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.
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.
The present study is to determine the level of depression, anxiety and stress among Universiti Kebangsaan Malaysia (UKM) clinical year medical students and their help seeking behaviour in relation to their psychological aspect. A cross-sectional study was conducted in UKM Medical Centre for three months duration. The study population was the third, fourth and fifth year medical students via proportional sampling. They were given questionnaires consisting of socio-demographic items, Depression, Anxiety and Stress Scale 21 – Bahasa Malaysia version BM-DASS21 and questions regarding help-seeking behaviors. Psychometric assessment (BMDASS21) estimated the level of depression, anxiety and stress among medical students. Help-seeking behavior questions assessed the use of medical facilities and other help-seeking sources. Regarding questions on the barriers towards seeking help from the primary health-care, three parts were evaluated: structural barriers, barriers towards perceptions on mental-health disorder and barriers towards use of primary health-care services. There were 380 medical students who were involved in this research. It was found that some students experienced depression (1.3%), anxiety (2.4%) and stress (2.4%). Majority of them preferred to seek help from friends (283; 74.5%) followed by parents (275; 72.4%). There was a significant association between students who were anxious and help seeking behaviour from formal sources: counselor (p=0.001) and religious personnel (p=0.03). Hence, it is essential to increase their awareness on psychological disorders and more efficient screening programme should be used to recognize medical students with possible emotional disorders.