to avoid missing this condition.
Fulltext Concurrent Tuberculous Optic Neuritis and Optic Perineuritis in a Patient With Human Immunodeficiency Virus (HIV)

Ismail MA, Shariffudin NS, Bt Abd Jalil NF, Yew TC, Wan Hitam WH

Cureus, 2024 Mar;16(3):e55867.
PMID: 38595896 DOI: 10.7759/cureus.55867

Concurrent tuberculous optic neuritis (ON) and optic perineuritis (OPN) in a patient with human immunodeficiency virus (HIV) is extremely rare. HIV-induced progressive CD4 depletion is associated with an increased risk of tuberculosis (TB), disseminated TB, and death. Early detection and initiation of anti-TB therapy with corticosteroid commencement helps in achieving better visual outcomes. Interestingly, we report a case of concurrent ON and OPN in a patient with HIV-TB co-infection. A 29-year-old lady, a prisoner, with newly diagnosed treatment-naive HIV, presented with acute-onset reduced vision in the left eye for 10 days. It was associated with pain in eye movement and headache. The patient was known to be a drug abuser since the age of 19 years and was a sexual worker. Her CD4 count was 292 cells/mm3.Visual acuity of the right eye was 6/12 with a pinhole of 6/9, and there was no perception of light (NPL) in all four quadrants of the left eye. Relative afferent pupillary defect (RAPD) was positive in the left eye. Both anterior segments were unremarkable. The right eye fundoscopy showed a normal optic disc, while the left eye showed a hyperemic disc. During subsequent follow-up, the patient had reduced right eye vision, and the vision dropped to 6/30 with a pinhole of 6/15. Her erythrocyte sedimentation rate (ESR) was raised to 88 mm/h. The Mantoux test was positive. Chest radiography was normal. MRI of the brain and orbit showed significant enhancement of the right optic nerve and left optic nerve sheath suggesting the diagnosis of right eye ON and left eye OPN secondary to TB. The patient was co-managed with an infectious disease team. She was started on highly active antiretroviral therapy (HAART) treatment (oral Tenvir-EM and efavirenz) upon presentation. Anti-TB therapy was commenced two months later. She was started on the intensive phase of the anti-TB regime followed by the maintenance phase. Oral dexamethasone was given concurrently according to the central nervous system (CNS) TB regime for six weeks. During follow-up, her right eye visual acuity was 6/9, and her left eye visual acuity improved to 6/12. Fundoscopy showed bilateral pale discs. To date, no episodes of recurrence have been seen.
Fulltext Intra-axial Cortical-Based Tumour Presented as Homonymous Hemianopia in a Young Patient: A Diagnostic Dilemma

Aminuddin L, Wan Hitam WH, Mohamad SA, Abdul Halim S, Sapiai NA

Cureus, 2024 Jul;16(7):e64963.
PMID: 39161507 DOI: 10.7759/cureus.64963

Intra-axial cortical-based tumours are rare tumours affecting children and young adults. These tumours can be classified as either low-grade or high-grade, depending on their aggressiveness and rate of growth. We report a case of homonymous hemianopia secondary to an intra-axial cortical-based tumour in a young patient. A 26-year-old lady presented with bilateral blurring of vision for three weeks associated with a headache. Visual acuity was 6/6 in both eyes. Bilateral optic nerve functions were normal. The Humphrey visual field test showed left-homonymous hemianopia. A CT scan and MRI of the brain revealed an intra-axial cortical-based tumor. Differential diagnoses include pleomorphic xanthoastrocytoma (PXA), ganglioglioma, oligodendroglioma, and dysembryoplastic neuroepithelial tumour (DNET). The patient was treated conservatively and closely monitored through clinic follow-up.
Leber Hereditary Optic Neuropathy With Significant Visual Recovery: An MT-ND6 Mutation in a Malay Patient

Ozir MA, Nordin MH, Hashim SE, Adzahar S, Ahmad MA, Ng KS, et al.

Cureus, 2024 Oct;16(10):e71210.
PMID: 39525159 DOI: 10.7759/cureus.71210

Leber hereditary optic neuropathy (LHON) is a rare maternally inherited mitochondrial disorder that predominantly affects young men, leading to optic nerve degeneration and subsequent vision loss. The rarity of LHON and its clinical similarity to optic neuritis complicates diagnosis, necessitating genetic testing to confirm specific point mutations and predict visual outcomes. We report a rare case of an 18-year-old Malay male with m.14484T>C/MT-ND6 mutation of LHON, who demonstrated remarkable spontaneous visual recovery over a three-year follow-up period. This report highlights the pivotal role of genetic testing in diagnosing LHON, explores the variability in visual outcomes associated with different mutations, and underscores the potential for spontaneous recovery in specific mutation variants. Early diagnosis, genetic counseling, and supportive management are critical for optimizing outcomes and improving quality of life.
Orbital Abscess With Vision Threatening Optic Neuropathy Due to Odontogenic Sinusitis in Adolescence: A Case Report and Literature Review

Harun NF, Wan Hitam WH, Mohd Fauzi Yap MF, Jalaluddin J

Cureus, 2024 Oct;16(10):e71664.
PMID: 39553123 DOI: 10.7759/cureus.71664

Orbital abscesses secondary to odontogenic infections are rare but can lead to serious complications, including compressive optic neuropathy and permanent vision loss, if not diagnosed and treated promptly. We present the case of a 13-year-old child with a radiologically confirmed orbital abscess associated with a recent odontogenic infection. The patient initially presented with a one-week history of right eyelid swelling and fever. The symptoms began after treatment for dental caries, during which the patient was prescribed a three-day course of oral antibiotics. Despite emergency pulp extirpation, the swelling worsened, leading to severe proptosis, decreased vision, and mild optic nerve dysfunction. Surgical exploration of the right orbit with incision and drainage revealed 8 mL of thick purulent material. Culture results confirmed Streptococcus intermedius as the causative organism. Following a combination of intravenous antibiotics and surgical intervention, the patient showed significant improvement, with resolution of swelling and restoration of vision. This case highlights the critical importance of early diagnosis, timely imaging, and surgical and medical management integration in preventing vision-threatening complications of orbital abscesses caused by odontogenic infections in pediatric patients.
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.

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