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  1. Oo KT, Tay KS, Law WC, Shatriah I
    Taiwan J Ophthalmol, 2019 12 05;10(3):235-238.
    PMID: 33110759 DOI: 10.4103/tjo.tjo_69_19
    Over the past decade, the discovery of disease-specific aquaporin-4 antibodies has led to a better understanding of the diverse spectrum of disorders that are associated with neuromyelitis optica. Brainstem manifestations have been increasingly recognized in this disease. However, multiple cranial nerve palsies as an initial presentation of neuromyelitis optica are uncommon. We report a rare case of anti-aquaporin-4 antibody-positive neuromyelitis optica that presented with unilateral abducens and facial nerve palsies. Notably, this case did not involve the optic nerve or the spinal cord. Diagnosing neuromyelitis optica that presents as an isolated acute brainstem syndrome is challenging, but the outcome may be devastating if the diagnosis is delayed.
  2. Ong Chin Feng W, Wan Hitam WH
    Taiwan J Ophthalmol, 2020 06 20;10(3):189-196.
    PMID: 33110750 DOI: 10.4103/tjo.tjo_22_20
    Purpose: Peripapillary retinal nerve fibre layer (RNFL) thickness might be useful in monitoring ongoing subclinical structural damage especially in eyes with no history of optic neuritis (ON) in neuromyelitis optica (NMO).

    Objective: To evaluate the peripapillary RNFL thickness and optic nerve functions in fellow eye of NMO with unilateral optic neuritis.

    Materials and Methods: A comparative cross-sectional study was conducted in 2 tertiary hospitals from August 2017 to May 2019. RNFL thickness and optic nerve functions were evaluated. Statistical analysis was performed using Statistical Package for Social Science version 24.

    Results: A total of 26 NMO patients and 26 controls were involved in this study. The median age (IQR) of NMO patients was 32.5 (12) years old. The RNFL thickness was significantly reduced in NMO patients with non-ON eyes as compared to control group. Best corrected visual acuity between the 2 groups were comparable (0.20 vs 0.00, p=0.071). Contrast sensitivity was also reduced in NMO patients (non-ON eyes) at all 5 spatial frequencies. In NMO group, 34.6% have normal colour vision. The mean deviation (MD) of Humphrey visual field (HVF) was higher in NMO group (p<0.001). There was a moderate correlation between RNFL thickness and contrast sensitivity. Weak correlation was found between the RNFL thickness with visual acuity and mean deviation of visual field test.

    Conclusion: Our study showed that the fellow eye of NMO patients with unilateral ON revealed a significant reduction in RNFL thickness and all the optic nerve functions have subtle early changes that signify a subclinical retinal damage.

  3. Ling KP, Wu AL, Lai CC, Wu WC
    Taiwan J Ophthalmol, 2019 1 15;8(4):249-252.
    PMID: 30637197 DOI: 10.4103/tjo.tjo_100_18
    We report a case with multiple recurrences of retinal detachment (RD) with severe proliferative vitreoretinopathy in a 12-year-old child who underwent vitrectomy using a heavy liquid perfluoro-n-octane (PFO) as a short-term postoperative tamponade. He had an encircling band and three vitrectomies with gas, followed by silicone oil tamponade for retinal redetachment prior to the use of PFO as a short-term tamponade. Short-term PFO tamponade was used in which inferior retinal reattachment was considered to be difficult with conventional gas or silicone oil tamponade, especially in regard to proper postoperative posturing. The PFO was left in the eye for 1 week, and the retina remained reattached after removal of the PFO which was replaced with silicone oil tamponade in this case. PFO appears feasible and tolerable as a short-term postoperative tamponade in the management of complex pediatric RD.
  4. Waheeda-Azwa H, Norihan I, Tai ELM, Kueh YC, Shatriah I
    Taiwan J Ophthalmol, 2020 02 12;10(4):278-283.
    PMID: 33437601 DOI: 10.4103/tjo.tjo_71_19
    PURPOSE: The available data on strabismus surgery in South East Asian countries are scarce. This study aimed to identify visual outcome and factors influencing surgical outcome of horizontal strabismus surgery in a Southeast Asian cohort.

    MATERIALS AND METHODS: A retrospective review of patients who underwent horizontal strabismus surgery between 2013 and 2017 in Hospital Universiti Sains Malaysia was conducted. Surgery was considered successful if the post-operative deviation was within 10 prism diopters at 6 months' postoperative period. Factors influencing the outcome of surgery at 6 months were identified. Chi-square and Fisher's exact tests were used in data analysis.

    RESULTS: Ninety-eight patients were included. Both genders were equally affected. Exotropia (58.2%) was the most common type. About 65.3% of patients had alternating strabismus, while 51% had an angle of deviation of more than 45 prism diopters. Amblyopia was documented in 14.3% of patients. Those operated on below 10 years of age comprised 64.3%. Ninety-four patients completed follow-ups at 6 months after the surgery. The success rate was 81.6%. Approximately 92% of the patients had best-corrected visual acuities of 6/12 and better at 6 months' postoperative period. There was no significant association between age of onset, gender, presence of amblyopia, type of deviation, amount of deviation, and postoperative best-corrected visual acuity with surgical outcome at 6 months' postoperative period (P > 0.05).

    CONCLUSION: The success rate was good. Postoperative best-corrected visual acuity was promising. Age of onset, gender, presence of amblyopia, type of deviation, amount of deviation, and postoperative best-corrected visual acuity did not influence the outcome of horizontal strabismus surgery in our review.

  5. Ahmad SS
    Taiwan J Ophthalmol, 2018 7 25;8(2):74-81.
    PMID: 30038885 DOI: 10.4103/tjo.tjo_106_17
    Glaucoma suspects are controversial clinical dilemmas. These individuals harbor certain risk factors or demonstrate some clinical features suggestive of an increased probability to develop glaucomatous optic atrophy in the future. These characteristics range from high intraocular pressure; optic disc, visual field, or retinal nerve fiber layer abnormalities; or abnormal angles to a positive family history of glaucoma and other risk factors. Individuals having these characteristics should be assessed diligently before a diagnosis of glaucoma is made. Glaucoma is a chronic, lifelong condition, having a negative impact on the quality of life, with an increased risk of medication-related side-effects, adverse economic impacts, and the need for lifestyle changes in the patient. Overdiagnosis and unnecessary treatment of such individuals is bereft of any advantage. This review aims to provide a practical blueprint for the proper diagnosis and management of such glaucoma suspects.
  6. Katherine SBH, Ngim YS, Juliana J, Ramli N
    Taiwan J Ophthalmol, 2020 03 04;10(1):54-57.
    PMID: 32309125 DOI: 10.4103/tjo.tjo_20_18
    This study aims to report two cases with an uncommon, early manifestation of herpes zoster ophthalmicus which is keratouveitis. The first patient is a 61-year-old female who had presented with painful facial skin eruption and right eye redness without impairment of vision. She was treated initially as herpes zoster blepharoconjunctivitis; however, the disease had progressed to neurotrophic keratitis with severe anterior chamber reaction manifested by a mixture of hypopyon and hyphema. The second patient is a 74-year-old female who had presented after 2 weeks of facial skin eruption with blurring of vision and similar keratouveitic manifestations. Both patients had poor visual outcome due to severe ocular inflammation.
  7. Shariffudin NS, Min TW, Adnan A, Hashim H, Teo KSS
    Taiwan J Ophthalmol, 2020 08 14;11(3):292-295.
    PMID: 34703746 DOI: 10.4103/tjo.tjo_29_20
    A 6-year-old boy was referred from the optometrist for bilateral painless blurred vision of 2 weeks duration during routine screening. Upon examination, best-corrected visual acuity was 20/200 (right eye) and 20/120 (left eye). Anterior segment examination was normal for both eyes. Funduscopy showed bilateral optic disc swelling with peripapillary exudates and diffuse retinochoroiditis involving the posterior pole. Optical coherence tomography revealed diffuse retinal thickening with intraretinal fluids and cystoid changes of central fovea. Fluorescein angiography showed bilateral hot discs with vasculitis in all quadrants and large areas of nonperfusion at peripheral retina. The patient was initially treated as presumed ocular tuberculosis (TB) based on clinical presentation and history of contact with family member having pulmonary TB. Antituberculous therapy was started and both eyes received panretinal laser photocoagulation. After 3 weeks of anti-TB treatment, serology for Bartonella turned out to be positive. Treatment was changed to intravenous ceftriaxone for 10 days followed by oral cotrimoxazole for 6 weeks and combined treatment with oral prednisolone. Gradual clinical improvement was seen with corresponding visual gain due to the reduction of macular edema, but residual thickening remained due to its chronicity.
  8. Ain-Nasyrah AS, Majid NA, Shatriah I
    Taiwan J Ophthalmol, 2020 10 21;11(4):413-416.
    PMID: 35070675 DOI: 10.4103/tjo.tjo_43_20
    Cortical blindness, also known as cerebral visual impairment, may occur in pediatric patients. Hepatic encephalopathy is a rare cause of cortical blindness in children. This report describes a girl with underlying type 1 autoimmune hepatitis, who complained of sudden-onset, painless visual loss in both eyes, which was associated with generalized headache and altered mental status. She was treated with intravenous antibiotics and syrup lactulose. The patient regained full visual recovery after 1 week. Prompt diagnosis and treatment are mandatory in such uncommon instances.
  9. Liong SL, Mohidin N, Tan BW, Ali BM
    Taiwan J Ophthalmol, 2015;5(4):164-168.
    PMID: 29018692 DOI: 10.1016/j.tjo.2015.07.006
    BACKGROUND/PURPOSE: The effect of orthokeratology (OK) on low myopia is well known, but there are a few reports on its effect on high myopia. In this study, the parametric changes in high and low myopia as results of wearing OK lenses for a period of 6 months have been analyzed.
    METHODS: Records of schoolchildren (age 7-17 years) undergoing OK treatment from an optometry clinic were retrospectively reviewed. Data involving refractive errors, uncorrected visual acuity, and corneal curvatures at baseline and after 1 day, 1 week, 1 month, 3 months, and 6 months of OK treatment from 25 patients who fulfilled the inclusion criteria were examined. For the analysis, the participants were arbitrarily divided into two groups comprising high myopia (< -6.00 D) and low to moderate myopia (from -1.00 D to -6.00 D).
    RESULTS: Significant reductions of refractive error, improvement in visual acuity, and corneal-curvature flattening were found in all participants after 6 months of OK lens wear compared to the baseline. No significant changes were found in corneal toricity in both high and low to moderate myopic groups. Almost all of these occurred after one night of lens wear in both the high- and low-myopia groups.
    CONCLUSION: The OK lens wear significantly reduced the refractive error and corneal curvature that results in the improvement in visual acuity in both high- and low-myopia groups, and the reduction seemed to occur nearly at the same time despite the difference in initial myopic power. High myopes with refractive power up to -8.25 D would benefit significantly from OK lenses.
    Study site: Optometry clinic, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
  10. Ahmad SS
    Taiwan J Ophthalmol, 2016 Oct-Dec;6(4):182-186.
    PMID: 29018738 DOI: 10.1016/j.tjo.2016.05.009
    An understanding of the pathogenesis of glaucoma is one of the foundations in glaucoma management. A number of theories have been presented to explain glaucomatous neural degeneration. The vascular theory attempts to explain the causation of glaucoma on the basis of vasogenic factors and altered he-modynamics in the body; however, this theory remains controversial. There are proponents for and against the role played by vascular factors in the development of glaucomatous optic nerve degeneration. This review aims to analyze the various studies performed to provide evidence for and against the vascular theory of glaucoma. It also affirms the need to undertake further studies regarding the path-ogenesis of glaucoma and integrate them into our management strategies. The literature search for this systemic analysis was performed using search engines, such as PubMed, The Virtual Library of the Ministry of Health Malaysia, Google Scholar, and ClinicalKey.
  11. Wai YZ, Radhakrishnan DM, Lingam G, Hamzah N, Rahmat J
    Taiwan J Ophthalmol, 2023;13(4):527-534.
    PMID: 38249495 DOI: 10.4103/tjo.TJO-D-22-00162
    PURPOSE: We aimed to analyze our 4-year experience of intra-arterial chemotherapy (IAC) for retinoblastoma (RB) and to examine the tumor response, globe salvage, mortality, and safety profile of IAC in the Malaysian profile.

    MATERIALS AND METHODS: This was a retrospective, interventional case series. A total of 22 eyes of 20 patients with RB who underwent IAC using melphalan and topotecan from January 2018 to December 2021 in Hospital Kuala Lumpur were retrospectively reviewed. Tumor response, globe salvage, mortality, and safety profile of IAC were compared based on the International Classification of Retinoblastoma.

    RESULTS: The mean patient age at IAC was 21.3 months. An overall globe salvage rate of 63.6% was observed: more specifically, 100% for Group A, 75% for Groups B and C, 66.7% for Group D, and 42.9% for Group E. Poor tumor response after IAC was significantly associated with a lesser chance of globe salvage (P = 0.045). The overall rate of good tumor response following IAC was 77.3%. Specifically, rates of good tumor response in each group were 100%, 75%, 75%, 83.3% and 71.4% in group A, B, C, D and E, respectively. The mortality rate was 5%. Complications (per-catheterization) included cerebral infarct (2.2%), oxygen desaturation (2.2%), vomiting (26.1%), periorbital edema (8.8%), ptosis (6.5%), fever, femoral hematoma, and hyperpigmentation over lid (4.4% each).

    CONCLUSION: Four-year experience showed that IAC is a safe and effective method for RB management. Patients with a poor response after IAC may have a lower chance of globe salvage. Careful patient selection is of utmost importance to achieve the best outcome in a setting of limited health-care resources.

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