Valsalva retinopathy is an uncommon type of retinopathy that manifests as a rapid and painless vision decline, typically observed in young individuals without prior medical conditions. This condition ...arises from an elevated pressure within the veins of the eye, causing preretinal haemorrhage with a notable tendency to impact the macula. We describe here a case of valsalva-related sub-internal limiting membrane (sub-ILM) macular haemorrhage which was successfully treated with anti-vascular endothelial growth factor (anti-VEGF). A 27-year-old woman presented with a clinical presentation of a large sub-ILM macular haemorrhage resulting from a valsalva maneuver following a prolonged severe cough. The sub-ILM macular haemorrhage was completely resolved after being treated with three injections of intravitreal ranibizumab with a visual recovery of vision from counting fingers to 20/20 on three month follow-up.
Post-surgical scarring is a known cause of trabeculectomy failure. The aim of this study was to investigate the effectiveness of ranibizumab as an adjuvant anti-scarring agent in experimental ...trabeculectomy. Forty New Zealand white rabbits were randomised into four eye treatment groups: groups A (control), B (ranibizumab 0.5 mg/mL), C (mitomycin C MMC 0.4 mg/mL), and D (ranibizumab 0.5 mg/mL and MMC 0.4 mg/mL). Modified trabeculectomy was performed. Clinical parameters were assessed on post-operative days 1, 2, 3, 7, 14, and 21. Twenty rabbits were euthanised on day 7, and the other twenty were euthanised on day 21. Eye tissue samples were obtained from the rabbits and stained with haematoxylin and eosin (H&E). All treatment groups showed a significant difference in IOP reduction compared with group A (
< 0.05). Groups C and D showed a significant difference in bleb status on days 7 (
= 0.001) and 21 (
= 0.002) relative to group A. H&E staining showed significantly low fibrotic activity (
< 0.001) in group C on both days and inflammatory cell grade in group B on day 7 (
< 0.001). The grade for new vessel formation was significantly low in groups B and D on day 7 (
< 0.001) and in group D on day 21 (
= 0.007). Ranibizumab plays a role in reducing scarring, and a single application of the ranibizumab-MMC combination showed a moderate wound-modulating effect in the early post-operative phase.
Recurrent Miller Fisher Syndrome Ooi, Say Ting; Ahmad, Ameilia; Yaakub, Azhany
Curēus,
06/2022, Volume:
14, Issue:
6
Journal Article
Peer reviewed
Open access
Miller Fisher syndrome (MFS) is an uncommon systemic autoimmune condition. Recurrent Miller Fisher syndrome is extremely rare. We want to highlight a rare case of recurrent Miller Fisher syndrome, ...which manifested as external and internal ophthalmoplegia, areflexia, and ataxia following an episode of upper respiratory tract infection (URTI). The patient developed a recurrent attack of Miller Fisher syndrome two months later with only internal and external ophthalmoplegia symptoms. Both episodes wholly resolved in a month without treatment. Miller Fisher syndrome can mimic various other neurological illnesses. Therefore, diagnosing this disease is often challenging. However, prompt diagnosis and management can be achieved with awareness of this rare illness.
PurposeOur study aimed to describe the clinical profile of endogenous endophthalmitis, focusing on patient demographics, infection sources, microbial profiles, clinical outcomes, and factors ...affecting the final visual outcome.MethodsA retrospective review was performed on data from 68 eyes of 60 patients diagnosed with endogenous endophthalmitis and hospitalized in two tertiary hospitals on the East Coast of Peninsular Malaysia from January 2011 to December 2020. The analysis encompassed evaluating patient age, gender, laterality, risk factors, infection origins, presenting and final visual acuity, microbial results, treatment responses, and factors affecting final visual outcomes.ResultsThe average age of the patient cohort was 54.9 ± 13.3 years. Females were more likely to have endogenous endophthalmitis than males (33, 55.0% vs. 27, 45.0%). Twenty-seven patients (45.0%) presented with endogenous endophthalmitis in the left eye, while 25 patients (41.7%) had it in the right eye, and eight patients (13.3%) had bilateral involvement. Most patients had underlying predisposing conditions, predominantly diabetes mellitus (53, 88.3%). Infection sources were identified in 42 patients (70.0%), out of which urinary tract infections account for the majority (11, 18.3%). Klebsiella species(14, 22.7%) were the leading pathogens and were significantly associated with liver abscess cases. In this series, the majority of patients had poor presenting and final visual acuity of worse than 3/60 (56, 82.4% and 53, 77.9%, respectively). Thirty-six eyes (52.9%) underwent vitrectomy, resulting in only four eyes (11.11%) achieving final visual acuity better than 6/12. Presenting visual acuity was identified as the factor contributing to the blind final visual outcome (r = 0.707, p < 0.001).ConclusionFemales were found to be more commonly affected by endogenous endophthalmitis than males. Klebsiella species were the most commonly isolated microorganisms and were typically associated with liver abscesses. Urinary tract infection was the most common predisposing factor. A majority of the patients had poor presenting and final visual acuity, in which poor visual acuity is a significant indicator of blind visual outcomes.
Purpose
This study aims to determine the 5-year visual field progression and identify the prognostic factors for progression in Malay patients with primary glaucoma.
Methods
A retrospective cohort ...record review study was conducted among 222 patients (222 eyes) with primary glaucoma who were selected from a glaucoma research database of a tertiary center in Malaysia. The patients were Malays and diagnosed with primary open-angle glaucoma (POAG) or primary angle-closure glaucoma (PACG). Patients who were followed up regularly for at least 6 months between 1 January 2009 and 31 December 2014 and completed another 1-year follow-up after recruitment (between 1 January 2015 and 31 December 2015) were selected. Multiple prognostic factors that influence visual field progression were identified. Progression of visual field loss was based on the Advanced Glaucoma Intervention Study and Hodapp–Parrish–Anderson scores. Kaplan–Meier survival and Cox proportional hazard regression analyses were performed.
Results
Sixty-three patients (28.4%) developed visual field progression after a mean (SD) follow-up of 6.9 (3.3) years. Those with POAG progressed faster (mean time, 10.6 years; 95% confidence interval CI, 9.3, 11.9) than those with PACG (17.3 years; 95% CI, 14.8, 19.9) but not statistically significant. Disc hemorrhage and history of eye pain increased the risk of progression by 2.8-folds (95% CI, 1.6, 4.8) and 2.5-folds (1.4, 4.4), respectively.
Conclusion
The 5-year survival of the Malay primary glaucoma patients with visual field progression was similar with that of other Asian populations. However, aggressive management is required for those with disc hemorrhages and eye pain related to increased intraocular pressure.
In this article, we report a rare case of an optic nerve metastasis secondary to lung adenocarcinoma. The ocular manifestation was the first clinical sign of the disease, and further investigation ...led to the diagnosis of the underlying malignancy. A 59-year-old woman presented with progressive blurring of vision in the right eye for the past month. She had been having headaches for the past two weeks and left upper limb weakness for one day. She also had loss of appetite and weight for the past few months. She looked lethargic. On presentation, her bilateral eye vision was 6/18. Both anterior segments were unremarkable. Fundoscopy showed a normal optic disc in both eyes. A nervous system examination showed mild motor sensory impairment over the left upper and lower limbs and also impairment of cranial nerves V and VII. Brain computed tomography was conducted and revealed soft tissue lesions at the lateral aspect of the optic nerve and multiple recent cerebral infarcts. Brain and orbital magnetic resonance imaging showed a metastasis intraconal lesion at the right intraorbital segment of the optic nerve. CT thorax, abdomen, and pelvis were done. The finding revealed carcinoma of the left lung with distant metastasis. The patient's general condition deteriorated in less than two weeks. The family refused further intervention. The patient died three months after the initial presentation.
BackgroundOptic disc swelling (ODS) is a pathological condition with a variety of causes, including optic neuritis (ON), anterior ischemic optic neuropathy, and papilledema. Determining the causes of ...ODS is critical due to the possibilities of vision- or life-threatening diseases, such as space-occupying lesions. This study aimed to investigate the clinical profile of unilateral and bilateral ODS in Penang Hospital, Malaysia.MethodologyThis retrospective, descriptive study was conducted in Penang Hospital. Medical records of patients who were diagnosed with ODS from June 2018 until June 2020 in Penang Hospital Eye Emergency Clinic were reviewed. We excluded patients who defaulted on subsequent three months of follow up and those with pseudo-ODS.ResultsODS was diagnosed in 43 patients who were all included in the study. Majority were females 55.8% (n = 24), with age ranging from 16 to 78 years. ON contributed most (41.9%, n = 18), followed by non-arteritic anterior ischemic optic neuropathy (NA-AION) (34.9%, n = 15), and papilledema (9.3%, n = 4). Other causes (14%, n = 6) included diabetic papillitis (n = 1), hypertensive retinopathy (n = 1), and central retinal vein occlusion (n = 4). Poor mean initial visual acuity was seen in patients with ON (1.07 ± 0.68) and NA-AION (1.33 ± 0.67). ON showed better final visual outcomes compared to NA-AION at the one-year follow-up.ConclusionsON and NA-AION were identified as the two most common causes of ODS in Penang Hospital for both unilateral and bilateral presentations. Most cases presented with poor initial visual acuity. After one year of follow-up, good visual recovery was seen in ON cases compared to other cases. These results were comparable with studies conducted in other Asian counties.
Purtscher's retinopathy represents an occlusive retinal microvasculopathy that poses a potential threat to vision and is linked to traumatic events. This condition typically manifests in individuals ...following trauma, commonly associated with long bone fractures, head injuries, or thoracic compression. We report a rare case of unilateral Purtscher's retinopathy after sustaining a long bone fracture. A 27-year-old healthy man sustained an open, comminuted midshaft fracture of the right femur after an alleged motor vehicle accident. On day 3 post trauma, he developed sudden right eye painless reduced vision. Visual acuity in the right eye was 6/12 pinhole 6/12 and the left eye was 6/9 pinhole 6/6. The pupillary reflex was normal in both eyes. Both anterior segments were unremarkable. Fundoscopy showed the presence of multiple cotton wool spots and fleckens in the right eye. Macula optical coherence tomography of the right eye confirmed hyperreflective lesions within the retinal nerve fiber layer. He was diagnosed with Purtscher's retinopathy. The patient was treated conservatively given the fairly good visual acuity. There was complete resolution of fundus lesions with good visual acuity of 6/6 after one month. Ophthalmologic evaluation is crucial in cases of post-traumatic visual impairment, particularly in scenarios involving long bone fractures, to effectively exclude the possibility of Purtscher's retinopathy.
Bayesian optimization (BO) is commonly used to optimize the hyperparameters of transfer learning models to improve the model's performance significantly. In BO, the acquisition functions direct the ...hyperparameter space exploration during the optimization. However, the computational cost of evaluating the acquisition function and updating the surrogate model can become prohibitively expensive due to increasing dimensionality, making it more challenging to achieve the global optimum, particularly in image classification tasks. Therefore, this study investigates and analyses the effect of incorporating metaheuristic methods into BO to improve the performance of acquisition functions in transfer learning. By incorporating four different metaheuristic methods, namely Particle Swarm Optimization (PSO), Artificial Bee Colony (ABC) Optimization, Harris Hawks Optimization, and Sailfish Optimization (SFO), the performance of acquisition function, Expected Improvement (EI), was observed in the VGGNet models for visual field defect multi-class classification. Other than EI, comparative observations were also conducted using different acquisition functions, such as Probability Improvement (PI), Upper Confidence Bound (UCB), and Lower Confidence Bound (LCB). The analysis demonstrates that SFO significantly enhanced BO optimization by increasing mean accuracy by 9.6% for VGG-16 and 27.54% for VGG-19. As a result, the best validation accuracy obtained for VGG-16 and VGG-19 is 98.6% and 98.34%, respectively.
