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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 Migraine with aura complicated by “migraine triggered seizures” and “occipital lobe infarction”: A case report

Juliena Muhammed, Sanihah Abdul Halim, Wan Hazabbah Wan Hitam, Tharakan, John

Neurology Asia, 2014;19(3):323-326.
MyJurnal

Migraine with aura is one of the major subtypes of migraine, and can be associated with ischaemic brain infarction. Use of oral contraceptive pills (OCPs) increases the risk of infarction in this type of migraine. Seizures and migraine also have a complex relationship, one element of which is migraine- triggered seizures. We report a case of bilateral occipital lobe infarction and migraine-triggered seizures, most likely precipitated by oral contraceptive pills (OCPs) in a patient with migraine with visual aura. OCPs, triptans and ergotamines should be used cautiously in these patients. Methods of birth control other than OCPs should be considered.
Fulltext Large full thickness medial canthal reconstruction: a report of two cases and review of literature

Nor Idahriani Muhd Nor, Azhany Yaakub, Naik, Venkatesh R., Wan Hazabbah Wan Hitam, Liza Sharmini Ahmad Tajudin

Archives of Orofacial Sciences, 2012;7(1):1-6.
MyJurnal

The reconstruction of the upper eyelid with medial canthal involvement post extensive removal of malignant tumour remains a challenge. Proper eyelid reconstruction is necessary to reestablish anatomic integrity, restoration of its functions and to maintain the best cosmetic appearance. These case reports illustrate an alternative reconstructive technique for large upper eyelid full thickness defect with medial canthal involvement. Two cases of upper eyelid tumours involving medial canthal region underwent staged reconstruction by glabellar flap advancement and reconstruction of the posterior lamellar with autologous graft using buccal mucosa and ear cartilage. The posterior lamellar graft and flap survived without any complication except for mild eyelid margin notching in one of the two cases. The staged reconstruction with glabellar flap advancement provides adequate defect coverage, excellent blood supply, maintains eyebrow contour and function of the eyelid. The flap also perfectly matches the surrounding tissue with minimal donor site morbidity.
Fulltext Cavernous sinus hemangioma presenting with binocular diplopia

Lathalakshmi, T., Tai, Evelyn L.M., Qi, Zhe Ngoo, See, Khim Sim, Wan-Hazabbah Wan Hitam, Liza-Sharmini A.T.

Journal of Biomedical and Clinical Sciences, 2017;2(2):32-34.
MyJurnal

A hemangioma is a benign vascular tumor of the brain, which rarely occurs in the cavernous sinus. We report a rare case of cavernous sinus hemangioma presenting with binocular diplopia. A 23-year-old lady presented with binocular diplopia associated with restricted left lateral gaze for 3 months. Visual acuity of both eyes was 6/6 with normal pupillary reaction. Both anterior and posterior segment were unremarkable. Contrasted computed tomography of brain showed an irregular mass within the left cavernous sinus causing pressure effect on the adjacent bone. Cerebral magnetic resonance imaging (MRI) showed a convexity in the left cavernous sinus, with a well-defined heterogeneous lesion with mixed hypo and hyperintensity in T1WI and T2WI; post gadolinium contrast, it was minimally enhanced. The patient was managed conservatively and at one-year post presentation, her symptoms improved but the lesion morphology and size remained static. We highlight the classic radiological presentation of a hemangioma and discuss the features differentiating it from the more commonly observed meningioma seen in the cavernous sinus.
Fulltext Recurrent optic neuritis as early presentation of idiopathic hypertrophic cranial pachymeningitis

Norhayaty Samsudin, Tai, Evelyn Li Min, Chui, Yain Chen, Kumar, Lakana, Azhany Yaakub, Adil Hussein, et al.

Journal of Biomedical and Clinical Sciences, 2017;2(1):23-26.
MyJurnal

44-year-old Malay lady presented with drooping of the right eyelid and worsening of left eye vision for one week duration. There was associated headache, periorbital discomfort and diplopia on left gaze. She previously had a history of recurrent optic neuritis affecting both eyes over a period of 12 years. On examination, there was right-sided partial ptosis and left exotropia. The adduction, abduction, elevation and depression of the right eye was limited. Left eye extraocular movements were full. The right eye visual acuity was 6/9, while the left eye visual acuity was perception to light, with a positive relative afferent papillary defect and a pale optic disc. The right optic disc was normal. There was reduced sensation in the trigeminal nerve distribution over the right side of the face. Neurological examination was otherwise normal. Magnetic resonance imaging of the brain and orbit revealed meningeal thickening with involvement of the right orbital apex and cavernous sinus. Blood investigations for infectious and autoimmune causes were unremarkable. She was diagnosed to have idiopathic hypertrophic cranial pachymeningitis and treated with systemic corticosteroids. The right eye extraocular motility improved, while the left eye visual acuity improved to counting finger. This case demonstrates that idiopathic hypertrophic cranial pachymeningitis may present as recurrent optic neuritis in the early phase, before radiological evidence of the disease is present. A high index of suspicion for the underlying cause is essential to prevent irreversible optic nerve damage due to recurrent optic neuritis.
Fulltext Isolated optic neuritis secondary to presumed tuberculosis in an immunocompetent child

Norazizah MA, Wan Hazabbah WH, Rohaizan Y, Shatriah I

Med J Malaysia, 2012 Feb;67(1):102-4.
PMID: 22582557 MyJurnal

Isolated optic neuritis as a presenting sign of tuberculosis in children is uncommon. We report a case of an immunocompetent child who displayed features of bilateral optic neuritis secondary to presumed tuberculosis. It is essential to highlight this alarming presentation in a child, as the presence of tuberculosis has re-emerged as a serious public health problem especially in developing countries.
Fulltext Clinical profile and aetiology of optic neuritis in Hospital Universiti Sains Malaysia--5 years review

Ismail S, Wan Hazabbah WH, Muhd-Nor NI, Daud J, Embong Z

Med J Malaysia, 2012 Apr;67(2):159-64.
PMID: 22822635

Although few studies concerning optic neuritis (ON) in Asian countries have been reported, there is no report about ON in Malaysia particularly within the Malay population. We aimed to determine the clinical manifestation, visual outcome and aetiology of ON in Malays, and discussed the literature of ON studies in other Asian populations. This was a retrospective study involving 31 consecutive patients (41 eyes) with ON treated at Hospital Universiti Sains Malaysia commencing from July 2005 till January 2010 with a period of follow-up ranging from 18-60 months. The clinical features, laboratory results, possible aetiology, and visual acuity after one year were analysed. Females were the predominant group. The age of the patients ranged between 3-55 years and peaked between 21-30 years old. 67.7% of the patients had unilateral involvement. Pain on ocular movement was observed in 31.7% of the affected eyes. 73.3% of 41 involved eyes showed visual acuity equal 6/60 or worse on presentation. Paracentral scotoma was the most common visual field defect noted. Optic disc papillitis proved more widespread compared to the retrobulbar type of ON. The aetiology was idiopathic in more than 50%, while the risk of multiple sclerosis was extremely low (3.2%) in our series. 66.0% demonstrating visual acuity improved to 6/12 or better at one year after the attack. 16.1% showed evidence of recurrence during follow-up. In conclusion, the clinical profile and aetiology of ON in Malay patients are comparable to other ON studies reported by other Asian countries.
Vernal Keratoconjunctivitis-When Medication Fails

Abd Hamid MR, Tai ELM, Wan Hazabbah WH, Ramli N

J Allergy Clin Immunol Pract, 2019 Apr;7(4):1308-1309.
PMID: 30581132 DOI: 10.1016/j.jaip.2018.11.016
Use of recombinant tissue plasminogen activator for treatment of recalcitrant anterior uveitis: A case series

Patrick S, Hui-Tze C, Wan-Hazabbah WH, Zunaina E, Azhany Y, Liza-Sharmini AT

J Taibah Univ Med Sci, 2018 Oct;13(5):483-487.
PMID: 31435366 DOI: 10.1016/j.jtumed.2018.03.005

Management of inflammation after surgery for recalcitrant anterior uveitis is challenging. Herein, we report successful treatment using intracameral injection of recombinant tissue plasminogen activator (rtPA) in two patients with recalcitrant anterior uveitis, due to infective uveitis and Vogt-Koyanagi-Harada disease, respectively. A 40-year-old woman presented with bilateral redness and vision reduction that had persisted 2 weeks. She also had bilateral anterior uveitis, vasculitis, retinitis, and optic disc swelling. Serology was positive for Bartonella henselae and Toxoplasma gondii. She was treated using long-term systemic corticosteroids and appropriate antibiotics. Our second case; a healthy 30-year-old man with bilateral eye redness and reduced vision without pain, and associated with headache and tinnitus for 1 weeks. He showed bilateral granulomatous inflammation with vitritis, choroiditis, retinitis, and hyperemic optic disc. The patient was diagnosed with Vogt-Koyanagi-Harada disease and treated with systemic corticosteroids. Both patients developed secondary cataracts and glaucoma that necessitated surgical intervention. Persistent chronic inflammation led to the formation of a thick fibrin membrane anterior to the intraocular lens (IOL) after phacoemulsification surgery with IOL implantation. This membrane was removed surgically, and intracameral injection of rtPA (25 μg) was carried out. The persistent inflammation had resolved and visual acuity had significantly improved within 1 week of intracameral rtPA injection. There were no reported ocular or systemic side effects. Intracameral rtPA is beneficial in patients with recalcitrant anterior uveitis who have undergone intraocular surgery. In most cases, surgical intervention improves the patients' vision. Intracameral rtPA should be considered in cases of persistent inflammation of varying etiology.
Fulltext Neuroretinitis in ocular bartonellosis: a case series

Raihan AR, Zunaina E, Wan-Hazabbah WH, Adil H, Lakana-Kumar T

Clin Ophthalmol, 2014;8:1459-66.
PMID: 25120352 DOI: 10.2147/OPTH.S63667

We report a case series of neuroretinitis in ocular bartonellosis and describe the serologic verification for Bartonella henselae. This is a retrospective interventional case series of four patients who presented in the ophthalmology clinic of Hospital Universiti Sains Malaysia from June 2012 to March 2013. All four patients had a history of contact with cats and had fever prior to ocular symptoms. Each patient presented with neuroretinitis characterized by optic disc swelling with macular star. Serology analysis showed strongly positive for B. henselae in all of the patients. All patients were treated with oral azithromycin (except case 4, who was treated with oral doxycycline), and two patients (case 1 and case 3) had poor vision at initial presentation that warranted the use of oral prednisolone. All patients showed a good visual outcome except case 3. Vision-threatening ocular manifestation of cat scratch disease can be improved with systemic antibiotics and steroids.
Study site: Ophthalmology clinic, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
Fulltext Diffuse unilateral subacute neuroretinitis in a young boy: a case report

Guan-Fook N, Hayati AA, Raja-Azmi MN, Liza-Sharmini AT, Wan-Hazabbah WH, Zunaina E

Clin Ophthalmol, 2012;6:487-90.
PMID: 22536041 DOI: 10.2147/OPTH.S29806

We report a case of diffuse unilateral subacute neuroretinitis in a young boy with no clinical visualization of nematode. The diagnosis was made based on clinical findings and detection of Toxocara immunoglobulin G by Western blot test. An 11-year-old Malay boy presented with progressive blurring of vision in the left eye for a duration of 1 year. It was associated with intermittent floaters. Visual acuity in the left eye was 6/45 and improved to 6/24 with pinhole. There was positive relative afferent pupillary defect, impaired color vision, and presence of red desaturation in the left eye. There were occasional cells in the anterior chamber with no conjunctiva injection. Posterior segment examination revealed mild-to-moderate vitritis and generalized pigmentary changes of the retina with attenuated vessels. The optic disk was slightly hyperemic with mild edema. There was presence of multiple, focal, gray-white subretinal lesions at the inferior part of the retina. Full blood picture results showed eosinophilia with detection of Toxocara immunoglobulin G by Western blot test. Investigations for other infective causes and connective tissue diseases were negative. The diagnosis of diffuse unilateral subacute neuroretinitis secondary to Toxocara was made based on clinical findings and laboratory results. He was treated with oral albendazole 400 mg daily for 5 days and oral prednisolone 1 mg/kg with tapering doses over 6 weeks. At 1 month follow-up, the inflammation had reduced, and multiple, focal, gray-white subretinal lesions were resolved; however there was no improvement of vision.
Fulltext Serological IgG avidity test for ocular toxoplasmosis

Suresh S, Nor-Masniwati S, Nor-Idahriani MN, Wan-Hazabbah WH, Zeehaida M, Zunaina E

Clin Ophthalmol, 2012;6:147-50.
PMID: 22291456 DOI: 10.2147/OPTH.S26844

BACKGROUND: The purpose of this study was to evaluate the immunoglobulin (Ig) G avidity of serological toxoplasmosis testing in patients with ocular inflammation and to determine the clinical manifestations of ocular toxoplasmosis.
METHODS: A retrospective review of all patients presenting with ocular inflammation to the Hospital Universiti Sains Malaysia, Kelantan, Malaysia between 2005 and 2009 was undertaken. Visual acuity, clinical manifestations at presentation, toxoplasmosis antibody testing, and treatment records were analyzed.
RESULTS: A total of 130 patients with ocular inflammation were reviewed retrospectively. The patients had a mean age of 38.41 (standard deviation 19.24, range 6-83) years. Seventy-one patients (54.6%) were found to be seropositive, of whom five (3.8%) were both IgG and IgM positive (suggestive of recently acquired ocular toxoplasmosis) while one (0.8%) showed IgG avidity ≤40% (suggestive of recently acquired ocular toxoplasmosis) and 65 patients (50.0%) showed IgG avidity >40% (suggestive of reactivation of toxoplasmosis infection). Chorioretinal scarring as an ocular manifestation was significantly more common in patients with seropositive toxoplasmosis (P = 0.036). Eighteen patients (13.8%) were diagnosed as having recent and/or active ocular toxoplasmosis based on clinical manifestations and serological testing.
CONCLUSION: Ocular toxoplasmosis is a clinical diagnosis, but specific toxoplasmosis antibody testing helps to support the diagnosis and to differentiate between reactivation of infection and recently acquired ocular toxoplasmosis.
Fulltext Effect of Axial Eye Length on Retinal Vessel Parameters in 6 to 12-Year-Old Malay Girls

Tai EL, Li LJ, Wan-Hazabbah WH, Wong TY, Shatriah I

PLoS One, 2017;12(1):e0170014.
PMID: 28107389 DOI: 10.1371/journal.pone.0170014

PURPOSE: Retinal vessel analysis is affected by both systemic and ocular factors. Malays are the major ethnicity in South East Asia. Data on the retinal microvasculature in Malays is limited, especially among children. We aim to evaluate the influence of ocular biometry on retinal vessel parameters in young Malay girls.
METHODS: This was a cross-sectional, hospital-based study involving 86 Malay girls aged 6 to 12 years old in Hospital Universiti Sains Malaysia from 2015-2016. Ocular examination, refraction, biometry, retinal photography, and anthropometric measurements were performed. The central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE) and overall fractal dimension (Df) were measured using validated computer-based methods (Singapore I vessel analyzer, SIVA version 3.0, Singapore). The associations of ocular biometry and CRAE, CRVE and Df were analyzed using multivariable analysis.
RESULTS: The mean CRAE, CRVE and Df in Malay girls were 171.40 (14.40) um, 248.02 (16.95) um and 1.42 (0.05) respectively. Each 1 mm increase in axial length was associated with a reduction of 4.25 um in the CRAE (p = 0.03) and a reduction of 0.02 in the Df (p = 0.02), after adjustment for age, blood pressure and body mass index. No association was observed between axial length and CRVE. Anterior chamber depth and corneal curvature had no association with CRAE, CRVE or Df.
CONCLUSION: Axial length affects retinal vessel measurements. Narrower retinal arterioles and reduced retinal fractal dimension were observed in Malay girls with longer axial lengths.
Fulltext Evaluation of Retinal Nerve Fibre Layer Thickness and Choroidal Thickness in Parkinson Disease Patients

Ng KS, Hudzaifah-Nordin M, Sarah ST, Wan-Hazabbah WH, Sanihah AH

Prague Med Rep, 2023;124(4):421-434.
PMID: 38069647 DOI: 10.14712/23362936.2023.32

To evaluate the retinal nerve fibre layer (RNFL) thickness and choroidal thickness (CT) in Parkinson disease (PD) patients. A comparative cross-sectional, hospital-based study. 39 PD and 39 controls were recruited, who were gender and age matched. Subjects that fulfilled the inclusion criteria underwent optical coherence tomography for evaluation of RNFL thickness and choroidal thickness (CT). There was significant reduction of RNFL thickness in average (adjusted mean 88.87 µm vs. 94.82 µm, P=0.001), superior (adjusted mean 110.08 µm vs. 119.10 µm, P=0.002) and temporal (adjusted mean 63.77 µm vs. 70.36 µm, P=0.004) in PD compared to controls. The central subfoveal CT was significantly thinner in PD compared to controls (adjusted mean 271.13 µm vs. 285.10 µm, P=0.003). In PD group, there was significant weak negative correlation between the duration of PD with average RNFL thickness (r=-0.354, P=0.027), moderate negative correlation between the duration of PD with central subfoveal CT (r=-0.493, P=0.001), and weak negative correlation between the stage of PD with central subfoveal CT (r=-0.380, P=0.017). PD group had significant thinner average, superior and temporal RNFL thickness and CT compared to controls.
Fulltext Open globe injury in Hospital Universiti Sains Malaysia - A 10-year review

Madhusudhan AP, Evelyn-Tai LM, Zamri N, Adil H, Wan-Hazabbah WH

Int J Ophthalmol, 2014;7(3):486-90.
PMID: 24967196 DOI: 10.3980/j.issn.2222-3959.2014.03.18

To identify the aetiology of open globe injuries at Hospital Universiti Sains Malaysia over a period of 10y and the prognostic factors for visual outcome.
Fulltext Comparison of peripapillary retinal nerve fiber layer thickness between myopia severity groups and controls

Tai ELM, Ling JL, Gan EH, Adil H, Wan-Hazabbah WH

Int J Ophthalmol, 2018;11(2):274-278.
PMID: 29487819 DOI: 10.18240/ijo.2018.02.16

AIM: To compare the peripapillary retinal nerve fiber layer (RNFL) thickness measuredviaoptical coherence tomography (OCT) between different groups of myopia severity and controls.
METHODS: This was a prospective cross-sectional study. All subjects underwent a full ophthalmic examination, refraction, visual field analysis and A-scan biometry. Myopic patients were classified as low myopia (LM) [spherical equivalent (SE) from greater than -0.5 D, up to -3.0 D], moderate myopia (MM; SE greater than -3.0 D, up to -6.0 D) and high myopia (HM; SE greater than -6.0 D). The control group consisted of emmetropic (EM) patients (SE from +0.5 D to -0.5 D). A Zeiss Cirrus HD-OCT machine was used to measure the peripapillary RNFL thickness of both eyes of each subject. The mean peripapillary RNFL thickness between groups was compared using both analysis of variance and analysis of covariance.
RESULTS: A total of 403 eyes of 403 subjects were included in this study. The mean age was 31.48±10.23y. There were 180 (44.7%) eyes with EM, 124 (30.8%) with LM, 73 (18.1%) with MM and 26 (6.5%) with HM. All groups of myopia severity had a thinner average RNFL than the EM group, but after controlling for gender, age, and axial eye length, only the HM group differed significantly from the EM group (P=0.017). Likewise, the superior, inferior and nasal RNFL was thinner in all myopia groups compared to controls, but after controlling for confounders, only the inferior quadrant RNFL was significantly thinner in the HM group, when compared to the EM group (P=0.017).
CONCLUSION: The average and inferior quadrant RNFL is thinner in highly myopic eyes compared to emmetropic eyes. Refractive status must be taken into consideration when interpreting the OCT of myopic patients, as RNFL thickness varies with the degree of myopia.
Fulltext Ultrasonographic findings in eyes with retinopathy of prematurity in malaysia

Lee KF, Abdul Rahim A, Raja Azmi MN, Wan Hazabbah WH, Embong Z, Noramazlan R, et al.

Med J Malaysia, 2013;68(1):39-43.
PMID: 23466765 MyJurnal

RetCam is an excellent screening tool for the detection of retinopathy of prematurity (ROP). However, affordability is a barrier when adopting the use of RetCam in developing countries. We aimed to describe different stages of ROP using ultrasonographic B-scan and to evaluate the association between funduscopic examinations and ultrasonographic B-scan findings in premature neonates with ROP in Malaysia. A descriptive cross sectional study was conducted in 90 eyes of 47 premature neonates with different stages of ROP in three tertiary hospitals in Malaysia. Experienced ophthalmologists performed detailed funduscopic examinations using binocular indirect ophthalmoscopy (BIO). A masked examiner performed a 10 MHz ultrasonographic B-scan evaluation with 12 meridian position images within 48 hours of clinical diagnosis. Data from the clinical examination and ultrasonographic findings were collected and analysed. We recruited 37 eyes (41.1%) with stage 1 ROP, 29 eyes (32.3%) with stage 2, 18 eyes (20.0%) with stage 3, and 3 eyes (3.3%) with stages 4 and 5 based on the clinical assessment. Ultrasonography correctly identified 3 (8.1%) stage 1 eyes, 17 (58.6%) stage 2 eyes, 13 (72.2%) stage 3 eyes, and 3 each (100%) of the stage 4 and 5 eyes. There was a significant association between the funduscopic signs and the ultrasound findings for stage 2 ROP and above (Fisher's exact test, p <0.001). In conclusion, all stages of ROP were detected and described with a 10 MHz ultrasonic B-scan system. A significant association was observed between funduscopic signs and ultrasonographic findings in premature Malaysian neonates with stage 2 ROP and above.

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