Malaysian Journal of Ophthalmology

Comparison of three measurement methods of intraocular pressure in patients with keratoconus undergoing MyoRing implantation

Mostafa Naderi — 2025-01-27

Purpose: This study aimed to assess intraocular pressure (IOP) before and after MyoRing implantation in keratoconus patients.

Methods: IOP was measured in 13 eyes before and six months after MyoRing implantation using Goldmann applanation (as the gold standard), iCare, and Corvis ST (uncorrected, corrected, and biomechanically corrected).

Results: Preoperatively, IOP levels were overestimated using iCare and Corvis (biomechanically corrected). However, uncorrected Corvis measurements were associated with underestimation. Postoperatively, iCare and Corvis (biomechanically corrected) continued to show overestimation, whereas uncorrected Corvis measurements resulted in underestimating IOP.

Conclusion: The Goldmann applanation tonometer proves to be a reliable gold standard for obtaining consistent IOP readings in keratoconus patients undergoing MyoRing implantation. Conversely, using iCare and Corvis before and after surgery yielded inconsistent results.

Evaluating the outcomes of manual small incision cataract surgery for advanced cataract in New Zealand

Jee Ah Oh — 2025-02-18

Purpose: To evaluate patient demographics, visual and keratometric outcomes, and complications of manual small incision cataract surgery (mSICS) to treat advanced cataract in New Zealand.

Study design: A total of 289 eyes undergoing consecutive mSICS by a single surgeon in Rotorua Eye Clinic in New Zealand between January 2011 and October 2015 were prospectively included.

Methods: Patient demographics, visual and keratometric outcomes including corrected distance visual acuity (CDVA) and vector analysis of surgically induced astigmatism (SIA), were analysed. Predicted and observed risk-adjusted surgical complications were compared.

Results: The mean patient age at time of surgery was 73.6 years. New Zealand European constituted the single largest ethnic group at 51.6% (n = 149). Māori were the second largest ethnic group at 35.6% (n = 103). Overall, 88.2% (n = 255) of patients achieved postoperative CDVA of 6/12 or better at 4 weeks following surgery. The
mean postoperative logMAR CDVA was 0.17 ± 0.37 SD (6/9 + 2 Snellen equivalent). The mean SIA magnitude was 0.99 D (SD = 0.76 D). Preoperative risk of posterior capsule rupture was 5.2% but no cases were observed. Iris prolapse was noted in 1 case (0.4%) and endophthalmitis in 2 cases (0.7%).

Conclusions: This is the largest study of mSICS in a developed country to date. mSICS is a safe and effective technique for advanced cataract extraction in a developed country with excellent visual outcomes. The incidence of posterior capsular rupture was below the predicted rate; however, endophthalmitis was higher than expected for a cohort of this size.

Scleral patch with amniotic membrane for tube exposure of glaucoma drainage device in a Malaysian tertiary eye centre

Jiah Bou Koay — 2025-01-27

Background: Glaucoma drainage device (GDD) implantation can cause serious complications such as hypotony, tube exposure, and endophthalmitis. This study illustrates the management of tube exposure.

Case series: In primary surgery, all GDD tubes were covered with a donor scleral or a pericardial flap. All cases manifested with a non-leaking conjunctival dehiscence. One eye developed exogenous endophthalmitis which resolved with antibiotic treatment. Another initially had failures with different graft materials and methods, ultimately requiring a scleral patch. A scleral patch was used to cover the exposed tube, further enclosed by a double-layered amniotic membrane using inlay and overlay grafting method. Postoperatively, instillation of autologous serum eyedrops was commenced to promote conjunctival epithelialization. All eyes epithelialized successfully to cover the scleral patch. On the other hand, another developed new conjunctival erosion and ultimately required a new GDD implantation.

Conclusion: A scleral patch graft and a double-layer amniotic membrane transplant supplemented with autologous serum eye drops may be considered in the management of GDD tube exposure.

Is this too sweet? Orbital infiltration as the only sign of Sweet syndrome relapse

Yi Wen Lim — 2025-01-27

Background: Sweet syndrome (acute febrile neutrophilic dermatosis) is a rare dermatologic disorder with accompanying features of systemic inflammation. Ocular presentations of Sweet syndrome vary, including periorbital/orbital inflammation, dacryoadenitis, conjunctivitis, episcleritis, limbal nodules, iritis, peripheral ulcerative keratitis, and choroiditis.

Case presentation: We present a case of a relapsed Sweet syndrome manifesting only with ocular features of extraocular muscle infiltration. The patient presented only with limited extraocular movement, resulting in diplopia. He responded well to oral steroids and fully recovered after 3 months.

Conclusion: Ocular manifestation could be the only presenting sign of Sweet syndrome relapse even in the absence of other systemic manifestations and negative laboratory investigations. Therefore, a high index of clinical suspicion is necessary in order to initiate early and appropriate treatment.

Oedipism: psychosis-induced self-enucleation

Sieng Teng Seow — 2025-01-27

Background: We report a case of complete unilateral self-enucleation in a schizophrenic patient.

Case presentation: A young male who defaulted schizophrenia treatment presented to the emergency department after self-enucleation of his right eye. He was brought in by his father, together with the intact enucleated globe packed in ice. On examination, he was agitated. The right eye socket showed periorbital oedema, ecchymosis, and no active bleeding. Horizontal laceration wounds were found over both canthi. Extraocular muscles were well-attached to the globe except for the superior and inferior oblique muscles. Serum and urine toxicology reports were negative. Computed tomography found no evidence of intracranial haemorrhage. He was treated as schizophrenia in acute psychosis.

Conclusion: Self-enucleation is a rare and serious act of self-mutilation as a result of untreated psychosis. It requires comprehensive care and multidisciplinary management to prevent further self-injury.

A rare presentation of systemic lupus erythematosus in a paediatric patient: a case report

Kah Suen Leng — 2025-01-30

Background: Systemic lupus erythematosus (SLE) is the prototype of a multisystem autoimmune disease. We report a rare case of severe vaso-occlusive retinopathy as the first presenting feature of SLE in a child.

Case presentation: An 11-year-old girl presented with sudden blurred vision in the right eye for 1 day. Visual acuity in the right eye was counting fingers. The patient was diagnosed with combined central retinal artery and vein occlusion in the right eye. Fundus examination of the left eye was normal. On day 2, vision in the right eye deteriorated to no light perception and the left eye’s fundus developed Roth spots. Laboratory findings suggested SLE. The patient was comanaged by a multidisciplinary team consisting of paediatrics, rheumatology, and ophthalmology.

Conclusion: We highlight the significance of early detection and multidisciplinary approach in the management of this patient to protect the fellow eye and for systemic control of inflammation.