Bilateral spontaneous rupture of anterior lens capsules in a middle-aged woman

Hypermature cataracts are commonly seen in developing countries. Spontaneous rupture of the anterior capsule, resulting in dislocation of the lens nucleus into the anterior chamber, presents rarely in hypermature cataracts. We describe a middle-aged woman who presented with spontaneous anterior dislocation of the nucleus in both eyes. The presence of calcification spots in the posterior capsule at the pupillary edge strongly suggested that our patient had hypermature cataracts. It is important to highlight this uncommon cause of nucleus dislocation in a patient with no previous history of ocular trauma

A randomized comparison on the corneal endothelial morphology after the use of 2 different viscoelastic agents during phacoemulsification surgery

Objective: To compare corneal endothelial morphological changes after the use of Healon 5 (sodium hyaluronate 2.3%) and Healon GV (sodium hyaluronate 1.4%) during phacoemulsification surgery, particularly at three months after the surgery. Settings: Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Malaysia and Eye clinic, Hospital Kota Bharu, Kelantan, Malaysia. Materials and Methods: One hundred and ten patients were randomized, 55 per group, in a prospective randomized clinical trial of phacoemulsification surgery using Heal on 5 or Heal on GV. Three ophthalmologists performed the surgeries. The corneal endothelial cells density, average cell size, coefficient variation and hexagonality were assessed preoperatively and at three months postoperatively using a non-contact specular microscope Topcon SP2000P. Analysis of the data was performed using SPSS version 10.0, Independent-Samples T Test. Results: There was statistically significant difference between Healon 5 group and Healon GV group based on endothelial cell density (p=0.015) and percentage of cell loss (p=0.033). The cell size was noted significantly smaller in the Healon 5 group compared to the Healon GV group at three months (p=0.004). A similar result was also noted in percentage of changes in cell size (p=0.033). There were no statistically significant differences in changes of coefficient variation of cell size and hexagonality in both groups at three months after the surgery. Conclusion: Minimal corneal endothelial morphological changes were noted in the Healon 5 group compared to the Healon GV group, particularly in term of less cell loss and less alteration in cell size at three months after the surgery. Thus, indicates that Healon 5 is more effective than Healon GV in minimizing risk of corneal endothelial injury during phacoemulsification surgery

Assessment of the Optic Nerve Head Parameters Using Heidelberg Retinal Tomography III in Preterm Children

Background: Variations in optic nerve head morphology and abnormal retinal vascular pattern have been described in preterm children using digital image analysis of fundus photograph, optical coherence tomograph and serial funduscopy. We aimed to compare the optic nerve head parameters in preterm and term Malay children using Heidelberg Retinal Tomograph III. Design: A cross sectional study. Methodology/Principal Findings: Thirty-two preterm Malay children who were born at up to 32 weeks postconception, and 32 term Malay children aged 8–16 years old were recruited into this cross sectional study, which was conducted in the Hospital Universiti Sains Malaysia, Malaysia from January to December 2011. Their optic nerves were scanned and analyzed using a Heidelberg Retinal Tomography (HRT) III (Heidelberg Engineering, Germany). Preterm children showed an increased rim volume (SD) (0.56 (0.26) vs 0.44 (0.18) mm3, respectively), smaller cup shape (SD) (0.18 (0.07) vs 0.25 (0.06) mm, respectively), increased height variation contour (SD) (0.44 (0.14) vs 0.35 (0.08) mm, respectively), and increased cup depth (SD) (0.24 (0.11) vs 0.17 (0.05) mm3, respectively) when compared to their normal peers (p,0.05). There were no significant differences in the mean disc area, cup area, cup to disc ratio or rim area between the preterm and term children (p.0.05) in our study. Conclusions/Significance: Preterm children exhibit different characteristics of optic nerve head parameters with HRT III analysis. Increased cup depth in preterm children suggests a need for close observation and monitoring. It may raise suspicion of pediatric glaucoma when proper documentation of intraocular pressure and clinical funduscopy are unsuccessful in uncooperative children

Choroidal neovascularization secondary to Best’s vitelliform macular dystrophy in two siblings of a Malay family

Best’s vitelliform macular dystrophy complicated with choroidal neovascularization is rare in children. We report three children from a Malay family of five siblings with Best’s vitelliform macular dystrophy, in which two of them subsequently developed choroidal neovascularization. The possible pathogenesis of this rare condition is described and highlighted in this report

Infantile esotropia in Malaysian children: The impact of surgery on health-related quality of life assessment in patients and their parents

Introduction: Limited information is available on healthrelated quality of life (HRQoL) in children with strabismus in South East Asia. We aimed to evaluate the HRQoL and associated factors pre- and post-strabismus surgery in Malaysian children with infantile esotropia and their parents/guardians. Methods: A prospective study was conducted on children with infantile esotropia aged 8-17 years old and their parents/guardians who attended two tertiary hospitals with a paediatric ophthalmology service from 2017 to 2018. The patients and parents answered the Intermittent Exotropia Questionnaire (IXTQ), translated into Malay, at the time of enrolment and three months after the surgery. Results: Thirty-four children and one (each) of their parents/guardians were enrolled. Thirteen (38.2%) children had esotropia with angles of deviation of more than 50 prism dioptres. A total of 33 (97.1%) children achieved successful alignment correction three months after surgery. Surgery significantly improved the total mean scores of the children, which were 62.87 (17.05) preoperatively and 87.13 (13.26) postoperatively (p<0.001). There was statistically improvement in the total mean scores in the parent/guardian group, which was 37.07 (22.01) preoperatively and 75.39 (22.09) postoperatively (p<0.001). The parents/guardians functional, psychosocial and surgery subscales also had a significant increment in the score postoperatively (p<0.001). Older children and children with poorer visual acuity on presentation had a lower score preoperatively, while girls scored better postoperatively (p<0.05). Mothers scored significantly lower preoperatively and postoperatively (p<0.05). Conclusion: Surgery significantly improved the HRQoL score in Malaysian children with infantile esotropia and their parents/guardians. The score was significantly higher in female children after the surgery. Mothers exhibited poor scores before and after surgery

Optic neuritis in a child with biotinidase deficiency: case report and literature review

Optic atrophy has often been reported in children with biotinidase deficiency. The visual prognosis is usually poor. This report is of a 6-year-old boy with an early onset of biotinidase deficiency who presented with acute profound visual loss in both eyes. Fundoscopy revealed swollen discs in both eyes, and the imaging was consistent with bilateral optic neuritis. He was treated with systemic corticosteroid, and commenced on oral biotin. The final visual outcome was promising

Kingella kingae Keratitis in a Child with Underlying Vernal Keratoconjunctivitis

Kingella kingae had rarely been reported as a causative organism for corneal ulcer and had not been described before in vernal keratoconjunctivitis (VKC). Generally regarded as commensals of respiratory tract particularly in young children, it had however been isolated fromthe corneal ulcer scraping of both adult and children.We report a case of bacterial ulcer with isolation of Kingella kingae from the corneal scraping in a young child with underlying VKC

Concurrent hyphema and orbital apex syndrome following herpeszoster ophthalmicus in a middle aged lady

INTRODUCTION: Hyphema and orbital apex syndrome occurring concurrently in a patient with herpeszoster ophthalmicus have not been reported previously. We present a case with these unique findingsand discuss the pathogenesis of these conditions and their management.PRESENTATION OF CASE: A 59-year-old Malay lady with underlying diabetes mellitus presented withmanifestations of zoster ophthalmicus in the left eye. Two weeks later, she developed total hyphema,and complete ophthalmoplegia suggestive of orbital apex syndrome. She was treated with combinationof intravenous acyclovir and oral corticosteroids, and regained full recovery of ocular motility. Totalhyphema persisted, and she required surgical intervention.DISCUSSION: Hyphema is postulated to occur due to an immune vasculitis affecting the iris vessels. Orbitalapex syndrome is probably due to an occlusive vasculitis affecting the vasculature of the extraocular mus-cles and optic nerve, resulting from a direct invasion by varicella zoster virus or infiltration of perivascularinflammatory cells. Magnetic Resonance Imaging of the brain is essential to exclude possibility of localcauses at the orbital apex area.CONCLUSION: Herpes zoster ophthalmicus is an uncommon ocular presentation. Managing two concur-rent complications; persistent total hyphema and orbital apex syndrome is a challenging clinical situation.Early diagnosis and prompt treatment are essential to prevent potential blinding situation

Concurrent hyphema and orbital apex syndrome following herpeszoster ophthalmicus in a middle aged lady

INTRODUCTION: Hyphema and orbital apex syndrome occurring concurrently in a patient with herpes zoster ophthalmicus have not been reported previously. We present a case with these unique findings and discuss the pathogenesis of these conditions and their management. PRESENTATION OF CASE: A 59-year-old Malay lady with underlying diabetes mellitus presented with manifestations of zoster ophthalmicus in the left eye. Two weeks later, she developed total hyphema,and complete ophthalmoplegia suggestive of orbital apex syndrome. She was treated with combinationof intravenous acyclovir and oral corticosteroids, and regained full recovery of ocular motility. Totalhyphema persisted, and she required surgical intervention. DISCUSSION: Hyphema is postulated to occur due to an immune vasculitis affecting the iris vessels. Orbitalapex syndrome is probably due to an occlusive vasculitis affecting the vasculature of the extraocular muscles and optic nerve, resulting from a direct invasion by varicella zoster virus or infiltration of perivascularinflammatory cells. Magnetic Resonance Imaging of the brain is essential to exclude possibility of localcauses at the orbital apex area. CONCLUSION: Herpes zoster ophthalmicus is an uncommon ocular presentation. Managing two concur-rent complications; persistent total hyphema and orbital apex syndrome is a challenging clinical situation.Early diagnosis and prompt treatment are essential to prevent potential blinding situation