Enhancing Visual Outcomes and Patients’ Satisfaction: A Case Series of Mix-and-Match Approach for Unhappy Presbyopic Patients Post-Cataract Surgery This case series explored the mix-and-match approach of implanting an extended depth of focus (EDOF) intraocular lens (IOL) in the fellow eye to improve visual outcomes, reduce spectacle dependence, and enhance satisfaction in presbyopic patients dissatisfied with monofocal IOL outcomes, highlighting personalised refractive solutions for suboptimal results post-cataract surgery. Seven patients dissatisfied with post-operative presbyopia following monofocal IOL in first eye received EDOF IOL in the second eye (mix-and-match approach). Visual outcomes were assessed using a logMAR chart for near (40 cm), intermediate (60 cm and 80 cm) and distance (6 m) visual acuity (VA). Contrast sensitivity was measured using the Pelli-Robson chart, and halos and glare were evaluated with the Zeiss Halo and Glare Stimulator. Patient satisfaction was measured using the CATQUEST-9SF 2011 questionnaire before and after EDOF IOL implantation in the second eyes. Results showed statistically significant improvement in uncorrected near VA at 40cm and intermediate VA at 60cm in eyes with EDOF IOL (0.26 ± 0.18 and 0.11 ± 0.15 respectively) compared to eyes with monofocal IOL (0.64 ± 0.28 and 0.39 ± 0.26 respectively), while maintaining good uncorrected distance VA. Only one patient reported halos with the EDOF IOL, not affecting night driving. Contrast sensitivity showed no significant difference between monofocal IOL (1.60 ± 0.14) and EDOF IOL (1.60 ± 0.17) eyes. All patients were satisfied, experiencing improvements in recognised faces, walking on uneven surfaces, reading newspapers and TV subtitles, engaging in hobbies and seeing price tags. This mix-and-match approach demonstrated efficacy in enhancing near and intermediate vision while maintaining good distance vision, offering a personalised solution to reduce spectacle dependence without compromising contrast sensitivity or causing significant halos and glare.

Duration after Macular Hole Surgery for Stabilisation of Visual Acuity: A Long-term Retrospective Review The purpose of the study is to determine the median duration for visual recovery to achieve visual stability and visual acuity gain after macular hole surgery in our local population. This was a retrospective study. Patients with full-thickness macular holes (FTMH) from surgical logs were included between January 2009 and December 2019. The patients' medical records were reviewed for pre-, intra-, and post-operative data collection. Patients who fulfilled the inclusion and exclusion criteria were recruited and analysed. Data collected from the medical record pre-operatively, which included baseline best corrected visual acuity (BCVA), interval of symptoms development to surgery, any ocular co-morbidities, optical coherence tomography (OCT) for size and stage of macular hole and central subfield thickness (CST). Intra-operative notes included whether vitrectomy with or without phacoemulsification and with the internal limiting membrane (ILM) peel or ILM flaps, types of dye, and tamponade agent used. Post-operative data included BCVA and CST on each visit, types of macular hole closure, or any complications. Data were analysed using SPSS.Thirty-one patients were diagnosed with FTMH. Sixteen patients who underwent pars plana vitrectomy (PPV) were included and analysed. Fifteen patients (93.75%) achieved successful macular hole closure after the primary operation. The median duration BCVA reached at stability was 19.5 months (IQR 9 – 26.25), and visual acuity gained by 0.44 LogMAR (IQR 0.165 – 0.565). Ten patients (62.5%) underwent combined PPV with phacoemulsification. CST showed improvement from baseline, 444 (IQR 347.5 – 519.75) to 273 (IQR 232 -285.5), 230 (IQR 221.5-255), and 270 (IQR 254-322) at the period interval of 0 to 3 months, 3 to 6 months, and 6 to 12 months respectively. Gas C3F8 and membrane blue were commonly used as tamponade agents and dyes, and PPV with ILM peel was the common surgery performed. Six patients (40%) achieved type 1 macular hole closure within 12 months of follow-up. Despite the small sample size, our study provided practical information regarding patient’s expectations of when their vision can become stable after macula hole surgery in our local population.

Oh No! I Can’t See Well after Taking a Hot Shower! This was to report a case of a 33-year-old Malay woman who was previously diagnosed with seronegative neuromyelitis optica spectrum disorder ten years ago based on her clinical presentation, and magnetic resonance imaging (MRI) of the spine showed a long segment of the intramedullary lesion. Her diagnosis was revised to relapsing-remitting multiple sclerosis (RRMS) when she had recurrent optic neuritis with an MRI showing juxtacortical and periventricular lesions. She was started on disease-modifying treatment and was well for six years until she noticed left eye central blurred vision, especially after taking hot showers or exposure to hot weather. Ophthalmological examination revealed left eye visual acuity 6/9 with a relative afferent pupillary defect. Humphrey's visual field also showed left centrocecal scotoma. She was treated with intravenous methylprednisolone with tapering oral prednisolone, which resulted in improvement of the left central scotoma, and her visual acuity reverted to baseline.