1.Vitrectomy for Breakthrough Bleeding in Age Related Macular Degeneration and Polypoidal Choroidal Vasculopathy in a Malaysian Hospital
Bastion MLC ; Amelah MAQ ; Wong HS
Journal of Surgical Academia 2012;2(2):21-26
This study aimed to review the risk factors and clinical outcomes of patients undergoing pars planar vitrectomy (PPV) for breakthrough bleeding (BTB) from age related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). We performed a retrospective review of medical records of 346 patients operated by the vitreoretinal unit at Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia from January 2008 - June 2011. We found eight eyes of 8 patients with AMD/IPCV-related BTB who underwent PPV. Mean age of patients was 64.4 years (range 41-80 years) with 5 males. Five were Chinese. Duration of symptoms ranged from days to months. Four patients were on anti-coagulants. Two had history of prior photodynamic therapy. There were five cases of PCV, of which three were macular in location. All three cases of AMD were macular. Intraoperative intravitreal ranibizumab injection was given in three cases and two had combined vitrectomy and cataract extraction. All cases reported improvement in visual acuity with four cases achieving 6/60 or better post operatively including two cases of extramacular PCV achieving 6/9 vision. Mean follow-up was 60 weeks. Postoperative complications included retinal tear and detachment in one case, reattached on reoperation. Six patients had a history of hypertension including one individual with stroke. Our small series indicates a predominance of Chinese individuals with BTB. Usage of anticoagulants and hypertension may be a predisposing factor. Better visual prognosis occurs with extramacular lesions which tend to be of PCV type.
2.Successful Visual Outcome Following Vitrectomy for Complication of Ocular Tuberculosis
Norshamsiah MD ; Muhaya M ; Bastion MLC
Journal of Surgical Academia 2012;2(2):56-59
A 24-year-old Chinese gentleman presented with two weeks history of sudden floaters in his right temporal visual field associated with blurring of vision. This ex-smoker also reported chronic, bloody cough for two years and recent pleuritic chest pain. Examination revealed a thin patient with right eye visual acuity of 6/18 associated with optic nerve dysfunction, optic disc swelling and macula star, retinal vasculitis and retinitis. Despite anti-tuberculosis medication and corticosteroids, he developed neovascularisation. Subsequent vitreous haemorrhage necessitated trans pars plana vitrectomy, membrane peeling, endolaser and silicone oil injection. Final visual acuity was 6/9 with quiescent retinopathy.
3.Dislocated Posterior Chamber Intraocular Lens (PCIOL) in Patients with Retinitis Pigmentosa (RP)
Lam CS ; Mushawiahti M ; Bastion MLC
Journal of Surgical Academia 2017;7(1):38-42
Subluxation or dislocation of PCIOL is one of the complications of cataract operation in RP patients. This paper
reports the presentation of PCIOL dislocation and subluxation and the management and outcome in 3 eyes of 2 RP
patients. Two medical records of patients with RP who developed dislocated or subluxated PCIOL and subsequently
underwent explantation of the dropped IOL were evaluated. Two patients had bilateral eye cataract operation done
and had PCIOL implanted. Patient 1 developed left eye subluxated PCIOL inferiorly after 2 years of the cataract
operation and right eye dislocated PCIOL anteriorly 4 years after cataract operation. Patient 2 develop right eye
subluxated PCIOL inferiorly after 12 years of the cataract operation. Patient 1 with right eye dislocated PCIOL
underwent intraocular lens (IOL) explantation and was left aphakic as her visual prognosis was poor due to advanced
RP. The left IOL remained within the visual axis despite subluxation and no intervention has been done. Patient 2
with right eye subluxated PCIOL underwent IOL explantation and anterior chamber intraocular lens (ACIOL)
implantation. ACIOL remained stable and visual acuity improved post-operation. Both the operations were
uneventful. Post-operatively, there was no elevated intraocular pressure and no prolonged ocular inflammation,
which required prolonged anti-inflammatory and no retinal detachment was seen. Both patient and surgeon should be
aware of potential PCIOL subluxation or dislocation in RP. The presentation may be as late as more than a decade
after the cataract operation.
Retinitis Pigmentosa
4.Retinal Break Adjacent to the Optic Disc Causing Retinal Detachment in a Pathological Myopia
Noor Aniah A ; Bastion MLC ; Mushawiahti M
Journal of Surgical Academia 2017;7(2):21-23
Retinal detachment is one of the common complications of pathological myopia due to presence of retinal break. However, retinal break commonly occurs in the peripheral retina. This case report illustrates the rare incidence of retinal break adjacent to the optic disc, highlights the possible causes of poor visual outcome following surgical repair as well as the possible measures to treat the complications.
Vitrectomy
5.Retrospective Review of the Adjunctive Use of Pre- Operative Ranibizumab “LUCENTISTM” in the Surgical Management of Diabetic Retinopathy in a Tertiary Referral Hospital in Malaysia
Bastion MLC ; Siti Aishah S ; Aida Zairani MZ ; Barkeh HJ
Medicine and Health 2010;5(2):93-102
A retrospective case series review was conducted to determine the pre-operative role
and safety of pre-operative adjunctive anti-vascular endothelial growth factor (anti- VEGF) agent ranibizumab “LUCENTISTM” in patients with diabetic retinopathy requiring
vitrectomy. The study involved twenty consecutive eyes of sixteen patients (age range:
46-72 years; mean 57.5 years) which received intravitreal injection of 0.5 - 1 mg of
ranibizumab 3 to 8 days (mean 4.4 days) prior to vitrectomy for diabetic retinopathy.
There were no local or systemic post-injection complications. Indications for vitrectomy
were retinal detachment (RD) [n=11; 3 combined tractional (TRD) - rhegmatogenous RD
(RRD), 8 TRD], TRD with vitreous haemorrhage (VH) (n=3) ,VH (n=8) and vitreomacular
traction syndrome (n=1). Inclusion criteria include all consecutive eyes of
diabetic patients requiring vitrectomy receiving a first pre-operative injection of anti-
VEGF. Pre-operative visual acuity (VA) ranged from 6/36 to light perception. All eyes had
minimal to moderate intraoperative bleeding. Post-operative VH in eyes without
tamponade or gas tamponade was nil (n=1), mild (n=13) or moderate (n=1). Silicone
filled eyes had nil (n=1), moderate (n=3) or severe haemorrhages (n=1). Post-operative
VA was unchanged (n=2) (10%), improved (n = 14) (70%) or worsened (n=4). VA was
2/60 or better (n=15) to no light perception (n=1). Two eyes achieved 6/12 or better
vision (10%). Ten eyes (50%) had 6/36 or better vision. In conclusion, pre-operative
intravitreal ranibizumab is safe and useful in diabetic vitrectomy and appears to help with
perioperative bleeding leading to improvement in vision.
6.Case Report: Progression of Pre-Septal Cellulitis to Orbital Subperiosteal Abscess despite Intravenous Broad-Spectrum Antibiotics in a Child
Noor Aniah A ; Norshamsiah MD ; Bastion MLC ; Safinaz MK ; Mawaddah A
Journal of Surgical Academia 2016;6(1):62-65
We report a case of a 7-year-old girl who initially presented with painless right eyelid swelling with full extra-ocular
movement (EOM). She was treated with intravenous broad-spectrum antibiotics for preseptal cellulitis but her
condition worsened. An urgent magnetic resonance imaging (MRI) of the brain and orbit showed orbital abscess,
subperiosteal abscess in the medial orbital wall and evidence of sinusitis in the anterior ethmoidal air cells. She
underwent Endoscopic Orbital Decompression (EOD) surgery on day 4 of presentation and her condition improved
remarkably. We report a case of orbital abscess with subperiosteal abscess in the medial orbital wall. This case
highlights the possibility of progression of orbital cellulitis despite administration of a broad-spectrum antibiotic.
Orbital Cellulitis
8.Patterns of Polypoidal Choroidal Vasculopathy among a Multiracial Population in a Malaysian Hospital
Nazima SA ; Hanisah AH ; Rona AN ; Wong HS ; Amin A ; Bastion MLC ; Mushawiahti M ; Hazlita MI
Medicine and Health 2016;11(2):245-256
Polypoidal choroidal vasculopathy (PCV) is a retinal disorder characterized
by aneurismal polypoidal lesions in choroidal vasculature. PCV appears to
preferentially affect pigmented individuals and is considerably high among Asians.
Most reports on patterns of PCV around Asia are based on a homogenous race
(e.g. Chinese, Japanese) and very few descriptions from a multiracial population
like those seen in Malaysia. The present study aimed to describe the demographic
features, clinical and investigative characteristics of PCV in a multiracial group at
Universiti Kebangsaaan Malaysia Medical Centre (UKMMC). Ninety one eyes of 86
PCV patients, comprising of Chinese (65.1%), Malays (31.4%), Indians (2.3%) and
Eurasian (1.2%) were retrospectively reviewed. All underwent complete ophthalmic
examination and investigations. Mean patient age was 70.4 years with a male
preponderance (59.3%), and mostly unilateral presentation (94.1%). The logMAR
mean presenting visual acuity was 0.78 ± 0.64. Polypoidal vascular lesions were
located generally within the macula area (86.8%), manifesting mainly as submacular
hemorrhage (59.3%). Interestingly a number of eyes (43.9%) had associated drusen.
Optical coherence tomography largely demonstrated exudative changes (75.9%)
and almost all patients (97.7%) had loss of external limiting membrane (ELM) and
IS/OS interface. On indocyanine green angiography, majority of eyes had multiple
polyps (82.4%) with ‘cluster’ (58.2%) being the commonest configuration. In
conclusion, although the patterns of PCV in UKMMC were mainly similar to other
Asian patients, a number of our patients had associated drusen. This indicates
that PCV in our population could be a variant of neovascular age related macular
degeneration and not solely idiopathic in nature.
Retinaldehyde
;
Choroid
9.Retinal Redetachment After Pneumatic Retinopexy – The Importance of Case Selection
Muhammad Najmi K ; Aida Zairani MZ ; Mushawiahti M ; Bastion MLC ; Amin A
Journal of Surgical Academia 2017;7(2):18-20
Pneumatic retinopexy is known as one of the treatment options for a specific type of retinal detachment. It is done in
an office setting and may be the most cost-effective means of retinal reattachment surgery. Location and size of the
retinal break remain as the major criteria for a successful outcome. We describe a case that fulfilled all except one
major criteria for pneumatic retinopexy and underwent multiple procedures but failed. Fluctuation in the resolution
of the retinal detachment such as in this particular case suggested possibility of early treatment failure.
Vitrectomy
10.Spontaneous Closure of Large Base Idiopathic Full Thickness Macular Hole
Nurul Ain S ; Norshamsiah MD ; Safinaz MK ; Bastion MLC
Medicine and Health 2018;13(1):232-236
Spontaneous closure of idiopathic full thickness macular hole is a rare case as it occurs in only 3.5% while awaiting vitrectomy surgery. There are few pathologies associated with it such as vitreomacular traction (VMT) and posterior vitreous detachment. We report a case in a 74-year-old man who presented with right eye painless, progressive blurring of vision with idiopathic stage 4 full thickness macular hole which was confirmed on optical coherence tomography. It closed spontaneously after sometimes while waiting for surgery. It is important to monitor closely for the possibility of spontaneous closure based on the optical coherence tomography findings.