Difference in glaucoma progression between the first and second eye after consecutive bilateral glaucoma surgery in patients with bilateral uveitic glaucoma

PURPOSE: To determine whether the second eyes (SE) of patients with bilateral uveitic glaucoma undergoing filtration surgery have more glaucomatous progression in terms of visual acuity, visual field (VF) and optic nerve changes compared to the first eyes (FE). METHODS: This retrospective study analysed data of 60 eyes from 30 patients with bilateral uveitic glaucoma who had undergone glaucoma surgery in both eyes on separate occasions. Humphrey VF progression was assessed using the Progressor software. RESULTS: The pre-operative IOP between the FE (43.1 ± 7.7 mmHg) and SE (40 ± 8.7 mmHg) was not statistically significant (p = 0.15). IOP reduction was greater in the FE (64 %) than SE (59.7 %) post-operatively, but the mean IOP at the final visit in the FE (12.3 ± 3.9 mmHg) and SE (14.5 ± 7 mmHg) was not statistically different (p = 0.2). There was no significant change in mean logMAR readings pre and post-operatively (0.45 ± 0.6 vs 0.37 ± 0.6, p = 0.4) or between the FE and SE. The number of SE with CDR > 0.7 increased by 23 % compared to the FE. From 23 available VFs, five SE (21.7 %) progressed at a median of five locations (range 1-11 points) with a mean local slope reduction of 1.74 ± 0.45 dB/year (range -2.39 to -1.26), whereas only one FE progressed. However, there was no significant difference between mean global rate of progression between the FE (-0.9 ± 1.6 dB/year) and SE (-0.76 ± 2.1 dB/year, p = 0.17) in the Humphrey VF. CONCLUSION: In eyes with bilateral uveitic glaucoma requiring glaucoma surgery, the SEs had more progressed points on VF and glaucomatous disc progression compared to FEs at the final visit

Lupus nephritis with visual field defect secondary to hypertensive retinopathy: a case report

A 23-year-old lady presented with both eye progressive painless blurring of vision for two weeks in 2011. Prior to that she had malar rash, hair loss, photosensitivity and bilateral leg swelling. Ocular examination showed that visual acuity on the right was 6/60 and on the left was 6/24. Both optic disc were swollen with extensive peripapillary cotton wool spot (CWS), flame shape haemorrhages, dilated and tortuous vessels with macular oedema. Systemic examination revealed blood pressure of 176/111 mmHg, malar rash and alopecia. Diagnosis of grade 4 hypertensive retinopathy secondary to SLE was made. The diagnosis was confirmed by positive ANA/ dsDNA, low C3/ C4 and renal biopsy showed lupus nephritis. She was treated with oral prednisolone, hydroxychloroquine and cyclosporin A. Throughout the monitoring for hydroxychloroquine toxicity, vision over both eyes were 6/9, but serial visual fields showed non-progressive left superior and inferior scotoma while right eye showed inferior scotoma. The intraocular pressure was normal with pink optic disc and cup disc ratio of 0.3. Optical coherence tomography (OCT) showed temporal and nasal retinal nerve fiber layer thinning bilaterally. However, macula OCT, fundus fluorescein angiography and autofluorescence were normal. The visual field defect was concluded secondary to CWS indicating microinfarction of the retinal nerve fiber secondary to previous hypertensive retinopathy. Non-progressive visual field defects may occur after the appearance of CWS in hypertensive retinopathy and it should not be overlooked when diagnosing glaucoma or hydroxychloroquine toxicity

Good anatomical outcome of orbital plasmacytoma following chemo-radiotherapy

Extramedullary plasmacytoma is a rare complication from multiple myeloma. We report a 56-year-old lady with underlying multiple myeloma who developed swelling over the left eye. It caused a non-axial proptosis, exposure keratopathy and visual acuity of counting fingers. A tissue biopsy revealed infiltration of tissue fragments with neoplastic plasma cells positive for CD138 and Kappa light chain restrictions consistent with plasmacytoma. Following radio-chemotherapy, the mass shrunk tremendously but her visual outcome remained poor

Orbital cellulitis from untreated conjunctival wound

Orbital cellulitis is a potential blinding condition resulting from infection of the orbital contents, including the optic nerve. It may be fatal in cases with extension into the optic canal and subsequently the brain. Common aetiologies include extension of infection from paranasal sinusitis or preseptal cellulitis. This case report depicts the unusual occurrence of orbital cellulitis following a trivial superficial conjunctiva laceration wound from a motor-vehicle accident. Aggressive treatment with systemic antibiotics resulted in good visual outcome. All wound on or around the globe must be diligently treated to prevent such detrimental complication

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

Association of type II Waardenburg syndrome with hypermetropic amblyopia

We present a case of hypermetropic amblyopia in type II Waardenburg syndrome (WS) to highlight the association. WS is an “oculo-dermato-auditif” dysplasia described in 1947 by Waardenburg and by Klein in 1950. It is distributed worldwide, with no predilection for race or gender. The prevalence is estimated to be 1:42 000 live births in the general population. WS is a genetic disease with autosomal dominant transmission with incomplete penetrance and variable expressivity. Complex network of interaction between six genes have been identified to date. They are PAX3 gene, primarily responsible for type I and III WS; MITF, SOX10, and SNAI2 genes in type II WS; EDN3 and EDNRB genes in type IV WS

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

Letter to the edito

Binasal hemianopia due to bilateral internal carotid arteries dolichoectasia: A case report and literature review

Binasal hemianopia is rare. It is more commonly associated with ocular diseases than intracranial pathologies. Nevertheless, the proximity of internal carotid arteries (ICA) to the visual pathway may cause a variety of neurologic effects which may lead to visual loss. Although visual loss is uncommon, ICA aneurysm may compress the optic nerve causing visual field defect and reduced visual acuity. We report a 66-year-old male presented with asymptomatic binasal hemianopia detected during routine glaucoma screening. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain and orbit showed dolichoectasia in the cavernous segment of both ICA, which compressed the pre-chiasmatic optic nerve bilaterally. Humphrey’s visual field test confirmed the diagnostic of binasal hemianopia respecting the vertical midline. This was the first reported case of binasal hemianopia without visual disturbances. This case highlights the importance of using CT and MRI as additional diagnostic tools to identify the true cause of binasal hemianopia (ICA dolichoectasia) in patients with glaucoma. A thorough assessment of any visual field defect helps to detect life-threatening intracranial pathologies effectively and is managed accordingly

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