A 62-year-old man presented with severe bilateral ocular surface chemical injury and history of failed penetrating keratoplasty of right eye in 1996. Visual acuity was hand movement in right eye and light perception in left eye. Staged procedures of limbal stem cells allograft followed by penetrating keratoplasty have been done and resulted in good ocular surface restoration and rehabilitation of vision in right eye.

AIM: To report the involvement of extraocular muscles in a patient with for a month. Ocular examination revealed right sided superior oblique and inferior rectus palsy or superior rectus restriction. Investigation with CT however revealed superior rectus thickening with surrounding pansinusitis. Drainage of ethmoid sinus and superior rectus recession was done to relieve the diplopia.required to relieve residual diplopia following surgical drainage.

·AIM: To evaluate the clinical manifestations and visual outcome of syphilitic uveitis patients. ·METHODS: Case series of three patients with syphilitic uveitis were managed in Hospital USM.·RESULTS: Three patients were diagnosed to have uveitis secondary to syphilis. All three patients were not known to have syphilis prior to presentation but had positive history of sexual promiscuity.Allpatients presented with progressive blurring of vision for average of one-month duration. Two of them had association with fever,ocularpainandfloaters.Visualacuityat presentation ranged from 6/12 to hand movement. Mild anterioruveitis( non-granulomatous),vitritisand papillitis were present in all the patients. First patient had multifocal chorioretinitis with exudative retinal detachment. The second patient presented with exudative retinaldetachmentwhilethethirdpatienthad chorioretinitis only. All the patients were treated with intramuscular benzyl-penicillin 2.4 MU weekly for 4 weeks and two of them received oral doxycycline 200mg twice daily for 3 months. The uveitis responded well to the treatment and two of them showed dramatic visual improvement from 6/120 to 6/21 and 6/12 to 6/6. The one with worse outcome was confirmed to have positive retroviral.·CONCLUSION: Ocular syphilis presented here as non granulomatous inflammation associated with exudative retinal detachment, Final visual outcome is generally good despite slow improvement after treatment.

A 63-year-old male presented with sudden diminution of vision, eye discomfort, redness and watering in his left eye. He had undergone glaucoma valve filtering surgery for refractive secondary glaucoma one week back. He also had a history of failed augmented trabeculectomy one year earlier in the same eye. Ocular examination showed best corrected visual acuity(BCVA) of 6/18 and there was a bleb leak, shallow anterior chamber and intraocular pression(IOP) of 6mmHg. Successful sealing of bleb leak was performed using fibrin glue resulted in deepening of anterior chamber with IOP of 13mmHg. This case demonstrates that, fibrin glue is an effective method for management of early filtering bleb leak.

A 24 year-old Malay lady presented with high grade fever, myalgia, generalized rashes, severe headache and was positive for dengue serology test. Her lowest platelet count was 45 × 10(9) cells/L. She complained of sudden onset of painlessness, profound loss of vision bilaterally 7 days after the onset of fever. On examination, her right eye best corrected vision was 6/30 and left eye was 6/120. Her anterior segment examination was unremarkable. Funduscopy revealed there were multiple retinal haemorrhages found at posterior pole of both fundi and elevation at fovea area with subretinal fluid. Systemic examination revealed normal findings except for residual petechial rashes. She was managed conservatively. Her vision improved tremendously after 2 months. The retinal hemorrhages and foveal elevation showed sign of resolving. Ocular manifestations following dengue fever is rare. However, bilateral visual loss can occur if both fovea are involved.
Dengue ; complications ; diagnosis ; Female ; Fovea Centralis ; pathology ; Humans ; Macula Lutea ; pathology ; Retinitis ; diagnosis ; etiology ; Vision Tests ; Young Adult

RetCam is an excellent screening tool for the detection of retinopathy of prematurity (ROP). However, affordability is a barrier when adopting the use of RetCam in developing countries. We aimed to describe different stages of ROP using ultrasonographic B-scan and to evaluate the association between funduscopic examinations and ultrasonographic B-scan findings in premature neonates with ROP in Malaysia. A descriptive cross sectional study was conducted in 90 eyes of 47 premature neonates with different stages of ROP in three tertiary hospitals in Malaysia. Experienced ophthalmologists performed detailed funduscopic examinations using binocular indirect ophthalmoscopy (BIO). A masked examiner performed a 10 MHz ultrasonographic B-scan evaluation with 12 meridian position images within 48 hours of clinical diagnosis. Data from the clinical examination and ultrasonographic findings were collected and analysed. We recruited 37 eyes (41.1%) with stage 1 ROP, 29 eyes (32.3%) with stage 2, 18 eyes (20.0%) with stage 3, and 3 eyes (3.3%) with stages 4 and 5 based on the clinical assessment. Ultrasonography correctly identified 3 (8.1%) stage 1 eyes, 17 (58.6%) stage 2 eyes, 13 (72.2%) stage 3 eyes, and 3 each (100%) of the stage 4 and 5 eyes. There was a significant association between the funduscopic signs and the ultrasound findings for stage 2 ROP and above (Fisher’s exact test, p <0.001). In conclusion, all stages of ROP were detected and described with a 10 MHz ultrasonic B-scan system. A significant association was observed between funduscopic signs and ultrasonographic findings in premature Malaysian neonates with stage 2 ROP and above.

AIM:To evaluate if early ethambutol toxicity can be detected by comparing pre-and post-treatment anatomical and visual function using retinal nerve fiber thickness,pattern visual evoked potentials and conventional optic nerve function tests.METHODS:This was a prospective study involving 72 eyes of 36 patients treated with ethambutol according to directly observed treatment short-course(DOTS) strategy in Hospital Universiti Sains Malaysia,Kelantan,Malaysia.The visual acuity and optic nerve function tests were performed by a single investigator.Likewise,Humphrey automated perimetry,optical coherence tomography (OCT) measurement of the retinal nerve fibre layer (RNFL) and pattern visual evoked potential (PVEP) were performed by a single technician.The examinations were performed before initiating ethambutol treatment and 3mo after that.RESULTS:There was no change in visual acuity,colour vision,light brightness,red saturation and fundus findings pre and post ethambutol.However,there was a statistically significant deterioration in the mean deviation of the visual field post treatment (P=0.010).There were also significant changes on OCT and PVEP,with increased RNFL thickness in all quadrants (P＜ 0.05) and PVEP delayed P100 peak latency and amplitude (P＜0.001).CONCLUSION:Ethambutol toxicity is a known complication of tuberculosis treatment.Early detection of this toxicity may prevent severe irreversible visual loss.The use of OCT to detect RNFL thickness and PVEP to assess P100 latency and amplitude can assist in the detection of subclinical anatomical and visual function changes prior to development of abnormalities on conventional optic nerve function tests.