A 33-year-old man presented with a four-day history of redness and blurring of vision of the right eye. A clinical diagnosis of adenoviral keratitis was made with a differential of microsporidia epithelial keratitis. The patient subsequently developed nummular keratitis which was resistant to topical steroids. He continued to develop multiple recurrences of the condition. Treatment with tacrolimus ointment was started as the patient had an elevated intraocular pressure due to prolonged steroid use. Tacrolimus ointment showed a favourable outcome in the management of recurrent nummular keratitis.

A 42-year-old gentleman presented with left eye pain after accidental contact with Euphorbia lactea sap while gardening. At presentation, left eye best-corrected visual acuity (BCVA) was 20/30. Ocular examination revealed left eye conjunctiva congestion and cornea abrasion. Eye symptoms and BCVA deteriorated over 12 hours. Cornea showed diffuse stromal oedema with presence of anterior uveitis. A diagnosis of toxic keratouveitis was made. He was treated with intensive topical steroids, cycloplegics, lubricants, prophylactic antibiotics and oral non-steroidal anti-inflammatory analgesic. Patient achieved complete resolution two weeks later. We aim to raise awareness among the ophthalmologists to detect and manage these injuries.

The existing shortage of local donor corneas in our institution (University Malaya) and Malaysia, in general, prompted us to attempt the use of one donor cornea for two transplantation procedures; Descemet Stripping Endothelial Keratoplasty (DSEK) in a case of a pseudophakic bullous keratopathy (PBK) with underlying Fuchs endothelial dystrophy (FED) and lamellar patch graft in a case of limbal dermoid. The donor cornea was divided into anterior and posterior lamellae manually. The anterior corneal button was used as a patch graft for anterior lamellar keratoplasty in a 6-year-old patient with limbal dermoid, and the posterior corneal button was used for a DSEK procedure in a 68-year-old patient with corneal decompensation. Both patients had a stable and good visual outcome throughout a 1-year postoperative period. This allows the use of one corneal tissue by more than one recipient to overcome the shortage in donor corneas.
Transplants

Purpose: A clinical audit to establish whether eye doctors achieve the benchmark in reminding glaucoma patients about the dangers of driving. After introducing two simple interventions, a follow-up audit was performed. Methodology: Initially, we interviewed 85 patients with established glaucoma who underwent Humphrey visual field (HVF) testing and also reviewed their medical notes. We looked for documentation of their driving status, specifically whether those with bilateral visual field (VF) defects recalled being given advice about the dangers of driving and whether this was documented in the notes. After this initial audit, doctors were educated on the availability of guidelines on visual requirements for driving, and reminder adhesive labels were put on the front of medical notes of driving glaucoma patients. A follow-up audit was then performed on 95 different patients. Results: In the initial audit, none of the patients had their driving status recorded. Only 36% of drivers with bilateral VF defects recalled being advised of the dangers of driving, with no documentation of whether the advice was given to them. Following the interventions, documentation of driving status became 86%. All drivers with bilateral VF defects recalled being advised regarding the dangers of driving, with documentation of the advice being given recorded in 73% of the medical notes. Conclusion: Eye doctors are inadequately identifying, advising, and documenting the dangers of driving in the medical notes of glaucoma patients with bilateral VF defects. This can be improved with simple interventions, such as the education of doctors and creating reminder labels, for the benefit of our glaucoma patients.