High dose steroid and acute visual loss: case report and discussion on acute central serous chorioretinopathy in elderly

Central serous chorioretinopathy (CSCR) is one of sight-threatening side effects of systemic steroids. Although it is uncommon, CSCR seriously threatens the patient’s vision and it has the potential for permanent visual morbidity. This article reports about a 54-year-old Malay gentleman who developed central vision loss after received a course of oral prednisolone 50 mg/day for a month period for the treatment of multifocal motor neuropathy. His vision recovered 1 year after cessation of steroid as the CSCR resolved. However, subjectively the visual quality is poor. Steroids in any route of administration can induce CSCR and it must be used with precaution especially in the elderly. Although resolutions are usually spontaneous after cessation of steroid, chronic and recurrent CSCR can lead to irreversible visual impairment. Judicious use of systemic steroids, early detection and prompt co-management with the treating physician can help prevent permanent visual disturbance

Comparison of non-mydriatic fundus photography and optical coherence tomography with dilated fundus examination for detecting diabetic retinopathy including diabetic macular edema

Given increasing diabetes rates worldwide, better screening tools for diabetic retinopathy (DR) and macular edema (DME) are needed. The study aim was to compare reliability and predictive values between non-mydriatic fundus photography (NMFP) and spectral-domain optical coherence tomography (OCT) for detection of DR and DME with dilated fundus examination (DFE). This was a non-interventional, comparative study. Diabetics underwent both NMFP and macula OCT, followed by DFE. Images were interpreted by two masked ophthalmologists. The DFE result was considered gold standard. One hundred and fifty-four eyes of 83 patients were recruited. Sensitivity of NMFP for DR was 77.3% and 80.3% for OCT. Specificity for NMFP was 81.8% and 55.7% for OCT. Area under Receiver Operating Characteristics Curve (AROC) for DR was 0.80 for NMFP and 0.68 for OCT. The sensitivity of NMFP for DME was 63.2% and 82.5% for OCT. Specificity for DME was 90.1% by NMFP and 61.5% for OCT. Positive predictive value (PPV) of NMFP and OCT for DR was 76.1% (95% CI: 63.9-85.3%) and 57.6% (46.8-67.7%), respectively. Negative predictive value (NPV) of NMFP and OCT was 82.7% (95% CI: 72.8-89.7%) and 79.0% (66.4-87.9%) respectively. Positive predictive value of NMFP and OCT for DME was 80.0% (95% CI: 67.6- 88.5%) and 57.3% (45.9-68.0%), respectively. Negative predictive value of NMFP and OCT was 79.6% (95% CI:70.3 - 86.7%) and 84.8% (95% CI:73.4 - 92.1%), respectively. Eyes with normal OCT miss 21% of DR. In conclusion, NMFP is better than OCT for DR screening, while OCT is better than NMFP and DFE for detection of DME. Both modalities should be for better DR screening

Hormone Replacement Therapy and Dry Eye in Post Menopausal Women: Study in a Tertiary Centre in Malaysia

Background: Menopause involves decrease in the body estrogen level. There are many disorders associated with estrogen deficiency state. Postmenopausal women frequently report dry eye symptoms due to the decrease in the level of circulating estrogen hormone. Hormone replacement therapy (HRT) is given to alleviate some of the menopausal effects. This study aimed to compare the tear production between postmenopausal women treated with or without HRT.Methods: This cross-sectional study was performed on 140 participants attending various clinics in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) namely the obstetric and gynecology, Surgery, Orthopedic and Otorhinolaryngology clinics over a period of 3 months. The subjects were either with or without HRT. Schirmer’s Test strip was used to measure the tear quantity. Dry eye was defined when the length of the moistened area on the strip is less than 5 mm.Results: The results showed significant difference in tear quantity in postmenopausal women treated with or without HRT (p=0.003). No correlation was observed between tear quantity and duration of HRT consumption (p=0.217). No significant correlation was also found between the tear quantity and duration of menopause (p=0.150).Conclusions: Our results suggested that HRT helps in improving tear production in postmenopausal women regardless of the duration of HRT consumption or menopause. However, duration of HRT consumption or menopause exert no significant effect on the tear quantity