AIM: To report a case of postoperative uveitis secondary to syphilis in an elderly patient.METHODS:A 76-year-old Malay man, a case of bilateral immature cataract underwent uneventful right phacoemulsification. There was no history of uveitis before. On day 5 post operation, he developed sudden onset of vision blurring in the right eye. Examination showed generalized cornea edema with moderate anterior chamber reaction and increased intraocular pressure.RESULTS: The patient responded well to topical antibiotic and steroid. The intraocular pressure was controlled with anti-glaucoma agent. However, the patient developed similar episode of pain, redness and poor vision in the same eye after 3 weeks. Ocular examination revealed severe anterior uveitis with presence of mutton fat keratic precipitates. Venereal disease research laboratory (VDRL) and treponema pallidum hemagglutination assay (TPHA) were positive suggesting syphilis. The condition improved markedly with benzathine penicillin injection and topical steroid.CONCLUSION:This case illustrates syphilis as an under-recognized cause of postoperative uveitis in the elderly. Appropriate management with penicillin has showed rapid and remarkable outcome.

AIM: To report a rare case of optic perineuritis secondary to syphilis infection with severe visual loss showing a dramatic improvement following treatment with corticosteroids.METHODS: Case report.RESULTS: A 66-year-old Malay lady presented to us with sudden onset of unilateral loss of vision and pain on eye movement. Her vision had no perception of light and marked relative afferent pupillary defect (RAPD) was present over the right eye. Serological and radiological investigation showed evidence of syphilitic optic perineuritis. She was treated with intramuscular benzathine penicillin and intravenous methyl prednisolone, followed by oral steroid with tapering dose for long period. Her visual acuity improved remarkably after the treatment. She regained the vision of 6/18 and there was no sign of recurrence or steroid related side effects during 4 months follow-up.CONCLUSION: Accurate diagnosis and prompt treatment of this case has converted a poor vision to a better visual outcome.

This a case report on a rare case of denial of visual perception termed as inverse Anton syndrome. It is a rare extension of perception without awareness in which, specific brain lesions affected a patient’s visual abilities. A 66-year-old Malay gentleman presented with sudden onset of the painless bilateral total loss of vision with expressive aphasia for 2 days. His visual acuity was 6/12 in the right eye and 6/48 in the left eye. However, he was insistent that he could not see but did not request any form of assistance for his blindness. He also had neurological signs suggestive of parietal lobe syndrome. Brain imaging showed subacute left middle cerebral artery territorial infarct with no occipital lobe involvement. The denial of visual perception by this patient may be explained by a disconnection of parietal lobe attentional systems from visual perception