Spontaneous repositioning of posterior chamber intraocular lens: a mere coincidence? / Reposicionamento espontâneo de uma lente intraocular na câmara posterior: uma mera coincidência?

ABSTRACT Despite the recent developments in modern cataract surgery and the application of a vast array of new devices and machines, late in-the-bag intraocular lens dislocation remains a devastating, albeit rare, complication. Various nonsurgical and surgical techniques have been used to manage this complication. We report a case of spontaneous repositioning in the left eye of an anteriorly subluxated in-the-bag intraocular lens. The spontaneous repositioning may have been caused by antagonistic effects related to the topical administration of brimonidine and prednisolone. The dislocation was treated without aggressive manipulation or surgical intervention.

RESUMO Apesar dos recentes avanços na cirurgia moderna de catarata e da aplicação de uma ampla gama de novos dispositivos, o deslocamento tardio de uma lente intraocular dentro do saco capsular continua a ser uma complicação devastadora, ainda que rara. Várias técnicas cirúrgicas e não cirúrgicas têm sido usadas para tratar esta complicação. Este é o relato de um caso de reposicionamento espontâneo de uma lente intraocular sub-luxada anteriormente dentro do saco capsular do olho esquerdo. Este reposicionamento pode ter sido causado pelos efeitos opostos da aplicação tópica simultânea de brimonidina e prednisolona. O deslocamento foi tratado sem manipulação agressiva ou intervenção cirúrgica.

Efficacy of supratarsal injection of triamcinolone acetonide and dexamethasone sodium phosphate in treating paediatric vernal keratoconjunctivitis in suburban Malaysia / 国际眼科杂志(Guoji Yanke Zazhi)

·This study aims to describe the treatment efficacy of supratarsal injection of triamcinolone acetonide and dexamethasone sodium phosphate for paediatric vernal keratoconjuctivitis(VKC) over a 5-year-period in Hospital Universiti Sains Malaysia. Totally 10 patients were treated with this combination injection had clinical improvement by 1mo post injection. The main complication was increased intraocular pressure (4 patients). Four patients had recurrences within 6mo. We concluded that the clinical responsetosupratarsalcombination corticosteroids in VKC is fairly similar to that reported in the literature using a single corticosteroid agent. However, the risk of increased intraocular pressure is higher.

Optic disc topography of normal tension glaucoma patients in Malaysia

There are limited data in the literature on the optic disc topography in normal tension glaucoma (NTG) patients in Asian countries, especially in Southeast Asia. This study is aimed at comparing optic disc topography in NTG patients and a control group in Malaysia, and we discuss the literature on NTG studies in other Asian populations. A comparative cross-sectional study was conducted in two hospitals with glaucoma services in Malaysia from November 2010 to February 2012. A total of 109 eyes of 109 Malay patients were included in this study: 32 NTG patients and 77 subjects in the control group. All participants underwent a thorough ocular examination, including visual acuity, subjective refraction, anterior segment and fundus examinations, Humphrey visual field 24-2, intraocular pressure measurement, gonioscopy examination and fundus photography. Optic disc topography was assessed using the Heidelberg Retinal Tomograph III by an identified masked investigator in each hospital. NTG patients had a notably larger disc area (2.65 (0.41) vs 2.19 (0.43) mm(2), respectively), larger cupping (1.54 (0.43) vs 0.63 (0.40) mm(2), respectively), smaller retinal rim areas (1.12 (0.41) vs 1.56 (0.33) mm(2), respectively), higher cup volume (0.47 (0.28) vs 0.11 (0.19) mm(3), respectively), reduced rim volume (0.23 (0.13) vs 0.41 (0.16) mm(3), respectively), higher cup to disc area ratio (0.58 (0.14) vs 0.27 (0.15), respectively), higher linear cup to disc ratio (0.76 (0.09) vs 0.49 (0.17) mm(2), respectively), higher mean cup depth (0.37 (0.09) vs 0.22 (0.09) mm, respectively), higher maximum cup depth (0.77 (0.16) vs 0.59 (0.20) mm, respectively), higher mean of cup shape measure (-0.04 (0.06) vs -0.16 (0.07), respectively), and thinner mean retinal nerve fibre layer thickness (0.15 (0.15) vs 0.24 (0.07) mm, respectively) compared to the control group (p<0.05). In conclusion, most of the optic disc parameters were significantly different in NTG patients compared to healthy individuals in Malaysia. Our findings are comparable to those reported in NTG studies in other Asian countries.

Retinal pigment epithelial detachment post radiation therapy in metastatic ocular infiltration of non-Hodgkin's lymphoma: a case report / 国际眼科杂志(Guoji Yanke Zazhi)

A 32-year-old lady, diagnosed with anaplastic large cell non-Hodgkin's lymphoma of the mediastinum, presented with bilateral floaters and reduced right eye vision 3 years post chemotherapy. Ophthalmic examination revealed bilateral panuveitis with multiple deep seated choroidal lesions in the left eye. Computed tomography scanning of the orbit showed enhancing and bulky optic nerve sheath at the retrobulbar part of both optic nerves. The patient was treated with involved field radiation therapy of the orbit, with cumulative dose of 30Gy. Eight months post radiation therapy, she developed retinal pigment epithelial detachment at the macula and deep chorioretinal degeneration at superotemporal and inferonasal regions of the right fundus. There was evidence of vitreoretinal traction at the margin of chorioretinal degeneration areas, thus barricade lasers were performed in the affected eye. Her visual acuity remains 6/6 in both eyes. Retinal pigment epithelial detachment is a possible complication of radiation therapy in non-Hodgkin's lymphoma with intraocular metastasis. It is essential to alert the managing ophthalmologists about this rare complication.

Bilateral endogenous endophthalmitis in a young immunocompetent lady with septic arthritis / 国际眼科杂志(Guoji Yanke Zazhi)

·A 20-year-old healthy lady was admitted for septic arthritis in the right knee. Two weeks after the onset of joint pain, she complained progressive blurring of vision in both eyes. Slit-lamp examination revealed evidence of inflammation in both anterior and posterior segments. There were multiple chorioretinal lesions on both fundi. Synovial fluid aspiration of the right knee and blood culture grew Staphylococcus aureus . She responded well to topical and systemic antibiotics. Her final visual acuity was 6/6 in both eyes. This case illustrates a rare presentation of bilateral endogenous endophthalmitis in an immunocompetent young patient presenting with a concurrent septic arthritis. Early diagnosis and a prompt management carry a favorable visual prognosis.

Ocular and renal sarcoidosis in an Asian teenager: a case report / 国际眼科杂志(Guoji Yanke Zazhi)

Sarcoidosis typically affects young adults with bilateral hilar lympadenopathy, lung parenchymal disease and/or skin lesion. Childhood sarcoidosis is relatively a rare entity. Concurrent ocular and renal involvements are extremely uncommon especially in childhood sarcoidosis. We presented a case of an Asian teenager with bilateral recurrent anterior uveitis and features of renal failure due to childhood sarcoidosis. He showed remarkable clinical improvements after combination of oral corticosteroids and methotrexate. His final visual outcome was satisfactory following augmented trabeculectomy in both eyes due to intractable glaucoma. It is essential to make a prompt diagnosis and initiate proper management to avoid ocular mobidity in this unusual presentation.

A unilateral mild anterior uveitis due to intralenticular foreign body / 国际眼科杂志(Guoji Yanke Zazhi)

A 25-year man presented with symptom of photophobia and tearing in the right eye for 2 months duration. It was associated with painless gradual reduced vision. There was a history of hammering on a metal object prior to that. Ocular examination revealed signs of mild anterior uveitis due to a retained metallic intralenticular foreign body. Conjunctiva was white. Computed Tomography (CT) scan of the orbit confirmed presence of a single intraocular foreign body. The condition is misleading and can be easily overlooked. A detailed history and clinical examination are mandatory in this misleading situation.

A severe penetrating eye injury with a fish hook / 国际眼科杂志(Guoji Yanke Zazhi)

An interventional case-report about a rare case of penetrating eye injury caused by a fish hook. A 34-year old man was brought to the emergency department with a fish hook embedded in the eye. The fish hook occupied the whole globe with part of it penetrated into the posterior part of the sclera. It was extracted under general anaesthesia using the back-out method.The back-out method is the best option for the removal of the fish hook that penetrated the globe till to the posterior part of the sclera

Association of serum lipid profile with retinal hard exudates among patients with type 2 diabetes mellitus / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To study the association between lipid profile and retinal hard exudates in diabetic retinopathy (DR) and the association between oxidized-LDL with systemic diseases among type 2 diabetic patients.another 40 patients without DR. Demographic data was collected and comprehensive ocular examination was performed. Nine mL venous blood was taken for fasting serum cholesterol, triglycerides, HDL, LDL, ox-LDL, and for HbA1C. Compared to patients without retinopathy 5.0±1.03mmol/L (P=0.001). The mean serum LDL was 3.6±1.69mmol/L in retinopathy group compared to 3.0±1.02mmol/L in the contol group (P=0.005). There was a higher concentration of serum cholesterol, triglyceride and LDL in patients with severe retinal hard exudates compared to those with mild and moderate, however it was not statistically significant (P=0.082, 0.116, 0.218) respectively. The mean serum oxidized-LDL concentration was higher in DR with severe retinal hard exudates compared to mild and moderate. There was no statistically significant difference in the mean oxidized LDL with other systemic diseases or duration of diabetes.and LDL with DR. However there was no association between serum lipid profile with the severity of retinal hard exudates. Serum ox-LDL was also not associated with DR and other systemic co-morbidities in our study.

Restoring vision with an early penetrating keratoplasty after bee sting injury: a case report / 国际眼科杂志(Guoji Yanke Zazhi)

·A 27-year-old man was stung by a bee presented with severe pain in the right eye. It was associated with reduced vision and swelling of the eyelids. A retained stinger was identified at the center of the cornea, surrounded by dense corneal oedema and numerous folds in the Descemet's membrane. The sting was removed completely. He subsequently developed persistent corneal oedema and heterochromia iridis. He was treated with intensive topical steroids. He underwent penetrating keratoplasty five months after the injury. His visual acuity was satisfactory one year after the surgery. Corneal oedema is an uncommon complication of bee sting injuries. It can be persistent and results in severe visual impairment. An early penetrating keratoplasty offers a good visual outcome after bee sting injury.

Case series and Variants of ocular injury Secondary to firecrackers / 国际眼科杂志(Guoji Yanke Zazhi)

·Acquired uniocular blindness in pediatric group deserves an urgent attention. The blindness usually results from mechanical injury to the globe. It is one of the leading causes of acquired blindness in this group. Most of the ocular injuries were accidental and resulted from mechanical trauma. Firecracker is one of the potential causes for acquired uniocular blindness. The nature of injury varies from mild to severe, penetrating or blunt trauma, chemical or thermal. The irreversible nature of the visual loss is preventable. Public awareness will be one of the main contributors in preventing the ocular morbidity.

Successfully treated rare presentation of orbital melioidosis / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To report a rare case of melioidosis presenting as orbital abscess, who was successfully treated with highdose of intravenous ceftazidime.·METHODS; A case" report.·RESULTS; A 55-year-old Malay gentlemen who was newly diagnosed with diabetes mellitus, presented with prolonged low grade fever for three weeks and left eye swelling for five days duration. Initial CT scan of brain and orbit showed left periorbital cellulitis and acute left sphenoidal sinusitis. Initial swab culture grew Pseudo-monas sp. His general condition improved with regular antibiotics. However, upon completion of intravenous therapy his condition worsened and the left eye became more proptosed. Repeat CT scan of the brain and orbit showed left eye orbital abscess with intracranial exten? sion. Swab culture from fistula of the lateral part of upper eyelid showed Burkholderia pseudomallei. He was treated with high dose of intravenous ceftazidime, oral co-trimoxazole for the acute management and on maintenance dose of oral co-trimoxazole for 2 months. He responded well to treatment and had no relapse up to one year post treatment. Unfortunately his left eye vision was not salvageable.·CONCLUSION: This case illustrates a rare presentation of orbital abscess due to melioidosis which was complicated with cerebral abscess and septicemia. An accurate diagnosis was essential and high dose of susceptible antibiotics was important for the institution of therapy to successfully treat this potentially fatal condition.

Dental infection presenting with ipsilateral parapharyngeal abscess and contralateral orbital cellulitis – A case report

A 43 year-old man presented with pain on the right tooth for three days duration. Computed tomography showed left orbital cellulitis and right parapharyngeal abscess. There was also evidence suggestive of a dental abscess over right upper alveolar region. Magnetic resonance imaging revealed left superior ophthalmic vein thrombosis. Emergency drainage of the right parapharyngeal abscess was performed. Right maxillary molar extraction revealed periapical abscess. Left eye proptosis markedly reduced after initiating heparin.