Visual acuity and visual skills in Malaysian children with learning disabilities.

BACKGROUND: There is limited data in the literature concerning the visual status and skills in children with learning disabilities, particularly within the Asian population. This study is aimed to determine visual acuity and visual skills in children with learning disabilities in primary schools within the suburban Kota Bharu district in Malaysia. METHODS: We examined 1010 children with learning disabilities aged between 8-12 years from 40 primary schools in the Kota Bharu district, Malaysia from January 2009 to March 2010. These children were identified based on their performance in a screening test known as the Early Intervention Class for Reading and Writing Screening Test conducted by the Ministry of Education, Malaysia. Complete ocular examinations and visual skills assessment included near point of convergence, amplitude of accommodation, accommodative facility, convergence break and recovery, divergence break and recovery, and developmental eye movement tests for all subjects. RESULTS: A total of 4.8% of students had visual acuity worse than 6/12 (20/40), 14.0% had convergence insufficiency, 28.3% displayed poor accommodative amplitude, and 26.0% showed signs of accommodative infacility. A total of 12.1% of the students had poor convergence break, 45.7% displayed poor convergence recovery, 37.4% showed poor divergence break, and 66.3% were noted to have poor divergence recovery. The mean horizontal developmental eye movement was significantly prolonged. CONCLUSION: Although their visual acuity was satisfactory, nearly 30% of the children displayed accommodation problems including convergence insufficiency, poor accommodation, and accommodative infacility. Convergence and divergence recovery are the most affected visual skills in children with learning disabilities in Malaysia.

Candida glabrata endophthalmitis following penetrating keratoplasty in a patient with negative donor rim culture.

BACKGROUND: Candida glabrata endophthalmitis following keratoplasty is rare and almost always associated with positive donor rim culture. CASE PRESENTATION: A 63-year-old patient, diagnosed Fuch's endothelial dystrophy in both eyes underwent a penetrating keratoplasty in his right eye. He had multiple underlying medical problems, which included diabetes mellitus, hypertension, hypoadrenalism on oral dexamethasone and fatty liver secondary to hypertrigliseridemia. He developed multiple suture abscesses, corneal haziness, retrocorneal white plaques and a level of hypopyon two weeks after an uneventful penetrating keratoplasty in his right eye. Cultures of the donor button and the transport media culture were negative. Candida glabrata was isolated successfully from the aqueous and vitreous taps. He was treated with a combination of topical, intracameral, intravitreal and intravenous Amphotericin B. His final visual acuity remained poor due to the haziness of the corneal button. CONCLUSION: Candida glabrata endophthalmitis following penetrating keratoplasty can occur in negative donor rim and transport media cultures. The growth of the organism is facilitated by the patient's immunocompromised status. Awareness by the ophthalmologists and appropriate choice of antibiotics are mandatory in this challenging condition.

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.

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.