MyMedR

Fulltext Atypical Presentation of Idiopathic Bilateral Optic Perineuritis in a Young Patient

Tevaraj JM, Tai Li Min E, Mohd-Noor RA, Thavaratnam LK, Salmah WM, Wan Hitam WH

Case Rep Ophthalmol Med, 2016;2016:6741925.

PMID: 28078151 DOI: 10.1155/2016/6741925

A previously healthy 27-year-old Malay male presented with acute onset of painless, severe blurring of vision in his right eye. It was associated with headache and vomiting for the past week. Relative afferent pupillary defect was present in the right eye, with reduced optic nerve function. Patient also had bilateral generalised optic disc swelling, splinter haemorrhages, and tortuous vessels. Initial examination was suggestive of either optic neuritis or raised intracranial pressure. Typical features of bilateral optic perineuritis (OPN) such as tram track and doughnut sign were observed on magnetic resonance imaging. Connective tissue and infective screening were negative. He was diagnosed with bilateral optic perineuritis and treated with high dose intravenous corticosteroids followed by a three-month course of oral steroids. His vision and optic nerve function recovered to baseline levels.

Fulltext Cytomegalovirus Retinitis in Primary Immune Deficiency Disease

Ngai JJ, Chong KL, Oli Mohamed S

Case Rep Ophthalmol Med, 2018;2018:8125806.

PMID: 30327738 DOI: 10.1155/2018/8125806

INTRODUCTION: To report an unusual case of CMV retinitis in Primary Immune Deficiency Disease (PIDD).

CASE REPORT: 13-year-old child with combined T and B cell deficiencies was diagnosed of bilateral zone 1 CMV retinitis. Intravitreal injections were unable to be given in a regular and timely manner under general anaesthesia due to her underlying systemic disease. The child was treated with intravenous ganciclovir for 8 weeks until eventual resolution of the retinitis. However, visual acuity deteriorated due to progressive optic nerve involvement.

CONCLUSION: Paediatric patients often do not notice subtle symptoms of CMV retinitis. Although ocular manifestations are uncommon in PIDD, recognition and high index of suspicion will allow for timely referral, diagnosis, and treatment to be instituted for better visual outcomes.

Fulltext Kingella kingae Keratitis in a Child with Underlying Vernal Keratoconjunctivitis

Nurul-Laila S, Chai KS, Liza-Sharmini AT, Shatriah I

Case Rep Ophthalmol Med, 2017;2017:1087821.

PMID: 28546880 DOI: 10.1155/2017/1087821

Kingella kingae had rarely been reported as a causative organism for corneal ulcer and had not been described before in vernal keratoconjunctivitis (VKC). Generally regarded as commensals of respiratory tract particularly in young children, it had however been isolated from the corneal ulcer scraping of both adult and children. We report a case of bacterial ulcer with isolation of Kingella kingae from the corneal scraping in a young child with underlying VKC.

Fulltext Multifacet of Cornea Patch Graft in Anterior Segment Diseases

Chendran P, Meng Hsien Y, Wan Abdul Halim WH

Case Rep Ophthalmol Med, 2019;2019:6862487.

PMID: 31885979 DOI: 10.1155/2019/6862487

Incidence of cornea melting or perforation is commonly seen in variety of cornea conditions. It can cause debilitating vision loss and impair patient's daily activity. Several techniques have been described to surgically treat cornea perforation and melting. In this article, a series of corneal diseases treated with corneal patch graft are highlighted to relate different approach of cornea patch graft surgery. Post-operative management and complications are discussed.

Fulltext Cyphellophora sp. Isolated from a Corneal Ulcer in the Human Eye

Rajandran S, Razali KM, Mustapha M, Palaniappan PA, Amran F

Case Rep Ophthalmol Med, 2020;2020:5861258.

PMID: 32774963 DOI: 10.1155/2020/5861258

Cyphellophora is a black yeast-like fungus with most of the strains being isolated from soil and plants. It tends to cause sooty blotch and flyspeck disease in plants. In humans, it is known to cause superficial skin and nail infections. This report highlights the case of a patient who initially presented with a small corneal abrasion which rapidly progressed into a corneal ulcer after the patient did not respond to the initial conventional treatment. The laboratory results from the corneal scraping found it to be Cyphellophora sp.

Fulltext Infected Baerveldt Glaucoma Drainage Device by Aspergillus niger

Salim NL, Azhany Y, Abdul Rahman Z, Yusof R, Liza-Sharmini AT

Case Rep Ophthalmol Med, 2015;2015:249419.

PMID: 26064735 DOI: 10.1155/2015/249419

Fungal endophthalmitis is rare but may complicate glaucoma drainage device surgery. Management is challenging as the symptoms and signs may be subtle at initial presentation and the visual prognosis is usually poor due to its resistant nature to treatment. At present there is lesser experience with intravitreal injection of voriconazole as compared to Amphotericin B. We present a case of successfully treated Aspergillus endophthalmitis following Baerveldt glaucoma drainage device implantation with intravitreal and topical voriconazole.

Fulltext Recurrent bilateral occipital infarct with cortical blindness and anton syndrome

Kwong Yew K, Abdul Halim S, Liza-Sharmini AT, Tharakan J

Case Rep Ophthalmol Med, 2014;2014:795837.

PMID: 24744933 DOI: 10.1155/2014/795837

Bilateral cortical blindness and Anton syndrome, are most commonly caused by ischaemic stroke. In this condition, patients have loss of vision but deny their blindness despite objective evidence of visual loss. We report a case of a patient with multiple cardiovascular risk factors who developed recurrent bilateral occipital lobe infarct with Anton syndrome. A suspicion of this condition should be raised when the patient has denial of blindness in the presence of clinical and radiological evidence of occipital lobe injury. Management of this condition should focus on the underlying cause, in which our patient requires secondary stroke prevention and rehabilitation.

Fulltext Arteriovenous malformation in temporal lobe presenting as contralateral ocular symptoms mimicking carotid-cavernous fistula

Mohd-Tahir F, Siti-Raihan I, Wan Hazabbah WH

Case Rep Ophthalmol Med, 2013;2013:158961.

PMID: 23533876 DOI: 10.1155/2013/158961

Aim. To report a rare case of arteriovenous malformation in temporal lobe presenting as contralateral orbital symptoms mimicking carotid-cavernous fistula. Method. Interventional case report. Results. A 31-year-old Malay gentleman presented with 2-month history of painful progressive exophthalmos of his left eye associated with recurrent headache, diplopia, and reduced vision. Ocular examination revealed congestive nonpulsating 7 mm exophthalmos of the left eye with no restriction of movements in all direction. There was diplopia in left lateral gaze. Left IOP was elevated at 29 mmHg. Left eye retinal vessels were slightly dilated and tortuous. CT scan was performed and showed right temporal arteriovenous malformation with a nidus of 3.8 cm × 2.5 cm with right middle cerebral artery as feeding artery. There was dilated left superior ophthalmic vein of 0.9 mm in diameter with enlarged left cavernous sinus. MRA and carotid angiogram confirmed right temporal arteriovenous malformation with no carotid-cavernous fistula. Most of the intracranial drainage was via left cavernous sinus. His signs and symptoms dramatically improved following successful embolisation, completely resolved after one year. Conclusion. Intracranial arteriovenous malformation is rarely presented with primary ocular presentation. Early intervention would salvage the eyes and prevent patients from more disaster morbidity or fatality commonly due to intracranial haemorrhage.

Fulltext Refractory Scedosporium apiospermum Keratitis Successfully Treated with Combination of Amphotericin B and Voriconazole

Fadzillah MT, Ishak SR, Ibrahim M

Case Rep Ophthalmol Med, 2013;2013:413953.

PMID: 23509650 DOI: 10.1155/2013/413953

Aim. To report a case of refractory fungal keratitis caused by Scedosporium apiospermum. Methods. Interventional case report. Results. A 47-year-old Malay housewife presented with left eye cornea ulcer as her first presentation of diabetes mellitus. There was no history of ocular trauma, contact lens used, or cornea foreign body. Scedosporium apiospermum was isolated from the cornea scrapping. Her cornea ulcer initially responded well to topical Amphotericin B within 3 days but subsequently worsened. Repeat cornea scrapping also yields Scedosporium apiospermum. This refractory keratitis was successfully treated with a combination of topical Amphotericin B and Voriconazole over 6 weeks. Conclusion. Scedosporium apiospermum keratitis is an opportunistic infection, which is difficult to treat despite tight control of diabetes mellitus and intensive antifungal treatment. The infection appeared to have very quick onset but needed long duration of treatment to completely heal. Surgical debridement always plays an important role as a therapeutic procedure as well as establishes the diagnosis through repeat scrapping.

Fulltext Ocular tuberculosis with multiple cerebral abscesses

Nor-Masniwati S, Zunaina E, Azhany Y

Case Rep Ophthalmol Med, 2012;2012:606741.

PMID: 22611511 DOI: 10.1155/2012/606741

A 23-year-old Malay man presented with headache for one-month duration. It was associated with painless blurring of vision of the right eye. He had loss of appetite and reduced weight but no night sweats or hemoptysis. His visual acuity on the right eye was 6/45 and improved to 6/15 with pinhole. Right fundus examination revealed a choroidal tuberculoma located at one disc diameter away from optic disc superiorly with mild vitritis. Systemic examinations revealed no significant finding. Mantoux test reading was 22 mm with erythrocyte sedimentation rate that was 14 mm/h. Other blood investigations were negative with normal chest radiography. The computerized tomography scan of the brain revealed multiple cerebral abscesses. A clinical diagnosis of right ocular tuberculosis with multiple cerebral abscesses was made. He was treated with antituberculosis chemotherapy for one year which divided into intensive phase for three months and maintenance phase for nine months. Cerebral abscesses resolved after three months of antituberculosis drugs and at one-year follow-up, and the choroidal tuberculoma resolved completely with scar formation and significant macular striae.

Fulltext Pasteurella canis Isolation following Penetrating Eye Injury: A Case Report

Rashid NK, Zam Z, Mdnoor SS, Siti-Raihan I, Azhany Y

Case Rep Ophthalmol Med, 2012;2012:362369.

PMID: 22606491 DOI: 10.1155/2012/362369

A 3-year-old boy presented with history of trauma to the left eye after he accidentally injured his eye with a broom stick made up from coconut skewers. There was history of cats as their pets but not dogs. Ocular examination revealed left superonasal conjunctival laceration and scleral perforation with prolapsed vitreous. Fundus examination showed minimal vitreous haemorrhage and flat retina. Conjunctiva swab at the wound site was sent for gram staining, culture, and sensitivity. He underwent scleral suturing, vitreous tap, and intravitreal injection of Ceftazidime and Amikacin. Vitreous tap was sent for gram stained, culture and sensitivity. Postoperatively, he was started empirically on IV Ciprofloxacin 160 mg BD, Guttae Ciprofloxacin, and Guttae Ceftazidime. Conjunctiva swab grew Pasteurella canis which was sensitive to all Beta lactams, Ciprofloxacin, Chloramphenicol, and Aminoglycoside. Post-operative was uneventful, absent signs of endophthalmitis or orbital cellulitis.

Neurofibromatosis Type 2 Presenting with Oculomotor Ophthalmoplegia and Distal Myopathy

Tevaraj JM, Li Min ET, Mohd Noor RA, Yaakub A, Wan Hitam WH

Case Rep Ophthalmol Med, 2016;2016:1701509.

PMID: 27738538

Neurofibromatosis type 2 usually presents with bilateral acoustic schwannomas. We highlight the rare presentation of neurofibromatosis initially involving third nerve. A 23-year-old Malay female presented with left eye drooping of the upper lid and limitation of upward movement for 8 years. It was associated with right-sided body weakness, change in voice, and hearing disturbance in the right ear for the past 2 years. On examination, there was mild ptosis and limitation of movement superiorly in the left eye. Both eyes had posterior subcapsular cataract. Fundoscopy showed generalised optic disc swelling in both eyes. She also had palsy of the right vocal cord, as well as the third and eighth nerve. There was wasting of the distal muscles of her right hand, with right-sided decreased muscle power. Pedunculated cutaneous lesions were noted over her body and scalp. MRI revealed bilateral acoustic and trigeminal schwannomas with multiple extra-axial lesions and intradural extramedullary nodules. Patient was diagnosed with neurofibromatosis type 2 and planned for craniotomy and tumour debulking, but she declined treatment. Neurofibromatosis type 2 may uncommonly present with isolated ophthalmoplegia, so a thorough physical examination and a high index of suspicion are required to avoid missing this condition.

Successful Resolution of Preretinal Haemorrhage with Intravitreal Ranibizumab

Noorlaila B, Zunaina E, Raja-Azmi MN

Case Rep Ophthalmol Med, 2016;2016:4164198.

PMID: 27800200

We would like to report two cases of preretinal haemorrhage from two different aetiology courses of bleeding being treated with intravitreal ranibizumab and its outcome. Our first case was a 39-year-old man with a diagnosis of severe aplastic anaemia that presented with bilateral premacular haemorrhages in both eyes. His right eye vision was 6/45 and it was counting finger in the left eye. He was treated with intravitreal ranibizumab once to the right eye and twice to the left eye. Right eye showed complete resolution of premacular haemorrhage and minimal residual premacular haemorrhage in the left eye at 3 months after initial presentation. Our second case was a 32-year-old healthy teacher that presented with preretinal haemorrhage at superotemporal region extending to macular area in left eye secondary to valsalva retinopathy. Her left vision was counting finger. She was treated with single intravitreal ranibizumab to the left eye. There was significant reduction of premacular haemorrhage and her left eye vision improved to 6/6 at 10 weeks after injection. Both cases had favourable outcome with intravitreal ranibizumab and can be considered as nonsurgical treatment option in treating premacular haemorrhage.

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