Malaysian Journal of Ophthalmology

Post-traumatic hypertensive filtering bleb: a rare presentation

Vishel Soundarajan — 2025-11-07

Introduction: We present a rare case of hypertensive traumatic filtering bleb post trauma which deviates from the norm of hypotonic bleb reported in similar cases.

Case report: A 35-year-old male presented with a slowly progressive left eye swelling for a period of 1 year. He had undergone open globe injury repair 12 years ago and developed a traumatic filtering bleb with corneal decompensation associated with a raised intraocular pressure deviating from the norm of hypotony in similarly
reported cases. The intraocular pressure required optimization with antiglaucoma treatment. There was significant mechanical lagophthalmos induced by the subconjunctival cyst. Anterior segment imaging confirmed the presence of a fistula.

Conclusion: The atypical nature of this case shows that the mechanisms of trauma and complications that follow can vary. This unpredictable natural history of ocular trauma will in turn pose various challenges to management requiring early detection and tailored treatment to pre-empt possible complications.

Intralenticular foreign body: a case report

Loh Sze Lian — 2025-11-07

Background: To highlight the presentation, diagnosis, and management of a case of intralenticular foreign body.

Case report: A 51-year-old man with no known medical illness was referred for alleged metallic foreign body in the right eye while grinding a metal. Upon examination, visual acuity was 6/30 and 6/6 in the right and left eye, respectively. There was a self-sealed corneal laceration wound with an embedded metallic foreign body paracentrally at 5 o’clock, posterior synechiae, and traumatic cataract. Computed tomography of the orbit showed a hyperdense lesion in the lens. After removal of the foreign body, phacoemulsification with intraocular lens implantation, and corneal suturing, a postoperative computed tomography scan showed no signs of the hyperdense foreign body. The patient achieved a final best-corrected visual acuity of 6/7.5.

Conclusion: Penetrating eye injuries can lead to severe morbidity. Prompt diagnosis and early management, including imaging, are crucial in managing this type of injury.

Is this really juvenile glaucoma?

Kah Suen Leng — 2025-11-28

Background: Pigmentary glaucoma (PG) is a clinical diagnosis characterised by liberation of pigments from the iris pigment epithelium into the anterior segment, with the evidence of glaucomatous optic neuropathy.

Case presentation: A 34-year-old man presented with bilateral visual acuity of 6/9, normal anterior segment, intraocular pressure of 17 mmHg on 3 antiglaucoma eyedrops and cup-to-disc ratio of 0.8. Gonioscopy showed open angles in both eyes. Initial diagnosis was bilateral juvenile open-angle glaucoma. During subsequent follow-up, he was noticed to have bilateral concave iris and dense hyperpigmentation in both angles. Anterior segment optical coherence tomography (AS-OCT) showed bilateral posterior bowing of the mid-iris. Therefore, diagnosis was revised to PG. The reverse pupillary block was successfully treated with laser peripheral iridotomy.

Conclusion: The use of AS-OCT provides an objective visualisation of iris configuration, which aids in the diagnosis of PG.