Bilateral compressive optic neuropathy secondary to tuberculum sella meningioma in pregnancy

A 37-year-old primigravida in her second trimester presented with bilateral painless progressive visual loss. Her vision was hand motion in both eyes. Both pupils were dilated with sluggish reaction to light. Both fundus appeared myopic with bilateral optic atrophy. Magnetic resonance imaging (MRI) of the brain revealed a suprasellar mass with optic chiasm compression and bilateral optic nerve atrophy. As the mass has compromised her vision, a semi-emergency craniotomy and excision of tumour was performed. Histopathological examination confirmed the diagnosis of low grade meningothelial meningioma. Both mother and foetus were well after the surgery. However, post-operatively her vision remained poor due to optic nerve atrophy

Capsular bag distension syndrome following phacoemulsification with implantation of intraocular lens

Capsular bag distension syndrome is a rare complication following phacoemulsification with posterior chamber intraocular lens implantation. We describe the case of a middle-age male, who developed early onset capsular bag distension syndrome of the right eye after phacoemulsification with implantation of plate haptic posterior chamber intraocular lens (Zeiss CT ASPHINA 509MP). There was persistent poor vision during follow up at 1 week and 5 weeks post-surgery with a myopic shift of 2.5 diopters sphere (DS). The intraocular pressure was only elevated at 2 hours post-operative and was normal during the subsequent followup. Distension of capsular bag was confirmed with the IOP Master 700 which showed abnormal separation of posterior capsule from the intraocular lens. He was diagnosed with capsular bag distension syndrome secondary to retention of viscoelastic. Right eye removal of retained viscoelastic was performed and the capsular bag distension syndrome resolved successfully with best corrected visual acuity at 6/6. Hence, complete clearance of viscoelastic during phacoemulsification with plate haptic intraocular lens is important in order to prevent capsular bag distension syndrome

Severe endogenous endophthalmitis with panophthalmitis-lessons to learn

Endogenous endophthalmitis is a devastating intraocular infection. Finding the primary infection and directed treatment is life-saving. We describe a 47-year-old man, with uncontrolled diabetes mellitus, who presented with two weeks history of progressive reduced vision and redness of the left eye (LE). He was generally unwell since a month, previously. Examination showed relative afferent pupillary defect (RAPD) in the affected eye and visual acuity was hand movement. There was moderate anterior chamber and vitreous reaction. Fundus examination showed a huge dome-shaped choroidal mass covering the entire macula. Diagnosis of severe endogenous endophthalmitis was made, with isolation of Enterobacter sp. from his blood culture. Meanwhile, he also had elevated inflammatory markers with presence of leucocytosis, neutrophilia and elevated erythrocyte sedimentation rate (ESR) as well as C-reactive protein (CRP). Vitreous tap and aqueous tap had no growth, He improved with combination of intravitreal and systemic antibiotic, as shown by the resolved fever and reduced inflammatory markers but progressive inflammation occluded the fundus details and the LE vision eventually became no projection of light despite treatment. Subsequently, he developed rubeotic glaucoma and was treated conservatively because the LE was painless with poor vision. The repeated blood culture and urine was normal. In conclusion, endogenous endophthalmitis with eventual panophthalmitis is difficult to treat and has very poor visual prognosis. Our case highlights the challenges faced in the management of vision-threatening endophthalmitis and panophthalmitis in this patient

Venous stasis retinopathy complicating a case of cavernous-carotid fistula with an initial normal computed tomography angiogram of the brain

Carotid-cavernous fistula (CCF) can be spontaneous or due to trauma. Due to its complication to the eye, diagnosis and intervention should not be delayed. We report a case of an elderly female who presented with left eye redness with gradual onset of protrusion over the same eye. She was suspected to have CCF with the clinical presentation. Nevertheless, she had a normal computed tomography diagnosis of CCF was confirmed. However, due to delay in diagnosis and treatment, the patient developed venous stasis retinopathy and neovascular glaucoma. Her vision remained poor despite aggressive systemic and ocular treatments. This case report is to emphasise the importance of clinical suspicion of a disease despite a normal imaging. This is to prevent irreversible blindness and other systemic complications. angiogram of the brain. Later, she was scheduled for cerebral angiography and th

Chronic Follicular Conjunctivitis Secondary to Chlamydial Trachomatis

Chronic follicular conjunctivitis is commonly caused by Chlamydia trachomatis infection. Patients usually present with non-resolving conjunctivitis which is associated with tender lymphadenopathy. We report a case of a monogamous young female with chronic inclusion conjunctivitis. A 34-year-old healthy female presented with redness of the left eye (LE) for 3 days, associated with blurred vision and ocular discharge. Visual acuity (VA) of the right eye (RE) was 6/6 and 6/24 in LE with pinhole 6/6. There was mucopurulent discharge over the LE with injected conjunctiva and follicular reaction involving the upper eyelid. She was treated as LE bacterial conjunctivitis and started on topical eyedrops ciprofloxacin 0.3% and artificial tear eye drops every 2 hours. She denied any history of contact with patients with similar history or history of sexually transmitted infection. She discontinued treatment and presented again 3 weeks later with bilateral eyes injected with follicular reactions and the presence of a thin pseudomembrane over the upper eyelids associated with painful preauricular lymph nodes. Noted generalized punctate epithelial erosions (PEE) over bilateral eyes with mucous strands adhered to cornea epithelium. A corneal epithelial defect of 3.7 mm(V) x 4 mm(H) was noted in the RE. The VA in the RE was 6/18 with pinhole 6/12, and 6/9 in the LE, with pinhole the same. The diagnosis of bilateral follicular conjunctivitis with filamentous keratoconjunctivitis secondary to Chlamydia trachomatis was confirmed by a positive conjunctival smear. She was then treated with fucithalmic ointment twice daily and tetracycline 250 mg orally four times daily for three weeks. Signs and symptoms disappeared after completion of tetracycline treatment

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

Hemangioblastoma in the setting of Von Hippel Lindau disease: a case report

A 21-year-old Chinese gentleman with no known medical illness, presented with a history of right painless blurring of vision with central scotoma of two weeks duration. He also had a history of multiple episodes of seizures prior to presentation. Visual acuity was 1/60 with unremarkable anterior segment findings and no relative afferent pupillary defect. Fundus examination of the right eye revealed dilated and tortuous retinal veins with multiple retinal capillary hemangiomas and sub retinal hard exudates at the macula with edema. A diagnosis of Von Hippel Lindau disease was made when a posterior fossa mass suggestive of hemangioblastoma with obstructive hydrocephalus was seen on computed tomography of the brain. Craniotomy with nodule excision was performed. The retinal capillary hemangiomas were treated with the combination of laser photocoagulation and intravitreal Ranibizumab injections. Visual acuity subsequently improved to 6/36

Intracameral recombinant tissue plasminogen activator (rtPA) as the primary treatment for secondary pupillary block

Alteplase is a recombinant form of human tissue plasminogen activator (tPA) that converts plasminogen to plasmin essential for fibrinolysis. It is commonly used to treat embolic or thrombotic disorders such as ischemic stroke. Despite its rarity use in ophthalmology, we are reporting the effectiveness of recombinant tissue plasminogen activator (rtPA) in treating an eye with secondary pupillary block as a consequence of severe endophthalmitis. A patient presented with acute endophthalmitis after a complicated cataract extraction. Examination showed severe anterior chamber reaction leading to seclusion pupillae, iris bombe and presence of iridocorneal touch 360-degree. Following intracameral alteplase 2.5 microgram in 0.1 ml given, iris bombe was observed to resolve completely onehour later. Anterior chamber was also significantly deeper and slightly larger pupil compared to before rtPA injection. Due to clearer view of anterior segment, pars planar vitrectomy and extraction of intraocular lens could be performed with significant visual improvement after surgery. Our findings suggest that usage of rtPA, which is alteplase, was effective in treating secondary pupillary block due to intense anterior segment inflammation in endophthalmitis cases. Thus it is useful in replacing the conventional use of laser peripheral iridotomy in treating pupillary block, as the latter potentially aggravates the pre-existing inflammatory condition

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

‘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