·AIM: To report cases of carotid cavernous fistula in post traumatic patients successfully treated with coil embolization.·METHODS: Two cases of direct carotid cavernous fistula (CCF) underwent successful coil embolization. Both patients presented with clinical features of CCF following motor vehicle accident at two weeks and four months. One patient had good visual acuity with raised intraocular pressure (IOP) and the other had poor vision with borderline IOP. The diagnosis was confirmed with cerebral angiography. Coil embolization were performed in both cases.·RESULTS; After the procedure the vision was back to normal and IOP came down to normal range without anti-glaucoma. The features of CCF were also resolved, which included proptosis, ophthalmoplegia, chemotic conjunctiva, orbital bruit and fundus changes.·CONCLUSION: Carotid cavernous fistula should be diagnosed and treated early to prevent serious ocular complication of vision loss. Endovascular embolization is the current treatment of choice.

·AIM: To report a rare case of melioidosis presenting as orbital abscess, who was successfully treated with highdose of intravenous ceftazidime.·METHODS; A case" report.·RESULTS; A 55-year-old Malay gentlemen who was newly diagnosed with diabetes mellitus, presented with prolonged low grade fever for three weeks and left eye swelling for five days duration. Initial CT scan of brain and orbit showed left periorbital cellulitis and acute left sphenoidal sinusitis. Initial swab culture grew Pseudo-monas sp. His general condition improved with regular antibiotics. However, upon completion of intravenous therapy his condition worsened and the left eye became more proptosed. Repeat CT scan of the brain and orbit showed left eye orbital abscess with intracranial exten? sion. Swab culture from fistula of the lateral part of upper eyelid showed Burkholderia pseudomallei. He was treated with high dose of intravenous ceftazidime, oral co-trimoxazole for the acute management and on maintenance dose of oral co-trimoxazole for 2 months. He responded well to treatment and had no relapse up to one year post treatment. Unfortunately his left eye vision was not salvageable.·CONCLUSION: This case illustrates a rare presentation of orbital abscess due to melioidosis which was complicated with cerebral abscess and septicemia. An accurate diagnosis was essential and high dose of susceptible antibiotics was important for the institution of therapy to successfully treat this potentially fatal condition.

·A 20-year-old healthy lady was admitted for septic arthritis in the right knee. Two weeks after the onset of joint pain, she complained progressive blurring of vision in both eyes. Slit-lamp examination revealed evidence of inflammation in both anterior and posterior segments. There were multiple chorioretinal lesions on both fundi. Synovial fluid aspiration of the right knee and blood culture grew Staphylococcus aureus . She responded well to topical and systemic antibiotics. Her final visual acuity was 6/6 in both eyes. This case illustrates a rare presentation of bilateral endogenous endophthalmitis in an immunocompetent young patient presenting with a concurrent septic arthritis. Early diagnosis and a prompt management carry a favorable visual prognosis.

A fourteen years old Malay boy was involved in a motor vehicle accident and suffered multiple injuries. The patient was referred to ophthalmology for right periorbital haematoma, ocular examination was normal but proptosis of right eye was detected which was later associated with increase in the intraocular pressure (IOP). Direct carotid cavernous sinus fistula (CCF) was diagnosed by angiography and treated with embolization.

A 21-year-old and an 11-year-old patients presented with severe,resistant shield ulcers failed to respond to medical treatments which included topical steroids,mast cell stabilizers and antihistamines. Both of them were treated with surgical debridement of the ulcer,supratarsal injection of triamcinolone acetonide,topical cyclosporine 0.5g/L and ketotifen fumerate 0.25g/L. The ulcers healed well after three weeks. Topical cyclosporine was discontinued after two months in both patients. They were symptom free with no recurrence for six months. Combination of surgical debridement of the ulcer,supratarsal injection of triamcinolone acetonide,topical cyclosporine 0.5g/L and ketotifen fumerate 0.25g/L are effective as the treatment option in managing patients with severe vernal shield ulcer.KEYWORDS: vernal shield ulcer; surgical debridement; supratarsal injection of triamcinolone acetonide; cyclosporine; ketotifen fumerate

An interventional case-report about a rare case of penetrating eye injury caused by a fish hook. A 34-year old man was brought to the emergency department with a fish hook embedded in the eye. The fish hook occupied the whole globe with part of it penetrated into the posterior part of the sclera. It was extracted under general anaesthesia using the back-out method.The back-out method is the best option for the removal of the fish hook that penetrated the globe till to the posterior part of the sclera

A 42-year-old Malay lady presented with a 2-year history of painless and progressive right upper lid swelling. There was no history of trauma or similar lesion elsewhere. An excisional biopsy of the mass was performed and the histopathological findings of the excised lesion were consistent with those for a trichilemmal cyst. Trichilemmal cyst, although rare should be considered in any case of eye lid lesion.

AIM: To study the association between lipid profile and retinal hard exudates in diabetic retinopathy (DR) and the association between oxidized-LDL with systemic diseases among type 2 diabetic patients.another 40 patients without DR. Demographic data was collected and comprehensive ocular examination was performed. Nine mL venous blood was taken for fasting serum cholesterol, triglycerides, HDL, LDL, ox-LDL, and for HbA1C. Compared to patients without retinopathy 5.0±1.03mmol/L (P=0.001). The mean serum LDL was 3.6±1.69mmol/L in retinopathy group compared to 3.0±1.02mmol/L in the contol group (P=0.005). There was a higher concentration of serum cholesterol, triglyceride and LDL in patients with severe retinal hard exudates compared to those with mild and moderate, however it was not statistically significant (P=0.082, 0.116, 0.218) respectively. The mean serum oxidized-LDL concentration was higher in DR with severe retinal hard exudates compared to mild and moderate. There was no statistically significant difference in the mean oxidized LDL with other systemic diseases or duration of diabetes.and LDL with DR. However there was no association between serum lipid profile with the severity of retinal hard exudates. Serum ox-LDL was also not associated with DR and other systemic co-morbidities in our study.

A 25-year man presented with symptom of photophobia and tearing in the right eye for 2 months duration. It was associated with painless gradual reduced vision. There was a history of hammering on a metal object prior to that. Ocular examination revealed signs of mild anterior uveitis due to a retained metallic intralenticular foreign body. Conjunctiva was white. Computed Tomography (CT) scan of the orbit confirmed presence of a single intraocular foreign body. The condition is misleading and can be easily overlooked. A detailed history and clinical examination are mandatory in this misleading situation.

A 32-year-old lady, diagnosed with anaplastic large cell non-Hodgkin's lymphoma of the mediastinum, presented with bilateral floaters and reduced right eye vision 3 years post chemotherapy. Ophthalmic examination revealed bilateral panuveitis with multiple deep seated choroidal lesions in the left eye. Computed tomography scanning of the orbit showed enhancing and bulky optic nerve sheath at the retrobulbar part of both optic nerves. The patient was treated with involved field radiation therapy of the orbit, with cumulative dose of 30Gy. Eight months post radiation therapy, she developed retinal pigment epithelial detachment at the macula and deep chorioretinal degeneration at superotemporal and inferonasal regions of the right fundus. There was evidence of vitreoretinal traction at the margin of chorioretinal degeneration areas, thus barricade lasers were performed in the affected eye. Her visual acuity remains 6/6 in both eyes. Retinal pigment epithelial detachment is a possible complication of radiation therapy in non-Hodgkin's lymphoma with intraocular metastasis. It is essential to alert the managing ophthalmologists about this rare complication.