Case Series and Review Article: Perfluorocarbon Heavy Liquid as a Short-Term Tamponade after Vitrectomy for Inferior Rhegmatogenous Retinal Detachment This is to report outcomes of three cases with inferior rhegmatogenous retinal detachment (RRD) which were treated with vitrectomy and perfluorocarbon heavy liquid (PFCHL) insertion as short-term tamponade. We also aim to summarise the surgical outcomes and complications from the recent studies in PFCHL usage in vitrectomy surgeries. The mean tamponade period for our case series was 11 days. Two patients developed ocular hypertension, while another developed hypotony with subsequent retinal redetachment. Migration to the anterior chamber causing pupillary block glaucoma also occurred in one patient, requiring laser peripheral iridotomy. Previous studies reported that PFCHL is particularly useful for more complex cases of retinal detachment including giant retinal tears, inferior retinal tears, chronic rhegmatogenous retinal detachment (RRD), inferior RRD and proliferative vitreoretinopathy (PVR) due to its unique physical properties. However, it is not recommended as tamponade for long duration due to possible retinal toxicity. Otherwise, most of the complications due to PFCHL can be managed either medically or surgically. PFCHL can be a useful post-operative tamponade agent in vitreoretinal surgeries. Close post-operative monitoring is crucial for the potential complications from PFCHL.

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.

BACKGROUND: Different methods have been used to inject stem cells into the eye for research. We previously explored the intravitreal route. Here, we investigate the efficacy of intravenous and subretinal-transplanted human dental pulp stem cells (DPSCs) in rescuing the photoreceptors of a sodium iodate-induced retinal degeneration model. METHODS: Three groups of Sprague Dawley rats were used: intervention, vehicle group and negative control groups (n = 6 in each). Intravenous injection of 60 mg/kg sodium iodate (day 0) induced retinal degeneration. On day 4 postinjection of sodium iodate, the rats in the intervention group received intravenous DPSC and subretinal DPSC in the right eye; rats in the vehicle group received subretinal Hank’s balance salt solution and intravenous normal saline; while negative control group received nothing. Electroretinogram (ERG) was performed to assess the retinal function at day 0 (baseline), day 4, day 11, day 18, day 26, and day 32. By the end of the study at day 32, the rats were euthanized, and both their enucleated eyes were sent for histology. RESULTS: No significant difference in maximal ERG a-wave (p = 0.107) and b-wave, (p= 0.153) amplitude was seen amongst the experimental groups. However, photopic 30 Hz flicker amplitude of the study eye showed significant differences in the 3 groups (p = 0.032). Within the intervention group, there was an improvement in 30 Hz flicker ERG response of all 6 treated right eyes, which was injected with subretinal DPSC; while the 30 Hz flicker ERG of the nontreated left eyes remained flat. Histology showed improved outer nuclear layer thickness in intervention group; however, findings were not significant compared to the negative and vehicle groups. CONCLUSION Combination of subretinal and intravenous injection of DPSCs may have potential to rescue cone function from a NaIO3 -induced retinal injury model.

BACKGROUND: Different methods have been used to inject stem cells into the eye for research. We previously explored the intravitreal route. Here, we investigate the efficacy of intravenous and subretinal-transplanted human dental pulp stem cells (DPSCs) in rescuing the photoreceptors of a sodium iodate-induced retinal degeneration model. METHODS: Three groups of Sprague Dawley rats were used: intervention, vehicle group and negative control groups (n = 6 in each). Intravenous injection of 60 mg/kg sodium iodate (day 0) induced retinal degeneration. On day 4 postinjection of sodium iodate, the rats in the intervention group received intravenous DPSC and subretinal DPSC in the right eye; rats in the vehicle group received subretinal Hank’s balance salt solution and intravenous normal saline; while negative control group received nothing. Electroretinogram (ERG) was performed to assess the retinal function at day 0 (baseline), day 4, day 11, day 18, day 26, and day 32. By the end of the study at day 32, the rats were euthanized, and both their enucleated eyes were sent for histology. RESULTS: No significant difference in maximal ERG a-wave (p = 0.107) and b-wave, (p= 0.153) amplitude was seen amongst the experimental groups. However, photopic 30 Hz flicker amplitude of the study eye showed significant differences in the 3 groups (p = 0.032). Within the intervention group, there was an improvement in 30 Hz flicker ERG response of all 6 treated right eyes, which was injected with subretinal DPSC; while the 30 Hz flicker ERG of the nontreated left eyes remained flat. Histology showed improved outer nuclear layer thickness in intervention group; however, findings were not significant compared to the negative and vehicle groups. CONCLUSION Combination of subretinal and intravenous injection of DPSCs may have potential to rescue cone function from a NaIO3 -induced retinal injury model.

Steroid-induced glaucoma is the most serious complication of the injudicious use of steroids, particularly among children affected by allergic conjunctivitis. This condition is steroid-dependent, and children are commonly being prescribed topical anti-inflammatories, including topical steroids, by general practitioners. Furthermore, topical steroids are also available over the counter, and this availability contributes to overuse without proper monitoring by an ophthalmologist. We present a series of five cases illustrating the devastating effect of unmonitored, long-term use of steroids among children for vernal keratoconjunctivitis. The medications were prescribed initially by general ophthalmologists and were continually bought over the counter by parents. At the presentation to our center, these patients were already compromised visually, exhibiting glaucomatous optic disc changes and high intraocular pressure. The series highlights the optic nerve damage resulting in irreversible visual compromises among children on long-term, topical steroids and the importance of regular monitoring with a low threshold for ophthalmologist referral.

Traumatic middle meningeal arteriovenous fistula with sphenoparietal sinus involvement is very rare. It is usually associated with skull fracture and intracranial hemorrhage. Ocular manifestation as sole presentation is extremely rare and only a few cases have been reported. We report a case of traumatic middle meningeal arteriovenous fistula with sphenoparietal sinus involvement 2 months after head trauma, presenting with left eye redness and dilated corkscrew episcleral vessel. CT scan showed venous out flow disturbance of the cavernous sinus with dilated ophthalmic veins. Transarterial endovascular embolisation of the fistula was done successfully; clinical and 6 months MRA resolution was noted. In conclusion, patient with traumatic middle meningeal arteriovenous fistula into the sphenoparietal sinus can present solely with subtle ocular symptoms. Transarterial endovascular embolisation is an effective procedure to close the fistula as seen in this case
Arteriovenous Fistula

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