1.Optic disc topography of normal tension glaucoma patients in Malaysia.
Adlina, Abdul Rahim ; Shatriah, Ismail ; Liza Sharmini, Ahmad Tajudin ; Ahmad, Mt Saad
The Medical Journal of Malaysia 2013;68(4):338-42
There are limited data in the literature on the optic disc topography in normal tension glaucoma (NTG) patients in Asian countries, especially in Southeast Asia. This study is aimed at comparing optic disc topography in NTG patients and a control group in Malaysia, and we discuss the literature on NTG studies in other Asian populations. A comparative cross-sectional study was conducted in two hospitals with glaucoma services in Malaysia from November 2010 to February 2012. A total of 109 eyes of 109 Malay patients were included in this study: 32 NTG patients and 77 subjects in the control group. All participants underwent a thorough ocular examination, including visual acuity, subjective refraction, anterior segment and fundus examinations, Humphrey visual field 24-2, intraocular pressure measurement, gonioscopy examination and fundus photography. Optic disc topography was assessed using the Heidelberg Retinal Tomograph III by an identified masked investigator in each hospital. NTG patients had a notably larger disc area (2.65 (0.41) vs 2.19 (0.43) mm(2), respectively), larger cupping (1.54 (0.43) vs 0.63 (0.40) mm(2), respectively), smaller retinal rim areas (1.12 (0.41) vs 1.56 (0.33) mm(2), respectively), higher cup volume (0.47 (0.28) vs 0.11 (0.19) mm(3), respectively), reduced rim volume (0.23 (0.13) vs 0.41 (0.16) mm(3), respectively), higher cup to disc area ratio (0.58 (0.14) vs 0.27 (0.15), respectively), higher linear cup to disc ratio (0.76 (0.09) vs 0.49 (0.17) mm(2), respectively), higher mean cup depth (0.37 (0.09) vs 0.22 (0.09) mm, respectively), higher maximum cup depth (0.77 (0.16) vs 0.59 (0.20) mm, respectively), higher mean of cup shape measure (-0.04 (0.06) vs -0.16 (0.07), respectively), and thinner mean retinal nerve fibre layer thickness (0.15 (0.15) vs 0.24 (0.07) mm, respectively) compared to the control group (p<0.05). In conclusion, most of the optic disc parameters were significantly different in NTG patients compared to healthy individuals in Malaysia. Our findings are comparable to those reported in NTG studies in other Asian countries.
2.Fibrin glue for sealing early bleb leak :a case report
Ali Hassan ALASHWAL ; Azhany YAAKUB ; Raja Azmi Mohd NOOR ; Liza Sharmini Ahmad TAJUDIN
International Eye Science 2009;9(5):831-832
A 63-year-old male presented with sudden diminution of vision, eye discomfort, redness and watering in his left eye. He had undergone glaucoma valve filtering surgery for refractive secondary glaucoma one week back. He also had a history of failed augmented trabeculectomy one year earlier in the same eye. Ocular examination showed best corrected visual acuity(BCVA) of 6/18 and there was a bleb leak, shallow anterior chamber and intraocular pression(IOP) of 6mmHg. Successful sealing of bleb leak was performed using fibrin glue resulted in deepening of anterior chamber with IOP of 13mmHg. This case demonstrates that, fibrin glue is an effective method for management of early filtering bleb leak.
3.Clinical Presentation, Severity and Progression of Primary Angle Closure in Malays
Ahmad Tajudin Liza-Sharmini ; Yusof Nor Sharina ; Dolaboladi Ali Jaafari ; Zaid Nik Azlan ; Yaakub Azhany ; Embong Zunaina
The Medical Journal of Malaysia 2014;69(1):21-26
Introduction: There is limited knowledge on primary angle
closure (PAC) in Malays. Understanding the clinical
presentation and progression of PAC in Malays is important
for prevention of blindness in Southeast Asia.
Material and methods: A retrospective record review study
was conducted on Malay patients seen in the eye clinic of
two tertiary hospitals in Kelantan, Malaysia. Based on the
available data, Malay patients re-diagnosed as primary angle
closure suspect (PACS), primary angle closure (PAC), and
primary angle closure glaucoma (PACG) based on the
International Society Geographical Epidemiological
classification. Clinical data was collected from initial
presentation including the presence of acute primary angle
closure until at least 5 years follow up. Progression was
defined based on gonioscopic changes, vertical cup to disc
ratio (VCDR), intraocular pressure (IOP) and Humphrey
visual field (HVF) analysis. Progression and severity of
PACG was defined based Hodapp-Parrish-Anderson
classification on reliable HVF central 24-2 or 30-2 analysis.
Results: A total of 100 patients (200 eyes) with at least 5
years follow up were included. 94 eyes (47%) presented with
APAC. During initial presentation, 135 eyes (67.5%) were
diagnosed with glaucomatous changes with 91 eyes already
blind. After 5 years of follow up, 155 eyes (77.5%)
progressed. There was 4 times risk of progression in eyes
with PAC (p=0.071) and 16 times risk of progression in PACG
(p=0.001). Absence of laser peripheral iridotomy was
associated with 10 times the risk of progression.
Conclusion: Angle closure is common in Malays. Majority
presented with optic neuropathy at the initial presentation
and progressed further. Preventive measures including
promoting public awareness among Malay population is
important to prevent blindness.
4.Clinical Presentation, Severity and Progression of Primary Angle Closure in Malay and Chinese Patients
Ahmad Tajudin Liza-Sharmini ; Guan Fook Ng ; Yusoff Nor-Sharina ; Md Isa Khairil Anuar ; Zaid Nik Azlan ; Yaakub Azhany
The Medical Journal of Malaysia 2014;69(6):245-251
Objective: To compare the clinical presentation, severity and
progression of primary angle closure between Chinese and
Malays residing in Malaysia.
Methods: A comparative retrospective record review study
was conducted involving one hundred (200 eyes) Malay and
fifty eight (116 eyes) Chinese patients. They were selected
from medical records of Hospital Universiti Sains Malaysia,
Kelantan and Hospital Pulau Pinang, Penang, Malaysia. The
selected patients were re-diagnosed based on the
International Society of Geographical and Epidemiological
classification. The clinical data on presentation including
the presence of systemic diseases were documented.
Progression of the disease was based on available reliable
visual fields and optic disc changes of patients who have
been on follow-up for at least five years.
Results: Malay patients presented at older age (61.4 years
SD 8.4) compared to Chinese (60.6 years SD 8.3). There was
significant higher baseline Intraocular Pressure (IOP) among
Malays (34.7 SD 18.5mmHg) compared to Chinese (30.3 SD
16.7mmHg) (p=0.032). The Chinese patients presented with
significantly better visual acuity (p<0.001) and less
advanced cup to disc changes (p=0.001) compared to
Malays. Malay patients progressed faster than the Chinese.
Majority progressed within 1 year of diagnosis. Malays
without laser peripheral iridotomy (LPI) have a 4 fold (95% CI
1.4, 10.9) risk of progression. Higher baseline IOP, more
advanced visual field defect and absence of LPI was
identified as significant predictors associated with
progression.
Conclusion: The Malays presented with more advanced
angle closure glaucoma as compared to the Chinese in
Malaysia. Aggressive disease progression was observed in
Malays with the onset of optic neuropathy. Effective public
awareness and aggressive management is important to
prevent blindness in the Malaysian population.
5.Large full thickness medial canthal reconstruction: a report of two cases and review of literature
Nor Idahriani Muhd Nor ; Azhany Yaakub ; Venkatesh R. Naik ; Wan Hazabbah Wan Hitam ; Liza Sharmini Ahmad Tajudin
Archives of Orofacial Sciences 2012;7(1):28-33
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 re-establish 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.
6.Dengue related maculopathy and foveolitis.
Jaafar JUANARITA ; Mohd Noor Raja AZMI ; Yaakub AZHANY ; Ahmad Tajudin LIZA-SHARMINI
Asian Pacific Journal of Tropical Biomedicine 2012;2(9):755-756
A 24 year-old Malay lady presented with high grade fever, myalgia, generalized rashes, severe headache and was positive for dengue serology test. Her lowest platelet count was 45 × 10(9) cells/L. She complained of sudden onset of painlessness, profound loss of vision bilaterally 7 days after the onset of fever. On examination, her right eye best corrected vision was 6/30 and left eye was 6/120. Her anterior segment examination was unremarkable. Funduscopy revealed there were multiple retinal haemorrhages found at posterior pole of both fundi and elevation at fovea area with subretinal fluid. Systemic examination revealed normal findings except for residual petechial rashes. She was managed conservatively. Her vision improved tremendously after 2 months. The retinal hemorrhages and foveal elevation showed sign of resolving. Ocular manifestations following dengue fever is rare. However, bilateral visual loss can occur if both fovea are involved.
Dengue
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complications
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diagnosis
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Female
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Fovea Centralis
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pathology
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Humans
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Macula Lutea
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pathology
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Retinitis
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diagnosis
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etiology
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Vision Tests
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Young Adult
8.Diagnosis of Ankylosing Spondylitis: Do not let the spine bites the eye
Liza-Sharmini Ahmad Tajudin ; Chew Chia Chee ; Chin Ju Juen ; Wan Hazabbah Wan Hitam ; Chong Mei Fong
Malaysian Family Physician 2021;16(2):73-77
Background: A diagnosis of ankylosing spondylitis (AS) is challenging and often delayed despitebpatients being symptomatic. Low back pain is the most common initial symptom, appearing in the second and third decades of life. Acute anterior uveitis (AAU) occurs much later in the course of the disease, often when the destruction of the spine is already debilitating.
Objective: Here, we report three cases of AS that were diagnosed after the patients developed AAU.
Methods: A case series illustrated AAU leading to the diagnosis of AS years after the initial episode of low back pain. A comparison of the clinical presentation, diagnosis, and outcomes was also illustrated.
Result: We report three cases of acute anterior uveitis (AAU)-associated AS diagnosed only after many visits to the primary health care provider with the complaint of chronic low back pain. All three patients had irreversible radiological changes upon diagnosis of AS. The AAU resolved with topical steroids, and one patient developed cataract.
Conclusion: A high index of suspicion of AS in a young adult with chronic back pain before the development of AAU may prevent further functional loss and provide a better prognosis. Diagnosis of AS following AAU is not only associated with dependency but also may rob the vision of a young adult.
9.Effects of Arterial Stiffness on Visual Field Severity and Progression in Malay Patients with Primary Open Angle Glaucoma
Kiu Kwong Yew ; Sarah-Murniati Che Mat Nor ; Syed Mudassar Imran Bukhari ; Aida Hanum Ghulam Rasool ; Liza-Sharmini Ahmad Tajudin
Malaysian Journal of Medicine and Health Sciences 2022;18(No.4):27-34
Introduction: Vascular dysregulation is postulated to be involved in the pathogenesis of primary open angle glaucoma (POAG). Systemic arterial stiffness may accelerate the pre-existing damage. The purpose of this study was to determine the association of arterial stiffness with severity and progression of visual field in Malay patients with POAG.
Methods: A cross-sectional study was conducted with 55 patients with POAG and 55 age- and sex-matched control
subjects. The patients with POAG were further divided in accordance with their Advanced Glaucoma Intervention
Study (AGIS) scores on their visual fields (VFs) (mild in 23 patients, moderate in 18, and severe in 14). Progression
was defined as the worsening of the VF defect quantified as an increase in AGIS score of 4 points from the baseline.
Arterial stiffness was measured using SphygmoCor and quantified as pulse wave analysis (PWA) and pulse wave
velocity (PWV). Results: No significant differences in PWA and PWV were found between the patients with POAG
and the control subjects (p=0.333 and p=0.443, respectively). The mean follow-up duration for the patients with
POAG was 4.7±3.1 years. PWA and PWV showed no significant association with POAG severity after the confounding factors were controlled for. Ten patients with progression of VF were identified. In the analysis of covariance, a
significantly higher PWV was found in the patients with disease progression (p=0.036). Conclusion: VF severity and
progression were not associated with systemic arterial stiffness. The probable reason is that other factors affecting
retinal microcirculation may play a larger role in the severity and progression of POAG.
10.Modulation Agents of Wound Healing in Ocular Surgeries
Yaakub Azhany ; Mohd-Yusof Siti-Fairuz ; Azlina Ahmad ; Wan Nazirah Wan Yusuf ; Low Jen Hou ; Ahmad-Tajudin Liza-Sharmini ; Jemaima Che Hamzah
Malaysian Journal of Medicine and Health Sciences 2024;20(No.1):293-303
Wound healing is a complex process that includes haemostasis and inflammation, followed by a proliferation period and repair and finally remodelling. Ocular surgeries, particularly in glaucoma cases, aim at minimal fibrosis to preserve the function of trabeculectomy as an alternative pathway for aqueous drainage. Hence, it is important to find an agent to modulate the wound healing process. This review presents compilation of wound modulation agents that have been tested in vitro, in vivo, or clinically on patients undergoing ocular surgeries, particularly for glaucoma. We identified agents into four groups, mostly for glaucoma filtration operations: anti-metabolites, anti-growth factors, mechanical barriers and rho kinases. The effect of these agents is highlighted in this review. In conclusion,
despite recognized drawbacks of antimetabolites, they are still regarded as the gold standard and the most efficient treatment as anti-scarring agents use in ocular surgeries. More studies are needed to inquire agents that efficient yet has minimal adverse effects both in short and long term.