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Fulltext Bilateral Jensen disease in a healthy young lady

Ghani Siti-Ilyana, Koh, Yi-Ni, Embong Zunaina

Journal of Biomedical and Clinical Sciences, 2018;3(1):19-24.
MyJurnal

Toxoplasmic optic neuropathy is rare and usually occurs monoocularly. This case report demonstrates a rare presentation of bilateral
juxtapapillary retinochoroiditis (Jensen disease) due to toxoplasma infection in
a young healthy patient. A 20-year-old lady presented with bilateral painless
blurring of central vision for 5 days duration. It was preceded by fever, upper
respiratory tract symptoms and headache. There was no history of contact or
being scratched by a cat. Visual acuity was counting fingers for the right eye
and 6/45 for the left eye. There was presence of relative afferent pupillary
defect in the right eye. Optic nerve functions were impaired bilaterally which
was severe in the right eye. Both eyes showed the presence of mild anterior
segment inflammation and vitritis. Fundus examination revealed juxtapapillary
retinochoroiditis bilaterally with swollen optic disc. Optical coherence
tomography (OCT) showed presence of intra-retinal and sub-retinal fluid at
macular area bilaterally. Serology for anti-toxoplasma Immunoglobulin G (IgG)
was positive with titre of 1450 IU/ml. Computed tomography scan (CT scan) of
brain and orbit was normal. A diagnosis of bilateral juxtapapillary
retinochoroiditis or Jensen disease was made. Oral azithromycin 500 mg daily
and guttae prednisolone 4 hourly for 6 weeks was commenced. Oral
prednisolone 50 mg daily (1 mg/kg/day) was added after completion of 1 week
of antibiotic and was tapered down within 5 weeks. There was improvement of
vision as early as 3 weeks post initiation of the treatment. Upon 6 weeks
completing the treatment, her vision has improved to 6/7.5 on both eyes with
resolution of optic disc swelling and sub-retinal fluid. Early recognition and
initiation of treatment in toxoplasma infection associated with juxtapapillary
retinochoroiditis usually result in good visual prognosis.
Fulltext Malignant hypertension and acute loss of vision in a patient with history of pre-eclampsia

Ghani Siti-Ilyana, Ang, Wen-Jeat, Wan-Hazabbah Wan-Hitam, Embong Zunaina

Journal of Biomedical and Clinical Sciences, 2018;3(1):11-14.
MyJurnal

Pre-eclampsia may have an impact on women’s health beyond their
pregnancies and has been associated with increased risks for future hypertension
and cardiovascular disease. We report a case of a patient with history of preeclampsia and emergency caesarean section at 31 weeks of gestation due to
impending eclampsia who defaulted follow up and presented with malignant
hypertension and acute loss of vision 10 years later. A 34-year-old Malay female,
presented with generalized painless reduced vision of 5 days duration which was
preceded by an intermittent headache for 1 months duration. She had a history of
pre-eclampsia during her last childbirth 10 years ago and was not started on any
antihypertensive medication as her blood pressure normalized 2 weeks post-delivery.
Subsequently, she defaulted on her follow up. Visual acuity was counting finger at 1
meter in both eyes with no relative afferent pupillary defect. Funduscopy revealed
bilateral grade IV hypertensive retinopathy with the presence of optic disc swelling
and macular star. Optical coherence tomography showed bilateral sub-retinal fluid at
the macula. Her blood pressure was 255/168 mmHg with other systemic
examinations being normal. Ultrasonography of the kidneys showed the presence of
bilateral renal parenchymal disease with elevation of serum urea and creatinine
levels. Her blood pressure was controlled with triple oral antihypertensive agents. Her
vision improved to 6/36 and 6/6 with a pinhole in both eyes and resolution of
papilloedema and sub-retinal fluid at three months follow-up. Patients with a history
of pre-eclampsia must be closely monitored during the postpartum period. Even
though her blood pressure was normalized, careful monitoring and long-term medical
follow up plan must be clearly explained to the patient as she might develop chronic
or essential hypertension afterward. Our patient most likely had essential
hypertension superimposed with pre-eclampsia during her last pregnancy and
currently presented with malignant hypertension due to undiagnosed chronic
hypertension as she defaulted her medical follow up.
Fulltext Effect of 532 nm argon laser pan retinal photocoagulation on corneal thickness and corneal endothelial cell parameters among proliferative diabetic retinopathy patients

Ghani SI, Zunaina E

J Diabetes Metab Disord, 2021 Jun;20(1):561-569.
PMID: 34222077 DOI: 10.1007/s40200-021-00780-9

Background: Laser photocoagulation has been the mainstay treatment for diabetic retinopathy (DR). However, the applied laser light must pass through multiple ocular structures such as the cornea to reach the retina, potentially causing thermal injury to non-target tissues. The purpose of this study was to examine the effects of 532 nm Argon laser pan-retinal photocoagulation (PRP) on corneal thickness and corneal endothelial cell parameters by comparing central corneal thickness (CCT), endothelial cell density (ECD), and endothelial cell area coefficient of variation (CoV) before and after PRP for proliferative diabetic retinopathy (PDR). The effect of laser PRP on these corneal parameters may help in adapting treatment protocols to reduce corneal damage and thereby improve patient outcome.
Methods: This was a prospective cohort study involving newly diagnosed PDR patients. All patients underwent specular microscopy examination (CCT, ECD and endothelial cell area CoV) both pre-PRP and at 1-week and 6-weeks after the final PRP session (post-PRP). A Carl Zeiss Visulas Argon laser (532 nm) was used to perform PRP.
Results: A total of 33 newly diagnosed PDR patients were included in this study. There were no significant differences in mean CCT, ECD, and endothelial cell area CoV at 1-week and 6-weeks following PRP compared to pre-treatment baseline (p > 0.05). Further, there were no significant correlations between laser energy delivered and CCT, ECD and endothelial cell area CoV at either post-PRP examination time.
Conclusion: Argon laser (523 nm) energy delivered within recommended ranges for PRP had no adverse effects on corneal structure.
Fulltext Extensive Forehead Swelling Including the Periorbital Area in a Child: A Rare Manifestation of Acute Lymphoblastic Leukemia

Hanapi MS, Ghani SI, Sonny Teo KS, Wan-Embong WZ, Ariffin N, Wan Hitam WH

Cureus, 2018 Nov 03;10(11):e3539.
PMID: 30648072 DOI: 10.7759/cureus.3539

Acute lymphoblastic leukemia (ALL) manifestations in a child are varied. We report a unique and rare presentation of acute lymphoblastic leukemia in a child who presented with frontal swelling involving bilateral upper lids. A previously healthy one-year-old girl presented with progressively increasing frontal swelling of seven months duration. An examination revealed erythematous, firm, nontender forehead swelling that extended up to the medial part of bilateral upper eye lids. The extraocular muscle movement was normal. The anterior segment and fundus examination were also normal in both eyes. Other systemic examination revealed multiple leukemic cutis on the scalp. The cervical lymph nodes were also palpable with hepatosplenomegaly. A full blood picture (FBP) showed the presence of leucoerythroblastic blood film with 62% blast cells. Flow cytometry and bone marrow aspiration confirmed the diagnosis. Computed tomographic (CT) scan images revealed multiple well-defined hyperdense lesions at the subcutaneous skull with the largest lesion at the anterior glabella. Upon diagnosis, the patient was started on chemotherapy and the swelling resolved after one month post treatment. Extensive forehead swelling is a rare manifestation of acute lymphoblastic leukemia. A high index of suspicion aided with diagnostic investigations could help the doctors arrive at a correct diagnosis and treatment.