Displaying all 18 publications

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  1. Choo MM, Jaais F
    Med J Malaysia, 2002 Jun;57(2):225-8.
    PMID: 24326658
    "Cauliflower Ears" describes the appearance of swelling of the auricular cartilage resulting in gross distortion of the auricle. The underlying pathology is inflammation of the auricular cartilage. We report a case of a patient who presented to the ophthalmology clinic with an ocular inflammation, whose subsequent diagnosis of replapsing polychondritis was clinched with the finding of "Cauliflower Ears". This case emphasizes the importance of an appropriate general examination of ophthalmic patients for early diagnosis and prompt institution of medical treatment, which may prevent life-threatening complications to the patient.
    Study site: Eye clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
  2. Fathilah J, Choo MM
    Med J Malaysia, 2003 Aug;58(3):437-9.
    PMID: 14750386
    A patient with ocular syphilis is presented. She experienced deterioration in vision following the commencement of treatment due to a Jarisch-Herxheimer reaction. This is a transient febrile illness that can occur in patients after the first adequate dose of an anti-microbial drug to treat infectious diseases such as syphilis, Lyme disease and relapsing fever. However, a Jarisch-Herxheimer reaction occurring in a patient receiving treatment for ocular syphilis can be serious, resulting in the rapid loss of vision.
  3. Badaruddin A, Choo MM
    Malays Fam Physician, 2021 Mar 25;16(1):117-120.
    PMID: 33948150 DOI: 10.51866/cr1108
    Otitis externa is an infection of the external auditory canal. It rarely results in facial palsy except in severe cases such as necrotizing otitis externa, which is a life-threatening invasive infection of the external auditory canal. Early recognition with prompt and appropriate treatment of necrotizing otitis externa is crucial to prevent more sinister complications. Here we report a case of an elderly gentleman who presented with otitis externa and developed facial palsy a month later. We identified possible problems that may have led to the complication so that such an occurrence can be prevented in the future.
  4. Annamalai T, Fong KC, Choo MM
    J Ocul Pharmacol Ther, 2011 Feb;27(1):105-7.
    PMID: 21235384 DOI: 10.1089/jop.2010.0117
    To report a case of bilateral endogenous candida endophthalmitis treated with intravenous fluconazole.
  5. Kamalden TA, Choo MM, Kadir K, Khaliddin N
    Neuroradiol J, 2009 Jan 20;21(6):861-4.
    PMID: 24257059
    Orbital arteriovenous malformation is a rare condition which poses a management problem in view of the complexity of the vessels involved, and the potentially blinding and life-threatening complications from the modes of treatment. Treatment requires obliteration of the abnormal vascular communication. Vision may be adversely affected by the condition itself, as well as a result of invasive treatment modalities. This case reports such a situation where the visual outcome was severely affected following embolization of the feeding vessels.
  6. Mahyudin M, Choo MM, Ramli NM, Omar SS
    Case Rep Ophthalmol, 2010 Aug 02;1(1):30-35.
    PMID: 21116342
    A 23-year-old man presented with central retinal vein occlusion. The retinal haemorrhages worsened and signs of retinal vasculitis appeared later as vision dropped from 6/60 to Counting Fingers. No signs of systemic disease were observed. Routine Mantoux test and chest radiograph were negative for tuberculosis. Fundus flourescein angiogram confirmed presence of retinal vasculitis. Both systemic and topical corticosteroid therapy were ineffective. Polymerase chain reaction analysis of vitreous fluid showed presence of Mycobacterium tuberculosis. A full 6-month course of antituberculosis therapy was given and inflammation subsided. Vision improved to 3/60. This is a rare case of ocular tuberculosis without evidence of systemic infection, presenting first as a central retinal vein occlusion.
  7. Choo MM, Martin FJ, Theam LC, U-Teng C
    J AAPOS, 2009 Oct;13(5):446-9.
    PMID: 19840721 DOI: 10.1016/j.jaapos.2009.06.008
    To identify differences in incidence, risk factors, and outcomes of retinopathy of prematurity (ROP) between 2 birth weight categories within a cohort of extremely low birth weight (ELBW) infants in Malaysia.
  8. Abd Manan N, Choo MM, Effendi Tenang I, Zahari M
    Neuroophthalmology, 2022;46(3):194-198.
    PMID: 35574170 DOI: 10.1080/01658107.2021.1996612
    A 37-year-old man presented with a 1-week history of diplopia. He was under investigation by otorhinolaryngology for left sinonasal malignancy after imaging of the paranasal sinuses had revealed a large homogenous mass in the left nasal cavity. His visual acuity was 6/9 in each eye with no relative afferent pupillary defect. The left pupil, though was mid-dilated and unresponsive to light. He had a left-sided ptosis. Extraocular movements of the left eye were restricted in all directions of gaze and there was with limited abduction, dextroelevation and dextrodepression of the right eye. A trans-nasal biopsy revealed extranodal natural killer/T-cell lymphoma. Further imaging showed a large enhancing nasopharyngeal mass with intracranial extension to the cavernous sinuses and local infiltration together with intracranial abscesses. The patient was started on empirical intravenous antibiotics and supportive treatment. While awaiting institution of lymphoma chemotherapy, he died. The involvement of the cavernous sinus in sinonasal lymphoma represents an advanced stage. This case highlights that lymphoma should be considered in any patient presenting with a cavernous sinus syndrome and sinonasal disease.
  9. Choo M, Prakash K, Samsudin A, Soong T, Ramli N, Kadir A
    Int J Ophthalmol, 2010;3(3):234-6.
    PMID: 22553561 DOI: 10.3980/j.issn.2222-3959.2010.03.12
    To compare corneal endothelial structure and central corneal thickness (CCT) between type II diabetics and non-diabetic control patients. To look for correlations between diabetic status and corneal findings.
  10. Ramli N, Supramaniam G, Samsudin A, Juana A, Zahari M, Choo MM
    Optom Vis Sci, 2015 Sep;92(9):e222-6.
    PMID: 25730335 DOI: 10.1097/OPX.0000000000000542
    PURPOSE: To evaluate the prevalence of ocular surface disease (OSD) in glaucoma and nonglaucoma subjects using different clinical tests and to determine the effect of number of antiglaucoma medications and preservatives on OSD.
    METHODS: This is a cross-sectional, case-comparison study at the Eye Clinic of the University of Malaya Medical Centre, Malaysia, between June 2012 and January 2013. Glaucoma subjects (n = 105) using topical antiglaucoma medications were compared with control subjects (n = 102) who were not on any topical medications. The presence of OSD was assessed using the tear film breakup time (TBUT) test, corneal staining, Schirmer test, and Ocular Surface Disease Index (OSDI) questionnaire grading.
    RESULTS: The prevalence of OSD varied from 37 to 91% in the glaucoma group, depending on the type of clinical test. More subjects in the glaucoma group had corneal staining (63% vs. 36%, p = 0.004), abnormal Schirmer tests (39% vs. 25%, p = 0.049), and moderate OSDI symptoms (17% vs. 7%, p = 0.028). The percentage with abnormal TBUT increased with higher numbers of topical medications and was high with both benzalkonium chloride-containing and preservative-free eye drops (90% and 94%, respectively, both p < 0.001). Benzalkonium chloride was associated with a nearly three times higher odds ratio of showing abnormal OSDI.
    CONCLUSIONS: Ocular surface disease is common in those using topical antiglaucoma medications. Abnormal TBUT is associated with increasing number of eye drops and benzalkonium chloride-containing eye drops, although this also occurs with the use of preservative-free eye drops.
    Study site: Eye Clinic, University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia,
  11. Koay AC, Choo MM, Nathan AM, Omar A, Lim CT
    J Ocul Pharmacol Ther, 2011 Jun;27(3):309-11.
    PMID: 21542771 DOI: 10.1089/jop.2011.0013
    The purpose of this report was to describe 2 cases of periocular infantile hemangiomas (IHs) that were successfully treated with low-dose oral propranolol alone and in combination with oral prednisolone.
  12. Samsudin A, Isaacs N, Tai ML, Ramli N, Mimiwati Z, Choo MM
    BMC Ophthalmol, 2016;16:39.
    PMID: 27079202 DOI: 10.1186/s12886-016-0215-3
    Vascular insufficiency has been reported to be a cause of normal tension glaucoma (NTG). The aim of this study was to compare ocular perfusion pressure (OPP) and ophthalmic artery flow (OAF) between patients with NTG and those without glaucoma.
  13. Lim JJ, Salowi MA, Adnan TH, Anuar NA, Ngah NF, Choo MM
    Med J Malaysia, 2021 03;76(2):190-198.
    PMID: 33742627
    INTRODUCTION: The aim of this study was to compare the visual outcomes of phacoemulsification with intraocular lens implantation (IOL) surgery in patients with and without diabetes mellitus (DM) in Malaysia over a 12-year period and to identify factors that may contribute to poor visual outcome.

    MATERIALS AND METHODS: Data was retrieved from the webbased Malaysian Cataract Surgery Registry (CSR). Perioperative data for cataract surgery performed from 2007- 2018 were analysed. Inclusion criteria were age ≥40 years, phacoemulsification and IOL and senile cataract. Combined surgeries, surgeries performed by trainees and ocular comorbidities were excluded. Post-operative Best-Corrected Visual Acuity (BCVA) were compared. Factors affecting poor visual outcomes among those with DM were analysed using multivariate logistic regression to produce adjusted odds ratio (OR) for variables of interest.

    RESULTS: Total number of cases between 2007-2018 was 442,858, of whom 179,210 qualified for our analysis. DM group consisted of 72,087 cases (40.2%). There were 94.5% cases in DM group and 95.0Ź from non-DM group who achieved BCVA ≥6/12 (p<0.001). Among patients with DM, advanced age (70-79 years old, OR: 2.54, 95% Confidence Interva, 95%CI: 1.91, 3.40; 80-89 years old, OR: 5.50, 95%CI: 4.02, 7.51), ≥90 years, OR: 9.77, 95%CI: 4.18, 22.81), poor preoperative presenting visual acuity [<6/18-6/60] (OR: 2.40, 95%CI: 1.84, 3.14) and <6/60-3/60 (OR: 3.00, 95%CI: 2.24, 4.02), <3/60 (OR 3.63, 95%CI: 2.77, 4.74)], presence of intraoperative complication (OR 2.24, 95%CI: 1.86, 2.71) and presence of postoperative complication (OR 5.21, 95%CI: 2.97, 9.16) were significant factors for poor visual outcome.

    CONCLUSIONS: Visual outcomes following phacoemulsification with IOL implantation surgery among cases with DM were poorer compared to cases without DM. Risk factors for poor visual outcomes among cases with DM were identified.

  14. Krishna L, Abdul Jalil NF, Lott PW, Singh S, Choo MM
    Eur J Ophthalmol, 2021 Mar;31(2):NP119-NP122.
    PMID: 31390886 DOI: 10.1177/1120672119867605
    PURPOSE: To report three cases of juvenile myasthenia gravis aged between 18 and 24 months with ocular symptoms as their first presentation.

    METHOD: A case series.

    RESULTS: We present a case series of juvenile myasthenia gravis in a tertiary centre in Malaysia. Two of the three cases consist of a pair of twins who presented with ptosis of bilateral eyes; the first twin presented 4 months later than the second twin. These two cases were positive for anti-acetylcholine receptor antibodies and had generalized myasthenia gravis, whereas the other case was negative for receptor antibodies and was purely ocular myasthenia gravis.

    CONCLUSION: Juvenile myasthenia gravis is relatively rare in toddlers. Early diagnosis and commencement of treatment is important to slow the progression of the disease and avoiding life-threatening events.

  15. Choo MM, Yeong CM, Grigg JR, Khaliddin N, Kadir AJ, Barnes EH, et al.
    Medicine (Baltimore), 2018 Nov;97(48):e13357.
    PMID: 30508927 DOI: 10.1097/MD.0000000000013357
    To report observations of horizontal corneal diameter (HCD) and central corneal thickness (CCT) changes in premature infants with stable optic disc cupping and intraocular pressures (IOPs). The HCD and CCT at term serve as a baseline for premature infants.Sixty-three premature infants were enrolled in a prospective case series. HCD, CCT, and IOP were measured. RetCam images of the optic discs were used to evaluate the cup-disc ratio (CDR) and read by an independent masked observer. Data were collected at between preterm (32-36 weeks) and again at term (37-41 weeks) postconceptual age. Left eye measurements were used for statistical analysis. Left eye findings were combined to construct predictive models for HCD and CCT.The mean HCD was 9.1 mm (standard deviation [SD] = 0.7 mm) at preterm and 10.0 mm (SD = 0.52 mm) at term. The mean CCT preterm was 618.8 (SD = 72.9) μm and at term 563.9 (SD = 50.7) μm, respectively. The average preterm CDR was 0.31 and at maturity was 0.33. Average IOP of preterm and term was 13.1 and 14.11 mm Hg, respectively. There was significant linear correlation between HCD with the postmenstrual age (r = 0.40, P mm/wk) and CCT (R = 0.23, -11.4 μm/wk) with postconceptual ages.The HCD and CCT variation did not affect IOP reading over time. CCT was not correlated with birth parameters and decreased as the infant reached term. Corneal diameter correlated with gestational age at birth and head circumference.
  16. Choo MM, Grigg J, Barnes EH, Khaliddin N, Kamalden TA, Ahmad Kamar A, et al.
    BMJ Open Ophthalmol, 2021;6(1):e000626.
    PMID: 33768163 DOI: 10.1136/bmjophth-2020-000626
    Objective: An ongoing third epidemic of retinopathy of prematurity (ROP) is contributed largely by developing nations. We describe a cohort of infants in a single neonatal unit where two limits of oxygen saturation were administered, to show real-world outcomes from trend in neonatology for higher oxygen to improve survival.

    Methods and analysis: This retrospective, comparative study of prospectively collected data in an ROP screening programme included infants indicated by gestational age ≤32 weeks, birth weight <1501 g, ventilation for 7 days or requiring oxygen >1 month, who underwent dilated fundoscopic examination from age 4 weeks, every 2 weeks until full retinal vascularisation. Infants with ROP were examined weekly and treated where indicated. Data were divided into two epochs. Epoch 1 oxygen saturation targets were [88-92%], epoch 2 targets [90-95% (99%)] with allowance of increase to 20% for several hours after procedures. Outcome measures included development of ROP, treatment, mortality, sepsis and intraventricular haemorrhage.

    Results: A total of 651 infants underwent examination between 2003 and 2016. The incidence of ROP in epoch 1 was 29.1% and epoch 2 was 29.3% (p=0.24). ROP progression doubled in epoch 2 (5 vs 11%, p=0.006), proportion of cases treated halved (14% vs 6%, p=0.0005), sepsis was halved (78.5% vs 41.2%, p<0.0001) and intraventricular haemorrhage doubled (20.2% vs 43.8%, p=0.0001) in epoch 2. Mortality was 4% and 0% in epochs 1 and 2, respectively.

    Conclusion: Incidence of ROP did not differ, although ROP cases that worsened doubled with higher oxygen targets. ROP cases requiring treatment decreased, as did sepsis and mortality. Intraventricular haemorrhage cases doubled.

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