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Fulltext Iatrogenic corneal injury secondary to trypan blue usage during cataract surgeries: a case series

Joanne, Shalini CR, Fazliana I., Nor Hasnida AG, MD, Ahmad Nurfahmi AA, Aidila JJ, Khairidzan MK

Journal of Biomedical and Clinical Sciences, 2018;3(2):6-9.
MyJurnal

— To report clinical features and management of toxic keratopathy
induced by inadvertent intrastromal trypan blue injection (0.06%) during
cataract surgery. We report two cases of toxic keratopathy induced by
iatrogenic intrastromal trypan blue injection during cataract surgery. The
two cases were performed by ophthalmology residents at our centre.
Intraoperatively in both cases, trypan blue dye was inadvertently injected
into the corneal stromal via side port wound. Surgery was abandoned due
to development of corneal oedema. They were treated as toxic keratopathy
due to the bluish discoloration of the cornea, generalized (limbal to limbal)
panstromal edema and marked Descemet membrane folds. There were
epithelial microbullae and mild circumcorneal injection. Both patients’ vision
deteriorated with only minimal anterior chamber reaction and normal
intraocular pressure. Intensive topical corticosteroid, prophylactic antibiotic,
gutt hypertonic saline 5%, and cycloplegic agent eyedrops were given. The
cornea edema and staining in both patients resolved completely by 6
weeks. They underwent uncomplicated elective phacoemulsification 3
months after the incident. Intraoperative Iatrogenic inadvertent intrastromal
vision blue injection during cataract surgery can cause toxic keratopathy. A
decision to abandon the surgery and prompt management to reverse the
complication can produce excellent outcome.
Fulltext Prevalence of diabetic retinopathy and its associated factors among diabetic patients in primary care clinics, Kuantan, Pahang

Mohd Aznan MA, Khairidzan MK, Razman MR, Fa’iza A

International Medical Journal Malaysia, 2018;17(2):11-16.
MyJurnal

Introduction: Diabetic retinopathy (DR) is one of the commonest complications of diabetes mellitus. This study was to determine the prevalence of DR and its association with chronic kidney disease (CKD), high HbA1c and dyslipidemia among diabetic patients in government primary care clinics.
Materials and Methods: A cross sectional study was carried out. The respondents were selected from diabetic registry at two government primary care clinics in Kuantan, Pahang via stratified random sampling method during the study period from May 2010 to April 2011. The respondents were interviewed and assessed clinically using a structured questionnaire. Retinal examination was performed by accredited staff using non-mydratic retinal imaging and DR was classified according to the International Clinical Diabetic Retinopathy Disease Severity Scale.
Results: Out of 400 respondents, 58.8% were diagnosed with diabetes less than 5 years and 51.0% had uncontrolled blood pressure (>130/80 mmHg). The prevalence of DR and maculopathy were 33.5% and of 17.8% respectively. Most of these patients (22.3%) had mild non-proliferative DR. DR patients had higher percentages CKD (17.9% vs. 6.8%; p<0.001) and a higher mean of HbA1C (8.69 vs. 8.11; p=0.015) compared to non-DR patients. The study revealed that DR was independently associated with CKD {OR: 3.46, 95% CI (1.76, 6.80)} and high HbA1c {OR: 1.12, 95% CI (1.02, 1.23)}. Those with dyslipidemia however, has 39% less risk of DR {OR: 0.61, 95% CI (0.39, 0.94)}.
Conclusion: This study showed that diabetic patients with CKD and high HbA1c have greater risks to develop DR but has protective risk with dyslipidemia.
KEYWORDS: diabetic retinopathy (DR), non-mydratic retinal camera, primary care clinic
Fulltext Corneo-pterygium total area measurements utilising image analysis method

Mohd Radzi H, Khairidzan MK, Mohd Zulfaezal CA, Azrin EA

J Optom, 2019 05 13;12(4):272-277.
PMID: 31097348 DOI: 10.1016/j.optom.2019.04.001

PURPOSE: To describe an objective method to accurately quantify corneo-pterygium total area (CPTA) by utilising image analysis method and to evaluate its association with corneal astigmatism (CA).
METHODS: 120 primary pterygium participants were selected from patients who visited an ophthalmology clinic. We adopted image analysis software in calculating the size of invading pterygium to the cornea. The marking of the calculated area was done manually, and the total area size was measured in pixel. The computed area is defined as the area from the apex of pterygium to the limbal-corneal border. Then, from the pixel, it was transformed into a percentage (%), which represents the CPTA relative to the entire corneal surface area. Intra- and inter-observer reliability testing were performed by repeating the tracing process twice with a different sequence of images at least one (1) month apart. Intraclass correlation (ICC) and scatter plot were used to describe the reliability of measurement.
RESULTS: The overall mean (N=120) of CPTA was 45.26±13.51% (CI: 42.38-48.36). Reliability for region of interest (ROI) demarcation of CPTA were excellent with intra and inter-agreement of 0.995 (95% CI, 0.994-0.998; P<0.001) and 0.994 (95% CI, 0.992-0.997; P<0.001) respectively. The new method was positively associated with corneal astigmatism (P<0.01). This method was able to predict 37% of the variance in CA compared to 21% using standard method.
CONCLUSIONS: Image analysis method is useful, reliable and practical in the clinical setting to objectively quantify actual pterygium size, shapes and its effects on the anterior corneal curvature.

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