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Soon-Phaik Chee

Publications and source records attributed to Soon-Phaik Chee.

At least 19 recordsLinked to original sources
PubMed2007

Corneal endotheliitis associated with evidence of cytomegalovirus infection.

OBJECTIVE: To describe the clinical presentation of cytomegalovirus (CMV) corneal endotheliitis in human immunodeficiency virus (HIV)-negative patients. DESIGN: Retrospective interventional case series. PARTICIPANTS: Twelve consecutive patients with corneal endotheliitis diagnosed between 2002 and 2005. METHODS: Aqueous of eyes with corneal endotheliitis was analyzed for viral DNA by polymerase chain reaction (PCR), and patient records were reviewed for demographic data, medical and ocular history, best-corrected Snellen visual acuity, intraocular pressure (IOP), anterior and posterior segment findings, laboratory workup, diagnosis, and treatment. MAIN OUTCOME MEASURE: Presence of CMV DNA. RESULTS: Corneal endotheliitis was seen in 12 eyes of 10 patients during the study period. There were 8 men and 2 women, and all were Chinese. Their mean age was 49 years (range, 25-61 years). The corneal involvement ranged from small areas of focal endotheliitis to diffuse bullous keratopathy. The keratic precipitates had a variable appearance. There was only mild anterior chamber inflammation with no posterior synechiae. Two thirds of eyes had diffuse iris atrophy. All the eyes had elevated IOP. Eleven of the 12 eyes were positive for CMV DNA. None of the patients were positive for HIV. All patients had received local or systemic immunosuppression, or both, before corneal endotheliitis developed. Ten eyes of 8 patients were treated with systemic antiviral therapy. After treatment, the endotheliitis resolved completely in 7 eyes, and 3 eyes had significant improvement in corneal translucency. The IOP was normal, with no medications in all but 1 eye. Repeat PCR analysis in all the treated eyes was negative for CMV DNA. CONCLUSIONS: Cytomegalovirus infection is an important cause of corneal endotheliitis in our patients, and appropriate antiviral therapy may prevent more ocular damage.

Adult↗
PubMed2006

Spectrum of Vogt-Koyanagi-Harada disease in Singapore.

PURPOSE: Review of all cases of Vogt-Koyanagi-Harada disease (VKH) handled in the Uveitis Clinic of the Singapore National Eye Centre, with the aim of determining the clinical spectrum of this disease in these patients and the outcomes of treatment. METHODS: The case notes were retrospectively analyzed for patient demographics, clinical signs, investigations, complications and treatment received. The treatment groups were classified according to the steroid regimen (dose and timing). The early-high (EH) group received > or =1 mg/kg per day of systemic prednisolone within 2 weeks of presenting with symptoms, the late-high (LH) group received the same dose between 2 and 4 weeks of presenting with symptoms, and the low-dose (LD) group received no or lower doses of oral corticosteroids, or received the same high dose, but only after more than 1 month of presenting with symptoms. RESULTS: A total of 178 eyes of 89 patients, mainly of Chinese ethnicity, were examined. The mean age of the patients at onset of the study was 41.80 +/- 14.65 (SE) years, and there were nearly equal numbers of male and female patients. The mean duration of the follow-up was 9.42 years (+/-9.87 years). There were 60 eyes in the EH group, 18 in the LH group, and 68 in the LD group. When the results on our patient group were compared to known data on a number of other ethnic groups, our patients were found to be similar to the Japanese with respect to gender distribution and prevalence, to the Hispanics for alopecia, and to the non-Hispanics of North America for tinnitus and vitiligo. The EH group were more likely to achieve complete resolution, with fewer complications, than the LD group, but one third of the former still developed chronic disease. CONCLUSION: Higher doses of systemic steroids may be required to ensure adequate immunosuppression in VKH patients.

Acute Disease↗
PubMed2006

An unusual case of self-inflicted penetrating needle injury to both eyes.

BACKGROUND: To describe an unusual case of non-accidental, penetrating needle injury to both eyes. METHODS: Case report. RESULTS: The patient was a 12-year-old girl with no medical or psychiatric problems detected during regular school health screenings. She presented with sudden bilateral eye pain with severe visual loss, but denied any prior trauma. She was was found to have central, penetrating corneal wounds in both eyes, which extended to the fovea in the left eye. The penetrating needle track involved the mid-cornea to the fovea, suggesting that the patient had intentionally aimed the needle into the eye while directly focusing on the needle. She subsequently underwent bilateral cataract operations; and an associated tractional retinal detachment in the left eye remained stable. Postoperatively, her visual acuity improved from perception of light to 6/9 in the right; 6/30 in the left eye. Psychological evaluations and clinical assessments did not suggest any evidence of child abuse or sexual assault. It is thus highly possible that these needle injuries could be self-inflicted. CONCLUSIONS: This is an unusual case of self-inflicted needle injury to the eyes in a pediatric patient.

Cataract↗
PubMed2006

Evaluation of the effect on outcomes of the route of administration of corticosteroids in acute Vogt-Koyanagi-Harada disease.

PURPOSE: To compare the effect on outcomes of the route of administration of corticosteroids in acute Vogt-Koyanagi-Harada disease. DESIGN: Retrospective comparative interventional case series. METHODS SETTINGS: Nine international uveitis specialty clinics. STUDY POPULATION: Forty-eight patients presenting over a three-year period to a study center with acute Vogt-Koyanagi-Harada disease. INTERVENTION: Initial treatment with corticosteroid either orally (Oral only group) or intravenously followed by an oral taper (IV+Oral group). MAIN OUTCOME MEASURES: Change in visual acuity with treatment; development of ocular complications, including visually significant cataract, choroidal neovascularization, subretinal fibrosis, fundus pigment migration, nummular hypopigmented lesions, and diffuse fundus depigmentation; use of immunosuppressive therapy. RESULTS: The Oral only group comprised 15 patients (31%) and the IV+Oral group 33 patients (69%). Median follow-up was 15 months. There was no difference in duration of follow-up between groups (P = .234). There was no difference in the change in visual acuity between groups, adjusting for initial visual acuity (P = .402). There were no differences in the rates of development of visually significant cataract, fundus pigmentary changes, or in the rate of use of subsequent immunosuppressive therapy between treatment groups. No patients developed choroidal neovascularization or subretinal fibrosis over the study period. CONCLUSIONS: Route of administration of corticosteroid had no detectable effect on change in visual acuity nor on the development of visually significant complications over the study period. Prospective trials are necessary to address speed of resolution and definitively answer outcome questions.

Acute Disease↗
PubMed2006

Posterior-assisted levitation: outcomes in the retrieval of nuclear fragments and subluxated intraocular lenses.

PURPOSE: To report the outcomes of posterior-assisted levitation (PAL) to retrieve nuclear fragments and subluxated intraocular lenses (IOLs). SETTING: Singapore National Eye Centre, Singapore, Singapore. METHODS: In a retrospective series, the case notes of consecutive surgeries performed by a single surgeon between 1999 and 2006 were reviewed. Posterior-assisted levitation was performed for intraoperative posterior capsule rupture with nucleus-IOL dislocation or for late subluxation of posterior chamber intraocular lenses (PC IOLs). This was accomplished by the pars plana insertion of a needle followed by levitation of the subluxated object. Ophthalmic viscosurgical device injection was not used as an adjunct for levitation. RESULTS: Fourteen patients with PAL were followed for a mean of 18.71 months (range 1 to 79 months). There were 3 cases of dropped nucleus/nuclear fragments, 1 case of intraoperative subluxated PC IOL, and 10 cases of late subluxated PC IOLs. Complications included 1 case of retinal detachment occurring 20 months after PAL and 1 case of cystoid macular edema in a patient with previous anterior uveitis. Best corrected visual acuity was 20/40 or better in all except 3 patients (1 retinal detachment, 1 corneal edema/scarring, 1 unspecified). CONCLUSION: Posterior-assisted levitation provided an effective, relatively noninvasive means of levitating nuclear fragments and PC IOLs with few complications.

Aged↗
PubMed2005

Sympathetic ophthalmia in Singapore: new trends in an old disease.

BACKGROUND: Sympathetic ophthalmia (SO) is an uncommon uveitic condition that occurs after injury to the uvea of one eye and may occur after accidental ocular trauma or ocular surgery. We sought to investigate the common causes of SO in Singapore and the demographic profile as well as the final visual acuity after treatment in these patients. METHODS: This was a retrospective, non-comparative case series in which patients with SO were identified from the Singapore National Eye Centre uveitis database in the period between 1993 and 2003. The patients' case records were examined for a history of ocular trauma or surgery and subsequent development of bilateral or contralateral uveitis consistent with SO or histopathological evidence of SO in enucleated eyes. The medical records of these patients were reviewed for details of the inciting event, presentation, treatment, and visual acuity. RESULTS: A total of ten patients (six men and four women) were diagnosed with SO in the period of study. SO occurred after accidental trauma in three patients and following ocular surgery in seven. Vitreoretinal surgery was responsible for four of these cases, and diode laser cyclophotoablation for another two, whereas neodymium:yttrium-aluminium-garnet (Nd:YAG) laser cyclotherapy was the cause in the last patient. Overall, six of ten patients underwent at least one vitreoretinal procedure. Four of the patients had a final visual acuity of 6/15 or better, whereas five had a visual acuity of 6/30 or worse. Good final visual acuity appeared to be associated with early initiation of immunosuppressive therapy. CONCLUSION: In this series, ocular surgery, especially vitreoretinal surgery, had overtaken non-surgical trauma as the major cause of SO. A good outcome was possible in most cases if an early diagnosis was made and immunosuppressive treatment started promptly.

Adult↗
PubMed2005

Visual function in Vogt-Koyanagi-Harada patients.

BACKGROUND: Vogt-Koyanagi-Harada (VKH) disease presents with anterior segment inflammation, choroiditis and exudative retinal detachment. Following resolution of the inflammation, VKH patients have been noted to complain of visual disturbances despite good visual acuity. We therefore investigated the visual function deficits of convalescent VKH patients. METHODS: A cross-sectional observational nonrandomized controlled study of convalescent VKH patients from the Uveitis Service of the Singapore National Eye Centre, and normal subjects was performed. The best-corrected visual acuities (BCVA) and multifocal electroretinograms (mfERGs) of VKH patients with and without peripapillary atrophy (PPA) were compared with those of the normal eyes. The mfERG results were subdivided into those obtained from the peripapillary area and those from the rest of the macular. RESULTS: Eleven VKH eyes with large PPA to disc ratios (PPA/D ratio >2), 15 VKH eyes with PPA/D ratios<1 and 6 normal eyes were included in the study. Five eyes (54.5%) of VKH patients with PPA/D>2 had a BCVA of less than 20/40. All the other eyes had 20/20 vision. Nine of the 11 VKH eyes with PPA/D>2 also had large areas of chorioretinal atrophy. The mfERG responses of VKH eyes with PPA/D ratio >2 were markedly reduced in amplitude (p<0.001) and delayed in implicit time (p<0.001) throughout the entire macular area. VKH patients with PPA/D ratio<1 had significantly reduced mfERG amplitudes throughout the entire macular area, as well as delayed implicit times at the peripapillary region (p=0.026). Sub-division of VKH eyes with PPA/D<1 into eyes with no PPA and eyes with a small PPA, showed that both groups had a similar reduction in response amplitude over the entire macular region. However, the implicit time was significantly delayed in eyes with small PPA when compared to those without PPA (p<0.03). CONCLUSIONS: VKH patients with large PPA have clinically significant visual dysfunction. VKH patients without PPA also have subclinical retinal dysfunction. The mfERG may be a useful adjunct in the management of VKH by detecting early retinal damage.

Cross-Sectional Studies↗
PubMed2005

Progression of varicella-zoster virus necrotizing retinopathy in an HIV-negative patient with transient immune deviation.

PURPOSE: To report a case of unilateral varicella-zoster virus (VZV) necrotizing retinopathy that progressed from outer retinitis with features of progressive outer retinal necrosis (PORN) to typical acute retinal necrosis (ARN) in an HIV-negative patient with a transient decrease in CD4 lymphocyte counts and CD4/CD8 ratio. METHOD: Case report. RESULTS: A 41-year-old Chinese man presenting with blurred vision in the right eye was diagnosed with herpetic necrotizing retinitis without vitritis. Fundus examination revealed retinal arteritis and extensive deep whitish retinal lesions in the mid-periphery with minimal vitritis. Aqueous humor and vitreous PCR were positive for VZV. His CD4 count on presentation was depressed (239 cells/ul) and the CD4/CD8 ratio was low (0.8). The referring ophthalmologist had treated him with prednisolone 60 mg/day. At our institution, when intravenous acyclovir was started and the steroid therapy discontinued, he developed severe vitritis and the deep retinal lesions progressed to full-thickness retinitis typical of ARN. Repeat CD4 count was 512 cells/ul at day 14. In total, he was treated with 14 days of i.v. acyclovir (12 mg/kg 8-hourly) followed by oral valaciclovir 500 mg three times a day for 3 months. Prednisolone 30 mg once daily was restarted and tapered over 3 months. Despite prophylactic argon retinal photocoagulation to the edge of the retinitis, the patient developed a total retinal detachment at 3 months. CONCLUSIONS: VZV retinal infection in an HIV-negative patient with transient immune deviation can manifest initially as outer retinitis with features similar to PORN and progress to typical ARN when CD4 counts return to normal.

Adult↗
PubMed2005

Endophthalmitis after microincision cataract surgery.

We report the first case of streptococcal endophthalmitis after uneventful right bimanual phacoemulsification. Microincision cataract surgery is perceived to be minimally invasive as smaller wounds are equated to shortened healing time, increased safety, and reduced risk for postoperative endophthalmitis. Recommendations for modifications in wound construction are discussed.

Anti-Infective Agents↗
PubMed2004

Immunopathology of progressive subretinal fibrosis: a variant of sympathetic ophthalmia.

PURPOSE: We report the immunopathology of progressive subretinal fibrosis, a variant of sympathetic ophthalmia. DESIGN: Brief case report. METHOD: Review of medical record and immunopathology of a chorioretinal biopsy of a 40-year-old man who presented with left total retinal detachment (RD) following multiple vitrectomies in the right eye for RD. Small peripherally retinal holes, snow banks, and inflammatory nodules along the ora serrata were observed during left vitrectomy. Both eyes deteriorated rapidly to blindness with progressive subretinal fibrosis and inflammation over 3 months, and the patient was unresponsive to systemic prednisolone and azathioprine. RESULT: Immunopathology of the chorioretinal biopsy of the right eye revealed aggregates of CD20+ B cells, surrounded by CD3+ T cells. CD68+ macrophages were scattered throughout. CONCLUSION: The rapid clinical course described in this case may be related to the unique immunopathology of rapidly forming peudogerminal centers in the choroids and retina.

Adult↗
PubMed2004

Spontaneous disinsertion of a multipiece foldable acrylic intraocular lens haptic 3 and 12 months after implantation.

We report 2 cases of spontaneous postoperative haptic disinsertion with the Alcon AcrySof MA60BM posterior chamber intraocular lens (PC IOL). A 14-year-old girl with a history of acute retinal necrosis and pars plana vitrectomy with lensectomy for retinal detachment repair had secondary implantation of a PC IOL in the ciliary sulcus. Three months later, the superior haptic disinserted from the optic and dislocated into the anterior chamber. In the second case, a 22-year-old man had lens aspiration and PC IOL implantation in the capsular bag. One year after surgery, the PC IOL had a similar problem, with the disinserted superior haptic remaining in the capsular bag while the optic and inferior haptic dislocated into the anterior chamber. In both patients, the PC IOLs were exchanged for rigid single-piece PC IOLs. The patients have had no further problems.

Acrylic Resins↗
PubMed2004

The epidemiology of acute endophthalmitis after cataract surgery in an Asian population.

OBJECTIVE: To describe the incidence, risk factors, and clinical outcome of acute endophthalmitis after cataract extraction in a multiethnic Asian population. DESIGN: Prospective case series. PARTICIPANTS: All patients with cataract extractions performed at the Singapore National Eye Center from 1996 to 2001. METHODS: Data on patients with acute endophthalmitis cases presenting within 6 weeks after cataract surgery were prospectively collected in a standardized format. MAIN OUTCOME MEASURES: Acute endophthalmitis after cataract surgery. RESULTS: During the study period, 44 803 cataract operations (25 476 phacoemulsification and 19 327 extracapsular cataract extractions) were performed. There were 34 cases of acute endophthalmitis (average annual incidence of 0.076%), 21 of which were culture positive (average annual incidence of 0.040%). In multivariate analysis, risk of endophthalmitis was associated with phacoemulsification technique (relative risk [RR], 1.9; 95% confidence interval [CI], 0.9, 3.9; P = 0.10 for all endophthalmitis cases; RR, 3.1; 95% CI, 1.1, 9.4; P = 0.04 for culture-positive endophthalmitis cases) and the occurrence of intraoperative posterior capsule rupture (RR, 8.0; 95% CI, 3.1, 20.7; P<0.001 for all endophthalmitis cases; RR, 11.0; 95% CI, 3.7, 23.9; P<0.001 for culture-positive endophthalmitis cases). After a median follow-up of 234 days, half of the eyes achieved a final best-corrected visual acuity of 20/40. Predictors of this visual acuity included baseline acuity of counting fingers or better, culture-negative endophthalmitis, or infection caused by coagulase-negative Staphylococcus. CONCLUSION: The incidence of acute endophthalmitis after cataract extraction in Singapore is consistent with rates reported elsewhere. The phacoemulsification technique is associated with a higher risk of acute culture-positive endophthalmitis compared with extracapsular cataract extraction. Intraoperative posterior capsule rupture is associated with an 8- to 11-fold higher risk of acute endophthalmitis, suggesting that these eyes should be closely monitored for signs of infection in the immediate postoperative period.

Acute Disease↗