1.Retinoblastoma in an Older Child: A Case Report
Ong Wu ZHUAN ; Jamalia RAHMAT ; Sunder RAMASAMY ; Amir SAMSUDIN
Malaysian Journal of Medicine and Health Sciences 2018;14(2):93-96
Retinoblastoma is a rare intraocular malignant tumour more commonly seen in children below five years of age. We presented a rare case of retinoblastoma in an older child. A nine-year-old girl noticed that she had loss of vision OS following a fall at home. Her vision was 6/6 OD and only light perception OS. Examination of the left eye revealed an extensive exudative retinal detachment. Her right eye examination was unremarkable. CT scan showed a left eye intraocular mass with calcification. EUA revealed a mixed endophytic and exophytic mass with extensive exudative retinal detachment. Family members consented to left eye enucleation and histopathological report confirmed the diagnosis of retinoblastoma. Post enucleation, patient is doing well with a prosthetic eye. In conclusion, any unexplained visual loss in children regardless of age warrants a full ophthalmological examination as the possibility of retinoblastoma cannot be ruled out.
2.Ultrasonographic Findings in Eyes with Retinopathy of Prematurity in Malaysia
Lee Kok Foo ; Abdul Rahim Adlina ; Raja Azmi Mohd Noor ; Wan Hazabbah Wan Hitam ; Embong Zunaina ; Abdullah Sarimah ; Noramazlan Ramli ; Zulkifli Abdul Ghani ; Josept Vijaya Alagaratnam ; Jamalia Rahmat ; Sunder Ramasamy ; Ismail Shatriah
The Medical Journal of Malaysia 2013;68(1):39-43
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.
3.Visual impairment and amblyopia in Malaysian pre-school children - The SEGPAEDS study
Fiona Chew Lee Min ; Lakana Kumar THAVARATNAM ; Intan Nor Chahaya Bt Shukor ; Sunder RAMASAMY ; Jamalia RAHMAT ; Daniel D REIDPATH ; Pascale ALLOTEY ; Joseph ALAGARATNAM
The Medical Journal of Malaysia 2018;73(1):25-30
Introduction: Little is known regarding the extent of visualimpairment amongst pre-school children in Malaysia.Objective: To determine the prevalence of visual impairmentand amblyopia in Malaysian preschool children.Methodology: A cross-sectional, population-based studywas conducted on children aged four to six years from 51participating kindergartens in the district of Segamat, Johor,Malaysia from 20 March 2016 to 6 April 2016. All subjects hadinitial eye screening consisting of LogMar visual acuity,orthoptics examination and Spot vision screenerassessment. Subjects who failed the initial eye screeningwere invited for a formal eye assessment consisting ofcycloplegic refraction and a comprehensive ocularexamination. Definitions of visual impairment and amblyopiawere based on the Multi-Ethnic Pediatric Eye Disease Studycriteria.Results: A total of 1287 children were recruited. Meansubject age was 5.03 (SD:0.77) and males represented 52.3%of subjects. Subjects by ethnicity were Malay (54.8%),Chinese (27.7%), Indian (15.6%) and Orang Asli (1.9%).Formal eye assessment was required for 221 subjects and88.8% required ophthalmic intervention. Refractive error,representing 95.4% of diagnosed ocular disorders,comprised of astigmatism (84%), myopia (9%) andhypermetropia (6.9%). With-the-rule astigmatism waspresent in 93.4% of the subjects with astigmatism. Visualimpairment was present in 12.5% of our subjects, with 61%having bilateral visual impairment. Of the subjects withvisual impairment, 59.1% had moderate visual impairment.The prevalence of amblyopia was 7.53%, and 66% of theamblyopic subjects had bilateral amblyopia.Conclusion: Our study highlights an urgent need forinitiation of preschool vision screening in Malaysia.
4.Paediatric cataract surgery in Hospital Kuala Lumpur - A 5-year review of visual outcomes
Fiona LM Chew ; Suriya Eh Qurut ; Izzaifa Hassan ; Lim See Teng ; Sunder Ramasamy ; Jamalia Rahmat
The Medical Journal of Malaysia 2019;74(1):15-24
Paediatric cataract surgery is challenging with
reported post-operative visual acuity (VA) of 0.3LogMar or
better varying between 33% to 68% of patients. OBJECTIVE:
The aim is to document the post-operative refraction, VA and
complications of non-traumatic pediatric cataract surgery
performed in a tertiary referral center in Malaysia.
5.Factors determining the outcome of paediatric exotropia surgery
Ivan Lai Yoon Ki ; Ting Siew Leng ; Cheah Whye Lian ; Sunder Ramasamy ; Jamalia Binti Rahmat
The Medical Journal of Malaysia 2019;74(4):266-269
Objective: To determine the socio-demographic and clinical
profile of exotropia surgery outcomes amongst paediatric
patients.
Methods: This is a descriptive, retrospective, clinical study
of surgeries performed between 2014 and 2016 at the
Sarawak Heart Centre, Malaysia. Medical records of patients
with primary and secondary exotropia were reviewed. The
following factors that affected the surgical outcomes were
collected: onset age of squint, age at the time of surgery, the
interval between diagnosis and surgery, the type of
exotropia, visual acuity, presence of amblyopia, previous
patching, anisometropia, refractive error, type of surgery,
preoperative and postoperative deviation, pre-existing
ocular comorbidity and systemic illness.
Result: A total of 15 patients were studied with more than
two thirds being females. Seven patients had primary
exotropia while eight patients had secondary exotropia.
Average interval between diagnosis and surgery was 1.3
years (±0.82) for primary exotropia and 1.2 years (±0.84) for
secondary exotropia. Average pre-operative angle for
primary exotropia was 50.57PD (±10.83) whereas secondary
exotropia was 39.38PD (±8.63). Seven patients had
successful surgical outcomes of within 10 prism dioptres,
five for primary exotropia and two for secondary exotropia.
The response to surgery was 3.0PD/mm (±0.59) for primary
exotropia and 2.2PD/mm (±0.74) for secondary exotropia.
Conclusion: In our study, primary exotropia had larger
preoperative angle than secondary exotropia. The response
to surgery was positively correlated with the preoperative
angle of deviation. Primary exotropia showed better surgical
outcome.