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Fulltext Unilateral ischaemic retinopathy and bilateral subdural haemorrhage in an infant with non-accidental injury: An ophthalmological approach

Ee CL, Mohd Abdullah AA, Samsudin A, Khaliddin N

Ulus Travma Acil Cerrahi Derg, 2019 09;25(5):527-530.
PMID: 31475330 DOI: 10.5505/tjtes.2018.57059

Non-accidental injury (NAI) is not an uncommon problem worldwide, which leads to significant morbidity and mortality in infants. The presence of retinal or subdural haemorrhages, or encephalopathy with injuries inconsistent with the clinical history is highly suggestive of NAI. In this study, we report on a case of a a 3-month-old infant who presented to the casualty department with a very sudden onset of recurrent generalised tonic-clonic seizures. There was no history of trauma or visible external signs. She was found to have bilateral subdural haemorrhages and atypical unilateral ischaemic retinopathy. Retinal photocoagulation was performed with subsequent resolution of vitreous and retinal haemorrhages. However, visual recovery in that eye remained poor. The findings showed that a high index of suspicion of NAI is required in infants with intracranial haemorrhage and unilateral retinal haemorrhages.

Matched MeSH terms: Light Coagulation
Fulltext Von Hippel angioma

Chong PK, Loo AV, Alagaratnam JV

Med J Malaysia, 2007 Oct;62(4):343-4.
PMID: 18551944 MyJurnal

We report a three year follow up of a 35-year-old Indian gentleman who presented with sudden, painless blurring of left (L) eye vision with initial visual acuity (VA) of 6/60. Fundoscopy revealed (L) vitreous haemorrhage and subsequently confirmed a (L) inferotemporal capillary haemangioma. The adjacent area of capillary haemangioma was treated with barricade argon laser photocoagulation to prevent progression of exudative retinal detachment inferiorly. Subsequent follow up showed mild regression of capillary haemangioma with maintenance of (L) eye vision at 6/9.

Matched MeSH terms: Light Coagulation/instrumentation
Fulltext Resolution of exudative retinal detachment and regression of retinal macrocyst post-laser in Coats disease

Munira Y, Zunaina E, Azhany Y

Int Med Case Rep J, 2013;6:37-9.
PMID: 23966803 DOI: 10.2147/IMCRJ.S47769

A 15-year-old boy presented with painless progressive blurring of vision in the right eye for 1 year in duration. His visual acuity in the right eye was hand movement. The right fundus showed presence of extensive subretinal exudates at the posterior pole and a retinal macrocyst at the temporal periphery. It was associated with exudative retinal detachment at the inferior periphery of the retina. Fundus angiography revealed telangiectatic retinal vessels at the superotemporal retina. Based on clinical and angiographic findings, a diagnosis of Coats disease was made. He was treated with retinal laser photocoagulation. There was resolution of the exudative retinal detachment, reduction of subretinal exudates, and regression of the retinal macrocyst with improvement of visual acuity to 1/60 post-laser therapy.

Matched MeSH terms: Light Coagulation
Application of different imaging modalities for diagnosis of Diabetic Macular Edema: A review

Mookiah MR, Acharya UR, Fujita H, Tan JH, Chua CK, Bhandary SV, et al.

Comput Biol Med, 2015 Nov 1;66:295-315.
PMID: 26453760 DOI: 10.1016/j.compbiomed.2015.09.012

Diabetic Macular Edema (DME) is caused by accumulation of extracellular fluid from hyperpermeable capillaries within the macula. DME is one of the leading causes of blindness among Diabetes Mellitus (DM) patients. Early detection followed by laser photocoagulation can save the visual loss. This review discusses various imaging modalities viz. biomicroscopy, Fluorescein Angiography (FA), Optical Coherence Tomography (OCT) and colour fundus photographs used for diagnosis of DME. Various automated DME grading systems using retinal fundus images, associated retinal image processing techniques for fovea, exudate detection and segmentation are presented. We have also compared various imaging modalities and automated screening methods used for DME grading. The reviewed literature indicates that FA and OCT identify DME related changes accurately. FA is an invasive method, which uses fluorescein dye, and OCT is an expensive imaging method compared to fundus photographs. Moreover, using fundus images DME can be identified and automated. DME grading algorithms can be implemented for telescreening. Hence, fundus imaging based DME grading is more suitable and affordable method compared to biomicroscopy, FA, and OCT modalities.

Matched MeSH terms: Light Coagulation
Outcomes of Subliminal Transscleral Cyclophotocoagulation treatment in glaucoma

Chow JY, Wan Norliza WM, Bastion MC

Med J Malaysia, 2021 03;76(2):236-240.
PMID: 33742635

BACKGROUND: Subliminal transscleral cyclophotocoagulation (SL-TSCPC) is a new alternative therapy to reduce intraocular pressure (IOP) safely and effectively. However, there are few studies regarding SL-TSCPC by Supra 810 laser machine and limited data regarding its effectiveness in moderate severity glaucoma that still has good preservation of vision. This study was conducted to evaluate the outcome of SL-TSPCPC in various types of glaucoma including patients with good vision.
METHODS: A retrospective, non-comparative, analytical case series of all patients who received SL-TSCPC treatment from October 2018 to April 2019 at Hospital Tengku Ampuan Afzan, Pahang, Malaysia. Data was collected during the second week, sixth week, third month and sixth month follow-up. The primary outcome measure gave success rate at six months post-treatment. Secondary measures were changes in visual acuity, mean IOP reduction, mean number of IOP lowering medications reduced and ocular side effects noted during follow-up.
RESULTS: The success rate was 43.8% (seven eyes out of sixteen eyes) at six months post-treatment. The mean IOP reduced from 43.0mmHg±14.8mmHg pre-treatment to 24.7mmHg±12.0mmHg at two weeks post treatment with 42.6% reduction. Subsequently, mean IOP at sixth week, third month and sixth month were 33.8mmHg±16.9mmHg, 35.2mmHg±14.9mmHg, and 29.0mmHg±16.2mmHg respectively. Vision maintained in 13 patients, two patients had improvement in vision however, five patients had deterioration in vision. No serious ocular side effects were noted.
CONCLUSION: Subliminal TSCPC is a safe and alternative method of lowering IOP in moderate to advanced glaucoma over 6 months duration of follow-up. As it has good safety profile and repeatability, it is a good treatment option for patients with uncontrolled glaucoma.

Matched MeSH terms: Light Coagulation
Fulltext Diabetic retinopathy and the effect of pregnancy

Mallika P, Tan AK, Aziz S, Asokumaran T, Syed Alwi SAR, Intan G

Malays Fam Physician, 2010;5(1):2-5.
PMID: 25606177 MyJurnal

Pregnancy is associated with increased risk of development and progression of diabetic retinopathy (DR). Although pregnancy does not have any long term effect on DR, progression of retinopathy changes occur in 50%-70% of cases. The greatest risk of worsening occurs during the second trimester and persists as long as 12 months postpartum. The other factors found to be associated with its progression include duration of the diabetes, severity of retinopathy at conception, hyperglycaemic control, anaemia and progression of coexisting hypertension. Because of the increased risk of progression of the disease in pregnancy, conception should be delayed till the ocular disease is treated and stabilized and laser photocoagulation should be promptly instituted in all cases of severe non-proliferative retinopathy and should not be delayed till the patient develops early proliferative changes. Good diabetic control before and during pregnancy can help prevent this increase in the progression and serious vision loss.

Matched MeSH terms: Light Coagulation
Fulltext Bilateral profound visual loss as a consequence of leukaemia – a case report

Raajini, Devi K., Safinaz, M.K., Hazlita, M.I.

Journal of Surgical Academia, 2015;5(1):61-63.
MyJurnal

An 18-year-old Malay gentleman was noted to have profound bilateral blurred vision for one month duration, associated with loss of weight, appetite, low grade fever and abdominal distension. Visual acuity on presentation was 6/60 on the right, counting finger on the left with no afferent pupillary defect. Anterior segments were unremarkable. Vitreous cells were occasional bilaterally. Fundus revealed multiple choroidal and sub-retinal Roth spots with areas of pre-retinal and intra-retinal haemorrhages, involving the macula in the left eye. Vessels were dilated and tortuous in all quadrants of the right eye. Many areas of capillary fall out at peripheral retina were demonstrated in fundus fluorescein angiogram. Further systemic and laboratory review confirmed the diagnosis of CML and chemotherapy was initiated. Both eye ischaemic retinopathy secondary to CML was confirmed and scatter pan retinal photocoagulation was performed bilaterally. Good improvement in vision noted during subsequent follow up to 6/24 on the right, 6/60 on the left. High levels of suspicion and accurate early recognition of fundus changes are vital in these types of cases to ensure the institution of prompt treatment.

Matched MeSH terms: Light Coagulation
Implantation and diabetes: analysis of 525 cases

Lim AS, Ang BC, Heng LK, Hart PM, Ngui MS, Chew P, et al.

Ann Acad Med Singap, 1989 Mar;18(2):174-7.
PMID: 2751233

This is a retrospective study of 525 posterior chamber implants in diabetics performed by A S M Lim and B C Ang of Singapore. The patients were reviewed by visiting ophthalmologists--J E Kennedy (Sydney), M Ngui (East Malaysia) and P M Hart (Belfast). This study did not show any significant difference in the complication of post-operative visual acuity between diabetics and non-diabetics. 95% obtained 6/12 vision or better when pre-existing disease was excluded. It also showed that posterior chamber implants can be inserted in eyes with maculopathy or proliferative retinopathy if laser treatment was effectively done before or after surgery.

Matched MeSH terms: Light Coagulation
Exudative Retinal Detachment due to Coats Disease in a Teenager with Senior-Loken Syndrome: Case Report and Review of Literature

Khairil-Ridzwan KK, Azian A, Hanizasurana H, Shatriah I

Cureus, 2019 Apr 15;11(4):e4460.
PMID: 31205846 DOI: 10.7759/cureus.4460

Senior-Loken syndrome is a rare disorder that presents in the first two decades of life. It commonly manifests with nephronophthisis and retinal dystrophy. We describe a teenager who had end-stage renal failure presenting with bilateral visual impairment due to retinal dystrophy with concomitant unilateral Coats disease and exudative retinal detachment. The patient was treated with a combination of endolaser photocoagulation and external drainage of the subretinal fluid. The final visual acuity remained poor in both eyes. Options of treatment in this challenging situation is discussed in this case report.

Matched MeSH terms: Light Coagulation
Fulltext Silent occlusive retinal vasculitis in a patient with pulmonary tuberculosis

Nadia Yaacob, Adil Hussein, Maizan Yaakob, Zuraidah Mustari

Journal of Biomedical and Clinical Sciences, 2018;3(1):31-34.
MyJurnal

The presence of retinal vasculitis in patients with pulmonary tuberculosis is not uncommon. However, asymptomatic presentations are quite rare. Here, we present a case of 25-year-old Malay gentleman with pulmonary tuberculosis, who was referred for an eye assessment following initiation of anti-tuberculosis drugs. His vision was good; he had no other symptoms despite having retinal neovascularization, pre-retinal haemorrhages and healed choroiditis at the fundus of the left eye. Fundus fluorescein angiography showed multiple areas of capillary fallouts at the superotemporal quadrant of the left eye with leakage from the retinal neovascularization. He was treated with laser retinal photocoagulation and oral steroids for 6 weeks, while the anti-tuberculosis drugs were continued for 9 months. Subsequent follow-ups showed regression of the neovascularization. He has remained asymptomatic since his initial visit to the eye clinic.

Matched MeSH terms: Light Coagulation
Fulltext Vitreous haemorrhage: a consequence of herpes simplex acute retinal necrosis

Sherina, Q., Rosiah, M., Mushawiahti, M.

Medicine & Health, 2019;14(2):271-277.
MyJurnal

Acute retinal necrosis (ARN) is a rare, blinding disease that typically affects adults. However, in this case report, we highlight the diagnosis, management and outcome of herpes simplex acute retinal necrosis in a 13-year-old healthy girl, who presented with painful right eye, redness and blurring of vision for one week. Examination of the right eye showed features of granulomatous panuveitis. Optic disc was swollen and retina appeared pale. There were multiple patches of retinitis and haemorrhages at mid-periphery of the fundus with inferior serous detachment observed. Rapidly progressive inflammation in just four days along with secondary cataract that obscured fundus view, imposed greater challenge to the diagnosis and management. Intravenous acyclovir 300mg, 3 times a day was initiated promptly while vitreous fluid was sent for polymerase chain reaction, which identified Herpes Simplex Virus-1. Inflammation improved, but she developed vitreous haemorrhage secondary to proliferative retinopathy, which required panretinal photocoagulation. ARN is therefore, principally a clinical diagnosis and high index of suspicion is crucial particularly, in children for prompt diagnosis and treatment. Complications should also be addressed timely to improve the chances of preserving vision.

Matched MeSH terms: Light Coagulation
Fulltext Bilateral retinal vasculitis: a presumed case of ocular TB without inflammation

Umi Kalthum, M.N., Norfarizal, A., Rona Asnida, N., Ayesha, M.Z., Jemaima, C.H.

Medicine & Health, 2012;7(2):97-101.
MyJurnal

A 17-year-old male student of Indonesian parentage presented with two weeks history of progressive painless bilateral visual deterioration. There was no contact with tuberculosis (TB)-infected patients and parents claimed that all immunization including BCG was completed. However, BCG scar was not apparent. Visual acuity was 6/36 and 6/60 in the right and left eyes respectively. The anterior and vitreous chambers were quiet. Funduscopic examination revealed retinal vasculitis with perivascular exudates, branch vein occlusion, neovascularization and macular oedema. Fluorescein angiography confirmed large areas of capillary non-perfusion and leaking new vessels. Mantoux test was positive and full regime anti-TB therapy was instituted. HIV screening was negative. Three days later, an immunosuppressive dose of oral steroid was started. Both eyes received intensive laser photocoagulation.Interestingly, there was no development of vitritis throughout.

Matched MeSH terms: Light Coagulation
Fulltext Hemangioblastoma in the setting of von hippel lindau disease: a case report

Raajini Devi K, Aida Zairani MI, Hazlita MI, Jemaima CH, Farizal F, Safinaz Mohd Khialdin

Journal of Surgical Academia, 2016;6(1):54-58.
MyJurnal

A 21-year-old Chinese gentleman with no known medical illness, presented with a history of right painless blurring of vision with central scotoma of two weeks duration. He also had a history of multiple episodes of seizures prior to presentation. Visual acuity was 1/60 with unremarkable anterior segment findings and no relative afferent pupillary defect. Fundus examination of the right eye revealed dilated and tortuous retinal veins with multiple retinal capillary hemangiomas and sub retinal hard exudates at the macula with edema. A diagnosis of Von Hippel Lindau disease was made when a posterior fossa mass suggestive of hemangioblastoma with obstructive hydrocephalus was seen on computed tomography of the brain. Craniotomy with nodule excision was performed. The retinal capillary hemangiomas were treated with the combination of laser photocoagulation and intravitreal Ranibizumab injections. Visual acuity subsequently improved to 6/36.

Matched MeSH terms: Light Coagulation
Fulltext Retinal vasculitis in systemic lupus erythematosus: an indication of active disease

Md Noh UK, Zahidin AZ, Yong TK

Clin Pract, 2012 Mar 30;2(2):e54.
PMID: 24765453 DOI: 10.4081/cp.2012.e54

A 26-year-old woman with a recent flare-up of systemic lupus erythematosus presented with peripheral retinal hemorrhages at a routine check-up. She is on a tapering dose of immunosuppressive agents. Her visual acuity was good. Fluorescein angiogram revealed vasculitic changes with capillary non-perfusion areas. A few weeks later, she developed cerebral lupus with advanced lupus nephritis. Immunosuppressive therapy was restarted and panretinal photocoagulation was delivered. Her visual acuity remained stable, despite development of a cataract from prednisolone therapy.

Matched MeSH terms: Light Coagulation

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