Ismail Shatriah

• MD, MMed, Fellowship in Pediatric Ophthalmology
• Professor at Universiti Sains Malaysia, Kelantan, Malaysia

Retinoblastoma (RB) is the most common malignant intraocular tumour in children and can present as unilateral or bilateral disease. Unilateral RB represents 60% of all cases and tend to present at a relatively advanced stage of RB. Unilateral RB in Malaysia has a one-year survival rate of 99.0% and five-year survival of 93.0%. Shorter lag time, lon...

Introduction: This study aims to evaluate the choroidal thickness and its correlation with age, spherical equivalent, and axial length in Malay children with myopia, addressing the limited data available on this topic in Southeast Asia. Material and methods: A cross-sectional, hospital-based study was conducted from 2022 to 2024 at Hospital Shah...

Purpose: Worldwide, limited information is available on the psychosocial function and health-related quality of life (HRQoL) in children with congenital ptosis, nor the effect of corrective surgery on these parameters. This study aimed to evaluate the social anxiety and HRQoL of Malaysian children with primary simple unilateral congenital ptosis f...

Introduction: Little is known about the prevalence of refractive errors and amblyopia among school children on the islands of East Coast Malaysia. This study aimed to investigate the prevalence of these conditions and their associated factors in this unique and remote geographical location. Materials and methods: This multicentre cross-sectional...

Purpose: There has been a lack of data on health-related quality of life (HRQoL) in children with vernal keratoconjunctivitis (VKC) from South East Asia. This study evaluated the levels (mean total score and subscales score) of HRQoL, comparing the VKC and normal children groups, and within the VKC severity groups. Methods: A cross-sectional stu...

Purpose: This study aimed to evaluate the treatment efficacy, anatomical outcomes, and refractive outcomes of laser photocoagulation (LPC) and intravitreal ranibizumab (IVR) in the treatment of type I retinopathy of prematurity (ROP) at one-year follow-up. Methods: This is a retrospective study on the treatment of type I ROP and aggressive ROP (A-R...

Introduction: Vernal keratoconjunctivitis (VKC) is a chronic allergic disease characterised by intense ocular surface symptoms and corneal involvement. There is limited data about the corneal changes in children with VKC based on severity of the disease. We aimed to compare the central corneal thickness (CCT) and corneal topographic indices in Mal...

Introduction: Acute acquired concomitant esotropia (AACE) is an uncommon type of strabismus that occurs due to interruption of fusion. Limited data are available on AACE from Asian countries especially from the Southeast Asian region. We aim to describe the clinical profile and surgical outcomes of AACE patients treated in a tertiary hospital in M...

We report two cases of diffuse unilateral subacute neuroretinitis (DUSN) where multimodal imaging was used to assist in locating the nematode. The first case presented with clusters of migrating choroiditis with a suspicious tiny visualized worm noted on serial fundus photography. The second case had an atypical presentation with extensive exudativ...

Choroidal melanoma with ciliary body involvement is rare, especially in young adults and Asians. Here, we report the case of a young, healthy Chinese woman who complained of decreased vision in the left eye for one week. Her ocular examination and imaging were suggestive of choroidal melanoma involving the ciliary body. The patient underwent enucle...

Background and objectives: The study aims to investigate the normal reference values for optic nerve head (ONH) and retinal nerve fiber layer (RNFL) parameters in emmetropic Malay children, utilizing measurements obtained through Cirrus SD-OCT (Carl Zeiss Meditec, Dublin, CA). Methodology: A cross-sectional study was conducted on 95 Malay children,...

This is a case of an orbital abscess evidenced radiologically in a 41-year-old female with no comorbidities. She was healthy and had no history of trauma or infection of the adjacent structures. She denied having symptoms of upper or lower respiratory and urinary tract infections. The decision for surgical drainage was made following a slow respons...

Purpose: The aim of this study is to determine the mean central corneal thickness (CCT) and mean intraocular pressure (IOP) in children with type 1 diabetes mellitus (T1DM) and to determine the relationship between CCT and IOP on the one hand and age, gender, retinopathy hemoglobin A1c (HbA1c), and duration of diabetes on the other. Methods: Thi...

MicroRNAs (miRNAs) are short, 19-23 nucleotide non-coding RNA molecules that regulate gene expression by silencing or degrading the target mRNA gene. Since their discovery in the nineties of the last century, they have emerged as key inflammatory regulators. Inflammation induces the synthesis of various miRNAs that modulate the expression of multip...

Endogenous endophthalmitis is a very rare but potentially devastating intraocular inflammation resulting from hematogenous dissemination into the eye from a remote focus of infection. We present a case of a 49-year-old Vietnamese gentleman with underlying hypertension and ischemic heart disease who presented with sudden onset bilateral eye blurring...

Introduction: Pregnancy causes an increase in central corneal thickness (CCT) and a reduction in intraocular pressure (IOP), especially in the third trimester. However, there is very limited published data regarding CCT and IOP in gestational diabetes mellitus (GDM) on diet control. This study is aimed to compare the means of CCT and IOP between p...

Purpose: Macular edema, serous retinal detachment, and retinal pigment epithelial detachment have been reported in patients with nephrotic syndrome. However, there is limited data about macular thickness in children with nephrotic syndrome. The aim of this study was to compare the mean macular thickness in children with nephrotic syndrome and in a...

Objective: This study aimed to study the aetiologies, clinical profile and recovery of isolated third cranial nerve palsy (ITCNP) patients, at a tertiary neuro-ophthalmology center on the East Coast Peninsular of Malaysia. Material and Methods: This was a retrospective study, involving 33 patients with newly diagnosed ITCNP, who were treated at...

Primary non-Hodgkin's lymphoma of the lacrimal sac is extremely rare, usually representing secondary involvement of systemic malignancy. We report a case of bilateral primary non-Hodgkin's lymphoma of the lacrimal sac presenting with bilateral medial canthal swelling for one month which was preceded by a history of chronic bilateral epiphora and a...

There is no consensus regarding the classification of optic neuritis, and precise diagnostic criteria are not available. This reality means that the diagnosis of disorders that have optic neuritis as the first manifestation can be challenging. Accurate diagnosis of optic neuritis at presentation can facilitate the timely treatment of individuals wi...

MicroRNAs (miRNAs) are the small non-coding RNA molecules which regulate target gene expression post-transcriptionally. They are known to regulate key cellular processes like inflammation, cell differentiation, cell proliferation and cell apoptosis across various ocular diseases. Due to their easier access, recent focus has been laid on the investi...

Optic perineuritis (OPN) in pulmonary tuberculosis (PTB) patients while on anti-tuberculous treatment is rare. It may occur due to tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS). Visual prognosis is poor if not treated early. We report a rare case of bilateral OPN in an elderly patient on treatment for PTB. A 79-year-old Malay m...

Vernal Keratoconjunctivitis (VKC) is a chronic conjunctival inflammatory condition that typically affects children. Extracellular microRNAs (miRNAs) are small noncoding RNA molecules, the expression of which is reported to regulate cellular processes implicated in several eye diseases. The aim of this preliminary study is to identify the miRNA expr...

Central serous chorioretinopathy (CSCR) following coronavirus disease 2019 (COVID-19) infection is rare. We describe an adult patient who survived a COVID-19 infection and received intravenous and oral corticosteroid treatment for three weeks. He presented three weeks post COVID-19 infection with central visual loss in both eyes for six days. Fundu...

Trauma to the periorbital region is common in children. Foreign bodies in traumatic cases may be missed where history, examination, and investigation are inadequate. Here, we report the case of a four-year-old boy who presented with a small forehead scar and left upper lid swelling two months post-trauma. Imaging showed a retained foreign body, and...

Purpose: The prevalence of retinopathy of prematurity (ROP) is higher in developing countries compared to developed countries. There is limited data on vision-related quality of life (VRQoL) among children with severe type of ROP in developing countries. This study evaluated the influence of threshold and pre-threshold ROP on VRQoL in Malaysian ch...

Acute lymphoblastic leukaemia (ALL) is the most frequent childhood cancer. Children usually present with signs of bone marrow failure like recurrent or prolonged fever, pallor, lethargy, bleeding tendencies, bone pain and others. Occasionally they may present with sign of infiltration of leukaemic cells into other organs such as testicular and cent...

Retinopathy of prematurity (ROP) is a proliferative retinal vascular disorder attributed to an ischaemic stimulus in preterm infants. Haemoglobin, the main component for oxygen transportation, may be implicated in ROP development. This retrospective study compared the mean weekly haemoglobin levels between infants with and without ROP over the firs...

Introduction: There is limited information regarding the problems faced by children with large angle infantile esotropia (LAIE). The aim of this study was to explore the problems that children with LAIE encounter from both their perspectives and those of their parents. Methods: This study included children who had LAIE (with angle of 40 prism di...

Candida guilliermondii is an opportunistic pathogen that rarely causes invasive candidiasis even in immunocompromised humans. We report a case presentation of invasive C. guilliermondii rhinosinusitis causing an orbital and intracranial extension (frontal lobe abscess). An aggressive multidisciplinary team management is a key approach in invasive f...

Infectious endophthalmitis is an ocular infection caused by bacterial or fungal organisms involving intraocular tissues, aqueous, and vitreous humour. Bacillus sp. is an uncommon microorganism causing endophthalmitis. We describe a teenager who presented with a self-sealed corneal laceration, cataractous lens, and evidence of a breach in the anteri...

Purpose: There are limited data from Asian countries regarding retinal thickness in children with type 1 diabetes mellitus (T1DM). This study aimed to compare the macular and retinal nerve fiber layer (RNFL) parameters between diabetic children without retinopathy and non-diabetic healthy children. We also evaluated the factors associated with RNF...

Platelets are a primary source of pro- and anti-angiogenic cytokines. However, the evidence of their role in retinopathy of prematurity (ROP) is controversial. This retrospective study aimed to compare mean weekly platelet counts between infants with and without ROP over the first 6 weeks of life. A total of 93 infants matched by gestational age an...

Septic cavernous sinus thrombosis is a rare but often debilitating and potentially fatal disease. We describe a case of bilateral orbital cellulitis with rapidly progressing cavernous sinus thrombosis and left sigmoidal sinus thrombosis in an immunocompetent 20-year-old military man who had undergone intensive physical training. The patient present...

Cortical blindness, also known as cerebral visual impairment, may occur in pediatric patients. Hepatic encephalopathy is a rare cause of cortical blindness in children. This report describes a girl with underlying type 1 autoimmune hepatitis, who complained of sudden-onset, painless visual loss in both eyes, which was associated with generalized he...

Introduction: Limited information is available on healthrelated quality of life (HRQoL) in children with strabismus in South East Asia. We aimed to evaluate the HRQoL and associated factors pre- and post-strabismus surgery in Malaysian children with infantile esotropia and their parents/guardians. Methods: A prospective study was conducted on ch...

Despite the recent developments in modern cataract surgery and the application of a vast array of new devices and machines, late in-the-bag intraocular lens dislocation remains a devastating, albeit rare, complication. Various nonsurgical and surgical techniques have been used to manage this complication. We report a case of spontaneous repositioni...

Background The information about macular and retinal nerve fibre layer (RNFL) thickness in women with gestational diabetes mellitus (GDM) is scarce. GDM is a risk factor for development of type 2 diabetes mellitus. Purpose The purpose of this study was to evaluate mean macular and RNFL thickness in pregnant women with GDM in a teaching institution...

Purpose To evaluate the efficacy of the “weight, insulin-like growth factor 1, neonatal retinopathy of prematurity” (WINROP) algorithm in predicting retinopathy of prematurity (ROP) requiring treatment in Malaysia. Participants This was a retrospective study involving premature infants with gestational age less than 32 weeks treated from September...

PURPOSE: The available data on strabismus surgery in South East Asian countries are scarce. This study aimed to identify visual outcome and factors influencing surgical outcome of horizontal strabismus surgery in a Southeast Asian cohort. MATERIALS AND METHODS: A retrospective review of patients who underwent horizontal strabismus surgery between 2...

Vitrectomy surgery in proliferative diabetic retinopathy improves the vision-related quality of life. However, there is lack of data on the duration of maintenance of visual gains post vitrectomy. This study thus aimed to determine the survival time of visual gains and the prognostic factors of vision loss after vitrectomy surgery for complications...

Over the past decade, the discovery of disease-specific aquaporin-4 antibodies has led to a better understanding of the diverse spectrum of disorders that are associated with neuromyelitis optica. Brainstem manifestations have been increasingly recognized in this disease. However, multiple cranial nerve palsies as an initial presentation of neuromy...

Introduction: Limited data is available on paediatric orbital cellulitis in Asia. We aimed to describe demographic data, clinical presentation, predisposing factors, identified micro-organisms, choice of antibiotics and management in children with orbital cellulitis treated in a tertiary care centre in Malaysia. Methods: A retrospective review w...

Endogenous endophthalmitis is an ocular emergency, with severe sight-threatening complications. We report a case of unilateral endogenous Klebsiella pneumonia endophthalmitis with a large sub-retinal abscess in a 39-year-old lady that developed four days after presentation with sepsis secondary to urinary tract infections and pyelonephritis. Despit...

Senior-Loken syndrome is a rare disorder that presents in the first two decades of life. It commonly manifests with nephronophthisis and retinal dystrophy. We describe a teenager who had end-stage renal failure presenting with bilateral visual impairment due to retinal dystrophy with concomitant unilateral Coats disease and exudative retinal detach...

Purpose To describe the visual presentation and factors affecting visual outcome in pediatric patients treated for craniopharyngioma at a referral center in the East Coast states of Peninsular Malaysia. Methodology A retrospective review of medical records of children aged 17 years and below who had been treated for craniopharyngioma in Hospital Un...

Introduction Pseudomonas aeruginosa is a common cause of microbial keratitis that can cause a significant loss of visual acuity. Antibiotics, including fluoroquinolones and aminoglycosides, are clinically effective against Pseudomonas-induced keratitis, but their effectiveness has been conspicuously reduced as resistant pathogens have become more p...

We aimed to compare clinical and pathological reactions towards locally synthesized bovine bone derived from hydroxyapatite (bone docosahexaenoic acid (dHA)) and commercially available porous polyethylene (Medpor®, Porex Surgical Incorporation, Georgia, USA) orbital implants in animal models. An experimental study was performed on 14 New Zealand wh...

Background: The available data on strabismus surgery in South East Asian countries is scarce. This study aimed to identify visual outcome and factors influencing surgical outcome of horizontal strabismus surgery in a South East Asian cohort. Methods: A retrospective review of patients who underwent horizontal strabismus surgery between 2013 and 201...

Purpose To describe the demographics, indications, clinical outcomes and survival rate of penetrating keratoplasty in Malaysian children living in a suburban area, and discuss the literature on paediatric penetrating keratoplasty. Methodology A retrospective review of medical records was performed on children younger than 17 years of age who had un...

Intracranial tuberculoma is a rare manifestation of tuberculosis involving the central nervous system. The involvement of the ventricular system is extremely uncommon. We describe a young woman with bilateral papilledema secondary to intraventricular tuberculoma with hydrocephalus. She was treated with anti-tuberculosis therapy and intravenous dexa...

Wernicke’s encephalopathy following severe hyperemesis gravidarum is an uncommon clinical entity. We describe a rare manifestation of optic discs swelling in a pregnant woman that has caused a diagnostic dilemma. With high index of suspicion of clinical manifestations and radiological evidences, a clinical diagnosis of Wernicke’s encephalopathy was...

This study aims to describe the treatment efficacy of supratarsal injection of triamcinolone acetonide and dexamethasone sodium phosphate for paediatric vernal keratoconjuctivitis (VKC) over a 5-year-period in Hospital Universiti Sains Malaysia. Totally 10 patients were treated with this combination injection had clinical improvement by 1mo post in...

Background: Leptospirosis is a waterborne zoonosis, commonly found in tropical countries with heavy rainfall. Leptospirosis poses a diagnostic challenge due to its diverse clinical features that range from prodromal symptoms to multiorgan failure. Most cases of leptospirosis are under diagnosed due to its biphasic nature of presentation. We report...

Background: Leptospirosis is a waterborne zoonosis, commonly found in tropical countries with heavy rainfall. Leptospirosis poses a diagnostic challenge due to its diverse clinical features that range from prodromal symptoms to multiorgan failure. Most cases of leptospirosis are under diagnosed due to its biphasic nature of presentation. We report...

Purpose Childhood obesity is associated with adult cardiometabolic disease. We postulate that the underlying microvascular dysfunction begins in childhood. We thus aimed to compare retinal vascular parameters between obese and non-obese children. Methods This was a cross-sectional study involving 166 children aged 6 to 12 years old in Malaysia. Oc...

Systemic, ocular and retinal vascular parameters of study subjects. (DOCX)

Central retinal arterial occlusion is an ocular emergency. Central retinal artery occlusion following cardiac procedures have been described in adults. We describe a pediatric patient who developed central retinal artery occlusion following pulmonary artery stenting. It is important to highlight this potential risk to ensure early diagnosis and pro...

Background. Toxoplasmosis is caused by infection from a ubiquitous obligate intracellular parasite known as Toxoplasma gondii, which can infect both human and warm-blooded animals. This infection is commonly prevalent in developing country. Objectives. The purpose of this study is to report on a 7-year review of ocular toxoplasmosis patients that p...

Dengue fever is common in the tropics and its clinical manifestations and complications are well-known. However, dengue-related ocular complications are rare. Here we present a postpartum female who complained of bilateral central scotoma, at five days after the clinical diagnosis of dengue fever. The ocular examination was suggestive of dengue mac...

Hearing loss is rarely associated with sympathetic ophthalmia. We describe a young man who presented with sympathetic ophthalmia and concurrent hearing loss one month post globe rupture. The presentation was very subtle and atypical. However, the patient recovered fully after two weeks of prompt oral corticosteroid therapy which resulted in good vi...

Unilateral anemic retinopathy is an uncommon but reversible condition. A 43-year-old female presented with right eye blurring of vision for one week duration. She also had menorrhagia for a year. Examination showed visual acuity of counting fingers (right eye) and 6/6 (left eye). Right funduscopy showed optic disc swelling with retinal hemorrhages,...

Introduction Ocular tuberculosis (TB) encompasses a broad spectrum of clinical manifestations affecting different structures of the eye. It is caused by Mycobacterium tuberculosis, a great ancient organism that induces various types of diseases and unfavorable outcomes if unrecognized and not well treated. Purpose To report the clinical profile of...

Ptosis is a rare side effect of vincristine chemotherapy in patients treated for cancer. We report a case of a child with common B-cell acute lymphoblastic leukemia who developed bilateral moderate ptosis following the chemotherapy protocol of the United Kingdom Acute Lymphoblastic Leukemia (ALL) regimen A. The patient showed dramatic clinical impr...

Purpose: To evaluate the refractive errors, ocular abnormalities, and introcular pressure in severe preterm and term Malay children aged 8 - 16 years old. Design: Comparison cross-sectional study. Participants: Children aged 8 to 16 years old at follow up visit at Hospital universiti sains Malaysia of risk factor of prematurity. Methods: Detailed e...

Purpose: To evaluate the refractive errors, ocular abnormalities, and introcular pressure in severe preterm and term Malay children aged 8 - 16 years old. Design: Comparison cross-sectional study. Participants: Children aged 8 to 16 years old at follow up visit at Hospital universiti sains Malaysia of risk factor of prematurity. Methods: Detailed e...

The aim of this study is to determine the risk factors for retinopathy of prematurity (ROP), and also to screen Norrie Disease Pseudoglioma (NDP) gene mutation in order to determine if mutation in the NDP gene may play a role in the development of ROP among Malay premature infants. This was a case control study among Malay premature infants from Ho...

Introduction: The management of orbital abscesses in neonates and infants is very challenging. Surgical drainage of the abscess is aimed at removing the pus and preventing blindness. We describe a case of orbital abscess in an infant that was caused by methicillin-resistant Staphylococcus aureus and that was successfully drained with image-guided...

Purpose Retinal vessel analysis is affected by both systemic and ocular factors. Malays are the major ethnicity in South East Asia. Data on the retinal microvasculature in Malays is limited, especially among children. We aim to evaluate the influence of ocular biometry on retinal vessel parameters in young Malay girls. Methods This was a cross-sec...

Sample of SIVA screen. (JPG)

Systemic, ocular and retinal vascular parameters of study subjects. (PDF)

Kingella kingae had rarely been reported as a causative organism for corneal ulcer and had not been described before in vernal keratoconjunctivitis (VKC). Generally regarded as commensals of respiratory tract particularly in young children, it had however been isolated from the corneal ulcer scraping of both adult and children. We report a case of...

Introduction: Hyphema and orbital apex syndrome occurring concurrently in a patient with herpes zoster ophthalmicus have not been reported previously. We present a case with these unique findings and discuss the pathogenesis of these conditions and their management. Presentation of case: A 59-year-old Malay lady with underlying diabetes mellitus...

Purpose: To describe a self-made smartphone adaptor which can be attached to a surgical microscope and a smartphone telescope which can be wirelessly linked to an LED TV or monitor. Methods: A smartphone slit lamp adaptor is built for microscope-assisted ocular surgery in which video can be recorded. For surgeries not utilising the microscope (such...

Corticosteroid is the first line of treatment in severe anterior uveitis. Subconjunctival abscess is a known but rare complication of high dose of corticosteroid regime. We describe a middle-aged healthy patient who developed multiple subconjunctival abscesses following a combination of oral and topical corticosteroid treatment for his severe anter...

Ocular cat scratch disease (CSD) is a condition attributed to infection by Bartonella sp. This condition commonly presents as neuroretinitis. Increased intracranial pressure and aseptic meningitis are rare presentation of CSD. We highlight a case of a 17-year-old female who presented with aseptic meningitis with neuroretinitis and raised intracrani...

To determine the mean central corneal thickness (CCT) and the relationship between the CCT and visual field progression in primary angle closure (PAC) and primary angle closure glaucoma (PACG). A combined cross-sectional and prospective study on PAC and PACG. A total of 35 eyes were included in the study for each group of normal control, PAC, and P...

A 60-year-old lady presented with a fleshy mass at the nasal limbus of the right eye of two months’ duration which was progressively increase in size. Right eye examinations showed a fleshy exophytic mass arising from inferonasal limbus with the base involving cornea and conjunctiva. There was presence of few big feeder vessels at medial part of th...

Rhino–orbital–cerebral mucormycosis (ROCM) is an uncommon but fatal fungal infection. We report a rare case of unilateral ROCM with ipsilateral central retinal artery occlusion and contralateral choroiditis, which later progressed to endogenous fungal endophthalmitis. The patient was successfully treated with sinuses debridement, systemic liposomal...

Rhino–orbital–cerebral mucormycosis (ROCM) is an uncommon but fatal fungal infection. We report a rare case of unilateral ROCM with ipsilateral central retinal artery occlusion and contralateral choroiditis, which later progressed to endogenous fungal endophthalmitis. The patient was successfully treated with sinuses debridement, systemic liposomal...

Conjunctival necrosis is a rare complication following periocular/intraocular triamcinolone acetonide injection and has been reported extensively in adults. We describe a child who developed conjunctival necrosis following subconjunctival injection of triamcinolone acetonide for severe chronic anterior uveitis. Prompt diagnosis and management of th...

Background: There are limited data concerning the optic disc topography in normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG) patients living in Southeast Asian countries. This study aims to compare optic disc parameters in patients with NTG and POAG in Malaysia and to discuss the results in comparison with studies of NTG and POAG...