1.Chemotherapy Related Optic Neuritis
Nur AS ; Jemaima CH ; Safinaz MK
The International Medical Journal Malaysia 2017;16(2):133-136
In children, most cases of optic neuritis are immune-related. Less frequently, it may also be due to
demyelinating disorders. Other secondary causes such as infection of adjacent structures or infiltration are
even rarer. The occurrence of optic neuritis in children on chemotherapy also has not being extensively
reported. We report a case of bilateral optic neuritis in a young girl with subacute visual loss after receiving
systemic chemotherapy for embryonal ovarian carcinoma.
2.Bilateral Profound Visual Loss As a Consequence of Leukaemia – A Case Report
Raajini Devi K ; Safinaz MK ; Hazlita MI
Journal of Surgical Academia 2015;5(1):61-63
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.
Vision Disorders
3.Tube-Cornea Touch Following an Ahmed Valve Implantation in a Patient with Congenital Rubella Syndrome: A Case Report
Edwin Ooi IL ; Safinaz MK ; Ropilah AR
Journal of Surgical Academia 2014;4(2):53-55
This was a 28-year-old mentally-challenged girl with underlying congenital Rubella syndrome. She was bilaterally
aphakic after congenital cataract surgery. She then developed bilateral aphakic glaucoma and had to undergo
multiple glaucoma filtering surgeries. The most recent procedure she had undergone for her left eye was a second
Ahmed valve implantation with an overlying sclera patch. Postoperatively, intraocular pressure was well controlled.
However, nine months later, slit lamp examination revealed the tube was adherent to the overlying cornea with
surrounding deep and superficial cornea vascularization. Siedel test was negative and intraocular pressure was
normal. Subsequently the tube was removed but the plate was left in situ.
4.Intrastromal Corneal Foreign Body – Case Series and Discussion on the Physics of Injury
Journal of Surgical Academia 2018;8(2):23-26
Traumatic injury to the eye can occur due to various causes, most of which are avoidable. Here we report three cases of intrastromal corneal foreign bodies (FB) which required surgical removal. Most corneal FBs are removed easily at the slit lamp, however, these cases required surgical intervention due to the mechanism of which the FB penetrated into the stroma. Although the mechanism of injury was similar, with all three cases occurring at high velocity, we observed that the entry and level of penetration differed in each case. In the first case, the corneal FB penetrated the cornea and was embedded in the anterior stroma, whereas in the second case, the FB was embedded in the posterior stroma, but with an intact endothelium. In the third case, the FB caused a full thickness, self-sealed laceration wound but remained embedded in the stroma. Through further evaluation, we noted that several factors contribute towards the severity of the injury, namely, anatomy of the cornea, area affected, shape, size, mass and velocity of the object. We speak in depth about the mechanism of injury and physics associated with these injuries and why the penetration differed in each case.
corneal stroma
;
foreign bodies
;
injury
;
mechanics
;
physics
5.Solar Retinopathy with Interesting Imaging Findings. A Case Report
Oh KL ; Wong HS ; Safinaz MK ; Lakana K ; Hazlita MI
Medicine and Health 2016;11(2):289-293
Solar retinopathy is an injury of the retinal photoreceptors due to excessive
exposure to the solar radiation. Diagnosis of the disease is challenging and requires
combination of a detailed history and imaging modalities. This case report focuses
on a 55-year-old fruit picker with an irreversible central scotoma of the right eye.
A diagnosis of solar retinopathy was made based on history but mainly by several
imaging modalities, such as optical coherence tomography (OCT), infrared (IF)
imaging of the fundus and fundus autofluorescence (FAF). Electroretinogram (ERG)showed flattened and reduced waves in both scotopic and photopic response.
Fundus angiography (FA) revealed no obvious telangectatic vessels. In conclusion,
solar retinopathy is a disease where multimodal imaging may play an important
role in the diagnosis. The condition may be irreversible thus advocating protective
eyewear is mandatory in patients who are chronically exposed to the sun.
Photoreceptor Cells, Vertebrate
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
7.Bilateral Compressive Optic Neuropathy Secondary to Tuberculum Sella Meningioma in Pregnancy
Ainal Adlin N ; Mushawiahti M ; Amin A ; Safinaz MK
Journal of Surgical Academia 2016;6(2):33-36
A 37-year-old primigravida in her second trimester presented with bilateral painless progressive visual loss. Her
vision was hand motion in both eyes. Both pupils were dilated with sluggish reaction to light. Both fundus appeared
myopic with bilateral optic atrophy. Magnetic resonance imaging (MRI) of the brain revealed a suprasellar mass with
optic chiasm compression and bilateral optic nerve atrophy. As the mass has compromised her vision, a semiemergency
craniotomy and excision of tumour was performed. Histopathological examination confirmed the
diagnosis of low grade meningothelial meningioma. Both mother and foetus were well after the surgery. However,
post-operatively her vision remained poor due to optic nerve atrophy.
Optic Atrophy
;
Pregnancy
8.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 MK
Journal of Surgical Academia 2016;6(1):54-58
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.
Hemangioblastoma
;
von Hippel-Lindau Disease
9.A Rare Case of Recurrent Orbital Solitary Fibrous Tumour with Intracranial Extension
Ainal Adlin N ; Umi Kalthum MN ; Amizatul Aini S ; Reena Rahayu MZ ; Safinaz MK
Journal of Surgical Academia 2016;6(1):59-61
A 47-year-old lady, presented with progressive proptosis of left eye with deterioration of vision. She had a history of
left solitary fibrous tumour and had undergone left frontal craniotomy and orbitotomy in 2004. Surveillance
Magnetic resonance imaging (MRI) six years later showed tumour recurrence with intracranial extension. However,
she did not follow-up and only presented again 3 years, later. Tumour resection and left exenteration was performed.
Histology showed ‘patternless’ pattern of neoplastic cells, and CD34 staining was diffusely positive. Diagnosis of
recurrent solitary fibrous tumour with intracranial extension was made.
Solitary Fibrous Tumors
;
Neoplasms
10.A Rare Complication of MRSA Lid Abscess and Orbital Abscess Following Strabismus Surgery in a Child
Kenneth Teow KL ; Nor Akmal B ; Jamalia R ; Safinaz MK
Journal of Surgical Academia 2018;8(1):32-35
Strabismus is one of the most common ocular problems affecting the preschool population and the aim of strabismus surgery is to correct abnormal alignment of the eyes. A 5-year-old girl with strabismus underwent an uneventful surgery and was discharged on the same day with topical medications. Two days later, she returned with a painful right lower eyelid swelling, eye discharge and fever which started 1 day post-surgery. She was admitted for intravenous (IV) antibiotic. Symptoms initially improved after 24 hours of treatment, but later she had worsening eyelid swelling. An urgent CT scan of the orbit showed a right lower lid abscess with orbital cellulitis. Subsequently an examination under anaesthesia (EUA) and incision and drainage (I&D) of the lower lid abscess were performed. Culture from the pus grew Community Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA), sensitive to Vancomycin. At day 2 post I&D she subsequently developed another episode of localised right lower lid swelling. Another EUA was done but showed the lower lid and wound was freeof pus. She was later found to have a toxic reaction to topical Gentamicin and hence this medication was stopped. She responded well to treatment and was discharged after completing her IV antibiotics. At 14 months outpatient follow up, she was well and orthophoric in primary gaze. While treating a disease, we should be opened to all possibilities and not to treat with multiple antibiotics once susceptibility is known.