Purpose: The purpose of this study was to determine the association between cigarette smoking and the severity of primary angle closure glaucoma (PACG) in Malay patients residing in Malaysia. Methods: A cross-sectional study was conducted involving 150 Malay PACG patients between April 2014 and August 2016. Ocular examination was performed including Humphrey visual field (HVF) 24-2 analysis assessment. On the basis of the 2 consecutive reliable HVFs, the severity of glaucoma was scored according to modified Advanced Glaucoma Intervention Study (AGIS) by 2 masked investigators and classified as mild, moderate, and severe. Those with retinal diseases, neurological diseases, memory problem, and myopia ≥4 diopters were excluded. Their smoking status and details were obtained by validated questionnaire from Singapore Malay Eye Study (SiMES). The duration of smoking, number of cigarettes per day, and pack/year was also documented. Multiple linear regression analysis was conducted. Results: There was a significant association between education level and severity of PACG (P=0.001). However, there was no significant association between cigarette smoking and severity of glaucoma (P=0.080). On the basis of multivariate analysis, a linear association was identified between cigarette smoked per day (adjusted b=0.73; 95% CI: 0.54, 1.45; P<0.001) and body mass index (adjusted b=0.32; 95% CI: 0.07, 1.35; P=0.032) with AGIS score. Conclusions: There was no significant association between cigarette smoking and severity of PACG. Cigarette smoked per day among the smokers was associated with severity of PACG. However, because of the detrimental effect of smoking, cessation of smoking should be advocated to PACG patients.
There was no significant difference in cost effectiveness between ECCE and phacoemulsification. The cost of cataract surgery in the MOH hospital was found to be high due to the high overhead costs.
Information about retinal vasculature morphology is used in grading the severity and progression of diabetic retinopathy. An image analysis system can help ophthalmologists make accurate and efficient diagnoses. This paper presents the development of an image processing algorithm for detecting and reconstructing retinal vasculature. The detection of the vascular structure is achieved by image enhancement using contrast limited adaptive histogram equalization followed by the extraction of the vessels using bottom-hat morphological transformation. For reconstruction of the complete retinal vasculature, a region growing technique based on first-order Gaussian derivative is developed. The technique incorporates both gradient magnitude change and average intensity as the homogeneity criteria that enable the process to adapt to intensity changes and intensity spread over the vasculature region. The reconstruction technique reduces the required number of seeds to near optimal for the region growing process. It also overcomes poor performance of current seed-based methods, especially with low and inconsistent contrast images as normally seen in vasculature regions of fundus images. Simulations of the algorithm on 20 test images from the DRIVE database show that it outperforms many other published methods and achieved an accuracy range (ability to detect both vessel and non-vessel pixels) of 0.91 - 0.95, a sensitivity range (ability to detect vessel pixels) of 0.91 - 0.95 and a specificity range (ability to detect non-vessel pixels) of 0.88 - 0.94.
Opacification of intraocular lens implant after successful cataract surgery is an important issue with the introduction of new intraocular lens. The complexity of the problem is not merely associated with visual impairment, but also lies in the difficulty in diagnosis and management of the case. We report 3 cases of late postoperative opacification of IOL implants warranted IOL exchange.
Objective: To report three cases of Von Hippel-Lindau (VHL) disease from a family with different presentations.Method: Case series.Results: Case 1, a 14-year-old Malay boy with a history of gradual blurring of vision in both eyes presented with sudden deterioration of right vision. Fundus examination revealed bilateral retinal capillary hemangioma with exudative retinal detachment. His right eye underwent combination therapy of laser photocoagulation, cryotherapy, intravitreal anti-VEGF and photodynamic therapy, but failed to improve vision. His left visiondeteriorated and eventually required surgical intervention. Case 2 was the sister of case 1. She was a 17-year-old Malay girl who presented with sudden onset of left eye pain and redness. Diagnosis of left eye rubeotic glaucoma with closed funnel retinal detachment secondary to a huge retinal hemangioma was made. She underwent left eye external drainage of subretinal fluid plus anterior retinal cryopexy. The rubeotic vessel regressed postoperatively and IOP reduced. Case 3 was the eldest sister of case 1; a 19-year-old Malay girl who came for eye screening after two of her siblings were diagnosed with VHL. She was, however, asymptomatic. Fundus examination revealed right retinal capillary hemangioma. She was treated with laser photocoagulation and her condition remained stable. Systemic investigations identified midline cystic masses in the brain, spine and pancreas. Conclusions: This case series highlight different clinical pictures of Von Hippel-Lindau disease. As marked visual loss is a dreadful sequela of VHL, it is important to screen the family members as early detection and management of ocular and systemic lesions save sight and life.
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