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Dieffenbachia-Induced Transient Crystalline Keratopathy: A Case Report and Review of Previously Reported Cases

Chong SH, Ch'ng TW, Mustapha M

Cureus, 2022 Jan;14(1):e21146.
PMID: 35165597 DOI: 10.7759/cureus.21146

We report a case of transient crystalline keratopathy induced by contact with Dieffenbachia plant sap and review previous reports on plant-induced crystalline keratopathy. A 27-year-old man with underlying diabetes mellitus presented with ocular pain, redness, and tearing after Dieffenbachia plant sap accidentally entered his right eye while he had been cutting the grass one day prior to presentation. The visual acuity of his right eye was 6/9. His conjunctiva was injected with an epithelial defect over the inferior conjunctiva. There were fine needle-like oxalate crystals in the epithelial and stromal layer of the cornea inferiorly. He was treated with topical dexamethasone and levofloxacin. The crystals disappeared from the cornea when he was reviewed one month later. He maintained good visual acuity, and no corneal opacity was noted. In conclusion, patients with crystalline keratopathy after exposure to Dieffenbachia plant sap can have a full recovery without sequelae after supportive treatment. Eliciting the history from patients regarding the type of plant involved is imperative. Ophthalmologists should be aware of the possibility of crystalline keratopathy developing, even though most patients retain good vision.
Dynamic changes of Elschnig pearls posterior capsule opacification

Basiron SF', Khaw AML, Ch'ng TW, Othman O

BMJ Case Rep, 2022 Mar 29;15(3).
PMID: 35351754 DOI: 10.1136/bcr-2021-248259

An adolescent female with underlying bilateral pseudophakia and idiopathic intermediate uveitis had reduced visual acuity due to posterior capsule opacification (PCO). The rapid progression and different morphological formations of Elschnig pearls were not influenced by the uveitis and immunosuppressive treatment. No capsulotomy was performed, and the PCO regressed spontaneously over time.
Fulltext Monsoon and primary acute angle closure in Malaysia

Ch'ng TW, Mosavi SA, Noor Azimah AA, Azlan NZ, Azhany Y, Liza-Sharmini AT

Med J Malaysia, 2013 Oct;68(5):410-4.
PMID: 24632871 MyJurnal

INTRODUCTION: Acute angle closure (AAC) without prompt treatment may lead to optic neuropathy. Environmental factor such as climate change may precipitate pupillary block, the possible mechanism of AAC.

OBJECTIVE: To determine the association of northeast monsoon and incidence of AAC in Malaysia.

MATERIALS AND METHODS: A retrospective study was conducted on AAC patients admitted to two main tertiary hospitals in Kelantan, Malaysia between January 2001 and December 2011. The cumulative number of rainy day, amount of rain, mean cloud cover and 24 hours mean humidity at the estimated day of attack were obtained from the Department of Meteorology, Malaysia.

RESULTS: A total 73 cases of AAC were admitted with mean duration of 4.1SD 2.0 days. More than half have previous history of possibility of AAC. There was higher incidence of AAC during the northeast monsoon (October to March). There was also significant correlation of number of rainy day (r=0.718, p<0.001), amount of rain (r=0.587, p<0.001), cloud cover (r=0.637, p<0.001), mean daily global radiation (r=- 0.596, P<0.001), 24 hours mean temperature (r=-0.298, p=0.015) and 24 hours mean humidity (r=0.508, p<0.001) with cumulative number of admission for AAC for 12 calendar months.

CONCLUSION: Higher incidence of AAC during northeast monsoon suggested the effect of climate as the potential risk factor. Prompt treatment to arrest pupillary block and reduction of the intraocular pressure is important to prevent potential glaucomatous damage. Public awareness of AAC and accessibility to treatment should be part of preparation to face the effect of northeast monsoon.
Fulltext Effect of surgical intraocular pressure lowering on retinal structures - nerve fibre layer, foveal avascular zone, peripapillary and macular vessel density: 1 year results

Ch'ng TW, Gillmann K, Hoskens K, Rao HL, Mermoud A, Mansouri K

Eye (Lond), 2020 03;34(3):562-571.
PMID: 31409906 DOI: 10.1038/s41433-019-0560-6

OBJECTIVES: To determine the effect of surgical intraocular pressure (IOP) lowering on peripapillary retinal nerve fibre layer thickness (RNFL), fovea avascular zone (FAZ), peripapillary and macular vessel density (VD) in glaucoma using with optical coherence tomography angiography (OCT-A).
METHODS: This was a prospective observational study performed at the Glaucoma Research Centre, Montchoisi Clinic, Lausanne. In total 40 eyes with open-angle glaucoma were included. OCT-A scans were performed before glaucoma surgery, and at 1-month, 3-month, 6-month, and 12-month post-operatively. AngioVue AngioAnalytic (Optovue Inc, Fremont, CA) software was used to analyse the RNFL, FAZ, peripapillary and macular VD. Changes were analysed using analysis of variance (ANOVA) models.
RESULTS: Mean IOP dropped from 19.4 (±7.0) mmHg pre-surgery and stabilized at 13.0 (±3.1) mmHg at 12 months (p
Fulltext Ocular Perfusion Pressure and Severity of Glaucoma: Is There a Link?

Ch'ng TW, Chua CY, Ummi Kalsom MA, Azhany Y, Gong V, Rasool A, et al.

J Curr Glaucoma Pract, 2021 11 2;15(2):78-85.
PMID: 34720497 DOI: 10.5005/jp-journals-10078-1305

Aim and objective: To establish the association between 12-month inter-visits ocular perfusion pressure (OPP) and severity of glaucoma.
Materials and methods: A total of 164 eyes (60 primary open-angle glaucoma, 52 normal-tension glaucoma, and 52 primary angle-closure glaucoma) of 164 patients were analyzed in this prospective cohort study. Patients who demonstrated good compliance to treatment were recruited. The severity of glaucoma was stratified according to the Advanced Glaucoma Intervention Study (AGIS) score based on reliable and reproducible visual field analysis at baseline. OPP was obtained at baseline and a 3-monthly follow-up visit over a 12-month duration. The pattern and fluctuation of mean OPP were studied. Repetitive measure ANOVA and one-way ANOVA were used for statistical analysis.
Results: The inter-visits mean OPP (p = 0.010), systolic OPP (p = 0.020), diastolic OPP (p = 0.010), systolic blood pressure (p = 0.040), and diastolic blood pressure (p = 0.006) showed significant difference with severity of glaucoma. There was no significant difference between mean inter-visits intraocular pressure (IOP) and severity of glaucoma (p = 0.410). The end-stage glaucoma group had the lowest mean OPP and widest inter-visit mean OPP fluctuation. Early and mild glaucoma patients demonstrated higher mean OPP compared with moderate, severe, and end-stage glaucoma.
Conclusion: There is a significant association between OPP and the severity of glaucoma. Balancing blood pressure and IOP is important in optimizing adequate perfusion and prevent further damage to the optic nerve head.
How to cite this article: Ch'ng TW, Chua CY, Ummi Kalsom MA, et al. Ocular Perfusion Pressure and Severity of Glaucoma: Is There a Link? J Curr Glaucoma Pract 2021;15(2):78-85.
Fulltext Autonomy to refuse: please doctor, I want to fast, I don't want my medications

Kumurasamy V, Ahmad Fairuz M, Taib F, Mat Pa MN, Mohd Nazri S, Norzila Z, et al.

Education in Medicine Journal, 2014;6(1):66-69.
MyJurnal

This paper discusses the ethical issues of patient autonomy based on a case of a patient who refused medication during Ramadhan fasting period. Issues on patient autonomy include the right of a patient to refuse medication, informed decision making, the importance of effective communication and the physician roles and responsibilities are discussed. In conclusion, patient autonomy must be respected and valued. However, the need of effective communication in facilitating informed decision making to improve doctor-patient relationship, should not be overlooked and compromised.