'Carotid-cavernous fistula' (CCF) boleh berlaku secara spontan atau akibat kecederaan. Disebabkan komplikasi pada mata, proses mengenalpasti penyakit dan rawatan tidak harus ditangguhkan. Kami ingin melaporkan satu kes di mana seorang wanita tua yang mengalami kemerahan mata dan kemudiannya mata menjadi semakin bengkak. Beliau disyaki menghidapi penyakit CCF tetapi pemeriksaan imbasan tomografi berkomputer pada otak dilaporkan normal. Pesakit kemudiannya dijadualkan untuk cerebral angiografi dan beliau dikenalpasti menghidap penyakit CCF. Malangnya, pesakit tersebut mengalami komplikasi seperti retinopati stasis vena dan glaukoma neovascular disebabkan rawatan tergendala. Penglihatan beliau tidak dapat disembuhkan walaupun rawatan agresif telah diberikan. Kes ini bertujuan untuk menekankan kepentingan mengesyaki sesuatu penyakit melalui pemeriksaan klinikal walaupun dengan imbasan imej yang normal. Ini adalah untuk mengelakkan komplikasi seperti kebutaan yang tidak dapat disembuhkan.
Sindrom distensi beg kapsul ialah salah satu komplikasi yang jarang berlaku selepas fakoemulsifikasi dengan implan kanta intraokular dimasukkan ke dalam bag kanta dalam mata. Kami menerangkan satu kes sindrom distensi beg kapsul yang berlaku pada seorang lelaki berusia pertengahan yang menjalani fakoemulsifikasi dengan ‘plat haptic’ implan kanta intraokular (Zeiss CT ASPHINA 509MP) ke dalam mata kanan. Penglihatan mata kanan semasa pemeriksaan susulan 1 minggu and susulan 5 minggu selepas pembedahan tidak menunjukan penambahbaikan dengan refraksi kuasa mata bertukar menjadi minus 2.5 diopter. Tekanan intraokular hanya meningkat pada 2 jam selepas pembedahan dan normal semasa pemeriksaan susulan berikutnya. Beg kapsul distensi telah disahkan dengan menggunakan IOL Master 700. IOL Master 700 menunjukkan pengasingan abnormal beg kapsul dari implan kanta intraokular. Diagnosis sindrom distensi beg kapsul yang disebabkan oleh pengekalan viskoelastik dibuat. Pengeluaran viskoelastik yang tertinggal di dalam mata kanan telah dilakukan dan sindrom distensi beg kapsul berjaya diselesaikan dengan penglihatan mata kanan kembali ke 6/6. Oleh itu, pengeluaran viskoelastik dengan sepenuhnya semasa fakoemulsifikasi dengan ‘plat haptic’ implan kanta intrakular adalah penting untuk mengelakkan sindrom distensi beg kapsul.
This was a 28-year-old mentally-challenged girl with underlying congenital Rubella syndrome. She was bilaterally aphakic after congenital cataract surgery. She then developed bilateral aphakic glaucoma and had to undergo multiple glaucoma filtering surgeries. The most recent procedure she had undergone for her left eye was a second Ahmed valve implantation with an overlying sclera patch. Postoperatively, intraocular pressure was well controlled. However, nine months later, slit lamp examination revealed the tube was adherent to the overlying cornea with surrounding deep and superficial cornea vascularization. Siedel test was negative and intraocular pressure was normal. Subsequently the tube was removed but the plate was left in situ.
An 18-year-old Malay gentleman was noted to have profound bilateral blurred vision for one month duration, associated with loss of weight, appetite, low grade fever and abdominal distension. Visual acuity on presentation was 6/60 on the right, counting finger on the left with no afferent pupillary defect. Anterior segments were unremarkable. Vitreous cells were occasional bilaterally. Fundus revealed multiple choroidal and sub-retinal Roth spots with areas of pre-retinal and intra-retinal haemorrhages, involving the macula in the left eye. Vessels were dilated and tortuous in all quadrants of the right eye. Many areas of capillary fall out at peripheral retina were demonstrated in fundus fluorescein angiogram. Further systemic and laboratory review confirmed the diagnosis of CML and chemotherapy was initiated. Both eye ischaemic retinopathy secondary to CML was confirmed and scatter pan retinal photocoagulation was performed bilaterally. Good improvement in vision noted during subsequent follow up to 6/24 on the right, 6/60 on the left. High levels of suspicion and accurate early recognition of fundus changes are vital in these types of cases to ensure the institution of prompt treatment.
Spontaneous closure of idiopathic full thickness macular hole is a rare case as it occurs in only 3.5% while awaiting vitrectomy surgery. There are few pathologies associated with it such as vitreomacular traction (VMT) and posterior vitreous detachment. We report a case in a 74-year-old man who presented with right eye painless, progressive blurring of vision with idiopathic stage 4 full thickness macular hole which was confirmed on optical coherence tomography. It closed spontaneously after sometimes while waiting for surgery. It is important to monitor closely for the possibility of spontaneous closure based on the optical coherence tomography findings.
Endogenous endophthalmitis is a devastating intraocular infection. Finding the primary infection and directed treatment is life-saving. We describe a 47-year-old man, with uncontrolled diabetes mellitus, who presented with two weeks history of progressive reduced vision and redness of the left eye (LE). He was generally unwell since a month, previously. Examination showed relative afferent pupillary defect (RAPD) in the affected eye and visual acuity was hand movement. There was moderate anterior chamber and vitreous reaction. Fundus examination showed a huge dome-shaped choroidal mass covering the entire macula. Diagnosis of severe endogenous endophthalmitis was made, with isolation of Enterobacter sp. from his blood culture. Meanwhile, he also had elevated inflammatory markers with presence of leucocytosis, neutrophilia and elevated erythrocyte sedimentation rate (ESR) as well as C-reactive protein (CRP). Vitreous tap and aqueous tap had no growth, He improved with combination of intravitreal and systemic antibiotic, as shown by the resolved fever and reduced inflammatory markers but progressive inflammation occluded the fundus details and the LE vision eventually became no projection of light despite treatment. Subsequently, he developed rubeotic glaucoma and was treated conservatively because the LE was painless with poor vision. The repeated blood culture and urine was normal. In conclusion, endogenous endophthalmitis with eventual panophthalmitis is difficult to treat and has very poor visual prognosis. Our case highlights the challenges faced in the management of vision-threatening endophthalmitis and panophthalmitis in this patient.
In children, most cases of optic neuritis are immune-related. Less frequently, it may also be due to
demyelinating disorders. Other secondary causes such as infection of adjacent structures or infiltration are
even rarer. The occurrence of optic neuritis in children on chemotherapy also has not being extensively
reported. We report a case of bilateral optic neuritis in a young girl with subacute visual loss after receiving
systemic chemotherapy for embryonal ovarian carcinoma.
Solar retinopathy is an injury of the retinal photoreceptors due to excessive
exposure to the solar radiation. Diagnosis of the disease is challenging and requires
combination of a detailed history and imaging modalities. This case report focuses
on a 55-year-old fruit picker with an irreversible central scotoma of the right eye.
A diagnosis of solar retinopathy was made based on history but mainly by several
imaging modalities, such as optical coherence tomography (OCT), infrared (IF)
imaging of the fundus and fundus autofluorescence (FAF). Electroretinogram (ERG) showed flattened and reduced waves in both scotopic and photopic response.
Fundus angiography (FA) revealed no obvious telangectatic vessels. In conclusion,
solar retinopathy is a disease where multimodal imaging may play an important
role in the diagnosis. The condition may be irreversible thus advocating protective
eyewear is mandatory in patients who are chronically exposed to the sun.
Traumatic injury to the eye can occur due to various causes, most of which are avoidable. Here we report three cases of intrastromal corneal foreign bodies (FB) which required surgical removal. Most corneal FBs are removed easily at the slit lamp, however, these cases required surgical intervention due to the mechanism of which the FB penetrated into the stroma. Although the mechanism of injury was similar, with all three cases occurring at high velocity, we observed that the entry and level of penetration differed in each case. In the first case, the corneal FB penetrated the cornea and was embedded in the anterior stroma, whereas in the second case, the FB was embedded in the posterior stroma, but with an intact endothelium. In the third case, the FB caused a full thickness, self-sealed laceration wound but remained embedded in the stroma. Through further evaluation, we noted that several factors contribute towards the severity of the injury, namely, anatomy of the cornea, area affected, shape, size, mass and velocity of the object. We speak in depth about the mechanism of injury and physics associated with these injuries and why the penetration differed in each case.
It is rare for anterior chamber migration of an Ozurdex® implant from vitreous cavity, but it is seen more frequently in aphakic eyes or in pseudophakic cases with zonular dehiscense. We describe a case of a middle-aged gentleman who had persistent diabetic macular oedema not responding to anti-VEGF (vascular endothelium growth factor), who was treated with intravitreal Ozurdex® in his post vitrectomized eye and developed anterior migration of the implant to the anterior chamber. Anterior dislocation of an intravitreal implant of dexamethasone can be managed by repositioning it to the vitreous cavity or removing it through a corneal limbal incision. Ozurdex® is a friable implant, especially after a few weeks of implantation. Therefore, removal of the implant by grasping or aspiration may lead to its fracture or dispersion of the implant material. This is a report of a simple,fast and effective technique to remove a migrated Ozurdex® from the anterior chamber using a modified silicone tip.