Displaying publications 1 - 20 of 22 in total

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  1. Sharum MH, Sawri Rajan R, Iqbal T
    Cureus, 2024 Mar;16(3):e56503.
    PMID: 38638749 DOI: 10.7759/cureus.56503
    Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disorder with various systemic and ocular clinical manifestations. In patients with SLE, central retinal vein and artery occlusion, choroidopathy, and occlusive vasculitis are among the most significant and clinically relevant ocular manifestations, although they do not commonly occur. We present a case series of three SLE patients of different races and genders who developed ocular-related clinical features of SLE during the course of their systemic disease. The clinical outcomes of each patient were different, affecting their vision in bilateral eyes, with some patients having better visual recovery while others having permanently poor vision. These outcomes were not significantly related to the patients' age, gender, or race.
  2. Chon Han G, Iqbal T, Supramaniam G
    Cureus, 2024 Mar;16(3):e57044.
    PMID: 38681400 DOI: 10.7759/cureus.57044
    Neuromyelitis optica spectrum disorder (NMOSD) is a rare antibody-mediated neuroinflammatory disease of the central nervous system, typically manifesting in the optic nerves, spinal cord, and other regions of the central nervous system. We hereby report a case of a 16-year-old girl who presented with a six-month history of transverse myelitis with an acute episode of bilateral retrobulbar optic neuritis. MRI revealed patchy contrast enhancements over bilateral retrobulbar intraorbital optic nerves together with long-segment spinal cord hyperintensities (C2 to T2 level). Visual evoked potential testing during the acute presentation showed the absence of P100 bilaterally. However, both serum AQP4-IgG and MOG-IgG were reported to be negative. Despite remarkable improvement in bilateral optic nerve functions, she continued to have disabling bilateral lower limb spasticity, contractures, and loss of bilateral lower limb sensation after five cycles of plasma exchange. This case summarizes the challenges to diagnosing double seronegative NMOSD and its immediate therapeutic significance.
  3. Ng ZX, Chua KH, Iqbal T, Kuppusamy UR
    Int J Mol Sci, 2013;14(4):7480-91.
    PMID: 23552832 DOI: 10.3390/ijms14047480
    This study aims to investigate potential diabetic retinopathy (DR) risk factors by evaluating the circulating levels of pentosidine, soluble receptor for advanced glycation end-product (sRAGE), advanced oxidation protein product (AOPP) as well as glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities in DR patients. A total of 235 healthy controls, 171 type 2 diabetic without retinopathy (DNR) and 200 diabetic retinopathy (DR) patients were recruited. Plasma was extracted for the estimation of pentosidine, sRAGE, AOPP levels and GPx activity whereas peripheral blood mononuclear cells were disrupted for SOD activity measurement. DNR and DR patients showed significantly higher levels of plasma pentosidine, sRAGE and AOPP but lower GPx and SOD activities when compared to healthy controls. The sRAGE/pentosidine ratio in DR patients was significantly lower than the ratio detected in DNR patients. Proliferative DR patients had significantly higher levels of plasma pentosidine, sRAGE, AOPP and sRAGE/pentosidine ratio than non-proliferative DR patients. High HbA1c level, long duration of diabetes and low sRAGE/pentosidine ratio were determined as the risk factors for DR. This study suggests that sRAGE/pentosidine ratio could serve as a risk factor determinant for type 2 DR as it has a positive correlation with the severity of DR.
  4. Ng ZX, Kuppusamy UR, Iqbal T, Chua KH
    Gene, 2013 Jun 1;521(2):227-33.
    PMID: 23545311 DOI: 10.1016/j.gene.2013.03.062
    Receptor for advanced glycation end-product (RAGE) gene polymorphism 2245G/A is associated with diabetic retinopathy (DR). However, the mechanism on how it affects the disease development is still unclear.
  5. Peyman M, Ong MJ, Iqbal T, Subrayan V
    BMJ Case Rep, 2010;2010.
    PMID: 22802477 DOI: 10.1136/bcr.08.2010.3266
    Iris mammillations are dark brown, smooth, mound- or dome-shaped protuberances that are typically found on the anterior iris surface and are presumed to be congenital in origin. This congenital anomaly is usually unilateral and can be hereditary or sporadic. Lisch nodules in neurofibromatosis, tapioca melanoma of the iris, inflammatory iris granulomata and Cogan-Reese syndrome should be considered in the differential diagnosis. In this case report, the authors present a case of a bilateral iris mammillations in two siblings with congenital adrenal hyperplasia (CAH). To our knowledge, this is the first case where bilateral iris mammilations have been found to be associated with a systemic condition. Iris mammillations can be considered as one of the clinical signs in CAH in view of the pathogenesis discussed. Detailed ocular examination in CAH may reveal an increased incidence.
  6. Patel DK, Ali NA, Iqbal T, Subrayan V
    Ann Ophthalmol (Skokie), 2008;40(3-4):177-9.
    PMID: 19230359
    Colloid cysts are rare intracranial tumors most commonly found in the third ventricle. We present a case of colloid cyst of the third ventricle that manifested as bilateral advance optic disc cupping, superior hemifield defects in the visual fields and normal intraocular pressure.
  7. Lim YW, Lott PW, Mohamad NF, Begam Iqbal T
    Int J STD AIDS, 2021 09;32(10):968-973.
    PMID: 33969754 DOI: 10.1177/09564624211011917
    BACKGROUND: Penicillin is the conventional treatment for all stages of syphilis, including ocular and neurosyphilis, according to the recommendations by the Centre for Disease Control and Prevention Sexually Transmitted Disease. This case series highlighted three cases of ocular syphilis which showed prompt treatment response as early as 24 h after the adjunctive intravitreal ceftazidime injection.

    METHODS: Case Series.

    RESULTS: In case 1, there was significant improvement in the vision and vitritis after 24 h of a single intravitreal ceftazidime injection. In case 2, the patient achieved his best vision after a total of three intravitreal injections in his left eye and one in his right eye. In case 3, there was a further resolution of perivascular sheathing and retinal haemorrhages seen 1 week after a single intravitreal ceftazidime injection.

    CONCLUSION: The efficacy of intravitreal ceftazidime injection as a local adjunctive therapy in ocular syphilis treatment is noteworthy. It can be considered in cases which show suboptimal or slower treatment response despite early commencement of systemic penicillin to prevent devastating ocular sequelae.

  8. Sadef Y, Poulsen TG, Habib K, Iqbal T, Nizami AS
    Waste Manag, 2016 Oct;56:396-402.
    PMID: 27342191 DOI: 10.1016/j.wasman.2016.06.018
    Composting can potentially remove organic pollutants in sewage sludge. When estimating pollutant removal efficiency, knowledge of estimate uncertainty is important for understanding estimate reliability. In this study the uncertainty (coefficient of variation, CV) in pollutant degradation rate (K1) and relative concentration at 35days of composting (C35/C0) was evaluated. This was done based on recently presented pollutant concentration data, measured under full-scale composting conditions using two different sampling methods for a range of organic pollutants commonly found in sewage sludge. Non-parametric statistical procedures were used to estimate CV values for K1 and C35/C0 for individual pollutants. These were then used to compare the two sampling methods with respect to CV and to determine confidence intervals for average CV. Results showed that sampling method is crucial for reducing uncertainty. The results further indicated that it is possible to achieve CV values for both K1 and C35/C0 of about 15%.
  9. Balasubaramaniam D, Lott PW, Iqbal T, Singh S
    Cureus, 2023 Apr;15(4):e38033.
    PMID: 37228527 DOI: 10.7759/cureus.38033
    Purtscher's retinopathy is a rare angiopathy reported in patients with a history of severe trauma and other systemic diseases. The diagnosis is made on clinical grounds, and the severity varies. A 41-year-old gentleman with underlying poorly controlled diabetes mellitus and dyslipidemia was referred to the ophthalmology department for diabetic retinopathy screening. He denied visual complaints. Ocular examination revealed a negative relative afferent pupillary defect with a visual acuity of 6/6 bilaterally. The anterior segment examination was unremarkable. Both eye (oculus uterque, OU) fundus revealed a pink disc with a cup-to-disc ratio of 0.4 and peripapillary flame-shaped hemorrhages. Right eye (oculus dexter, OD) also showed multiple cotton wool spots along the superotemporal arcade involving zones 1 and 2 of the retina, while left eye (oculus sinister, OS) showed a single cotton wool spot along the superotemporal arcade at zone 1 of the retina. Otherwise, there were no visible retinal emboli, dot hemorrhages, or hard exudates, and the macula was normal. The retinal features were not characteristic of diabetic retinopathy. It mimicked hypertensive retinopathy, but the patient was normotensive. The absence of inner retinal thickening and hyperreflectivity on optical coherence tomography of the macula ruled out retinal vein occlusion. This prompted us to elicit further history, and the patient disclosed a recent admission for myocardial infarction in which he received cardiopulmonary resuscitation with chest compressions for seven minutes. Hence, the diagnosis of OU Purtscher's retinopathy was made, and the patient was monitored closely in the clinic. Purtscher's retinopathy remains a diagnostic dilemma and should not be neglected in complex clinical contexts.
  10. Goh Y, Kwan Z, Han WH, Iqbal T, Yahya F, Khang TF, et al.
    Int Ophthalmol, 2021 Jun;41(6):2139-2147.
    PMID: 33788072 DOI: 10.1007/s10792-021-01771-8
    PURPOSE: To evaluate ocular surface changes among patients with psoriasis in Malaysia, a developing country in Southeast Asia.

    METHODS: An interdisciplinary case-control study (60 psoriasis patients and 40 control subjects) to look at the differences in ocular surface manifestations between patients with psoriasis and a group of age-, gender- and ethnicity-matched healthy controls.

    RESULTS: One hundred and twenty eyes of 60 patients with psoriasis and 80 eyes of 40 healthy controls without psoriasis were included in the study. Mild-to-moderate psoriasis was found in 42 patients (70%), while 18 patients (30%) had severe psoriasis. Psoriatic arthritis was found in 19 patients (32%). Of the 60 psoriatic patients, the prevalence of ocular involvement was 65% (39/60), in which 32% (19/60) had dry eyes, 27% (16/60) had lid margin abnormalities, 33% (20/60) had cataract, and one had history of anterior uveitis. Compared to controls, ocular surface of psoriatic patients showed more eyelid margin abnormalities, higher meibomian gland loss and lower tear film break-up time. The estimated odds ratio for dry eyes in the psoriasis group was 2.2 (95% CI: 0.8-6.9).

    CONCLUSION: Ocular surface disorders encompassing eyelid margin abnormalities, meibomian gland loss and tear dysfunction occur at an earlier and higher rate among psoriatic patients.

  11. Santiagu F, Bakhtiari A, Iqbal T, Khaliddin N, Lansingh VC, Subrayan V
    Int Ophthalmol, 2018 Oct;38(5):2069-2076.
    PMID: 28879527 DOI: 10.1007/s10792-017-0701-5
    BACKGROUND: Purpose of this study is to evaluate changes in the central corneal thickness (CCT) in patients during the third trimester and postpartum phases of normal pregnancy, pregestational diabetes mellitus (DM), and gestational diabetes mellitus (GDM).
    METHODS: This was a prospective study. Patients that fulfilled the inclusion criteria were recruited from the obstetric clinic. They were grouped into normal pregnancy, pregestational DM, and GDM. Ophthalmic assessment and haematological investigations were done during the third trimester (after 28 weeks of gestation) and in the postpartum phase (6 weeks postpartum).
    RESULTS: A total of 192 pregnant patients were recruited for this study. Out of the 192 patients, only 143 of them came back for their follow-up 6 weeks postpartum. A total of 70 (36.5%) normal pregnancy patients, 51 (26.6%) DM patients, and 71 (36.9%) GDM patients were included in this prospective study. Our study showed that the CCT decreased postpartum in all three groups. Patients in all three groups did not have significantly different CCT during the third trimester of pregnancy and postpartum phase. However, patients who had thicker CCT irrespective of the grouping during the third trimester also had a thicker CCT post-delivery (p value <0.001). However, these changes did not appear to affect refractive error and visual acuity.
    CONCLUSIONS: Diabetes mellitus during pregnancy did not appear to influence the CCT.
    Study site: Obstetrics clinic, University Malaya Medical Center (UMMC), Kuala Lumpur, Malaysia
  12. Khor HD, Lott PW, Daman Huri SNR, Singh S, Iqbal T
    Cureus, 2023 Jul;15(7):e42722.
    PMID: 37654949 DOI: 10.7759/cureus.42722
    This study aims to report a case of neuro-ophthalmic manifestation in a coronavirus disease 2019 (COVID-19) patient and a literature review of neuro-ophthalmological manifestation in COVID-19 patients. A 57-year-old male presented with headache, giddiness, and sudden onset of diplopia over two days after having a flu-like illness. Clinical examination revealed bilateral bizarre extraocular movement with right lower motor neuron facial nerve palsy. A polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive. Computed tomography (CT) and contrast-enhanced CT of the brain and CT venography were unremarkable. Magnetic resonance imaging (MRI) of the brain, magnetic resonance angiography of the circle of Willis, and MRI of the internal auditory meatus revealed a subacute pontine infarction with no leptomeningeal or cranial nerve enhancement and a normal circle of Willis. The patient received a course of oral prednisolone and clinical symptoms improved gradually. Articles published between December 2019 and June 2022 were included. A total of 23 cases, with 14 male and nine female patients, were summarized. The mean age at presentation was 46.95 years (range = 9-71 years), with the most affected age group ranging from 31 to 70 years (17 of 23 cases, 73.91%). Neuro-ophthalmological symptoms and signs can be isolated or associated with neurological syndromes. The manifestations include optic neuritis, isolated or multiple cranial nerve palsies, acute vision loss, Miller Fisher syndrome, myasthenia gravis, acute disseminated encephalomyelitis, Guillain-Barré syndrome, internuclear ophthalmoplegia, and cerebrovascular events. Diagnosing neuro-ophthalmic complications secondary to SARS-CoV-2 infection is challenging, as there are no pathognomonic symptoms to detect the disease. High clinical suspicion aids in early diagnosis and initiation of treatment may help in relieving the symptoms.
  13. Khor HG, Lott PW, Wan Ab Kadir AJ, Singh S, Iqbal T
    J Ocul Pharmacol Ther, 2023 Sep 07.
    PMID: 37676992 DOI: 10.1089/jop.2023.0012
    Purpose: Ozurdex had shown promising anatomical and functional outcomes in managing refractory Irvine-Gass syndrome over the years. Burgeoning usage of Ozurdex has prompted the study of its related complications, particularly the anterior chamber migration of the implant. Methods: Literature reviews on the anterior chamber migration of the Ozurdex via PubMed, EBSCO, and TRIP databases were searched from 2012 to 2020. The predisposing factors, outcomes, and management of such cases were evaluated. Results: A total of 54 articles consisting of 105 cases of anterior migration of Ozurdex were included in this analysis. The vitrectomized eye and compromised posterior capsule were highly associated with this complication. About 81.9% of the cases had cornea edema upon presentation, with 31.4% of them ending up with cornea decompensation despite intervention. Although there was high intraocular pressure reported initially in 22 cases, only 2 cases required glaucoma filtration surgeries in which they had preexisting glaucoma. Numerous techniques of repositioning or surgical removal of the implant were described but they were challenging and the outcomes varied. Conclusions: A noninvasive method of manipulating the Ozurdex into the vitreous cavity via the "Trendelenburg position, external pressure with head positioning" maneuvers is safe yet achieves a favorable outcome. Precaution must be taken whenever offering Ozurdex to the high-risk eyes. Prompt repositioning or removal of the implant is crucial to deter cornea decompensation. Clinical Trial Registration number: NMRR-22-02092-S9X (from the Medical Research and Ethics Committee (MREC), Ministry of Health, Malaysia).
  14. Isa RM, Chong MC, Lee WL, Iqbal T, Mansor M, Zainudin AA, et al.
    Saudi Med J, 2023 Dec;44(12):1290-1294.
    PMID: 38016754 DOI: 10.15537/smj.2023.44.12.202320029
    OBJECTIVES: To describe the development of a webpage based on the Intervention Mapping (IM) protocol and usability testing of the Diabetic Retinopathy Health Education Profram (DRHEP).

    METHODS: The mixed methods pilot feasibility study was carried out between April and September 2021, involving 16 patients with type 2 diabetes mellitus and 5 experts. The usability score was rated according to the System Usability Scale (SUS).

    RESULTS: The average SUS score by the experts was 88. The patients gave a higher score of 85 for SUS, with 58 as the lowest. The average SUS score was 72. The findings indicate that the webpage is acceptable, good, and highly usable for users.

    CONCLUSION: The outcomes of this study signify the relationship between effective health applications and how their design might hamper their effectiveness in changing patients' behavior.

  15. Mahmood H, Mehmood S, Shakeel A, Iqbal T, Kazmi MA, Khurram AR, et al.
    Polymers (Basel), 2021 Jan 26;13(3).
    PMID: 33530601 DOI: 10.3390/polym13030388
    Glycerol pretreatment is a promising method for the environmentally-friendly transformation of lignocellulosic materials into sustainable cellulose-rich raw materials (i.e., biopolymer) to fabricate biocomposites. Here, a comparison of aqueous acidified glycerol (AAG) pretreatment of wheat straw (WS) with alkaline, hot water, and dilute acid pretreatments on the thermal and mechanical characteristics of their fabricated composite board is presented. A comparison of total energy expenditure during WS pretreatment with AAG and other solutions was estimated and a comparative influence of AAG processing on lignocellulosic constituents and thermal stability of WS fiber was studied. Results imply that AAG pretreatment was superior in generating cellulose-rich fiber (CRF) as compared to other pretreatments and enhanced the cellulose contents by 90% compared to raw WS fiber. Flexural strength of acidic (40.50 MPa) and hot water treated WS composite (38.71 MPa) was higher compared to the value of 33.57 MPa for untreated composite, but AAG-treated composites exhibited lower values of flexural strength (22.22 MPa) compared to untreated composite samples. Conversely, AAG pretreatment consumed about 56% lesser energy for each kg of WS processed as compared to other pretreatments. These findings recognize that glycerol pretreatment could be a clean and new pretreatment strategy to convert agricultural waste into high-quality CRF as a sustainable raw material source for engineered biocomposite panels.
  16. Rafique Ali AA, Ismail F, May May C, Mohd Abdullah AA, Khaliddin N, Hariri F, et al.
    Eur J Ophthalmol, 2021 Jul 05.
    PMID: 34219491 DOI: 10.1177/11206721211030093
    BACKGROUND: This study aims to collect local Malaysian data regarding the ophthalmic features and complications in craniosynostosis patients who attended the Combined Craniofacial Clinic (CFC) in University Malaya Medical Centre (UMMC).

    METHODS: Retrospective study of medical notes of craniosynostosis patients who attended the CFC in UMMC from 2014 to December 2020.

    RESULTS: Out of 37 patients, 29 had syndromic craniosynostosis, and 8 had non-syndromic craniosynostosis. Visual impairment was present in 32.1% of patients. Causes for visual impairment were as follows - amblyopia (25.0%), exposure keratopathy (3.6%), and optic atrophy (3.6%). Hypermetropia and myopia were each seen in 20.6% of patients. Astigmatism was seen in 47.1% of patients, and 29.1% had anisometropia. Proptosis was present in 78.6% and lagophthalmos in 53.3% of patients. Strabismus in primary position occurred in 51.7% of patients. Thirty-one percent of the patients had exposure keratopathy. Optic disc atrophy was seen in 13.7% of patients, and 8.3% had optic disc swelling. Optic disc swelling was resolved in all patients who underwent craniofacial surgery.

    CONCLUSION: Our experience in Malaysia was consistent with previously reported data on ophthalmic features of craniosynostosis patients. Additionally, we found that non-syndromic craniosynostosis patients are also at risk of ocular complications just as much as syndromic patients. Appropriate treatment of amblyogenic risk factors, ocular complications, and timely detection of papilledema, and prompt surgical intervention are crucial in preserving long-term visual function in these patients.

  17. Jamil A, Ching OP, Iqbal T, Rafiq S, Zia-Ul-Haq M, Shahid MZ, et al.
    J Hazard Mater, 2021 Sep 05;417:126000.
    PMID: 33992016 DOI: 10.1016/j.jhazmat.2021.126000
    This study presents an extended thermodynamic and phenomenological combined model to mitigate the environmental hazardous acid gas over composite membranes. The model has been applied to an acid gas such as carbon dioxide (CO2) for its permeation through polyetherimide incorporated montmorillonite (Mt) nanoparticles hollow fiber asymmetric composite membranes. The well-established non-equilibrium lattice fluid (NELF) model for penetrating low molecular weight penetrant in a glassy polyetherimide (PEI) was extended to incorporate the other important polymer/filler system features such as tortuosity in acid gas diffusion pathways resulted from layered filler aspect ratio and concentration. The model mentioned above predicts the behavior of acid gas in PEI-Mt composite membranes based on thermodynamic characteristics of CO2 and PEI and tortuosity due to Mt. The calculated results are compared to experimentally determined values of CO2 permeability through PEI-Mt composite asymmetric hollow fiber membranes at varying transmembrane pressures and Mt concentrations. A reasonable agreement was found between the model predicted behavior and experimentally determined data in terms of CO2 solubility, Mt concentration and aspect ratio were calculated based on average absolute relative error (%AARE). The proposed modified model efficiently predicts the CO2 permeance across MMMs up to 3 wt% Mt loadings and 6 bar pressure with ± 10%AARE.
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