tear-derived-exosomal-mir-15a-as-new-diagnostic-tool-for-diabetic

Tear-Derived Exosomal miR-15a as New Diagnostic Tool for Diabetic Retinopathy

Diabetic retinopathy (DR) is a major complication of diabetes mellitus, affecting a significant percentage of the diabetic population. Early diagnosis and ...

Universiti Malaya

Universiti Malaya Medical Centre

A patient's age, clinical presentation, medical history, and circumstances at time of palsy onset suggest likely underlying causes and help prioritize choice of imaging.

Isolated third nerve palsy: Lessons from the literature and 4 case studies.

Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoid malignancy in adults. It is an aggressive malignancy and requires a multidisciplinary approach with various modalities which include chemotherapy, radiotherapy as well as immunotherapy. A 63-year-old Malay male patient with underlying type 2 diabetes mellitus, hypertension, ischemic heart disease, and stage II chronic kidney disease presented with a one-month history of bilateral eye proptosis associated with lid swelling and red eye. He also complained of progressive right eye blurring of vision. Visual acuity was counting fingers on the right and 6/18 on the left. On examination, the relative afferent pupillary defect was negative. There was bilateral eye proptosis, conjunctival chemosis, and restricted extra-ocular movement in all gazes. There was also exposure keratopathy over the right eye, and intraocular pressure was raised. Bilateral cervical and axillary lymph nodes were palpable. A computerized tomography scan of the brain and orbit revealed bilateral orbital masses with no bony erosions. An incisional biopsy over the upper lid confirmed the diagnosis of diffuse large B-cell lymphoma with multiple myeloma-1 (MUM-1) positivity which defines the activated B-cell subtype (ABC). He was co-managed with a hematologist and was commenced on the rituximab-cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) chemotherapy regime. Bilateral eye proptosis, chemosis, and restriction of extra-ocular movement resolved after the completion of treatment. However, right eye vision remains poor as the patient developed central self-sealed corneal perforation with iris plugging which has healed with scarring. Diffuse large B-cell orbital lymphoma is a fast-growing and aggressive tumor, hence early diagnosis and prompt multi-disciplinary treatment are crucial for a good outcome.

Bilateral Large Orbital Lymphoma With Proptosis.

Purtscher's retinopathy is a rare angiopathy reported in patients with a history of severe trauma and other systemic diseases. The diagnosis is made on clinical grounds, and the severity varies. A 41-year-old gentleman with underlying poorly controlled diabetes mellitus and dyslipidemia was referred to the ophthalmology department for diabetic retinopathy screening. He denied visual complaints. Ocular examination revealed a negative relative afferent pupillary defect with a visual acuity of 6/6 bilaterally. The anterior segment examination was unremarkable. Both eye (oculus uterque, OU) fundus revealed a pink disc with a cup-to-disc ratio of 0.4 and peripapillary flame-shaped hemorrhages. Right eye (oculus dexter, OD) also showed multiple cotton wool spots along the superotemporal arcade involving zones 1 and 2 of the retina, while left eye (oculus sinister, OS) showed a single cotton wool spot along the superotemporal arcade at zone 1 of the retina. Otherwise, there were no visible retinal emboli, dot hemorrhages, or hard exudates, and the macula was normal. The retinal features were not characteristic of diabetic retinopathy. It mimicked hypertensive retinopathy, but the patient was normotensive. The absence of inner retinal thickening and hyperreflectivity on optical coherence tomography of the macula ruled out retinal vein occlusion. This prompted us to elicit further history, and the patient disclosed a recent admission for myocardial infarction in which he received cardiopulmonary resuscitation with chest compressions for seven minutes. Hence, the diagnosis of OU Purtscher's retinopathy was made, and the patient was monitored closely in the clinic. Purtscher's retinopathy remains a diagnostic dilemma and should not be neglected in complex clinical contexts.

Purtscher's Retinopathy After Cardiopulmonary Resuscitation: A Literature Review.

This study aims to report a case of neuro-ophthalmic manifestation in a coronavirus disease 2019 (COVID-19) patient and a literature review of neuro-ophthalmological manifestation in COVID-19 patients. A 57-year-old male presented with headache, giddiness, and sudden onset of diplopia over two days after having a flu-like illness. Clinical examination revealed bilateral bizarre extraocular movement with right lower motor neuron facial nerve palsy. A polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive. Computed tomography (CT) and contrast-enhanced CT of the brain and CT venography were unremarkable. Magnetic resonance imaging (MRI) of the brain, magnetic resonance angiography of the circle of Willis, and MRI of the internal auditory meatus revealed a subacute pontine infarction with no leptomeningeal or cranial nerve enhancement and a normal circle of Willis. The patient received a course of oral prednisolone and clinical symptoms improved gradually. Articles published between December 2019 and June 2022 were included. A total of 23 cases, with 14 male and nine female patients, were summarized. The mean age at presentation was 46.95 years (range = 9-71 years), with the most affected age group ranging from 31 to 70 years (17 of 23 cases, 73.91%). Neuro-ophthalmological symptoms and signs can be isolated or associated with neurological syndromes. The manifestations include optic neuritis, isolated or multiple cranial nerve palsies, acute vision loss, Miller Fisher syndrome, myasthenia gravis, acute disseminated encephalomyelitis, Guillain-Barré syndrome, internuclear ophthalmoplegia, and cerebrovascular events. Diagnosing neuro-ophthalmic complications secondary to SARS-CoV-2 infection is challenging, as there are no pathognomonic symptoms to detect the disease. High clinical suspicion aids in early diagnosis and initiation of treatment may help in relieving the symptoms.

COVID-19 and Crossed Eye: A Case Report and Literature Review.

 Ozurdex had shown promising anatomical and functional outcomes in managing refractory Irvine-Gass syndrome over the years. Burgeoning usage of Ozurdex has prompted the study of its related complications, particularly the anterior chamber migration of the implant.  Literature reviews on the anterior chamber migration of the Ozurdex via PubMed, EBSCO, and TRIP databases were searched from 2012 to 2020. The predisposing factors, outcomes, and management of such cases were evaluated.  A total of 54 articles consisting of 105 cases of anterior migration of Ozurdex were included in this analysis. The vitrectomized eye and compromised posterior capsule were highly associated with this complication. About 81.9% of the cases had cornea edema upon presentation, with 31.4% of them ending up with cornea decompensation despite intervention. Although there was high intraocular pressure reported initially in 22 cases, only 2 cases required glaucoma filtration surgeries in which they had preexisting glaucoma. Numerous techniques of repositioning or surgical removal of the implant were described but they were challenging and the outcomes varied.  A noninvasive method of manipulating the Ozurdex into the vitreous cavity via the "Trendelenburg position, external pressure with head positioning" maneuvers is safe yet achieves a favorable outcome. Precaution must be taken whenever offering Ozurdex to the high-risk eyes. Prompt repositioning or removal of the implant is crucial to deter cornea decompensation. Clinical Trial Registration number: NMRR-22-02092-S9X (from the Medical Research and Ethics Committee (MREC), Ministry of Health, Malaysia).

Review of Risk Factors and Complications of Anterior Migration of Ozurdex Implant: Lessons Learnt from the Previous Reports.

To evaluate the variation and stability of the posterior cornea surface parameters (posterior cornea curvature [PCC], posterior cornea astigmatism [PCA], and posterior cornea elevation [PCE]) after femtosecond laser-assisted in situ keratomileusis (LASIK) in patients with myopia and myopic astigmatism over a period of 6 months or longer.

Posterior corneal surface stability after femtosecond laser-assisted in situ keratomileusis in patients with myopia and myopic astigmatism.

To compare the thickness of the retinal nerve fibre layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), and choroid in healthy electronic cigarette smokers and non-smokers using spectral domain optical coherence tomography (SD-OCT).

The effects of electronic cigarette smoking on retinal nerve fiber layer, ganglion cell layer, inner plexiform layer, and choroidal thickness.

To shed light on one of the ocular adverse effects related to pembrolizumab.

Corneal Perforation Associated with Pembrolizumab - A Case Report with Literature Review.

To describe the clinical course and management challenges of chronic ocular complications in Stevens-Johnson syndrome (SJS) patients with co-existing autoimmune diseases, emphasizing the role of systemic immunomodulatory therapy (IMT) in controlling inflammation and preventing disease progression.

Article	Year
Isolated third nerve palsy: Lessons from the literature and 4 case studies. The Journal of family practice\| PubMed ID: 36947782	2023
Bilateral Large Orbital Lymphoma With Proptosis. Cureus\| PubMed ID: 37102017	2023
Purtscher's Retinopathy After Cardiopulmonary Resuscitation: A Literature Review. Cureus\| PubMed ID: 37228527	2023
COVID-19 and Crossed Eye: A Case Report and Literature Review. Cureus\| PubMed ID: 37654949	2023
Review of Risk Factors and Complications of Anterior Migration of Ozurdex Implant: Lessons Learnt from the Previous Reports. Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics\| PubMed ID: 37676992	2024
Posterior corneal surface stability after femtosecond laser-assisted in situ keratomileusis in patients with myopia and myopic astigmatism. Indian journal of ophthalmology\| PubMed ID: 39078954	2024
The effects of electronic cigarette smoking on retinal nerve fiber layer, ganglion cell layer, inner plexiform layer, and choroidal thickness. Cutaneous and ocular toxicology\| PubMed ID: 39498579	2024
Corneal Perforation Associated with Pembrolizumab - A Case Report with Literature Review. Ocular immunology and inflammation\| PubMed ID: 39883910	2025
Challenges in Managing the Ocular Complications of Stevens-Johnson Syndrome in Patients with Co-Existent Auto-Immune Disease. Seminars in ophthalmology\| PubMed ID: 40838291	2025

Sujaya Singh

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