Malaysian Journal of Ophthalmology

Complications of uneventful phacoemulsification on the first postoperative day: to determine the necessity of the first day review

2023-08-29T22:14:03+00:00

Purpose: To establish the type and number of complications detected on the first postoperative day and to determine the necessity of the first day review.

Study design: Clinical audit.

Methods: This is a retrospective review of 297 patients who underwent routine phacoemulsification cataract surgery by qualified ophthalmologists and trainees from September to December 2020 at our day-care operation theatre. All cases of uncomplicated phacoemulsification were analysed for the types and frequency of
complications on postoperative day one.

Results: Of 297 cases of routine cataract surgery, 6.7% of cases were excluded due to intraoperative complications. Of the remaining 277 cases, a total of 54 cases (19.5%) were found to have complications on day 1 postoperative review. These included raised intraocular pressure (67.0%), epithelial defect (20.0%), intense inflammation with presence of fibrin (5.0%), retained soft lens matter (4.0%), retained fibres (2.0%), and exposed corneal suture (2.0%). Two patients (0.7%) needed the removal of soft lens matter. Of 36 cases of raised intraocular pressure, 1 patient required anterior chamber paracentesis for retained viscoelastic, 18 patients required topical antiglaucoma medication, 15 patients needed systemic oral acetazolamide, and 2 patients with pre-existing glaucoma were instructed to continue their antiglaucoma medications.

Conclusions: Following uneventful phacoemulsification, only 19.5% of patients were found to have complications on day 1 postoperative review. The most frequent complication was raised intraocular pressure, which can be detected on the day of surgery. Reviewing patients on the same day of surgery can reduce workload and demands on clinician time. It can also significantly reduce health care costs without compromising patient safety.

A rare case of fulminant idiopathic intracranial hypertension

2023-08-29T22:14:15+00:00

Background: Idiopathic intracranial hypertension (IIH) is characterised by raised intracranial pressure and normal cerebrospinal fluid composition with no detectable intracranial aetiology. Fulminant IIH is rare and is defined by the acute onset of symptoms and signs (less than 4 weeks between onset of symptoms and severe vision loss) with progressive vision loss over days.

Case presentation: A 22-year-old woman with body mass index of 27.6 was diagnosed with fulminant IIH. Her presenting vision was hand movement and it progressed rapidly to no light perception by day 4. She was managed with oral acetazolamide and intermittent lumbar punctures. Nevertheless, she did not regain her vision.

Conclusion: Fulminant IIH is a vision-threatening condition that must be recognised and treated early to prevent irreversible vision loss.

Cessation of ocular hypertensive attacks following iStent trabecular micro-bypass stent implantation in a patient with Posner-Schlossman syndrome: a case report

2023-08-29T22:13:50+00:00

Background: Posner-Schlossman syndrome (PSS) is an ocular condition with self-limiting recurrent episodes of markedly elevated intraocular pressure (IOP) and non-granulomatous anterior chamber inflammation. Surgical treatment is indicated if medical therapy fails to control IOP.

Case presentation: A 58-year-old male presented with intermittent attacks of blurred vision and pain in the right eye for 6 months. Examination revealed keratic precipitates with IOP of 56 mmHg in the right eye. Gonioscopy revealed open angles in both eyes. Erythrocyte sedimentation rate was within normal limits, while aqueous tap
for viral PCR, rapid plasma reagent test, and Mantoux test were negative. IOP was in the high-teens (inappropriate) on 2 topical antiglaucoma medications and the patient developed ocular surface problems. iStent was implanted. IOP remained stable within the mid-teens with no further episodes of raised IOP in the following 6 months.

Conclusion: This case showed cessation of ocular hypertensive attacks in PSS after iStent implantation.

Improvement of optic nerve head perfusion and reversible visual field defect following XEN Gel Stent implant

2023-12-18T23:33:55+00:00

Background: Patients with juvenile onset ocular hypertension (OHT) have high intraocular pressure (IOP) and may develop early glaucomatous disc damage.

Case presentation: A 26-year-old woman with family history of glaucoma was diagnosed with OHT at age 18. Her vision was 6/6, with a bilateral cup-to-disc ratio of 0.5, normal visual field (VF), and IOP in the mid-teens on 2 topical antiglaucoma medications. The patient started having IOP spikes (20–48 mmHg) in her left eye despite maximum tolerable medical therapy, associated with intermittent headache and nasal step defect on VF test. XEN Gel Stent was implanted and IOP reduced to 10–14 mmHg without medical therapy. Optical coherence tomography angiography showed improvement in optic nerve head (ONH) perfusion density and flux, while the VF defect disappeared.

Conclusion: Improvement in ONH perfusion and reversibility of early glaucomatous VF defect is feasible with prompt XEN Gel Stent implant in juvenile OHT.

Infectious surgically induced necrotising scleritis presenting 10 years post-pterygium excision: a case report

2023-12-18T23:33:42+00:00

Background: Surgically induced necrotizing scleritis (SINS) is a rare sequela that may occur after ocular surgery. We report a case of infectious SINS as a complication of pterygium excision.

Case presentation: A 75-year-old man had undergone pterygium excision in the right eye and developed infectious SINS 10 years post-surgery. The sclera adjacent to the previous site of pterygium excision showed significant thinning with uveal show, complicated with signs of infection including purulent discharge, necrotic sclera, and hypopyon. Conjunctival swab culture yielded Pseudomonas aeruginosa. Blood investigations demonstrated positive rheumatoid factor. The patient was successfully treated with a 2-week course of systemic and topical antibiotics with topical steroid.

Conclusion: SINS may develop post-pterygium excision. Early diagnosis and intervention prevent progression and further complications.

Retinoblastoma and its adverse events experienced

2024-01-01T23:41:48+00:00

Background: Retinoblastoma management has seen a paradigm shift with intra-arterial chemotherapy (IAC). Using IAC as primary management in this paediatric cancer is becoming more widespread in developing countries such as Malaysia. Considerable evidence shows that IAC has a more beneficial globe salvage rate than
intravenous chemotherapy (IVC).

Case presentation: This case report describes a successful globe salvage in Group D retinoblastoma with primary IAC and the complications experienced with this mode of treatment, especially the vascular events seen which could possibly contribute to persistent poor vision despite a completely regressed tumour.

Conclusion: Despite the remarkable tumour regression and globe preservation, the patient’s vision did not improve in the treated eye. We wish to explore the possibilities resulting in those complications and methods to reduce them in the future.

Complications from the use of cyanoacrylate glue in conjunctival grafting for pterygium surgery: a case report

2023-12-31T23:41:42+00:00

Background: Pterygium is a wing-shaped fibrovascular tissue overgrowth of the conjunctiva that crosses over the nasal or temporal limbus, or both, and grows onto the corneal surface. We report a case of complications due to the use of cyanoacrylate glue in conjunctival grafting in pterygium surgery.

Case presentation: A 70-year-old Iban woman presented with worsening foreign body sensation in the nasal aspect of the left eye 10 years after undergoing nasal pterygium excision. The foreign body sensation had worsened over the course of 1 year. Upon examination, a greyish foreign body in the nasal aspect of the left eye
(acrylate-like material) was noted.

Conclusion: In this case report, we highlight the complications of the usage of cyanoacrylate glue in pterygium surgery and the possible intraoperative complications in this case.

Antiscarring agents in glaucoma surgery: a literature review

2023-12-19T23:34:44+00:00

Glaucoma filtering surgery has been gaining popularity as an early surgical intervention in glaucoma management. A thorough review of the literature revealed that the incidence of failure in glaucoma filtering surgery may be reduced with the use of antiscarring agents. Based on the published research, we hereby discuss the available types of antiscarring agents, their regimes, and their complications. Among the drugs used, mitomycin C and 5-fluorouracil are the most prominent. We discuss the indications for their use, mode of action, dosage, techniques, and duration of usage as well as complications. Although these agents have proven efficacy, they also increase the risk of complications. While newer agents have shown promising results, the long-term complications of these drugs are still inconclusive. We also explain the new agents and methods under investigation to control wound healing after filtration surgery. This is a crucial area to explore, as most of these agents are not tissue-selective and therefore their benefits must be weighed against their possible risks.