Malaysian Journal of Ophthalmology

Myopia: from refractive error to a public health challenge

Norazah Abdul Rahman — 2026-02-03

Joint position statement: Strengthening eye screening for newborns and pre-schoolers in Malaysia

Manoharan Shunmugam — 2026-02-20

The Malaysian Society of Ophthalmology, the College of Ophthalmologists, the Malaysia Advocacy for Myopia Prevention, the Association of Malaysian Optometrists, the Malaysian Association of Practising Opticians, and the Malaysian Paediatric Association present this joint position statement firmly recommending an all-of-Malaysia effort to strengthen eye screening for all children nationwide in Malaysia, especially for newborns aged 0–30 days and for preschoolers aged 5–6. This joint position statement is supported by colleagues from the Asia-Pacific Paediatric Retina Association (APPREA).

Short review of myopia and its impact in the COVID-19 era

Priscilla Peixi Choo — 2026-01-27

Myopia, or near-sightedness, is a common childhood eye condition where images are focused in front of the retina, often due to excessive eye length or lens curvature. If uncorrected, myopia can lead to severe visual impairment or blindness. The global prevalence of myopia is rising, expected to affect nearly half of the world’s population by 2050, with significantly higher rates in East and Southeast Asia compared to other regions. In Malaysia, studies show varying prevalence rates among different ethnic groups, with ethnic Chinese children exhibiting the highest rates. Myopia negatively impacts quality of life, affecting children’s academic performance, social interactions, and mental health. Economic burdens are substantial, with high costs for corrective measures and myopia-related complications, particularly in older adults. The COVID-19 pandemic exacerbated myopia progression due to increased screen time and reduced outdoor activities during lockdowns. Studies suggest that near work, especially using smartphones and computers, significantly contributes to myopia development, while outdoor activities have a protective effect. To mitigate myopia progression, especially during pandemics, it is crucial for parents to promote balanced eye habits, encourage outdoor activities, and monitor digital device usage. Treatments such as defocus incorporated multiple segments (DIMS) lenses, atropine eye drops, and maintaining good eye habits can slow progression. Despite limited evidence, eye exercises may also be beneficial. Proactive measures and alternative treatments are recommended when prolonged confinement is necessary.

A comparison of visual outcomes of deep anterior lamellar keratoplasty versus penetrating keratoplasty of keratoconus patients in two major corneal centres in Malaysia

Yin Peng Lai — 2026-01-20

Purpose: We conducted a retrospective study of keratoconus patients who underwent either penetrating keratoplasty (PKP) or deep anterior lamellar keratoplasty (DALK) in Malaysia from 2014 to 2018 to compare refractive and visual outcomes between PKP and DALK.

Study design: Retrospective case control study.

Methods: We studied 59 eyes of 53 keratoconus patients: 31 eyes underwent PKP and 28 underwent DALK. We obtained data that included demographic distribution, pre- and postoperative best-corrected visual acuity (BCVA in logMAR), postoperative refraction (spherical equivalent and astigmatism), postoperative topography (SimK1, SimK2, and Kcyl), type of correction (spectacles versus contact lens), incidence of rejection, and other complications.

Results: There were 22 female patients (42.0%) and 31 male patients (58.0%) with 55.0% Indians, 34.0% Malays, 7.0% Chinese, and 4.0% others. The mean age was 27.03 ± 8.68 years for the PKP group and 26.36 ± 7.26 years old for the DALK group (p = 0.784). There were no statistically significant differences in preoperative BCVA, postoperative refraction, and postoperative topography. However, there was a statistically significant difference in postoperative BCVA between PKP (0.16 ± 0.16) and DALK (0.33 ± 0.17) (p = 0.001). Graft rejection was a significant complication in the PKP group, with 5 eyes (16.0%) resulting in 2 graft failures (6.0%).

Conclusions: In this study, more men than women underwent corneal transplant for keratoconus within the second to third decades of life, most of whom were of Indian origin. PKP showed better visual outcome in terms of BCVA than DALK. Regarding refractive and keratometry parameters, there were no significant differences. However, DALK had a lower rate of graft rejection and graft failure compared to PKP.

Local experience of concurrent three-weekly high-dose pulsed intravenous methylprednisolone and orbital radiotherapy in thyroid eye disease

Ru Jian Jonathan Teoh — 2026-01-20

Purpose: To analyse the outcomes of concurrent high-dose pulsed intravenous methylprednisolone (IVMP) administered every 3 weeks for 4 cycles along with orbital radiotherapy (OR) in thyroid eye disease (TED).

Study design: Retrospective case series.

Methods: The medical records of 5 patients with moderate-to-severe active TED who underwent concurrent IVMP and OR in 2022 and 2023 were reviewed. All patients received concurrent pulsed IVMP (1 g per day for 3 consecutive days, administered 3-weekly for 4 cycles) and OR (20 Gy in 10 fractions). Improvement was assessed using the Clinical Activity Score (CAS) and International Thyroid Eye Disease (ITEDS) – Vision/Inflammation/Strabismus/Appearance (VISA) scoring system.

Results: The mean age of the 5 patients was 50.2 ± 5.2 years. The mean duration of ophthalmopathy and thyroid disease were 6.2 ± 4.2 months and 9.60 ± 9.29 months, respectively. Following treatment, there was a significant reduction in the mean CAS by 2.8 ± 1.3 (p = 0.009) and ITEDS-VISA scores by 5.8 ± 2.5 (p = 0.006). Improvement in proptosis measured by exophthalmometer was 2.3 ± 1.5 mm (p = 0.028). The mean follow-up duration was 6.0 ± 5.9 months.

Conclusion: Concurrent high-dose three-weekly pulsed IVMP with OR is a safe and effective treatment modality in the management of active TED.

Posterior placoid chorioretinitis: a disguise of ocular syphilis

Chien Xue Low — 2026-01-20

Background: To report a case of ocular syphilis presenting as acute syphilitic posterior placoid chorioretinitis.

Case presentation: A 38-year-old male presented with reduced vision in the left eye for 2 weeks. Best-corrected Snellen visual acuity was 6/60 in the affected eye and 6/9 contralaterally. Fundoscopy revealed mild vitritis, hyperaemic optic disc, a yellowish placoid lesion at the macula, and choroiditis. Optical coherence tomography of the macula showed disruption at the outer retinal layers and hyperreflective lesions in the choriocapillaris. Fundus fluorescein angiography showed a “hot” disc and patches of vasculitis. The diagnosis was delayed by spontaneous clinical resolution and false negative non-treponemal test due to the prozone phenomenon. Due to high clinical suspicion, the test was repeated with a diluted serum sample that turned out to be positive and was treated with intravenous benzylpenicillin.

Conclusion: A placoid lesion at the macula should raise high suspicion of ocular syphilis.

Serum eye drops in treating recurrent corneal erosion syndrome

Roslee Nur Ain Syafira — 2026-02-05

Background: Persistent recurrent corneal erosion syndrome (RCES) was successfully treated with plasma eye drops in a district hospital in Malaysia.

Case presentation: We report a case of a woman who presented with recurrent right eye pain and redness post trauma. She exhibited a chronic persistent epithelial defect despite multiple treatment modalities offered, which included medical and surgical intervention. She was initially treated with vigorous artificial tears, bandage contact lens application, and epithelial debridement; however, symptoms recurred. Significant improvement was seen 1 month after initiation of autologous serum eye drops and complete resolution was achieved following completion of this regime. No recurrence of symptoms was reported at 1 year after treatment completion.

Conclusion: The use of serum eye drops was shown to be effective in treating RCES.

Ocular effects of Euphorbia trigona sap: a case report

Chia Yaw Teoh — 2026-01-20

Background: African milk tree (Euphorbia trigona) sap contains toxic components, notably ingenol esters, causing cytotoxicity to corneal cells and hindering healing, thereby causing toxic keratopathy.

Case report: We present a case of ocular injury in a 45-year-old man following exposure to Euphorbia trigona sap during gardening. Despite immediate irrigation, the patient experienced discomfort, redness, and reduced vision in his right eye. Treatment involved aggressive topical antibiotics and subsequent corneal debridement.

Conclusion: Euphorbia trigona sap contains cytotoxic properties results in defective corneal epithelial healing. Understanding variations in latex compositions across species aid in clinical anticipation and individualised treatment.

Phthisis with a threat: imaging and histopathology of a ciliary body adenocarcinoma

Mariapan Sai Priyalatha — 2026-01-22

Background: Adenocarcinoma is a rare malignancy derived from the pigmented or non-pigmented epithelium of the ciliary body and/or iris.

Case presentation: A 35-year-old male with childhood left eye (LE) blindness developed throbbing pain and redness of LE for a few months. On examination, the LE showed conjunctival injection, chemosis, opaque cornea, and raised intraocular pressure. Computed tomography (CT) revealed LE phthisis bulbi and orbital cellulitis. Histopathology indicated a malignant epithelial tumour, likely adenocarcinoma of the ciliary body, with positive pancytokeratin immunohistochemistry. Contrast-enhanced CT showed an ocular mass without distant metastasis. Four months later, magnetic resonance imaging revealed residual tumour with local infiltration. The patient underwent exenteration and recovered well with a prosthesis.

Conclusion: A high index of suspicion for malignancy, along with appropriate laboratory tests, histopathological evaluation, imaging, and surgical intervention are essential to alleviate symptoms and preserve life.