MyMedR

Fulltext Spontaneous dislocation of intraocular lens as a late complication of uncomplicated cataract surgery: a case series

Lam HH, Visvaraja S

Clin Exp Optom, 2012 Jan;95(1):99-102.

PMID: 21954950 DOI: 10.1111/j.1444-0938.2011.00640.x

Five patients having uncomplicated phacoemulsification were implanted with CT-Asphina 603P intraocular lenses into the capsular bag. After a few months, three of the patients had haptic flexion anterior to the optic despite minimal capsular fibrosis. One patient had spontaneous dislocation of the intraocular lens into the anterior chamber with only minimal capsular fibrosis. Another patient had one haptic dislocated out of the bag. Late intraocular lens dislocation is also seen in newly designed preloaded intraocular lenses despite the absence of significant capsular fibrosis. Haptic-optic junction design and intraocular lens material play important roles in such complication. A slightly large capsulorhexis might be a deterrent for implantation of this intraocular lens.

47 XYY and morning glory syndrome--a unique association

Chew FL, Visvaraja S

J AAPOS, 2009 Aug;13(4):406-7.

PMID: 19487143 DOI: 10.1016/j.jaapos.2009.02.007

47 XYY syndrome is a sporadic condition in which the human male receives an extra Y chromosome. Few ocular associations have been documented. The authors report the first case of 47 XYY associated with morning glory syndrome, frontonasal meningoencephalocele, and midfacial defects.

Topical piperacillin/tazobactam for recalcitrant pseudomonas aeruginosa keratitis

Chew FL, Soong TK, Shin HC, Samsudin A, Visvaraja S

J Ocul Pharmacol Ther, 2010 Apr;26(2):219-22.

PMID: 20415627 DOI: 10.1089/jop.2009.0077

To report the treatment of therapy-resistant Pseudomonas aeruginosa keratitis with topical piperacillin/tazobactam.

Fulltext A lesion mistaken for malignant melanoma of the posterior uvea: a case report

Sukumaran K, Chandran S, Visvaraja S, Couper NT, Tan PE

Med J Malaysia, 1984 Dec;39(4):317-9.

PMID: 6544942

A case is presented to illustrate the difficulties
encountered in the clinical diagnosis of an intraocular mass. The fundus was not visible ophthalmoscopically because of opaque media. The anterior surface of the iris showed three discrete hyperpigmented nodular patches. Ultrasound showed an intraocular mass occupying half the posterior segment. The eye did not have useful vision and was enucleated after a clinical diagnosis of malignant melanoma of the choroid was made. The eye did not contain a melanoma but an organised blood clot after an extensive vitreous haemorrhage because of systemic hypertension.

Fulltext Risk factors for clinically significant macular edema in a multi-ethnics population with type 2 diabetes

Jew OM, Peyman M, Chen TC, Visvaraja S

Int J Ophthalmol, 2012;5(4):499-504.

PMID: 22937513 DOI: 10.3980/j.issn.2222-3959.2012.04.18

AIM: To determine the risk factors of clinically significant macular edema (CSME) in patients with non-proliferative diabetic retinopathy (NPDR) in a multi-ethnics Malaysian population.
METHODS: We performed a case control study in which 150 patients with bilateral NPDR and CSME in either eye were compared to 150 patients with bilateral NPDR and no CSME in both eyes. CSME and NPDR were graded according to Early Treatment of Diabetic Retinopathy Study criteria. Student's t-test, odds ratio and multiple logistic regression analysis were performed to analyze the duration of diabetes, body mass index (BMI), blood pressure(BP), total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides (TG), fasting blood glucose (FBG), HbA1c, full blood count, serum creatinine and proteinuria between the two groups.
RESULTS: Both groups were matched in terms of age, gender and ethnicity. Duration of diabetes, total serum cholesterol, serum LDL, FBG, HbA1c and serum creatinine were significantly higher in the CSME group (P<0.05). The hemoglobin, packed cell volume were significantly lower in the CSME group (p<0.05). There was no significant difference for serum HDL, TG, BMI, systolic and diastolic BP. Multiple logistic regression analysis showed that total serum cholesterol and HbA1c had significantly high odds of developing CSME.
CONCLUSION: HbA1c and total cholesterol are the two most important risk factors associated with CSME in patients with NPDR.
KEYWORDS: clinically significant macular edema; diabetes; risk factors
Study site: Ophthalmology clinic, Hospital Melaka, Malaysia

Neonatal herpes simplex virus type-1 central nervous system disease with acute retinal necrosis

Fong CY, Aye AM, Peyman M, Nor NK, Visvaraja S, Tajunisah I, et al.

Pediatr Infect Dis J, 2014 Apr;33(4):424-6.

PMID: 24378951 DOI: 10.1097/INF.0000000000000137

We report a case of neonatal herpes simplex virus (HSV)-1 central nervous system disease with bilateral acute retinal necrosis (ARN). An infant was presented at 17 days of age with focal seizures. Cerebrospinal fluid polymerase chain reaction was positive for HSV-1 and brain magnetic resonance imaging showed cerebritis. While receiving intravenous acyclovir therapy, the infant developed ARN with vitreous fluid polymerase chain reaction positive for HSV-1 necessitating intravitreal foscarnet therapy. This is the first reported neonatal ARN secondary to HSV-1 and the first ARN case presenting without external ocular or cutaneous signs. Our report highlights that infants with neonatal HSV central nervous system disease should undergo a thorough ophthalmological evaluation to facilitate prompt diagnosis and immediate treatment of this rapidly progressive sight-threatening disease.

Ocular Permeation of Topical Tazocin and Its Effectiveness in the Treatment of Pseudomonas aeruginosa Induced Keratitis in Rabbits

Singh S, Agarwal R, Razak ZA, Ngu R, Nyein LL, Vasudevan S, et al.

J Ocul Pharmacol Ther, 2018 01 17;34(1-2):214-223.

PMID: 29341837 DOI: 10.1089/jop.2017.0098

PURPOSE: Pseudomonas aeruginosa is the most common causative organism for contact lens-associated corneal ulcer and is commonly treated with fluoroquinolones. With the emergence of resistant strains, it is important to investigate alternative therapies. Despite well-established efficacy of tazocin against systemic Pseudomonas infections, its topical use for the treatment of Pseudomonas keratitis has not been described, hence this study was aimed to find the ocular permeation of Tazocin and its efficacy in treating keratitis in rabbit eyes.

METHODS: We investigated the ocular permeation of topical tazocin after single drop application in normal rabbit eyes by estimating piperacillin and tazobactam concentrations in cornea, aqueous, and vitreous using a validated LC-MS/MS method. Furthermore, we determined the efficacy of repeated dose administration of tazocin against experimentally induced P. aeruginosa keratitis in rabbits in comparison to moxifloxacin. To determine the efficacy, clinical examination, histopathological examination, and estimation of bacterial load and inflammatory cytokines in cornea were done.

RESULTS: Significant corneal concentration of piperacillin and tazobactam was detected in normal rabbit corneas after single dose treatment with tazocin. In rabbits with Pseudomonas-induced keratitis, topical tazocin caused significant clinical and histopathological improvement. This improvement was associated with reduction in corneal bacterial load and inflammatory cytokines. Compared to moxifloxacin 0.5%, tazocin treated group showed greater clinical response which was associated with higher interleukin (IL)-1β, lower tumor necrosis factor (TNF)-α, a comparable level of IL-8, greater reduction in corneal bacterial load, and lesser inflammatory cell infiltration.

CONCLUSION: Tazocin showed good ocular penetration and was effective in treatment of Pseudomonas induced keratitis in rabbits.

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