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Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease affecting about 25% of the general population.1,2 NAFLD has a broad disease...

Treatment outcomes of micropulse cyclophototherapy in uveitic glaucoma

Dear Editor, We present a case series, describing the utility of micropulse cyclophototherapy in the treatment of uveitic glaucoma. Prevalence of glaucoma in patients suffering from...

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The recent launch of Healthier SG—a national initiative by Singapore’s Ministry of Health (MOH) focusing on preventive health—will have far-reaching effects on the delivery...

Leveraging ChatGPT to aid patient education on coronary angiogram

Natural-language artificial intelligence (AI) is a promising technological advancement poised to revolutionise the delivery of healthcare.1 Traditionally, inclusion of technology in the augmentation of...

Promise and pitfalls of ChatGPT for patient education on coronary angiogram

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Artificial intelligence innovation in healthcare: Relevance of reporting guidelines for clinical translation from bench to bedside

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The eye as a window to the brain

Over the last 20 years, it has become evident that the age-old expression, “the eye is the window into the soul”, might in fact...

Clinical outcome of bacterial endogenous endophthalmitis in 15 patients

Dear Editor, Endophthalmitis refers to the inflammation of the ocular cavities and their immediate adjacent structures without extension beyond the sclera, usually secondary to...

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A 52-year-old woman with beading of intracranial arteries

A 52-year-old woman of Indian ethnicity with a history of well-controlled hypertension, hyperlipidaemia and recurrent transient ischaemic attacks presented with altered mentation and slurred...

Creutzfeldt-Jakob Disease Presenting with Visual Blurring, Diplopia and Visual Loss: Heidenhain’s Variant

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Glaucoma Pattern Amongst the Elderly Chinese in Singapore

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The Profile of Hospitalised Patients with Parkinson’s Disease

Prevalence studies in various parts of the world have shown that Parkinson’s disease (PD) is relatively common among the aged in all countries. Crude...

Frontal Sinus Mucoceles Causing Proptosis—Two Case Reports

Frontal mucoceles are collections of inspissated mucus which occur when there is obstruction to the outflow of the frontal sinuses. The obstruction may be...

The Alien Hand Sign–Case Report and Review of the Literature

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A Case Series of Ocular Disease as the Primary Manifestation in Sarcoidosis

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Trends in the Pattern of Blindness and Major Ocular Diseases in Singapore and Asia

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Electrophysiological Features in the Management of Meralgia Paraesthetica

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A Case of Accelerated Development of Proliferative Diabetic Retinopathy in a Woman with Type 2 Diabetes Mellitus after Pregnancy

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Trilateral Retinoblastoma—A Case Report

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A Retrospective Review of Patients with Clinically Definite Multiple Sclerosis

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Chronic Subdural Haematoma Presenting with Transient Ischaemic Attacks— A Case Report

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Excimer Laser Phototherapeutic Keratectomy for Recurrent Corneal Erosions

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Use of EMLA Cream or Alfentanil for Analgesia during Ophthalmic Nerve Blocks

Cataract surgery is performed mainly as day-case surgery, with the majority performed under regional anaesthesia. Retrobulbar block, combined with facial nerve block, provides good...

Palatal Myoclonus—A Case Report

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Potentiation of Acetylcholine-induced Smooth Muscle Contraction in Rat Ileum by Lead

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Extensor Pollicis Longus Paralysis Following Thoracoscopic Sympathectomy

A 24-year-old man was referred for hyperhidrosis of more than 15 years duration. It affected both hands, feet and axilla. This article is available only...

Retinopathy of Prematurity in Very Low Birth Weight Infants

Retinopathy of prematurity (ROP), which could lead to visual impairment and blindness, is a recognised serious morbidity amongst surviving premature infants. The inverse relationship...

Role of Magnetic Resonance Imaging and Magnetic Resonance Angiography in Patients with Hemifacial Spasm

Hemifacial spasm (HFS), characterized by intermittent twitching of muscles supplied by one facial nerve is commonly due to compression of the facial nerve by...

Diabetic Retinopathy

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Cross-Sectional Study of Near-work and Myopia in Kindergarten Children in Singapore

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The Reliability and Validity of the Alzheimer’s Disease Assessment Scale Cognitive Subscale (ADAS-Cog) among the Elderly Chinese in Hong Kong

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The Correction of Oriental Lower Lid Involutional Entropion Using the Combined Procedure

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The Current State of Multiple Sclerosis Genetic Research

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Myopia: Gene-environment Interaction

Myopia affects up to 70% of adults in Singapore, Taiwan, Hong Kong and Japan. The prevalence rates in these Asian countries are higher than...

The Genetics of Human Epilepsies

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Sleep/Wake Cycle and Circadian Disturbances in Shift Work: Strategies for Their Management—A Review

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Incidence and risk factors of delirium in post-anaesthesia care unit

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Delirium in patients following general anaesthesia

Delirium is a disturbance of consciousness characterised by an acute onset and fluctuating course of inattention, accompanied by either a change in cognition or...

Listeria Meningoencephalitis: Two Cases and a Review of the Literature

The general experience of local physicians and available data suggest that listerial infections of the central nervous system (CNS) are uncommon among adults in...

Panhypopituitarism due to Pituitary Cyst of Rathke’s Cleft Origin—Two Case Reports

Rathke’s cleft cysts are non-neoplastic cystic epithelial lesions of the sellar and suprasellar region which are thought to originate from the remnants of Rathke’s...

Causes and Management of Descemet’s Membrane Detachment Associated with Cataract Surgery—Not Always a Benign Problem

It is well known that stripping of Descemet’s membrane (DM) occurs not infrequently during cataract surgery. In 1928, Samuels described frequent DM detachments of...

Book Review

The above is a textbook of medicine written by Singapore doctors and published in Singapore. It is difficult not to be over-enthusiastic about it...

Advances in Neurointensive Care

Neurointensive care has come into being in the past decade as a recognised subspecialty. Pioneering neurointensivists in the United States, such as Allan Ropper...

The Eye in Neurology: Evaluation of Sudden Visual Loss and Diplopia—Diagnostic Pointers and Pitfalls

The first step in the evaluation of sudden visual loss is to determine if the visual loss is monocular or binocular. The first diagnostic...

Neuroprotection in Acute Stroke

The neuronal cells of the central nervous system are especially susceptible to various forms of insult such as trauma and ischaemia. Once the ischaemic...

Current and Emerging Treatments in Parkinson’s Disease

Parkinson’s disease (PD) affects 1% of adults above the age of 65 years. It is characterised histologically by the loss of neurons in the...

Trinucleotide Repeat Analysis of Huntington’s Disease gene in Singapore

Huntington’s disease (HD) is an autosomal dominantly inherited disease, affecting 1 in 10,000 individuals of European origin. The incidence in the Asian population is...

Aseptic Meningitis in Children—The Singapore Experience

Aseptic meningitis is a common diagnosis among infants admitted for fever without an obvious source. In cases where the aetiologic agent could be identified,...

Update in the Management of Stroke

Stroke is the fourth leading cause of death and a leading cause of morbidity in Singapore. The number of hospital admissions for cerebrovascular disorders...

6th Yahya Cohen Lecture: Visual Experience During Cataract Surgery

What a patient can see during his or her surgery can be a cause of anxiety for the patient. It may cause additional stress...

Stroke Disease Management—A Framework for Comprehensive Stroke Care

Disease management (DM) is an approach to patient care that coordinates medical resources for patients across the entire healthcare delivery system. It requires a...

Variance Analysis Applied to a Stroke Pathway: How This Can Improve Efficiency of Healthcare Delivery

Stroke is the fourth principal cause of death in Singapore, and the leading cause of long-term disability amongst developed countries. Due to the spiralling...

Age-related Macular Degeneration: What’s New

Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in the developed western world, accounting for approximately 50% of all cases of...

Visual Rehabilitation with New-Age Rigid Gas-Permeable Scleral Contact Lenses—A Case Series

Advanced primary corneal ectasia presents a difficult problem in terms of visual rehabilitation. Soft contact lenses do not address the astigmatic aberrations in these...

Nursing Home Falls: A Local Perspective

Falls in the elderly has been a well-studied subject and now occupies an important place in geriatric medicine. While many studies have been done...

Primary Meningococcal Arthritis and Endogenous Endophthalmitis: A Case Report

Primary meningococcal arthritis (PMA) and endogenous meningococcal endophthalmitis are both uncommon presentations of meningococcal infection that should be considered in the differential diagnosis of...

Seeing How We Think About Words Using BOLD Contrast fMR Imaging

Functional brain imaging refers to a set of non-invasive imaging techniques that are used to infer linkages between brain structure and function. In this...

Imaging of Acquired Immunodeficiency Syndrome (AIDS)

The pandemic of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a global healthcare problem and HIV infection is the most common cause of...

Gyrate Atrophy of the Choroid: Two Cases

Gyrate atrophy of the choroid (GA) is a rare choroidal dystrophy. It is an autosomal recessive disorder that results in progressive deterioration in peripheral...

Nipah Encephalitis Outbreak in Malaysia

From September 1998 to June 1999, there was an outbreak of viral encephalitis in several pig farming villages in Malaysia. The outbreak, which started...

MELAS: A Case Report

A 6-year-old Chinese boy presented at the Oral and Maxillofacial Surgery clinic with gingival bleeding due to poor oral hygiene, odontogenic pain due to...

Case Reports of Two Biopsy-proven Patients with Creutzfeldt-Jakob Disease in Singapore

Creutzfeldt-Jakob disease (CJD) is the commonest human transmissible subacute spongiform encephalopathy. It has a worldwide distribution with an estimated annual incidence of 0.5 to...

Initial Experience of Macular Translocation in Singapore – One-year Results

Choroidal neovascularisation (CNV) is a devastating complication of macular degeneration and a major cause of irreversible vision loss in many developed countries. The most...

Axoglial Interaction via the Notch Receptor in Oligodendrocyte Differentiation

Oligodendrocytes (OLs) derived from the common neural progenitor cells in the central nervous system (CNS) ensheathe the nude axon to form the myelin that...

Ocular Surface Stem Cells and Disease: Current Concepts and Clinical Applications

The ocular surface is a complex biological continuum responsible for the maintenance of corneal clarity, elaboration of a stable tear film for clear vision,...

Re: Evidence for an “epidemic” of myopia

In the Annals January 2004 theme issue on Myopia, Park and Congdon have disputed the reality of the increases in prevalence of myopia in...

Contact Lens Microbial Keratitis and Prior Topical Steroid Use: A Disaster in the Making?

Topical steroid use in cornea ulcers is still a very contentious issue in ophthalmology. A recent review by Wilhelmus found that the use of...

Integrated Hydroxyapatite Implant and Non-integrated Implants in Enucleated Asian Patients

Much has been published on the complications of integrated and non-integrated implants. Most studies on integrated implants pertain to experience with the hydroxyapatite implant,...

A Case of Right Loin Pain: Septic Ovarian Vein Thrombosis Due to Campylobacter fetus Bacteraemia

Septic ovarian venous thrombosis is an uncommon entity. Classically, it occurs as a postpartum complication with reported frequency of 1 in 600 to 2000...

Hemifacial Spasm in Singapore: Clinical Characteristics and Patients’ Perceptions

Hemifacial spasm (HFS) is a movement disorder characterised by intermittent involuntary contractions of the facial muscles. It begins with contractions of the orbicularis oculi,...

Characteristics and Acute Rehabilitation of Guillain-Barré Syndrome in Singapore

The Guillain-Barré syndrome (GBS) is an acute, frequently severe evolution of a demyelinating inflammatory polyradiculopathy with an autoimmune pathogenesis. In developed countries, GBS is...

Clinical Indications for Positron Emission Tomography (PET) Scanning

The purpose of these guidelines is to provide a broad framework for clinicians considering the use of positron emission tomography (PET) scanning for their...

PET Tracers and Radiochemistry

Positron emission tomography (PET) has become a powerful scientific and clinical tool for probing biochemical processes in the human body. This is due, in...

Physical Principles and Technology of Clinical PET Imaging

The past few years have seen the transition of positron emission tomography (PET) from the research domain into mainstream clinical applications for oncology. The...

Positron Emission Tomography – A Vital Component of Molecular Imaging

Contemporary medical imaging is progressing towards quantification of tissue function in addition to merely providing anatomical information, as illustrated by the rising use of...

Spinocerebellar Ataxia Type 2 with Focal Epilepsy – An Unusual Association

The spinocerebellar ataxias (SCAs) are a rare group of neurodegenerative disorders that are clinically and genetically heterogeneous. Almost all SCAs are due to trinucleotide...

The Correction of Myopia Evaluation Trial: Lessons from the Study Design

“A properly planned and executed clinical trial is a powerful technique for assessing the effectiveness of an intervention”. While each new clinical trial involves...

Myopia Progression Among Preschool Chinese Children in Hong Kong

Myopia occurs when the image of distant objects, focused by the cornea and lens, falls in front of the retina. It is the commonest...

The Epidemiology of Myopia in Hong Kong

Myopia is a refractive condition in which the image of a distant object is formed anterior to the retina of the unaccommodated (relaxed) eye....

Prevalence of Myopia in Taiwanese Schoolchildren: 1983 to 2000

Today in Taiwan, with increasing level of educational and living standard, the prevalence and severity of myopia appear to be on an upward trend....

Evidence for an “Epidemic” of Myopia

A number of authors have recently proposed that myopia is increasing at an “epidemic” rate, particularly in East Asia, and especially among populations of...

Using Natural STOP Growth Signals to Prevent Excessive Axial Elongation and the Development of Myopia

Myopia in humans results from an imbalance between the refractive power of the cornea and lens and the axial length of the eye, such...

Ocular Shape and Myopia

Myopia develops from a mismatch of the eye’s anatomical axial length and its focal length, as determined by the combined optical powers of the...

Is it Possible to Slow the Progression of Myopia?

The rates of myopia, including high myopia , have been reported to be rising to epidemic proportions in Asia and solutions to this huge...

Issues and Challenges for Myopia Research

Myopia is an ocular disorder of major public health and socioeconomic significance in many East Asian urban cities. In Singapore, the prevalence of myopia...

Accommodative Stimulus Response Curve of Emmetropes and Myopes

There is a strong association between myopia and near work, and it has been reported that the rapid rise in the prevalence of myopia...

Electrophysiological Findings in Persons With Nyctalopia

Nyctalopia is a subjective sensation of poor vision under dark conditions. It may be clinically associated with retinal diseases affecting the rod photoreceptors or...

Identification of a Common Genetic Risk Variant (LRRK2 Gly2385Arg) in Parkinson’s Disease

For diseases with complex inheritance, the age-old debate regarding the relative contribution of gene-environment interaction never fails to generate interest, discussion and hypothesis within...

Neisseria meningitidis Keratitis in Adults: A Case Series

Neisseria meningitidis has been reported as a causative organism for conjunctivitis and endogenous endophthalmitis, more commonly in neonates and young children. A search of...

Visual Recovery Following Emergent Orbital Decompression in Traumatic Retrobulbar Haemorrhage

Acute retrobulbar haemorrhage is a potentially sight threatening condition that can occur spontaneously or following retrobulbar injections and trauma to the orbit. Visual loss...

Macular Carotenoids and Age-related Maculopathy

The macula lutea is an anatomic region of the posterior retina that measures approximately 5.5 mm in diameter, and is exquisitely specialised for sharp...

Neural Progenitor and Stem Cells in the Adult Central Nervous System

Seminal studies in the 1960s, using -thymidine autoradiography, reported that neurogenesis occurs in discrete areas of the adult mammalian brain, in rodents. Studies in...

Book Review

Ophthalmologists today depend heavily on various investigative modalities such as fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) for an...

Recombinant Tissue Plasminogen Activator (r-TPA) in Fibrin Dissolution due to Postoperative Endophthalmitis

Cataract surgery is one of the most successful surgical procedures performed. However, postoperative endophthalmitis, defined as severe inflammation involving both the anterior and posterior...

Orbital Metastatic Tumour as Initial Manifestation of Asymptomatic Gastric Adenocarcinoma

Metastatic orbital tumour from gastric cancer is rare. In a Japanese survey of metastatic orbital tumours seen over 95 years, gastric metastases accounted for...

Eye Injuries in Singapore – Don’t Risk It. Do More. A Prospective Study

The issue of ophthalmic trauma is a major cause for concern. An estimated 55 million eye injuries occur each year worldwide, leaving 1.6 million...

Retrospective Review of Eyes with Neovascular Age-related Macular Degeneration Treated with Photodynamic Therapy with Verteporfin and Intravitreal Triamcinolone

Among the variety of paradigms implicated in the pathogenesis of choroidal neovascularisation (CNV), an inflammatory component has been a recent focus of interest. The...

Rates of Posterior Capsule Rupture During Cataract Surgery Among Different Races in Singapore

Posterior capsule rupture (PCR) is a potentially serious intraoperative complication of cataract surgery. The anecdotal experience of some surgeons suggests that differences in the...

Surgically-induced Corneal Changes Following Macular Translocation with Punctate Retinotomies and Chorioscleral Infolding (Limited Macular Translocation)

Changes in corneal curvatures and astigmatism after retinal surgery are well documented. Although some of these changes are mild and transient, some have reported...

Updates on the Surgical Management of Paediatric Cataract with Primary Intraocular Lens Implantation

Paediatric cataract has a low incidence compared with adult cataract. The estimated incidence is about 1 to 6/ 10,000 births. This article is available only...

Efficacy of Measuring Visual Performance of LASIK Patients under Photopic and Mesopic Conditions

LASIK is routinely carried out to correct the refractive errors of myopic patients. A high percentage of patients have good high-contrast visual acuity after...

Role of Ultrasound Biomicroscopy (UBM) in the Detection and Localisation of Anterior Segment Foreign Bodies

The presence of an intraocular foreign body (IOFB) is a common complication of ocular trauma. For surgical planning, the localisation of IOFBs has to...

Diabetic Retinopathy in Type II Diabetics Detected by Targeted Screening Versus Newly Diagnosed in General Practice

The epidemic of type II diabetes mellitus is now recognised worldwide. In India, it has been estimated that the population with type II diabetes...

Ethical Issues in Ophthalmology and Vision Research

The importance of ethics in research was highlighted in the USA when a healthy volunteer subject, 24-year-old Ellen Roche, died in a Johns Hopkins...

Can Long-term Corticosteroids Lead to Blindness? A Case Series of Central Serous Chorioretinopathy Induced by Corticosteroids

Central serous chorioretinopathy (CSCR) is an idiopathic disorder characterised by serous detachment of the macula, retinal pigment epithelial (RPE) detachment and areas of RPE...

A Novel Locus for X-linked Retinitis Pigmentosa

Retinitis pigmentosa (RP) is characterised by initial night blindness followed by progressive loss of visual fields and eventually, loss of central vision. RP is...

Utility and Validity of the Self-administered SF-36: Findings From an Older Population

The shift towards broader health perspectives and the emphasis on patient preferences have led to the development of many health questionnaires and their inclusion...

The Role of Optical Coherence Tomography (OCT) in the Diagnosis and Management of Retinal Angiomatous Proliferation (RAP) in Patients with Age-related Macular Degeneration

Retinal angiomatous proliferation (RAP), initially described as deep retinal vascular anomalous complex in 1992 by Hartnett et al, has been recently defined as a...

Axial Length: A Risk Factor for Cataractogenesis

There are several known risk factors for cataract formation, including older age, lower educational status, smoking, ultraviolet light exposure, trauma, dehydration, diabetes, uveitis and...

Clinical Features of Autosomal Dominant Retinitis Pigmentosa Associated with a Rhodopsin Mutation

Retinitis pigmentosa (RP) is the most prevalent group of inherited retinopathies. This spectrum of diseases affects approximately 1 in 4800 individuals. This article is available...

A Novel Mutation of the VMD2 Gene in a Chinese Family with Best Vitelliform Macular Dystrophy

Best vitelliform macular dystrophy is an autosomal dominant disorder characterised by an egg yolk-like appearance of the macula. The vitelliform “egg yolk” lesions result...

Characterisation of Human Tear Proteins Using High-resolution Mass Spectrometry

Over the last few years, with advances in mass spectrometry, there has been increasing interest in exploring the proteome of body fluids such as...

Scanning Laser Polarimetry in Pulmonary Tuberculosis Patients on Chemotherapy

Pulmonary tuberculosis is a worldwide disease. In Hong Kong, there are about 7000 new cases of pulmonary tuberculosis each year and the prevalence remains...

Time to Raise Awareness of Blindness as Another Smoking-related Condition

Singapore currently has a comprehensive range of tobacco control policies and programmes. It started implementing legislative measures against cigarette smoking in the early 1970s,...

“Galaxy in My Eye”: An Artist’s View of Cataract Surgery from Behind the Crystalline Lens

Cataract surgery is the most commonly performed elective surgery in many countries. As a result of advances in surgical and anaesthetic techniques, most cataract...

Methodologies for Interventional Myopia Studies

Past studies on intervention in myopia progression have given conflicting results. For example, in the past, studies on (PMMA) hard contact lenses took researchers...

Ethambutol-associated Optic Neuropathy

Tuberculosis (TB) has been present since ancient times. Around 460 BC, Hippocrates identified phthisis, which is the Greek term for consumption (TB seemed to...

Concurrent Intermediate Uveitis and an Enhancing Intracranial Lesion as the Initial Manifestation of Sarcoidosis

Sarcoidosis remains an enigmatic disease with protean manifestations. It is a multi-system disorder of unknown cause characterised by an accumulation of T-lymphocytes, mononuclear phagocytes...

Retrobulbar Alcohol Injection for Orbital Pain Relief Under Difficult Circumstances: A Case Report

The management of pain in the orbital region, whether ocular or orbital in origin, is complex and lies at the margins of several subspecialty...

Book Review

In Retinal Vascular Disorders, Dr Mohan and co-authors cover common and important retinal vascular disorders in a series of short chapters which are written...

Vision 2020 and Prevention of Blindness: Is it Relevant or Achievable in the Modern Era?

This review article considers the universal definition of blindness, the causes of world/global blindness, and ongoing international efforts in blindness prevention. The prospects for...

Enhancement of the Mechanical and Biological Properties of a Biomembrane for Tissue Engineering the Ocular Surface

The most recent treatment for severe ocular surface disease is the transplantation of cultivated corneal and conjunctival epithelial stem cells, which makes use of...

Mycobacterium-related Ocular Inflammatory Disease: Diagnosis and Management

Tuberculosis (TB) is an ancient disease that has been detected in 3000-year-old Egyptian mummies. Robert Koch’s discovery of the tubercle bacillus as the aetiologic...

Photodynamic Therapy for Choroidal Neovascularisation Secondary to Inflammatory Chorioretinal Disease

Photodynamic therapy using verteporfin (Visudyne, Novartis Ophthalmics) has been proven safe and effective for the treatment of predominantly classic, age-related macular degeneration (AMD)-related subfoveal...

Variables Determining Perceived Global Health Ranks: Findings from a Population-based Study

In 1982, Mossey and Shapiro first demonstrated that global self-rating of health was a better predictor of 7-year survival than medical records or self-reports...

Multivariate Analysis of Childhood Microbial Keratitis in South India

Corneal infection is the most common cause of profound ocular morbidity leading to blindness worldwide. Corneal infection in children is difficult to diagnose and...

Can the Sequential Use of Conventional Silicone Oil and Heavy Oil be a Strategy for the Management of Proliferative Vitreoretinopathy?

Advances in vitreoretinal surgery have greatly increased the anatomical re-attachment rate in cases with proliferative vitreoretinopathy (PVR). The availability of perfluoro-carbon liquids, indirect viewing...

Surgical Outcomes of 25-Gauge Transconjunctival Vitrectomy Combined With Cataract Surgery for Vitreoretinal Diseases

The recent development of 25-gauge instrumentation for vitreous surgery has promoted a great interest in the transconjuctival sutureless vitrectomy system. Similar to the trend...

New Concepts in the Management of Optic Nerve Sheath Meningiomas

Optic nerve sheath meningiomas (ONSMs) account for one-third of primary optic nerve tumours, are the second most common optic nerve tumours after gliomas, and...

Ophthalmic Regional Block

Patient comfort, safety and low complication rates are the essentials of local anaesthesia. The anaesthetic requirements for ophthalmic surgery are dictated by the nature...

Hyperbaric Oxygen Therapy for Radiation-induced Optic Neuropathy

Radiation optic neuropathy (RON) is an infrequent but usually devastating consequence of radiation to the optic pathways. It is almost exclusively an iatrogenic phenomenon,...

The Natural History of Occult Choroidal Neovascularisation Associated With Age-related Macular Degeneration. A Systematic Review

Choroidal neovascularisation (CNV) is a leading cause of blindness in the western world. It causes 90% of the visual loss in age-related macular degeneration...

Retinal Prostheses for the Blind

Each year, thousands of people are afflicted with photoreceptor degenerative diseases that reduce vision to bare light perception or complete blindness. Retinitis pigmentosa (RP)...

Age-related Macular Degeneration: An Emerging Challenge for Eye Care and Public Health Professionals in the Asia Pacific Region

Age-related macular degeneration (AMD) is a severe ocular disease characterised by progressive deterioration of the macula, the most sensitive central back portion of the...

Intravitreal Triamcinolone Acetonide for the Treatment of Diffuse Diabetic Macular Oedema – A Case Report

Focal and grid laser photocoagulation are the primary surgical treatments for diabetic macular oedema. However, laser treatment of eyes with diffuse macular oedema has...

Bruch’s Membrane Abnormalities in Dome-shaped and Mushroom-shaped Choroidal Melanomas

Uveal melanoma is the most common primary intraocular malignancy and is diagnosed chiefly in the fifth to seventh decades of life. The choroid is...

Human Limbal Progenitor Cell Characteristics are Maintained in Tissue Culture

The surface of the eye is covered by 3 distinct forms of non-keratinising stratified squamous epithelium – transparent corneal epithelium overlying the corneal surface,...

Angiographic Characteristics of Acute Central Serous Chorioretinopathy in an Asian Population

Acute central serous chorioretinopathy (CSCR) is a condition of unknown origin characterised by a serous detachment of the macula. It afflicts young healthy adults,...

A Nationwide Survey on the Knowledge and Attitudes of Malaysian Optometry Students on Patients’ Visual Experiences During Cataract Surgery

Cataract is one of the most common causes of visual impairment in the elderly and its surgery is the most common major ophthalmic surgery,...

Re-defining Neurological Syndromes: The Genotype Meets the Phenotype

Since time immemorial, generations of medical students and physicians have always been taught that a thorough and detailed history and examination is the foundation...

Towards 2020 Vision in Singapore

With the increasing demands of contemporary life, higher levels of visual performance are expected. In modern societies such as Singapore, many more adults will...

An Intelligent Tutoring System for Trauma Management (Trauma-Teach): A Preliminary Report

In Singapore, trauma1-7 is the leading cause of hospitalisation and the fifth leading cause of morbidity and mortality.8,9 Common causes of trauma include road...

Fungal Pan-sinusitis with Severe Visual Loss in Uncontrolled Diabetes

Fungi are known opportunistic organisms, which potentially invade and infect a host with depressed immunity. Fungal pan-sinusitis complicated with orbital apex syndrome or cavernous...

Prevalence of Refractive Error in Malay Primary School Children in Suburban Area of Kota Bharu, Kelantan, Malaysia

Refractive error remains one of the primary causes of visual impairment in children worldwide. Prevalence of visual impairment in children, is defined as uncorrected...

The Teaching of Radiology

A record of Diagnostic Radiology would be incomplete without reference to Wilheim Roentgen, who discovered the rays that he could not comprehend; hence, X-rays....

Opening Our Eyes to Guide Dogs for the Blind in Singapore

The concept of the modern guide dog first began in Germany after World War I in an effort to support veterans blinded in combat....

Ultrasound Assisted Thrombolysis in Acute Ischaemic Stroke: Preliminary Experience in Singapore

Most patients with acute ischaemic stroke have arterial thrombi that occlude extra- or intracranial vessels. Intravenously administered tissue plasminogen activator (IV-TPA) induces thrombolysis and...

Diabetic Retinopathy in Diabetics Referred to a Tertiary Centre from a Nationwide Screening Programme

Diabetic retinopathy (DR) is a leading cause of vision loss in Asia. Singapore has one of the highest prevalence rates of diabetes mellitus (DM)...

Functional Neuroimaging of Sleep Deprived Healthy Volunteers and Persons with Sleep Disorders: A Brief Review

Most adults have experienced sleep deprivation at some stage of their lives, be it in the context of work, illness or play. Sleep deprivation...

Treatment of Circadian Rhythm Sleep Disorders with Light

In humans, the daily pattern of consolidated sleep and wake is strongly influenced by the timing of exposure to light and darkness. In the...

Basic Science Review on Circadian Rhythm Biology and Circadian Sleep Disorders

The sleep-wake cycle, with its characteristic intervals of activity alternating with restfulness that recur with a periodicity approximating the 24-hour day-night cycle, is the...

Delayed and Extra-pontine Myelinolysis after Osmotic Dysregulation

A 58-year-old Chinese man was admitted because of increasing lethargy and confusion over 4 days. He had been taking hydrochlorthiazide for hypertension and regularly...

Limb-Shaking Transient Ischemic Attack with Distal Micro-Embolic Signals and Impaired Cerebrovascular Reactivity Using Transcranial Doppler

We present a patient with limb-shaking transient ischaemic attack (TIA) associated with extracranial carotid occlusion and suggest that the pathophysiological mechanism is hypoperfusion, as...

Progressive Hemi-facial Atrophy and Keratoconus

Progressive hemifacial atrophy (Parry-Romberg syndrome, PHA) is characterised by slowly progressive atrophy, usually involving one side of the face, and may be associated with...

Neuropsychiatry – An Emerging Field

Neuropsychiatry can be described as the interface between neurology and psychiatry – the intersecting field of enquiry for both the brain and the mind....

Effects on the Contralateral Eye After Intravitreal Bevacizumab and Ranibizumab Injections: A Case Report

Vascular endothelial growth factor (VEGF) is recognised as an important mediator in the pathogenesis of age-related macular degeneration (AMD) and retinal neovascularisation. Anti-VEGF therapies...

Alzheimer’s Disease – Towards More Patient-centred and Meaningful Clinical Outcomes

More than 100 years ago Alois Alzheimer first presented the clinical and pathological features of an unusual brain disease at his seminal lecture in...

Sir Gordon Arthur Ransome (1910-1978) – His Teaching Style and His Legacy

Sir Gordon Arthur Ransome was born in Salop, England, in 1910.1 He came to Singapore in 1938, where he taught and practised medicine for...

Corticospinal Tract Degeneration in Amyotrophic Lateral Sclerosis: A Diffusion Tensor Imaging and Fibre Tractography Study

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder characterised by spinal and cortical motor neuron degeneration. Although electro myography, muscle biopsy and motor...

Biomarkers of Mild Cognitive Impairment and Alzheimer’s Disease

Alzheimer’s disease (AD) is the most prevalent form of age-related dementia in the modern society. Other than symptomatic treatment with acetylcholinesterase inhibitors at its...

Validation of Transcranial Doppler with CT Angiography in Cerebral Ischaemia: A Preliminary Pilot Study in Singapore

Transcranial Doppler (TCD) is routinely performed to assess the blood flow in patients with cerebral ischaemia and provides important real-time information about cerebral haemodynamics....

Superior Sagittal Sinus Thrombosis: Subtle Signs on Neuroimaging

Cerebral venous thrombosis (CVT) is an infrequent but potentially deadly disease. The mortality rate of CVT is 10% to 20%, and surviving patients may...

Current Understanding of the Treatment and Outcome of Acute Primary Angle Closure Glaucoma: An Asian Perspective

Primary angle-closure glaucoma (PACG) is a major cause of irreversible blindness in Asia and many parts of the world. It is a particularly serious...

Seeing the Wood for the Trees: Approaches to Teaching and Assessing Clinical Pharmacology and Therapeutics in a Problem-based Learning Course

Over the last 3 decades, the rate of knowledge accumulation in drug development has been enhanced by advances in molecular modelling, the molecular genetics...

Embryonic Stem Cells and Parkinson’s Disease: Cell Transplantation to Cell Therapy

Although levodopa is currently a well-endorsed form of treatment for Parkinson’s Disease (PD), the search for a safe, long-term and dyskinesia-free treatment remains an...

Bridging the Gap Between Primary and Specialist Care – An Integrative Model for Stroke

Cerebrovascular disease (CVD) is Singapore’s fourth leading cause of death, comprising 9% of all deaths, a crude death rate of 40.4/100,000, an age- and...

Acute Concomitant Esotropia during Heroin Detoxification

Although acute concomitant esotropia following heroin detoxification or withdrawal has been described in a few case reports in Europe and Australia, it has not...

Malignant Syndrome of Two Parkinson Patients due to Withdrawal of Drugs

Neuroleptic malignant syndrome (NMS) is characterised by the impairment of consciousness, high fever, rigidity and autonomic instability. Although originally described in patients taking neuroleptic...

Intraocular Avastin (Bevacizumab) for Neovascularisation of the Iris and Neovascular Glaucoma

Neovascularisation of the iris is associated with many ischaemia retinal disorders and elevated levels of the vascular endothelial growth factor is found in patients...

Evaluating the Optic Nerve and Retinal Nerve Fibre Layer: The Roles of Heidelberg Retina Tomography, Scanning Laser Polarimetry and Optical Coherence Tomography

Glaucoma is an optic neuropathy with characteristic optic nerve damage and visual field loss. With the introduction of the ophthalmoscope by Helmholtz in 1851,...

Lack of Awareness amongst Community Patients with Diabetes and Diabetic Retinopathy: The Singapore Malay Eye Study

Diabetes is a major public health problem, and diabetic retinopathy is the leading cause of blindness in working-aged people.1 Previous studies have documented poor...

Radiology: Does It Have a Sell-by Date?

Radiology is riding the crest of a wave. We have superb images, available immediately in all parts of the hospital. Fusion of functional and...

Emergency Department Headache Admissions in an Acute Care Hospital: Why Do They Occur and What Can We Do About It?

Headache is a common presenting complaint in the Emergency Department (ED), accounting for 1% to 4% of all visits.1-3 A significant proportion of these...

Hypoxic-ischaemic Brain Injury in Young Infants

In young infants, different types of hypoxic-ischaemic brain injury can occur.1-6 Brain injury can be localised or diffused.2-6 In localised brain injury, arterial or...

Cysticercosis of the Levator Palpebrae Superioris

Cysticercosis cellulosae, the larval form of the pork tapeworm Taenia solium, causes cysticercosis, in which humans serve as the intermediate hosts in the parasite life cycle. Cysticercosis...

Multimodal Therapeutic Approach in Acute Ischaemic Stroke with Real-time Neurovascular Monitoring

Intravenously administered tissue plasminogen activator (IV-TPA) induces thrombolysis and remains the only FDA-approved therapy for acute ischaemic stroke (IS) within the therapeutic time-window according...

Validity and Reliability of the Zarit Burden Interview in Assessing Caregiving Burden

Dementia is a growing public health issue in the Asia-Pacific region. The number of people with dementia in the Asia-Pacific region will increase from...

Chewing-induced Facial Dystonia

Dystonia is a movement disorder characterised by sustained muscle contractions, repetitive twisting movements, and abnormal postures of the trunk, neck, face, or arms and...

Intraretinal Segmentation on Fourier Domain Optical Coherence Tomography

Optical coherence tomography (OCT) has become an indispensable tool in the management of retinal and optic nerve diseases as well as in clinical trials....

Timing of Arrival to a Tertiary Hospital after Acute Ischaemic Stroke – A Follow-up Survey 5 Years Later

Intravenous tPA is a proven treatment for acute ischaemic stroke. However as it has to be given in a narrow time window from symptom...

Alzheimer’s disease–The Inexorable Epidemic

Alzheimer's disease (AD) is the most common form of dementia which refers collectively to syndromes of progressive deterioration of memory along with other cognitive...

Unusual Cause for Unilateral Headache: A Quadrigeminal Cistern Arachnoid Cyst

Young adults are frequently presented with headaches due to various causes. Atypical facial pain, renamed as persistent idiopathic facial pain (PIFP) is a poorly...

Intravitreal Bevacizumab for the Treatment of Myopic Choroidal Neovascularisation in an Asian Population

Myopic choroidal neovascularisation (mCNV) is one of the most common causes of permanent central visual loss in patients with high myopia, and its natural...

Inadvertent Use of Bevacizumab to Treat Choroidal Neovascularisation During Pregnancy: A Case Report

The recognition that vascular endothelial growth factor (VEGF) plays an important role in the pathogenesis of neovascular age-related macular degeneration (NVAMD) has led to...

Genome-wide Association Studies: Promises and Pitfalls

Genetic testing is an important means to confirm the diagnosis of an inheritable disease. For this to be feasible, genes that are associated with...

Atypical Presentation of Central Retinal Artery Occlusion

Central retinal artery occlusion (CRAO) typically presents with a retinal “cherry red spot”. In CRAO, infarction of the retinal nerve fibre layer renders the...

Computed Tomography Features in Enteric Fever

Enteric fever is a potentially fatal multi-systemic febrile disease caused by Salmonella.  Salmonella are gram-negative, rod-shaped facultative intracellular anaerobic bacteria with more than 2500...

Epilepsy: Looking Beyond Seizures

World Epilepsy Day falls on 26 March 2013. As we observe this important date in Singapore, it is perhaps instructive to take a step...

Sleep, Public Health and Wellness: The Elephant in the Room

The rising cost of health care and the burden of chronic illness are perennial concerns. Remarkably, there exists a measure that around 30% of...

Bilateral Polychromatic Crystalline Keratopathy as the Initial Manifestation of IgG-Lambda Multiple Myeloma

Dear Editor, Multiple myeloma is a subgroup of plasma cell dyscrasias with neoplastic proliferation of plasma cells or their precursors. Crystalline keratopathy is a well-recognised...

Re: An Alternative Diagnosis: Bartonella Neuroretinitis

I would like to thank the authors for the reply to our case report. The differential diagnosis of Bartonella neuroretinitis in this patient was...

An Alternative Diagnosis: Bartonella Neuroretinitis

We refer to the letter ‘Lyme Neuroretinitis in Singapore: A Diagnostic Dilemma’ published in the April 2012 Vol. 41 No. 4 issue of the...

Single-level Anterior Corpectomy with Fusion versus 2-level Anterior Cervical Decompression with Fusion: A Prospective Controlled Study with 2-year Follow-up Using Cages for Fusion

Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are performed for decompression of the spine when the primary compressive...

27-Gauge Vitrectomy for Primary Rhegmatogenous Retinal Detachment: Is it Feasible?

Pars plana vitrectomy (PPV) using the 27-gauge transconjunctival approach is the last frontier of small gauge vitrectomy. Only 1 paper has been published so...

A Decade of Progress in the Understanding, Prevention and Treatment of Age-related Macular Degeneration in Singapore

The year 2014 had marked the 10th anniversary of the nationwide Age-related Macular Degeneration (AMD) Awareness Week in Singapore.1 This public health campaign, organised...

A maxillary sinus mass

A 55-year-old Chinese woman presented to the ear, nose and throat clinic with a 6-month history of left-sided blood-stained mucus. It was dark brown...

Chorea precipitated by phototherapy as initial presentation of systemic lupus erythematosus

Dear Editor, Chorea is a well-recognised albeit rare neuropsychiatric manifestation of systemic lupus erythematosus (SLE). We describe here a case of a 67-year-old woman presenting...

Attendance for ischaemic stroke before and during COVID-19 lockdown in Singapore

The coronavirus disease 2019 (COVID-19) outbreak has impacted healthcare systems worldwide. Globally, visits to the emergency department have fallen as much as 25% during...

Rare homozygous PRKN exon 8 and 9 deletion in Malay familial early-onset Parkinson’s disease

Little is known about the genetics of Parkinson’s disease (PD) in Southeast Asian populations.1 We extended knowledge of the Southeast Asian monogenic PD landscape...

Incidence and trends of ophthalmic cancer in Singapore: Data from Singapore Cancer Registry

Ophthalmic cancers are commonly encountered in clinical practice and are an important cause of morbidity and mortality. Globally, the incidence of ophthalmic cancers have...

Seeing through the eyes of patients with age-related macular degeneration

Age-related macular degeneration (AMD) is a severe ocular disease characterised by progressive deterioration of the macula, the most sensitive central part of the retina....

Neuro-Behçet’s disease presenting as isolated intracranial hypertension

Behçet’s disease (BD) is a chronic multisystem inflammatory disease with a classic triad of painful oral ulcers, genital ulcers and uveitis. Neurological manifestations, though...

Teleophthalmology and its evolving role in a COVID-19 pandemic: A scoping review

The World Health Organization declared coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern on 30 January 2020. To control the outbreak,...

Cost of inpatient rehabilitation for children with moderate to severe traumatic brain injury

The cost of rehabilitation for children post-traumatic brain injury (TBI) is significant. The annual total healthcare cost of TBI had been estimated to range...

Long-term outcomes of ischaemic stroke patients with diabetes in a multi-ethnic cohort in Singapore

Asia faces an epidemic of diabetes. The prevalence of diabetes in Asia is projected to grow from 114 million in 2007 to 180 million...

Recurrent vascular events in ischaemic stroke patients with diabetes

Stroke is a major cause of death and disability globally, with 6.55 million deaths (95% uncertainty interval 6.00–7.02 million), 101 million prevalent cases...

The Singapore Cerebral Palsy Registry: An important new resource for cerebral palsy research

Cerebral palsy (CP) is a common, lifelong disorder of movement and posture resulting from an insult or maldevelopment of the developing brain. The movement...