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

Retinal nerve fiber layer thickness post-laser treatment in diabetic retinopathy: argon versus pattern scanning laser

Conventional argon laser causes transient thickening of retinal nerve fibre layer (RNFL). The effect of pattern scanning laser (PASCAL) has not been well described. We compared the immediate changes in peripapillary RNFL thickness post-panretinal photocoagulation between conventional argon lasers and PASCAL in patients with diabetic retinopathy changes. A total of 32 subjects were recruited. There were 16 patients in the argon group and 16 patients in PASCAL group. Diabetic patients were recruited from Ophthalmology Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Complete eye examinations and fundus photographs were performed at baseline prior to laser treatment, and post-laser treatment at two and four months. RNFL thickness was measured using time domain optical coherence tomography. Both groups were comparable with respect to clinical characteristics and demographics. There was no significant difference in average RNFL thickness between the two groups prior to treatment (p= 0.323). RNFL post-laser treatment for patients receiving conventional argon laser remained unchanged with no significant differences in all quadrants at any time-point (two and four months). However, for the PASCAL group, significant thickening occurred at four months for average RNFL and the inferior quadrant (p <0.05). The other quadrants similarly demonstrated increasing thickness at four months but this did not reach statistical significance. Transient RNFL thickening occurs in both conventional and PASCAL laser patients. The PASCAL laser induces a greater increase in RNFL thickness than the argon laser group. Important events, such as laser eye treatments and even type of laser used, are worthy of consideration when evaluating RNFL

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

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

Relationship between central corneal thickness and severity of open angle glaucoma using optical coherence tomography.

Central corneal thickness plays a major role in the management of many types of glaucoma. Therefore, our aim is to determine the relationship between the severity of glaucoma measured by optical coherence tomography (OCT) and central corneal thickness (CCT) among normal tension and high tension glaucoma patients. This is an observational cross sectional study on 190 patients carried out in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Three groups of patients were identified; 60 normal tension glaucoma (NTG), 61 primary open angle glaucoma (POAG) and 69 control. Patients were identified based on the glaucomatous visual field changes and previous record of intraocular pressure before treatment. Visual acuity and intraocular pressure measurements were recorded. Specular microscope was used to measure the CCT and the severity of glaucoma was evaluated objectively based on the retinal nerve fibre layer (RNFL) thickness using optical coherence tomography. Results showed NTG patients had significantly thinner cornea, 503.07±32.27μm compared to the control group, 517.45±31.74 μm (p=0.012). However, there was no significant difference between the CCT of POAG and NTG groups (p=0.386).Retinal nerve fibre layer (RNFL) thickness was significantly different between the glaucoma and the control groups (p<0.05 in all quadrant). However, correlation between CCT and severity of RNFL thinning was only found for the POAG group but not for the NTG group. (mean RNFL and superior quadrant RNFL; r=0.251,0.401) . This study demonstrated the correlation between CCT and severity of glaucoma in POAG patients but not for the NTG group. Therefore, CCT is related to the severity of POAG-related visual loss

Long term outcome in unilaterally treated retinopathy of prematurity: a case report.

Retinopathy of prematurity (ROP) is a disorder describing an immature vascularisation of a developing retina in low birth weight preterm infants. This condition potentially leads to blindness. ROP developed as a response of hypoxia of the eye due to incomplete development of the retinal vessels. ROP is commonly reported as bilateral disease,a small percentage of infants have asymmetrical changes. We report a case of long-term outcome of a asymmetry ROP changes with peripheral retinal ablation in a single eye. This particular case demonstrates the possible long-term outcome of unilaterally treated ROP which could either be due to the severity of the disease itself or the treatment she received. It is important to highlight the possibility of unequal development of the eye in asymmetrical presentation of ROP

Vitreous haemorrhage: a consequence of herpes simplex acute retinal necrosis

Acute retinal necrosis (ARN) is a rare, blinding disease that typically affects adults. However, in this case report, we highlight the diagnosis, management and outcome of herpes simplex acute retinal necrosis in a 13-year-old healthy girl, who presented with painful right eye, redness and blurring of vision for one week. Examination of the right eye showed features of granulomatous panuveitis. Optic disc was swollen and retina appeared pale. There were multiple patches of retinitis and haemorrhages at mid-periphery of the fundus with inferior serous detachment observed. Rapidly progressive inflammation in just four days along with secondary cataract that obscured fundus view, imposed greater challenge to the diagnosis and management. Intravenous acyclovir 300mg, 3 times a day was initiated promptly while vitreous fluid was sent for polymerase chain reaction, which identified Herpes Simplex Virus-1. Inflammation improved, but she developed vitreous haemorrhage secondary to proliferative retinopathy, which required panretinal photocoagulation. ARN is therefore, principally a clinical diagnosis and high index of suspicion is crucial particularly, in children for prompt diagnosis and treatment. Complications should also be addressed timely to improve the chances of preserving vision