Wound healing is a complex process that includes haemostasis and inflammation, followed by a proliferation period and repair and finally remodelling. Ocular surgeries, particularly in glaucoma cases, aim at minimal fibrosis to preserve the function of trabeculectomy as an alternative pathway for aqueous drainage. Hence, it is important to find an agent to modulate the wound healing process. This review presents compilation of wound modulation agents that have been tested in vitro, in vivo, or clinically on patients undergoing ocular surgeries, particularly for glaucoma. We identified agents into four groups, mostly for glaucoma filtration operations: anti-metabolites, anti-growth factors, mechanical barriers and rho kinases. The effect of these agents is highlighted in this review. In conclusion, despite recognized drawbacks of antimetabolites, they are still regarded as the gold standard and the most efficient treatment as anti-scarring agents use in ocular surgeries. More studies are needed to inquire agents that efficient yet has minimal adverse effects both in short and long term.

Introduction: Vascular dysregulation is postulated to be involved in the pathogenesis of primary open angle glaucoma (POAG). Systemic arterial stiffness may accelerate the pre-existing damage. The purpose of this study was to determine the association of arterial stiffness with severity and progression of visual field in Malay patients with POAG. Methods: A cross-sectional study was conducted with 55 patients with POAG and 55 age- and sex-matched control subjects. The patients with POAG were further divided in accordance with their Advanced Glaucoma Intervention Study (AGIS) scores on their visual fields (VFs) (mild in 23 patients, moderate in 18, and severe in 14). Progression was defined as the worsening of the VF defect quantified as an increase in AGIS score of 4 points from the baseline. Arterial stiffness was measured using SphygmoCor and quantified as pulse wave analysis (PWA) and pulse wave velocity (PWV). Results: No significant differences in PWA and PWV were found between the patients with POAG and the control subjects (p=0.333 and p=0.443, respectively). The mean follow-up duration for the patients with POAG was 4.7±3.1 years. PWA and PWV showed no significant association with POAG severity after the confounding factors were controlled for. Ten patients with progression of VF were identified. In the analysis of covariance, a significantly higher PWV was found in the patients with disease progression (p=0.036). Conclusion: VF severity and progression were not associated with systemic arterial stiffness. The probable reason is that other factors affecting retinal microcirculation may play a larger role in the severity and progression of POAG.

Background: A diagnosis of ankylosing spondylitis (AS) is challenging and often delayed despitebpatients being symptomatic. Low back pain is the most common initial symptom, appearing in the second and third decades of life. Acute anterior uveitis (AAU) occurs much later in the course of the disease, often when the destruction of the spine is already debilitating. Objective: Here, we report three cases of AS that were diagnosed after the patients developed AAU. Methods: A case series illustrated AAU leading to the diagnosis of AS years after the initial episode of low back pain. A comparison of the clinical presentation, diagnosis, and outcomes was also illustrated. Result: We report three cases of acute anterior uveitis (AAU)-associated AS diagnosed only after many visits to the primary health care provider with the complaint of chronic low back pain. All three patients had irreversible radiological changes upon diagnosis of AS. The AAU resolved with topical steroids, and one patient developed cataract. Conclusion: A high index of suspicion of AS in a young adult with chronic back pain before the development of AAU may prevent further functional loss and provide a better prognosis. Diagnosis of AS following AAU is not only associated with dependency but also may rob the vision of a young adult.

Introduction: Precise pupillometry is crucial to determine ablation optical zone (OZ) size selection in LASIK. Significant difference in the selection induces unwanted postoperative night visual disturbance. Placido-disc topographer and Hartmann-Shack aberrometer are commonly used in LASIK preoperative assessment. However, little is known on the precision and agreement of these devices in pupillometry. Hence, this study aimed to evaluate the precision (repeatability and reproducibility) and inter-device agreement of a Placido-disc topographer and Hartmann-Shack aberrometer in measuring mesopic pupil size in pre-LASIK patients. Methods: Mesopic pupillometry on 38 pre-LASIK patients were performed using both devices by two masked operators, on two separate sessions. Intra-session repeatability, inter-operator reproducibility and inter-device agreement were analysed. A disagreement value of ±0.5 mm and 95% limits of agreement (LoA) were determined. Results: Hartmann-Shack aberrometer demonstrated higher repeatability and reproducibility than Placido-disc topographer in mesopic pupillometry. Ninety-seven percent and all of Hartmann-Shack wavefront aberrometer pupillometry were within ±0.5 mm in repeated sessions and between the operators, respectively. The mesopic pupil size obtained from Placido-disc topographer was significantly larger than Hartmann-Shack aberrometer results (P = 0.02). The agreement between devices was low (LoA > ±1 mm) and only 53% of Placido-disc topographer pupillometry were within ±0.5 mm of Hartmann-Shack aberrometer pupillometry. Conclusion: Hartmann-Shack aberrometer has higher precision within sessions and between operators, and it provides smaller mesopic pupillometry than Placido-disc topographer. Precise mesopic pupillometry could assist refractive surgeons in choosing a correct ablation OZ size during LASIK surgery to improve postoperative outcome.

Herpes zoster optic neuropathy (HZON) is a rare manifestation of herpes zoster ophthalmicus (HZO). It is a potentially blinding condition. We report a case of an immunocompetent patient with HZON following keratouveitis during the course of treatment. A 33-year-old gentleman presented with left eye (LE) worsening of visual acuity (6/9 reduced to 6/24) despite on treatment for HZO keratouveitis. It was associated with pain on ocular movement and central scotoma. He was on systemic acyclovir and topical corticosteroids prior to current complaint. Fundoscopy showed left optic disc swelling with impaired optic nerve functions. Diagnosis of left optic neuritis secondary to HZO was established in view of close temporal relationship with occurrence of cutaneous herpes zoster. Systemic corticosteroids was commenced. The patient had obtained good visual outcome at two months. Early referral for ophthalmology assessment is crucial to establish diagnosis of HZON and prompt initiation of treatment may preserve vision.

Introduction: Age-related macular degeneration (ARMD) is an ocular degenerative disorder that associated with impairment of central vision. Oxidative stress plays an important role in the pathogenesis of ARMD. The aim of this study was to determine the level of antioxidant enzymes (catalase and glutathione peroxidase) in tears among Malay ARMD patients. Methods: A cross sectional study was conducted between September 2015 and November 2017 among Malay ARMD patients. Schirmer paper was used to collect the tear samples. The level of catalase and glutathione peroxidase level in tears was evaluated using commercially available oxidative stress marker kits. Results: A total of 136 Malay ARMD patients were recruited into the study with 68 controls. Mean tear catalase and glutathione peroxidase levels were significantly lower in ARMD patients (1348.97 SD 109.11 µM and 453.87 SD 41.96 U/L respectively) as compared to the control group (1453.38 SD 38.87 µM and 502.28 SD 34.29 U/L respectively) (P<0.001 and P<0.001 respectively). Late ARMD has lower mean of catalase level in tears as compared to early ARMD (P=0.044). Based on subtypes of neovascular late ARMD, neovascular ARMD has lower mean catalase level in tears compared to idiopathic polypoidal choroidal vasculopathy (IPCV) (P=0.031). Conclusion: This study showed that antioxidant enzyme might play an important factor in the pathogenesis of ARMD.

Introduction: There is limited knowledge on primary angle closure (PAC) in Malays. Understanding the clinical presentation and progression of PAC in Malays is important for prevention of blindness in Southeast Asia. Material and methods: A retrospective record review study was conducted on Malay patients seen in the eye clinic of two tertiary hospitals in Kelantan, Malaysia. Based on the available data, Malay patients re-diagnosed as primary angle closure suspect (PACS), primary angle closure (PAC), and primary angle closure glaucoma (PACG) based on the International Society Geographical Epidemiological classification. Clinical data was collected from initial presentation including the presence of acute primary angle closure until at least 5 years follow up. Progression was defined based on gonioscopic changes, vertical cup to disc ratio (VCDR), intraocular pressure (IOP) and Humphrey visual field (HVF) analysis. Progression and severity of PACG was defined based Hodapp-Parrish-Anderson classification on reliable HVF central 24-2 or 30-2 analysis. Results: A total of 100 patients (200 eyes) with at least 5 years follow up were included. 94 eyes (47%) presented with APAC. During initial presentation, 135 eyes (67.5%) were diagnosed with glaucomatous changes with 91 eyes already blind. After 5 years of follow up, 155 eyes (77.5%) progressed. There was 4 times risk of progression in eyes with PAC (p=0.071) and 16 times risk of progression in PACG (p=0.001). Absence of laser peripheral iridotomy was associated with 10 times the risk of progression. Conclusion: Angle closure is common in Malays. Majority presented with optic neuropathy at the initial presentation and progressed further. Preventive measures including promoting public awareness among Malay population is important to prevent blindness.

Objective: To compare the clinical presentation, severity and progression of primary angle closure between Chinese and Malays residing in Malaysia. Methods: A comparative retrospective record review study was conducted involving one hundred (200 eyes) Malay and fifty eight (116 eyes) Chinese patients. They were selected from medical records of Hospital Universiti Sains Malaysia, Kelantan and Hospital Pulau Pinang, Penang, Malaysia. The selected patients were re-diagnosed based on the International Society of Geographical and Epidemiological classification. The clinical data on presentation including the presence of systemic diseases were documented. Progression of the disease was based on available reliable visual fields and optic disc changes of patients who have been on follow-up for at least five years. Results: Malay patients presented at older age (61.4 years SD 8.4) compared to Chinese (60.6 years SD 8.3). There was significant higher baseline Intraocular Pressure (IOP) among Malays (34.7 SD 18.5mmHg) compared to Chinese (30.3 SD 16.7mmHg) (p=0.032). The Chinese patients presented with significantly better visual acuity (p<0.001) and less advanced cup to disc changes (p=0.001) compared to Malays. Malay patients progressed faster than the Chinese. Majority progressed within 1 year of diagnosis. Malays without laser peripheral iridotomy (LPI) have a 4 fold (95% CI 1.4, 10.9) risk of progression. Higher baseline IOP, more advanced visual field defect and absence of LPI was identified as significant predictors associated with progression. Conclusion: The Malays presented with more advanced angle closure glaucoma as compared to the Chinese in Malaysia. Aggressive disease progression was observed in Malays with the onset of optic neuropathy. Effective public awareness and aggressive management is important to prevent blindness in the Malaysian population.

There are limited data in the literature on the optic disc topography in normal tension glaucoma (NTG) patients in Asian countries, especially in Southeast Asia. This study is aimed at comparing optic disc topography in NTG patients and a control group in Malaysia, and we discuss the literature on NTG studies in other Asian populations. A comparative cross-sectional study was conducted in two hospitals with glaucoma services in Malaysia from November 2010 to February 2012. A total of 109 eyes of 109 Malay patients were included in this study: 32 NTG patients and 77 subjects in the control group. All participants underwent a thorough ocular examination, including visual acuity, subjective refraction, anterior segment and fundus examinations, Humphrey visual field 24-2, intraocular pressure measurement, gonioscopy examination and fundus photography. Optic disc topography was assessed using the Heidelberg Retinal Tomograph III by an identified masked investigator in each hospital. NTG patients had a notably larger disc area (2.65 (0.41) vs 2.19 (0.43) mm(2), respectively), larger cupping (1.54 (0.43) vs 0.63 (0.40) mm(2), respectively), smaller retinal rim areas (1.12 (0.41) vs 1.56 (0.33) mm(2), respectively), higher cup volume (0.47 (0.28) vs 0.11 (0.19) mm(3), respectively), reduced rim volume (0.23 (0.13) vs 0.41 (0.16) mm(3), respectively), higher cup to disc area ratio (0.58 (0.14) vs 0.27 (0.15), respectively), higher linear cup to disc ratio (0.76 (0.09) vs 0.49 (0.17) mm(2), respectively), higher mean cup depth (0.37 (0.09) vs 0.22 (0.09) mm, respectively), higher maximum cup depth (0.77 (0.16) vs 0.59 (0.20) mm, respectively), higher mean of cup shape measure (-0.04 (0.06) vs -0.16 (0.07), respectively), and thinner mean retinal nerve fibre layer thickness (0.15 (0.15) vs 0.24 (0.07) mm, respectively) compared to the control group (p<0.05). In conclusion, most of the optic disc parameters were significantly different in NTG patients compared to healthy individuals in Malaysia. Our findings are comparable to those reported in NTG studies in other Asian countries.