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Biomedical subjects

E Y Yap

Publications and source records attributed to E Y Yap.

15 recordsLinked to original sources
PubMed1999

Pilomatrixoma of the eyelids and eyebrows in children and adolescents.

PURPOSE: To review the clinical features of pilomatrixomas of the eyelids and eyebrows in children and adolescents. METHODS: The authors reviewed the medical records of 95 patients, all of whom were 20 years old or younger and had the histopathologic diagnosis of pilomatrixoma made from 1976 through 1995. Special attention was given to that subgroup of patients with tumors involving the eyelids and eyebrows. Data analyzed included age at diagnosis, patient sex, location and size of tumor, preoperative diagnosis, and clinical description of tumor. RESULTS: Eleven (12%) of 95 patients had lesions involving the eyelid or eyebrow. Six of those patients (55%) were female. Eight patients (73%) were 10 years old or younger, and three were 11 to 20 years old. The tumor occurred on the upper lid or in the brow in eight patients, the lower eyelid in two patients, and the medial canthus in one patient. Tumor diameter was 1 cm or less in all 11 patients. Pilomatrixoma was included in the preoperative differential diagnosis in only four of the 11 patients. The most common misdiagnoses were epidermoid and dermoid cyst. Three patients had pink or blue discoloration of the overlying skin, two had visible yellow-white patches in the tumor, and two had dilated vessels on the tumor surface. CONCLUSIONS: Pilomatrixoma is an uncommon tumor that can occur on the eyelids and in the brow region of children and adolescents. It is commonly misdiagnosed preoperatively as an epidermoid or dermoid cyst. Distinctive clinical features, however, suggest the correct diagnosis.

Adolescent↗
PubMed1998

Nocardia choroidal abscess in a patient with systemic lupus erythematosus.

PURPOSE: Nocardia asteroides, a respiratory saprophyte in humans, may cause localized infection of the lungs in debilitated or immunosuppressed individuals. Haematogenous spread to the eye via the choroidal circulation may result in choroidal abscess formation. METHOD: We report the development of a choroidal abscess in the left eye of a woman treated with steroids and cyclophosphamide for systemic lupus erythematosus. Haematogenous spread of N. asteroides from a localized infection of the lung (empyema) is thought to have been the cause of the choroidal abscess. RESULTS: Surgical drainage of the empyema combined with intravenously administered antibiotics resulted in resolution of the choroidal abscess and improvement of vision. CONCLUSIONS: A choroidal abscess, caused by haematogenous spread of N. asteroides, may respond to appropriate systemic antibiotic treatment alone and not require ocular treatment.

Abscess↗
PubMed1998

Periocular capillary hemangioma: a review for pediatricians and family physicians.

The pediatrician or family physician is usually the first person to examine an infant with a periocular capillary hemangioma. The physician should know that, in addition to being cosmetically disfiguring, capillary hemangiomas have the potential to cause serious ocular complications such as amblyopia, strabismus, proptosis, and optic atrophy. Prompt evaluation and management of periocular hemangiomas are essential in order to prevent permanent visual loss. Corticosteroids have been the mainstay in the treatment of patients with large periocular hemangiomas, but other therapeutic modalities such as radiation, interferon, and surgical excision also have been effective in selected patients. This review provides pediatricians and family physicians with information on the natural history, complications, and current management of periocular hemangiomas in infants.

Capillaries↗
PubMed1998

Ophthalmic manifestations in Asian patients with systemic lupus erythematosus.

AIM OF STUDY: To determine the spectrum and prevalence of ophthalmic manifestations of systemic lupus erythematosus (SLE) in Asian patients. METHODS: We performed a standardised ophthalmic examination on consecutive Asian patients with SLE referred from a tertiary rheumatology unit to an ophthalmology department. RESULTS: Seventy patients were included in the study. There were 66 females (94%) and 4 males (6%). The mean (range) age of the patients was 32.9 (9-67) years. Five patients (7%) had ophthalmic symptoms while 65 (93%) were asymptomatic. Eighty-three eyes of 45 patients had abnormal Schirmer's #1 test and 27 of these eyes of 17 patients also had concomitant rose bengal staining of the cornea and/or conjunctiva. Seventeen eyes of 9 patients had retinal vascular lesions. Fourteen of these eyes had mild microangiopathic retinopathy with best-corrected visual acuity (BCVA) 6/12 or better and 3 had retinal vaso-occlusive disease with BCVA worse than 6/12. Twenty-eight eyes of 14 patients had cataract and 3 eyes of 2 patients had raised intraocular pressure. Twelve eyes of 7 patients had BCVA worse than 6/12 because of optic neuropathy (4 eyes), posterior subscapsular cataract (4 eyes), retinal vaso-occlusive disease (3 eyes) and phthisis bulbi (1 eye). None had any eyelid lesion, extraocular motility disorder or retrochiasmal disorder of vision. CONCLUSIONS: Asymptomatic dry eye is the most common ocular finding in patients with SLE. Sight-threatening complications of SLE include retinal vaso-occlusive disease and optic neuropathy.

Adolescent↗
PubMed1998

Frontal sinus mucoceles causing proptosis--two case reports.

Paranasal sinus mucoceles can present with a multitude of different symptoms including ophthalmic disturbances. We describe two patients with frontal sinus mucoceles presenting with non-axial proptosis, and give details of their presentation, investigations and treatment. Possible ocular manifestations of mucoceles and the diagnostic imaging techniques used are discussed. The treatment of mucoceles is reviewed. It is stressed that a team approach involving the ophthalmologist, otolaryngologist and radiologist is essential for accurate diagnosis and management.

Adult↗
PubMed1996

The long-term outcome of central serous chorioretinopathy.

OBJECTIVE: To assess the long-term outcome of central serous chorioretinopathy (CSR) among a group of patients who previously participated in a prospective argon laser photocoagulation study of CSR. DESIGN: Thirty-eight of 41 surviving patients with CSR participating in an earlier study were invited to participate in a follow-up study that included history taking, ophthalmoscopy, biomicroscopy, and fundus photography. RESULTS: Thirty-seven (38 eyes) of 38 surviving patients (97%) were available for follow-up between 11 and 15 years after participation in the earlier study. There were no clinically documented or historical recurrences of CSR among the six eyes previously treated by direct laser photocoagulation. There were 13 clinically documented recurrences and four historical recurrences among the 32 eyes not treated with direct laser photocoagulation. The difference in recurrences was statistically significant (P = .02). Pigment changes indistinguishable from age-related macular degeneration frequently occurred in eyes with CSR. The difference in the development of such pigment changes between eyes with CSR (33 of 38) and nonaffected fellow eyes (12 of 35) was significant (P = .001). CONCLUSIONS: The decreased rate of CSR recurrence after direct laser photocoagulation reported in an earlier study was sustained with follow-up beyond 10 years. Pigmentary changes in the fundus indistinguishable from those associated with age-related macular degeneration developed in eyes affected with CSR, probably as a consequence of the presence of subretinal fluid accompanying the CSR rather than from early age-related macular degeneration.

Choroid Diseases↗
PubMed1996

Oedipism.

BACKGROUND: Oedipism or self-enucleation is a rare form of self-mutilation, and most often described in acutely psychotic patients, who have religious or sexual delusions. CLINICAL RECORD: A 47-year-old Chinese man with a history of chronic schizophrenia enucleated his own left eye and mutilated his right eye. The reason for his behaviour was unknown. The history and legends surrounding autoenucleation and the medical literature are reviewed. RESULTS: The patient was managed jointly with the psychiatrist. He suffered extensive injury to his right eye, resulting in loss of vision. CONCLUSION: The management of Oedipism requires close cooperation between ophthalmologists and psychiatrists. Precautions must be taken to prevent repeated attempts or other self-mutilatory behaviour.

Eye Enucleation↗
PubMed1996

Spasmus nutans.

Spasmus nutans is classically described as a triad of nystagmus, head nodding and torticollis. It occurs in children, beginning in infancy and usually disappears in childhood. It is uncommon but its prompt recognition by ophthalmologists, paediatricians and neurologists can provide reassurance to the family of its benign nature. It is important to distinguish it from more serious conditions like gliomas which may present with signs mimicking spasmus nutans. We describe a case of a 3-year-old boy with acquired horizontal pendular nystagmus associated with head nodding and torticollis. The diagnosis of spasmus nutans, its implications and its management are discussed.

Child, Preschool↗
PubMed1993

A review of anaesthesia in ophthalmology.

In this article, we review the methods of anaesthesia commonly used in ophthalmology in Singapore. These include topical, local, regional and general anaesthesia. Topical and local anaesthesia is adequate for most outpatient procedures. The most common form of regional anaesthesia in Singapore is still retrobulbar anaesthesia. General anaesthesia is used in children and when more extensive procedures are performed.

Anesthesia↗
PubMed1992

Scleritis as an initial manifestation of choroidal malignant melanoma.

PURPOSE: The purpose of this article is to present the unusual circumstances in which malignant melanoma of the choroid can masquerade as scleritis, thus confounding its diagnosis. METHODS: Three cases of plaque-like malignant melanomas of the choroid are reported that, on initial examination, had features of scleritis. The events leading to their eventual correct diagnosis also are presented. RESULTS: In each case, there was ocular pain, blurred vision, anterior chamber and/or vitreous cavity cellular reaction, and an exudative retinal detachment associated with an ill-defined, relatively flat variably pigmented choroidal mass. In all three cases, the inflammatory component responded promptly to corticosteroid treatment and was accompanied by visual improvement. In two eyes, shrinkage of the choroidal mass accompanied the corticosteroid treatment, lending support to a working diagnosis of scleritis. By demonstrating expansion of the choroidal masses, examination of sequential fundus photographs influenced the decision to enucleate the eyes for presumed malignant choroidal melanoma. CONCLUSION: Clinicians should be alert to the circumstances in which malignant melanomas of the choroid can masquerade as scleritis. Careful evaluation by ophthalmoscopy, ultrasonography, fundus photography, and subsequent sequential examination is necessary to arrive at the correct diagnosis.

Adult↗
PubMed1992

Visual loss associated with pseudoxanthoma elasticum.

An 18-year-old woman with pseudoxanthoma elasticum had sudden profound bilateral visual loss, presumably as a result of optic nerve infarction caused by anemia and hypotension from massive gastrointestinal bleeding. Her central visual acuity largely recovered in her right eye, but her left eye had only hand motions acuity. During the subsequent 24 years, she underwent three separate surgical procedures for gastrointestinal bleeding. Abdominal arterial angiography showed numerous aneurysms of the gastric arteries. A subtotal gastrectomy was done, and histopathologic examination found advanced degenerative changes of the elastic lamina of the gastric arteries. At age 42 years, the patient lost residual vision in her right eye. This was caused by an extrafoveal subretinal choroidal neovascular membrane, which was obliterated with laser photocoagulation. Degeneration of elastic tissue, the primary defect in this syndrome, may cause cardiovascular complications and formation of breaks in the Bruch membrane, which are visible as angioid streaks. Ingrowth of fibrovascular tissue through angioid streaks may cause disturbances of macular function. The optic nerve ischemia and infarction associated with the profound visual loss in this patient reminds the ophthalmologist of the systemic nature of this disorder and the possibility that systemic vascular complications with massive blood loss may occur.

Adolescent↗
PubMedDate not supplied

Pupil abnormalities on the first postoperative day after cataract surgery.

Most, if not all, ophthalmologists strive to achieve a round pupil after cataract surgery with posterior chamber lens implantation. The presence of pupil abnormalities and iris modifications is cosmetically undesirable and may affect the quality of postoperative vision. The pupillary motility may be changed which will in turn affect both pupillary light reflexes and pupillary dilatation during fundus examination. In this paper, we prospectively studied 2 groups of patients who underwent uncomplicated cataract surgery with posterior chamber lens implantation; 100 patients who had planned extracapsular cataract extraction (ECCE), and 130 patients who underwent phacoemulsification. On the first postoperative day, we found a 16% rate of pupil abnormalities in the group which underwent ECCE surgery while only 5.3% of the phacoemulsification group had pupil abnormalities. There were different causes in which the two groups. The most common cause of pupil abnormality after ECCE was due to iris sphincter rupture, whereas the most common cause after phacoemulsification was due to iris trauma during phacoemulsification. These pupil abnormalities are the direct consequence of factors in surgery and we suggest ways to minimize the occurrence of such abnormalities in cataract surgery.

Cataract Extraction↗
PubMedDate not supplied

Outcome of late probing for congenital nasolacrimal duct obstruction in Singapore children.

OBJECTIVE: To evaluate the outcome of late probing in a mixed Asian children population with congenital nasolacrimal duct obstruction (CNLDO) and whether probing was associated with an increased risk of infection. METHOD: A retrospective clinical study was conducted. A clinical diagnosis of CNLDO was defined in an infant who presented with a history of tearing and/or eye discharge up to 1 year of age with no other accompanying ocular pathology. All patients with a presumed diagnosis of CNLDO who had probing after 12 months of age were included in our study. Prior to probing, most patients had a trial of conservative treatment with massage and/or topical antibiotics. Intra-operative patency of probing was determined when metal to metal contact of the probe and forceps was achieved and/or when fluorescein dye was recovered from the nose after syringing. Successful probing was defined as a resolution of symptoms within 1 month after probing. RESULTS: Seventeen patients involving 19 eyes fulfilled our inclusion criteria for this study. Fourteen (82%) infants were Chinese, two Malays (12%) and the remaining one Indian (6%). There were 10 males (59%) and 7 females (41%) and the mean age at probing was 2.2 years (range, 14 months to 5 years 6 months). The subjects were followed-up post-operatively for a mean duration of 21.2 months (range, 2 months to 8 years). Successful probing in our series was 89.5% (17/19 eyes). Of the two eyes with persistent tearing, one resolved with massage about 9 months after the unsuccessful probing; the other was referred to the oculoplastic service for further management. CONCLUSION: Late probing after 13 months old appears to be an effective approach in the management of CNLDO in Asian infants.

Child, Preschool↗