We report a case of a middle-aged gentleman with recalcitrant macular oedema (RMO) secondary to ischaemic central retinal vein occlusion (CRVO). He was given six injections of intravitreal ranibizumab (anti-VEGF) monthly. However, his visual acuity (VA) deteriorated and the macular oedema worsened. He then received an intravitreal dexamethasone implant eight months post-CRVO. His VA and macular oedema improved dramatically and significantly at first follow-up and remained stable at six months after implant. This case can be a reference for those who treating recalcitrant macular oedema. It shows the effect of an intravitreal dexamathasone implant might have in a patient with RMO due to CRVO. The patient enjoyed improvement of vision, with clinical evidence of reduction in central macular thickness (CMT) and with no serious adverse events after a single injection up to six months post implant.

A 28-year-old Malay woman presented with severe loss of vision in both eyes associated with periocular pain on eye movement. She was completely blind at presentation and examination showed optic discs swelling. Optic nerve imaging showed ‘doughnut sign’, characteristic of optic perineuritis. Steroid was given over six months. Visual function improved gradually and was maintained at one year follow-up. This case highlights the importance of differentiation between optic neuritis and optic perineuritis as visual recovery depends on prolonged management with corticosteroid in optic perineuritis.

A 28-year-old Malay woman presented with severe loss of vision in both eyes associated with periocular pain on eye movement. She was completely blind at presentation and examination showed optic discs swelling. Optic nerve imaging showed ‘doughnut sign’, characteristic of optic perineuritis. Steroid was given over six months. Visual function improved gradually and was maintained at one year follow-up. This case highlights the importance of differentiation between optic neuritis and optic perineuritis as visual recovery depends on prolonged management with corticosteroid in optic perineuritis.
Optic Neuritis