Late retinal redetachment due to proliferative vitreoretinopathy after more than one decade

A 44-year-old Malay lady presented with recent onset of inferior field defect for a week. Vision was 6/18, N18. She gave a history of myopia and two prior retinal detachment surgeries twelve years previously following which the retina was flat. Subsequently, the vision reduced to hand motions as the macula became involved. She then underwent successful re-attachment vitrectomy surgery for rhegmatogenous retinal detachment due to superior retinal breaks in association with proliferative vitreoretinopathy (PVR) Grade B. We share this interesting case of retinal redetachment in a previously vitrectomised eye that was stable during follow up for more than 10 years. This was associated with late onset PVR. Counselling of patients on the symptoms of redetachment due to late onset PVR is mandatory in patients after retinal detachment surgery

Dislocated posterior chamber intraocular lens (PCIOL) in patients with retinitis pigmentosa (RP)

Subluxation or dislocation of PCIOL is one of the complications of cataract operation in RP patients. This paper reports the presentation of PCIOL dislocation and subluxation and the management and outcome in 3 eyes of 2 RP patients. Two medical records of patients with RP who developed dislocated or subluxated PCIOL and subsequently underwent explantation of the dropped IOL were evaluated. Two patients had bilateral eye cataract operation done and had PCIOL implanted. Patient 1 developed left eye subluxated PCIOL inferiorly after 2 years of the cataract operation and right eye dislocated PCIOL anteriorly 4 years after cataract operation. Patient 2 develop right eye subluxated PCIOL inferiorly after 12 years of the cataract operation. Patient 1 with right eye dislocated PCIOL underwent intraocular lens (IOL) explantation and was left aphakic as her visual prognosis was poor due to advanced RP. The left IOL remained within the visual axis despite subluxation and no intervention has been done. Patient 2 with right eye subluxated PCIOL underwent IOL explantation and anterior chamber intraocular lens (ACIOL) implantation. ACIOL remained stable and visual acuity improved post-operation. Both the operations were uneventful. Post-operatively, there was no elevated intraocular pressure and no prolonged ocular inflammation, which required prolonged anti-inflammatory and no retinal detachment was seen. Both patient and surgeon should be aware of potential PCIOL subluxation or dislocation in RP. The presentation may be as late as more than a decade after the cataract operation

Case report: progression of pre-septal cellulitis to orbital subperiosteal abscess despite intravenous broad-spectrum antibiotics in a child

We report a case of a 7-year-old girl who initially presented with painless right eyelid swelling with full extra-ocular movement (EOM). She was treated with intravenous broad-spectrum antibiotics for preseptal cellulitis but her condition worsened. An urgent magnetic resonance imaging (MRI) of the brain and orbit showed orbital abscess, subperiosteal abscess in the medial orbital wall and evidence of sinusitis in the anterior ethmoidal air cells. She underwent Endoscopic Orbital Decompression (EOD) surgery on day 4 of presentation and her condition improved remarkably. We report a case of orbital abscess with subperiosteal abscess in the medial orbital wall. This case highlights the possibility of progression of orbital cellulitis despite administration of a broad-spectrum antibiotic

Exudative retinal detachment and macular hole as a rare sequelae of central vein occlusion

Central retinal vein occlusion (CRVO) is uncommon among young patients. Among the young adults, CRVO tends to be more benign with good visual prognosis. Macular oedema secondary to retinal vein occlusion is a relatively common complication that is currently being treated with intravitreal anti vascular endothelial growth factor with good outcomes. Other complications include lamellar hole,vitreous hemorrhage and neovascular glaucoma. We report a case of central retinal vein occlusion in a young female who presented to us with the complaint of blurring of vision in the left eye for four months. Fundus examination showed hyperemic optic disc, dilated tortuous vein, extensive retinal hemorrhages with macular oedema and an inferior shallow exudative retinal detachment. One month later, intravitreal ranibizumab injection for her macular oedema, a full thickness macular hole developed with reduction of macular oedema. Four months later, the hole spontaneously closed but her macular oedema persisted. The possibility of rare complications like exudative retinal detachment and full thickness macular hole must be kept in mind to ensure early detection and effective management is provided to preserve vision

Spontaneous closure of large base idiopathic full thickness macular hole

Spontaneous closure of idiopathic full thickness macular hole is a rare case as it occurs in only 3.5% while awaiting vitrectomy surgery. There are few pathologies associated with it such as vitreomacular traction (VMT) and posterior vitreous detachment. We report a case in a 74-year-old man who presented with right eye painless, progressive blurring of vision with idiopathic stage 4 full thickness macular hole which was confirmed on optical coherence tomography. It closed spontaneously after sometimes while waiting for surgery. It is important to monitor closely for the possibility of spontaneous closure based on the optical coherence tomography findings

Recurrent orbital cellulitis secondary to the ‘forgotten’ scleral buckle: a case report

Scleral buckle placement is a well-established technique for the treatment of primary rhegmatogenous retinal detachment. Complications associated with scleral buckle are uncommon and its presentations can be vary. We report a case of recurrent orbital cellulitis with anterior segment ischemia following a forgotten episode of previous scleral buckling surgery, presenting with blurring of vision, redness and swelling of the lids. The presence of scleral buckle was detected by detailed examination and confirmed by orbital imaging. Orbital infection and rubeosis iridis were successfully treated with scleral buckle removal, intravenous antibiotics and intracameral ranibizumab. However, the retinal detachment recurred and the visual acuity deteriorated to light perception. There was no further intervention as the family declined in view of her old age. In cases of recurrent orbital infection, detailed clinical examination is important to look for evidence of ocular prostheses as a source of infection. Orbital imaging is an adjunct for making the diagnosis especially in cases where history is unreliable. Anterior segment ischemia due to scleral buckle responds well to buckle removal with ranibizumab injection

Patterns of polypoidal choroidal vasculopathy among a multiracial population in a Malaysian hospital

Polypoidal choroidal vasculopathy (PCV) is a retinal disorder characterized by aneurismal polypoidal lesions in choroidal vasculature. PCV appears to preferentially affect pigmented individuals and is considerably high among Asians. Most reports on patterns of PCV around Asia are based on a homogenous race (e.g. Chinese, Japanese) and very few descriptions from a multiracial population like those seen in Malaysia. The present study aimed to describe the demographic features, clinical and investigative characteristics of PCV in a multiracial group at Universiti Kebangsaaan Malaysia Medical Centre (UKMMC). Ninety one eyes of 86 PCV patients, comprising of Chinese (65.1%), Malays (31.4%), Indians (2.3%) and Eurasian (1.2%) were retrospectively reviewed. All underwent complete ophthalmic examination and investigations. Mean patient age was 70.4 years with a male preponderance (59.3%), and mostly unilateral presentation (94.1%). The logMAR mean presenting visual acuity was 0.78 ± 0.64. Polypoidal vascular lesions were located generally within the macula area (86.8%), manifesting mainly as submacular hemorrhage (59.3%). Interestingly a number of eyes (43.9%) had associated drusen. Optical coherence tomography largely demonstrated exudative changes (75.9%) and almost all patients (97.7%) had loss of external limiting membrane (ELM) and IS/OS interface. On indocyanine green angiography, majority of eyes had multiple polyps (82.4%) with ‘cluster’ (58.2%) being the commonest configuration. In conclusion, although the patterns of PCV in UKMMC were mainly similar to other Asian patients, a number of our patients had associated drusen. This indicates that PCV in our population could be a variant of neovascular age related macular degeneration and not solely idiopathic in nature

‘Boating’ out migrated dexamethasone implant; surgical management of removal of anterior chamber migrated dexamethasone intravitreal implant : a case report

It is rare for anterior chamber migration of an Ozurdex® implant from vitreous cavity, but it is seen more frequently in aphakic eyes or in pseudophakic cases with zonular dehiscense. We describe a case of a middle-aged gentleman who had persistent diabetic macular oedema not responding to anti-VEGF (vascular endothelium growth factor), who was treated with intravitreal Ozurdex® in his post vitrectomized eye and developed anterior migration of the implant to the anterior chamber. Anterior dislocation of an intravitreal implant of dexamethasone can be managed by repositioning it to the vitreous cavity or removing it through a corneal limbal incision. Ozurdex® is a friable implant, especially after a few weeks of implantation. Therefore, removal of the implant by grasping or aspiration may lead to its fracture or dispersion of the implant material. This is a report of a simple,fast and effective technique to remove a migrated Ozurdex® from the anterior chamber using a modified silicone tip

Ocular syphilis: resurgence of an old disease in modern Malaysian society

Letter to the edito

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