Aliza Jap

Singapore National Eye Centre, Tumasik, Singapore

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Publications (48)127.99 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE:: To identify differences between cytomegalovirus (CMV)-positive and CMV-negative eyes presenting as suspected endothelial graft rejection after penetrating keratoplasty (PK). METHODS:: A retrospective consecutive case-control series. Aqueous humor samples of all eyes with corneal stromal edema and keratic precipitates (KPs) after PK, seen at the Singapore National Eye Centre from 2007 to 2010, were analyzed for CMV DNA by polymerase chain reaction. Their charts were reviewed for demographic data, medical and ocular history, best-corrected visual acuity, intraocular pressure, anterior segment clinical findings, and therapy. RESULTS:: Of 11 eligible eyes (11 patients), 7 were CMV positive. All eyes were negative for herpes simplex virus and varicella zoster virus. The 2 groups were similar in age, gender, and previous ocular surgery. The main differences were the presence of extensive heavily pigmented KPs, Descemet membrane folds, and the absence of vascularization of the donor in CMV-positive eyes (100% vs. 0%, P = 0.003, Fisher exact test). All the CMV-positive eyes were treated with ganciclovir (5 systemic, 2 topical), and the control eyes received immunosuppression. However, all the grafts failed. Best-corrected visual acuity at the last visit was worse than 20/400 in all except 1 control eye, which had a follow-up of 30 months. CONCLUSIONS:: There is a high prevalence of CMV infection in eyes that develop corneal stromal edema with KPs after PK. Heavy endothelial pigmentation, Descemet membrane folds, and the absence of donor vascularization may aid in the diagnosis of CMV in the event that aqueous analysis is not possible.
    Cornea 03/2013; · 1.75 Impact Factor
  • Soon-Phaik Chee, Aliza Jap
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    ABSTRACT: AIMS: To compare outcomes of indocyanine green angiography (ICGA) versus clinically monitored immunotherapy in Vogt-Koyanagi-Harada (VKH) disease. METHODS: Consecutive patients of Singapore National Eye Centre with VKH receiving high-dose corticosteroids within 4 weeks of onset of symptoms had therapy titrated to clinical signs of activity (controls) or ICGA findings (ICGA). Charts were reviewed for demographics, interval to treatment, duration of therapy and number of systemic immunosuppressants required. Outcome measures were best corrected acuity, disease activity, presence of sunset glow (SSG) fundus and peripapillary atrophy (PPA) at 2 years. RESULTS: 52 patients were included (38 controls, 14 ICGA). Duration of treatment was shorter in the control group (17 vs 42 months, p<0.001) and they required fewer systemic immunosuppressants than the ICGA group (16% vs 96%, p<0.001). The majority (49 eyes, 96.1%) had 6/12 or better vision and were clinically quiet (43 eyes, 84.3%) in both groups. SSG fundus and PPA were similar in both groups. Treatment within 2 weeks of onset was the main factor affecting their occurrence on multivariate analysis (OR 0.18, 95% CI 0.03 to 0.9, p=0.047; OR 0.08, 95% CI 0.01 to 0.51, p=0.007, respectively). CONCLUSIONS: ICGA-guided immunotherapy did not result in significantly better outcomes with respect to visual acuity and disease activity in VKH eyes treated within 1 month of onset.
    The British journal of ophthalmology 12/2012; · 2.92 Impact Factor
  • Aliza Jap, Soon-Phaik Chee
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    ABSTRACT: Evaluation of: Wensing B, Relvas LM, Caspers LE et al. Comparison of rubella virus- and herpes virus-associated anterior uveitis: clinical manifestations and visual prognosis. Ophthalmology 118(10), 1905-1910 (2011).The diagnosis of viral uveitis remains problematic, especially in cases of anterior uveitis (AU) where a number of viruses may have similar clinical features and a clinical syndrome may be caused by more than one virus. This study suggests that it may be possible to differentiate between rubella and a herpetic AU based on clinical signs, thereby reducing the need for aqueous analysis, which is invasive and may not always be readily available. However, the results are limited by the inability to determine the negative-predictive value of these signs due to the lack of a noninfective comparator group. Furthermore, the prevalence of viral AU, as well as the specific viruses involved, is influenced by the local seroprevalence of the virus; hence the results of this study may not be applicable to other populations.
    Expert Review of Ophthalmology 01/2012; 7(1):17-20.
  • Aliza Jap, Soon-Phaik Chee
    International ophthalmology clinics 01/2012; 52(4):163-72.
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    Aliza Jap, Soon-Phaik Chee
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    ABSTRACT: Cytomegalovirus (CMV) has increasingly been found as a cause of anterior segment infection in immunocompetent patients. This may manifest as an endotheliitis or as an acute episodic or chronic recurrent anterior uveitis, which is often associated with ocular hypertension. Its diagnosis is based on aqueous analysis for CMV DNA by PCR or for CMV-specific antibodies. Although it has a high response rate to systemic, intravitreal and ganciclovir implant, the relapse rate is also high, and patients may require prolonged treatment. Topical ganciclovir gel has a lower response rate but also a lower relapse rate and fewer adverse effects. The main cause of visual loss in CMV anterior uveitis is glaucoma, and endothelial failure in endotheliitis. Therefore, early diagnosis and treatment is vital, and glaucoma therapy is an important adjunctive modality of management.
    Expert Review of Ophthalmology 09/2011; 6(5):517-528.
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    J Wong, A Jap, S-P Chee
    Eye (London, England) 09/2011; 25(12):1661-2. · 1.97 Impact Factor
  • Aliza Jap, Soon-Phaik Chee
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    ABSTRACT: With improvements in molecular diagnostics tests, viruses are increasingly being found to be associated with what was previously described as idiopathic anterior uveitis. This review presents the clinical features of viral anterior uveitis. Herpes simplex virus/varicella zoster virus (HSV/VZV) are important causes of anterior uveitis, but other viruses including cytomegalovirus (CMV) and rubella are also found in a significant number of cases. The various viral anterior uveitides have similar features and should be suspected in eyes with diffuse, fine, stellate keratic precipitates, iris atrophy or ocular hypertension. Acyclovir remains the mainstay of therapy in HSV/VZV infections. CMV responds to ganciclovir, but the relapse rate is high and prolonged therapy may be required. Cataract and glaucoma are the main complications of viral anterior uveitis requiring appropriate management. There is considerable overlap between clinical manifestations of the different viral anterior uveitides as well noninfectious hypertensive anterior uveitis syndromes. Hence, corticosteroids should be used with caution in these eyes if virus diagnostic tests are not available.
    Current opinion in ophthalmology 09/2011; 22(6):483-8. · 2.49 Impact Factor
  • Soon-Phaik Chee, Aliza Jap
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    ABSTRACT: To determine treatment outcome and risk factors for visual loss in Cytomegalovirus (CMV) endotheliitis. Retrospective case-note review of all CMV positive endotheliitis patients seen at the Singapore National Eye Center, for demographics, visual acuity (VA), extent of corneal edema, anterior chamber (AC) activity, ocular history, glaucomatous optic neuropathy (GON), and ganciclovir therapy. Outcome measures were VA, corneal edema, and AC activity. Median age at diagnosis of the 19 patients (21 eyes) was 57 years. Median duration of follow up was 37 months. Sixteen eyes received systemic ganciclovir, and four eyes received ganciclovir gel. The AC inflammation resolved in 19 eyes. The corneal edema resolved in eight eyes, but persisted in 12 eyes. One patient resolved spontaneously. Pre-treatment corneal edema exceeding 75%, older age, GON, and previous corneal graft were risk factors for persistent corneal edema post treatment (P = < 0.001, 0.001, 0.02 and 0.02 respectively, Fisher's exact test), and VA worse than 6/60. Anterior chamber inflammation resolves with ganciclovir therapy, but severe pre-treatment corneal edema, older age, previous corneal graft, and GON are associated with a poor visual outcome.
    Albrecht von Graæes Archiv für Ophthalmologie 09/2011; 250(3):383-9. · 1.93 Impact Factor
  • Soon-Phaik Chee, Aliza Jap
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    ABSTRACT: To describe immune ring (IR) formation as a manifestation of cytomegalovirus (CMV) endotheliitis. Retrospective observational case series. Review of all consecutive CMV anterior uveitis and endotheliitis patients seen at the Singapore National Eye Centre for the occurrence of an IR. CMV infection was diagnosed by polymerase chain reaction analysis of the aqueous. None of the 72 eyes with CMV anterior uveitis had an IR formation. Four episodes of IR formation were seen in 3 eyes (14.3%) of 21 cases of CMV-positive endotheliitis. All were unilateral and all 3 patients were human immunodeficiency virus negative middle-aged Chinese males. The IR developed 2 to 7 months after occurrence of the endotheliitis and the aqueous was positive for CMV during 2 of the episodes of IR formation. In 2 eyes, the IR occurred at the completion of a course of systemic ganciclovir when the aqueous was negative for CMV. The immune rings resolved with combination therapy of topical prednisolone acetate 0.12% and ganciclovir. Patient 1 had a recurrence of the IR 4 months after stopping treatment but again resolved following treatment with ganciclovir and topical corticosteroids. Corneal immune rings can occur as a result of CMV infection. Hence CMV infection may have to be considered in such cases.
    American Journal of Ophthalmology 06/2011; 152(3):449-453.e1. · 4.02 Impact Factor
  • Article: Reply.
    American Journal of Ophthalmology 06/2011; 151(6):1106-7. · 4.02 Impact Factor
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    ABSTRACT: To determine risk factors for poor visual acuity outcomes in patients with endogenous Klebsiella pneumoniae endophthalmitis. Retrospective case-control study. We reviewed all consecutive patients diagnosed with endogenous Klebsiella pneumoniae endophthalmitis over 20 years. Data collected included patients' demographics, clinical findings, investigations, and therapeutic intervention. Main outcome measures were visual acuity (VA) at 3 months postinfection and/or evisceration. Poor vision was defined as VA worse than 4/200. Seventy-one eyes of 61 patients were studied. Mean age was 55.7 (standard deviation [SD] ± 13.1) years. Majority were male (49/61, 80.3%), Chinese (51/61, 83.6%), and had hepatobiliary sepsis (47/61, 77.5%). Mean time to ocular symptoms was 4.4 (± 3.0) days. Fifty-four of 71 eyes (80.2%) had poor vision and 19/71 eyes (26.8%) required evisceration. The most significant risk factor was hypopyon (41/71 eyes, 57.7%) on multivariate analysis (odds ratio [OR], 52.6; 95% confidence interval [CI], 1.7-1000; P = .01). Unilateral involvement (OR, 10.4; 95% CI, 1.2-90.2; P = .01) and patients that were managed before year 2000 (before routine screening was implemented) (OR, 5.2; 95% CI, 1.5-17.9; P = .037) were significant risk factors for evisceration on multivariate analysis. Patients presenting with hypopyon and unilateral involvement have a poorer prognosis.
    American Journal of Ophthalmology 02/2011; 151(2):338-44.e2. · 4.02 Impact Factor
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    ABSTRACT: To determine risk factors for poor visual outcome following cataract surgery in Vogt-Koyanagi-Harada (VKH) disease. Retrospective review of all VKH patients who underwent cataract surgery, for demographics, initial corticosteroid dose, treatment outcome, quiescence at time of cataract surgery, perioperative corticosteroid prophylaxis, preoperative best-corrected visual acuity (BCVA), cataract surgery technique, intraocular lens implanted, additional surgical procedures, complications and BCVA at 6 and 12 months postsurgery. 28 of 105 VKH patients (50 eyes) had cataract surgery. The mean age at surgery was 55 ± 13 years. The mean duration of postoperative follow-up was 89.8 months (range 8-252 months). At 12 months postsurgery, no patients lost more than two lines of their preoperative acuity. Forty-one eyes (82%) improved by two or more Snellen lines. Thirty-four eyes (68%) had a BCVA of 20/40 or better. Sixteen eyes (32%) had a poor visual acuity, nine (18%) from pre-existing macular lesions, two from cystoid macular oedema, one from posterior capsule opacification and four from disease recurrence. Recurrent inflammation was the only significant risk factor for poor visual outcome (p=0.004, χ(2) test). Recurrent inflammation is a critical poor prognostic factor for cataract surgery in VKH, but with appropriate management, good visual outcomes can be achieved.
    The British journal of ophthalmology 02/2011; 95(11):1542-6. · 2.92 Impact Factor
  • Soon-Phaik Chee, Aliza Jap
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    ABSTRACT: To determine outcome of cataract surgery in severely subluxated traumatic cataracts. Noncomparative case series. Retrospective review of cataract surgery in all consecutive eyes with at least 6 clock hours of zonulysis, for patient demographics, presenting best-corrected visual acuity (BCVA) and postoperative BCVA at various time points, extent of zonulysis, and type and timing of insertion of capsular tension device. Main outcome measures were retention of the capsular bag and BCVA at last visit. Secondary outcome measures included IOL stability and centration, and perioperative complications. There were 41 eyes (41 patients). Mean age at time of surgery was 57 years and the mean duration of follow-up was 21.4 months. The capsular bag was preserved with aid of a Cionni modified capsular tension ring (CTR) in 36 eyes (87.8%) and a combination of a capsular tension segment (CTS) and CTR in 2 eyes. In 3 eyes with total zonulysis, the bag could not be preserved despite the use of a CTS in 2 eyes. Preoperatively only 9 of the 41 eyes (22.0%) had a BCVA of 20/40 or better, as compared to 38 eyes at the last visit (92.7%, P < .001, χ(2) test). Posterior capsule rupture occurred in 3 eyes, 2 of which occurred during fixation of the CTR. The capsular bag can be successfully preserved even in severely subluxated traumatic cataracts with the aid of fixated capsular tension devices.
    American Journal of Ophthalmology 02/2011; 151(5):866-871.e1. · 4.02 Impact Factor
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    ABSTRACT: To describe the type of complications related to contact lens wear seen in a hospital setting in Singapore. Data were collated over a 2-year period from April 1999 to March 2001, from all public hospitals in Singapore. A standardized clinical record form was completed by the attending doctor when a patient presented for contact lens-related complications. Nine hundred and fifty-three contact lens-related complications were recorded. The mean age of presentation was 26.4 years. Women made up the majority n=491 (68%). Most patients were Chinese (555, 77%). Six hundred and seventy-six (93.7%) patients were soft contact lens wearers. Most patients, 585 patients (85.2%) wore their lenses on a daily basis. Two hundred and forty-four cases (25.6%) of infective keratitis were seen, with 55 patients requiring hospital admission for management of the infection. Soft disposable contact lens wear was associated with the majority of the infective keratitis (178, 73%). Epithelial keratitis occurred in 229 patients (24.0%) with punctuate epithelial erosions being the commonest presentation in 139 (14.6%). Allergic conjunctivitis occurred in 179 (18.8%) of the cases with giant papillary conjunctivitis accounting for 147 (15.4%) of them. Dry eyes (77, 8.1%), sterile infiltrates (71, 7.5%) and neovascularization of the cornea (75, 7.9%) were the next commonest complications seen. Corneal edema, solution- and lens-related complications occurred in small numbers, accounting for less than 5% of the complications reported. Infective keratitis secondary to soft lens wear was the most common complication, followed by epithelial keratitis and allergic conjunctivitis seen in public hospitals in Singapore.
    Eye & contact lens 01/2011; 37(1):16-9.
  • S-P Chee, A Jap
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    ABSTRACT: To determine the outcome of antiviral treatment of cytomegalovirus (CMV) anterior uveitis. A retrospective review of patients from Singapore National Eye Centre with CMV anterior uveitis diagnosed by aqueous polymerase chain reaction. Ganciclovir treatment consisted of systemic, topical, intravitreal injections or intravitreal implant. The main outcome measure was resolution of anterior chamber inflammation. 72 eyes of 70 patients were positive for CMV DNA. 35 eyes were treated (23 eyes with acute recurrent anterior uveitis and 12 eyes with chronic anterior uveitis). Eyes that did not respond or recurred with one treatment may receive another course of treatment. There were 47 treatment episodes, 36 (76.6%) of which resulted in a response. However, there were 27 (75.0%) episodes of recurrences after stopping treatment. Systemic and intravitreal ganciclovir and ganciclovir implant had good response rates but also had very high recurrence rates. Ganciclovir gel had moderate response rates, but its recurrence rates were also lower than those of the other modalities. Ganciclovir gel had lower recurrence rates than the systemic ganciclovir and the implant and should be considered as an option for treatment of CMV anterior uveitis.
    The British journal of ophthalmology 12/2010; 94(12):1648-52. · 2.92 Impact Factor
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    ABSTRACT: To determine the prognostic value of fluorescein angiography (FA) and indocyanine green angiography (ICGA) in Vogt-Koyanagi-Harada disease (VKH). Retrospective noninterventional study. Chart, FA, and ICGA review of VKH patients of Singapore National Eye Centre for age at onset, gender, race, timing of treatment, and angiographic features during the different phases of FA and ICGA. Outcome measure was disease outcome (acute resolved or chronic recurrent). Twenty-one of the 28 patients with pretreatment FA also had ICGA. Median follow-up duration was 3.6 years (range 0.94-13.42 years). Median age was 42.2 years (range 15.7-77.2 years). The majority (18, 64.3%) were Chinese. The most frequently observed FA features included early pinpoint hyperfluorescence in the posterior pole and disc hyperfluorescence. Large choroidal vessel hyperfluorescence (early and intermediate phase), areas of delayed choroidal perfusion (early phase), and persistent dark dots were the 3 most common ICGA features. Pinpoint peripapillary hyperfluorescence was found to be a significant prognostic FA factor on both univariate and multivariate analysis. None of the ICGA features were found to be significant prognostic factors. Early pinpoint peripapillary hyperfluorescence on pretreatment FA is a useful prognostic sign in VKH patients, whereas pretreatment ICGA has limited prognostic value.
    American Journal of Ophthalmology 10/2010; 150(6):888-93. · 4.02 Impact Factor
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    ABSTRACT: To compare wound characteristics and integrity of the 2.2-mm and 2.65-mm clear corneal incisions. Prospective, randomized clinical trial. Patients undergoing phacoemulsification with lens implant were randomized to receive a 2.2-mm or 2.65-mm temporal clear corneal incision. The incisions were evaluated at 2, 24, and 96 hours for gape and wound architecture using anterior segment optical coherence tomography and for integrity using the Seidel test. Squareness of an incision was calculated (ratio of the incision length to the width). There were 30 patients in each group. Both incision sizes were watertight, although a mild internal main wound gape was detected on anterior segment optical coherence tomography in 35 eyes (58.3%) at 2 hours. The smaller wound was more square (0.81; standard deviation [SD], 0.11) than the larger wound (0.62; SD, 0.08; P < .001, t test). The mean squareness of eyes without wound gape at 2 hours (0.66; SD, 0.11) was lower than those with a wound gape (0.75; SD, 0.14; P = .008). A squareness factor of 0.72 or more had a positive predictive value for presence of wound gape at 2 hours of 79.3% and a negative predictive value of 61.3%. One side port incision with squareness of 1.39 had a mild leak at 2 and 24 hours, but no gape was seen on anterior segment optical coherence tomography. Both the 2.2-mm and 2.65-mm clear corneal incisions clinically were competent, but the side port incision may leak. A truly square wound has a greater likelihood of being associated with internal wound gape at 2 hours after surgery, especially if the squareness factor is 0.72 or more.
    American Journal of Ophthalmology 02/2010; 149(5):768-76.e1. · 4.02 Impact Factor
  • International ophthalmology clinics 01/2010; 50(2):173-87.
  • Aliza Jap, Soon-Phaik Chee
    International ophthalmology clinics 01/2010; 50(2):155-71.
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    ABSTRACT: To compare the prevalence of dengue maculopathy among patients hospitalized for dengue fever during a 2007 epidemic with its prevalence during the 2005 epidemic. Cross-sectional observational study of consecutive patients hospitalized in two general hospitals with dengue fever during the dengue epidemic. A standard questionnaire on ocular history and symptoms was completed by all patients. Their near and distance vision, Amsler grid test results, and dilated fundal findings were recorded. Biochemical tests included dengue immunoglobulin M results, serum complement 3 level, platelet count, hematocrit, and transaminase levels. The main outcome measure was presence of dengue maculopathy. Risk factors were compared with the data from a 2005 study group. Dengue serotype results were obtained from population sampling. None of 87 patients who had positive results for dengue immunoglobulin M in the 2007 study group had maculopathy, whereas it was seen in 10% of the 2005 group (P = .002). The patients in the 2005 study group were younger and were more likely to have high transaminase levels. In 2005, the predominant serotype was type 1, and in 2007 it was type 2. The prevalence of dengue maculopathy, age of clinical disease, and extent of liver damage differs between epidemics with different predominant serotypes.
    American Journal of Ophthalmology 10/2009; 148(6):910-3. · 4.02 Impact Factor

Publication Stats

620 Citations
127.99 Total Impact Points

Institutions

  • 1999–2012
    • Singapore National Eye Centre
      Tumasik, Singapore
  • 2011
    • Tan Tock Seng Hospital
      • Department of Ophthalmology
      Singapore, Singapore
  • 2001–2011
    • Changi General Hospital
      • Department of Ophthalmology
      Singapore, Singapore