Atypical Contact Lens Related Corneal Ulcer Caused by Pasteurella Multocida

A 55-year-old healthy lady withhistory of regular contact lens (CL) use presented with 10 days history of progressive left eye blurring of vision, redness and pain. There was good CL hygiene practiced with no history of swimming, trauma or contact with domestic pets. Left eye vision was hand movement and right eye was 1/60, pinhole 6/18. On the left eye, there was a central, oval-shaped corneal infiltrate with an overlying large epithelial defect and stromal oedema, with significant anterior chamber cells and fibrin. B-mode ultrasound showed no vitritis. Intensive topical benzylpenicillin 10000iu/ml and topical gentamycin 1.4% hourly, homatropine 2% three times daily, oral doxycycline and oral ascorbic acid were started. The gram stain results showed gram positive cocci growth. Her ulcerimproved with the treatment and preservative-free dexamethasone 0.1% once daily was commenced to reduce inflammation and scarring. Interestingly, culture was reported as Pasteurella maltocida, a gram negative bacilli sensitive to penicillin, and so treatment was continued until the ulcer completely healed. She had central corneal scarring with best corrected vision of 6/24 in the left eye but was not keen on further surgery to improve her vision. Although it has not been previously reported, Pasteurella multocidacan cause CL related corneal ulcer with severe anterior chamber inflammation. This diagnosis should be considered even if there is trivial contact or no history of exposure to domestic animals.

Descemet Membrane Detachment Post-Phacoemulsification

We report the case series of phacoemulsification-related Descemet membrane detachment (DMD) encountered at a tertiary hospital in Kuala Lumpur. Case 1 was an iatrogenic DMD which was detected intraoperatively and managed early with good outcome. Case 2 and case 3 described unusual presentation of DMD which was initially undiagnosed. This report highlights the use of anterior segment optical coherence tomography (ASOCT) in detecting and confirming the correct diagnosis for DMD. With the aid of an experienced corneal specialist, the higher threshold for suspicious occurrence of DMD was confirmed using ASOCT. Treatment was tailored accordingly, with successful clearance of corneal oedema and visual recovery. This case series highlighted the importance of proper operative documentation and high threshold for suspicion for DMD in focal corneal oedema following an otherwise uneventful cataract surgery. It is concluded that ASOCT is an excellent tool to confirm diagnosis of DMD and success of treatment.

An Orbital Solitary Fibrous Tumor: Report of Two Cases with Different Presentation

Solitary fibrous tumour (SFT) is a rare spindle-cell neoplasm that can occur in the orbit. We report two cases of orbital SFT in a 35-year-old female and a 28-year-old male with different presentations. First patient presented with slowly progressive left lateral upper lid mass which is firm in consistency and non tender. Patient had non axial proptosis as the mass compressed the globe inferonasally. There was also funduscopy evidence of choroidal folds superotemporally. There is slight impairment of vision on the left eye comparing to right eye. Meanwhile, the second patient presented with a painless diffuse swelling of left upper eyelid. It was soft in consistency, non fluctuate and no opening or pus discharge noted. There is mild mechanical ptosis, however there was no proptosis and no evidence of compression into the globe nor visual impairment.Computed tomography (CT) imaging revealed a well circumscribed and contrast enhanced soft tissue mass intraorbital extraconal mass in both cases. However in the first case, the tumour was at the level of lacrimal gland with compression of the globe, while in second case, it was superior and posterior to the left lacrimal gland with no globe compression. Both patients underwent complete resection of their tumors. The histological findings showed alternating hypercellular and hypocellular areas composed of bland spindle cells with a fibrous stroma. The strong immunoreactivity for CD34 supported the diagnosis of orbital SFT. There was no recurrence at the 2nd and 3rd year follow-up visits for both patients. SFT should be considered as one of the differential diagnosis of an orbital tumor. The combination of CT scan, histologic findings and immunohistochemical staining provide accurate diagnosis. En bloc excision of the tumour is the mainstay of treatment.

Bilateral Retinal Vasculitis: A Presumed Case of Ocular TB without Inflammation

A 17-year-old male student of Indonesian parentage presented with two weeks history of progressive painless bilateral visual deterioration. There was no contact with tuberculosis (TB)-infected patients and parents claimed that all immunization including BCG was completed. However, BCG scar was not apparent. Visual acuity was 6/36 and 6/60 in the right and left eyes respectively. The anterior and vitreous chambers were quiet. Funduscopic examination revealed retinal vasculitis with perivascular exudates, branch vein occlusion, neovascularization and macular oedema. Fluorescein angiography confirmed large areas of capillary non-perfusion and leaking new vessels. Mantoux test was positive and full regime anti-TB therapy was instituted. HIV screening was negative. Three days later, an immunosuppressive dose of oral steroid was started. Both eyes received intensive laser photocoagulation. Interestingly, there was no development of vitritis throughout.