Malaysian Journal of Ophthalmology

Phacoemulsification in acute angle closure glaucoma: when is the right time?

Norlina Ramli — Mon, 29 Jun 2026 00:00:00 +0000

Management and outcomes of acute primary angle closure with phacoemulsification: a clinical audit at hospital Tengku Ampuan Rahimah

Tue, 23 Jun 2026 00:00:00 +0000

Purpose: To evaluate the demographic characteristics, treatment effects, and timing of cataract extraction of patients with acute primary angle closure (APAC) in Hospital Tengku Ampuan Rahimah (HTAR), Klang, Malaysia.

Study design: Retrospective descriptive analysis.

Methods: This study included 17 patients with APAC in HTAR from 2021 to 2024. Data on demographics, visual acuity (VA), intraocular pressure (IOP), and antiglaucoma medications (including oral acetazolamide) were collected at presentation, preoperatively, and 3 months postoperatively following phacoemulsification with posterior chamber intraocular lens implantation (PCIOL).

Results: There were 10 females (58.8%) and 7 males (41.2%), with age ranging from 42 to 84 years. Seven patients (41.2%) were Malay, 7 (41.2%) were Chinese, and 3 patients (17.6%) were Indian. A total of 14 patients (82.4%) underwent phacoemulsification within 6 weeks of presentation. Mean IOP was 50.44 mmHg upon attack, 18.24 mmHg during abortion of attack, and 13.06 mmHg after surgery (p < 0.001). Mean logMAR VA improved from 1.00 to 0.62 (p < 0.001). Oral acetazolamide use declined significantly from 8 patients upon attack to 2 postoperatively (p = 0.002). However, 13 out of 17 patients (76.5%) of patients still required 2 or more topical IOP-lowering medications at final follow-up. No significant relationship was found between preoperative medication burden and early surgical timing.

Conclusion: Cataract surgery effectively improves VA and IOP and reduces dependency on systemic acetazolamide. Nevertheless, a high proportion of patients progress to require long-term topical therapy for chronic glaucoma, underscoring the need for ongoing monitoring. Further studies are required to determine the optimal timing for cataract surgery in APAC.

Vision-related quality of life in patients suffering from coexisting glaucoma and cataract

Tue, 16 Jun 2026 00:00:00 +0000

Purpose: To evaluate the quality of life (QoL) and vision-related QoL in patients suffering from coexisting glaucoma and cataract.

Study design: Cross-sectional analytical study.

Methods: This study included a total of 222 cases: 163 patients suffering from coexisting glaucoma and cataract as the patient group and 59 healthy individuals as the control group. Data were gathered via EuroQol five-dimensional (EQ-5D) and National Eye Institute-Visual Functioning Questionnaire 39 (NEI-VFQ 39). The results were then compared before and one month after cataract surgery in the patient and control groups.

Results: The mean and 95% confidence interval of overall vision-related QoL scores in healthy individuals and patients in the pre- and postoperative phases were 86.65 (69.3–104.0), 48.7 (9.4–88.1), and 56.1 (12.2–100.0), respectively. There were significant differences among the 3 groups regarding all NEI-VFQ 39 items (P < 0.05). The mean and confidence interval of EQ-5D scores in the pre- and postoperative phases were 0.42 (0.21–0.64) and 0.58 (0.39–0.78), respectively (P = 0.017); for healthy individuals it was 0.70 (0.59–0.80). After surgery, all QoL items significantly increased among patients (P < 0.05). There were also significant differences in the scores compared to healthy individuals (P < 0.05). One month after surgery, all vision-related QoL item scores obtained by NEI-VFQ 39 and all QoL items scores obtained by EQ-5D were significantly lower in the treated patients than in healthy individuals (P < 0.05).

Conclusions: In patients suffering from coexisting glaucoma and cataract, The overall QoL and vision-related QoL scores improved after cataract surgery. However, there was a significant difference between patients and healthy individuals, with the healthy group having a superior score than the patients, both pre- and postoperatively.

Differences in retinal ganglion cell layer and ganglion cell-inner plexiform layer thickness among haemodialysis patients with and without diabetes mellitus

Mon, 22 Jun 2026 00:00:00 +0000

Introduction: This study aimed to compare the thickness of the retinal ganglion cell layer (GCL) and the ganglion cell-inner plexiform layer (GC-IPL) in haemodialysis (HD) patients with and without diabetes mellitus (DM).

Methods: This was a single-centre cross-sectional study conducted in Indonesia. Comprehensive ocular examinations and demographic information were gathered from 110 eyes of 110 HD patients. The sample was divided into DM and non-DM groups. Optical coherence tomography was used to analyse GCL and GC-IPL thickness. The independent t-test or Mann-Whitney test was used to examine the difference between the two groups, and a p-value of less than 0.05 was deemed significant.

Results: We analysed 110 eyes of 110 HD patients and divided them into the DM group (27, 24.5%) and non-DM group (83, 75.5%). The average duration of HD in the DM group was lower at 30.8 months than in the non-DM group of 50.6 months (p < 0.05). Hypertension was found in 24 (88.8%) patients in the DM group and 66 (79.5%) in the non-DM group (p < 0.05). HD patients with DM group showed significantly thinner GCL in all sectors (p < 0.05) and significantly thinner GC-IPL in 4 sectors (p < 0.05). In the hypertension cases, GCL and GC-IPL showed significant difference between the two groups (p < 0.05).

Conclusion: HD patients with DM demonstrated thinner GCL and GC-IPL. This finding indicates the importance of integrated ophthalmic evaluation in HD patients to prevent further damage of neural retina.

Exploring dedifferentiated orbital liposarcoma: a rare disease

Tue, 31 Mar 2026 00:00:00 +0000

Background: To report a rare case of dedifferentiated liposarcoma.

Case presentation: A 72-year-old man presented with worsening proptosis of the right eye for 2 months, accompanied by severe pain and redness. He had a three-year history of progressive upper eyelid swelling in the right eye. His vision in the right eye deteriorated in 1 year to no light perception. The right eye displayed severe non-axial proptosis, with inferomedial displacement and rupture of the globe caused by a 95 x 90 x 30 mm mass. Computed tomography of the orbit revealed a heterogeneous mass with calcification occupying intra- and extraconal space, with inferomedial displacement of the indented globe. Biopsy of the orbital mass in the right eye showed acute inflammation with squamous metaplasia. The patient underwent a lid-sparing modified exenteration procedure. Histopathological examination revealed dedifferentiated liposarcoma.

Conclusion: Dedifferentiated orbital liposarcoma can be debilitating, particularly when accompanied with displacement of the eyeball.

The diagnostic puzzle of orbital myositis

Tue, 14 Apr 2026 00:00:00 +0000

Background: Idiopathic orbital inflammatory disease (IOID) is a diagnosis of exclusion that poses a diagnostic challenge as it may closely resemble other orbital pathologies.

Case report: A 69-year-old woman presented with progressive blurred vision in the left eye associated with pain, redness, proptosis and restricted extraocular movements for 3 weeks. Orbital imaging was suggestive of thyroid orbitopathy, but thyroid function tests were normal. After 8 weeks of medical decompression and oral prednisolone with a suboptimal response, an incisional biopsy of the left lateral rectus muscle revealed non-malignant skeletal muscle with inflammatory cell infiltration, consistent with IOID. Systemic corticosteroid therapy was continued for a total of 16 weeks, resulting in significant improvement in visual acuity, proptosis, and extraocular muscle function.

Conclusion: Given that IOID can mimic orbital pathologies, appropriate imaging and histopathological confirmation are essential for accurate diagnosis. Timely and adequate corticosteroid therapy can lead to favourable visual and functional outcomes.

Evidence of retrograde trans-synaptic degeneration: retinal ganglion cell atrophy following occipital stroke

Indra T. Mahayana, Sang A. P. U. Pradnyadewi, Nyssa A. Tedjonegoro — Mon, 22 Jun 2026 00:00:00 +0000

Background: Trans-synaptic degeneration (TSD) is an uncommon phenomenon wherein the degeneration of one neuron leads to the subsequent degeneration of interconnected neurons.

Case report: A 50-year-old woman experienced sudden bilateral visual field loss for 10 days, accompanied by right-sided headache, numbness, tingling, and a sensation of tingling and heaviness in the tongue. The confrontation visual field indicated right homonymous hemianopia field loss, and automated static perimetry confirmed this finding. Magnetic resonance imaging showed recent acute infarcts on the left occipital lobe and optical coherence tomography of the ganglion cell layer revealed contralateral thinning, thus confirming retrograde TSD, as the post-synaptic damage in the occipital lobe was mirrored in the pre-synaptic neurons, i.e., ganglion cells.

Conclusion: This case report demonstrated evidence of TSD in the retinal ganglion cell layer of a patient with acute occipital stroke.

A clinical diagnosis quandary: herpes zoster ophthalmicus versus paederus dermatitis

Vinoshini Devi Kailaivasan, Sujaya Singh, Yi Wen Lim — Mon, 15 Jun 2026 00:00:00 +0000

Background: Herpes zoster ophthalmicus (HZO) and Paederus dermatitis (PD) may present with overlapping dermatological features, leading to diagnostic challenges.

Case report: A 15-year-old boy presented with a one-week history of right eye pain, swelling, and fever, accompanied by vesicular lesions distributed along the right V1 and V2 dermatomes, respecting the midline. He reported a Paederus fuscipes bite in the right cheek two days before symptom onset. Examination revealed conjunctival chemosis, mechanical ptosis, restricted extraocular motility, and a grade 1 relative afferent pupillary defect. Imaging showed preseptal cellulitis with facial extension and lacrimal gland abscess. Treatment comprised oral acyclovir, intravenous ceftriaxone, intravenous metronidazole, and topical chloramphenicol ointment, with gradual improvement in systemic, ocular, and dermatological findings, and restoration of optic nerve function.

Conclusion: The clinical overlap between HZO and PD emphasizes the importance of a thorough clinical assessment—including dermatome pattern recognition, ocular examination, and systemic symptoms—to guide appropriate treatment.

Ocular melioidosis: a diagnostic challenge with devastating visual consequences

Tue, 23 Jun 2026 00:00:00 +0000

Background: Melioidosis is a multi-system infectious disease caused by Burkholderia pseudomallei. Ocular involvement in melioidosis is rare, with a reported prevalence of less than 2%. It frequently affects adults with diabetes. For severe melioidosis, ceftazidime remains the first-line treatment, followed by extended maintenance therapy to reduce the risk of relapse and recurrence.

Case presentation: A 58-year-old man, presented with a 4-day history of pain, redness and photophobia in the right eye. He had diabetes with a history of disseminated melioidosis. Ocular examination showed conjunctival injection, hypopyon in the anterior chamber, and elevated intraocular pressure in the right eye. A conjunctival culture and sensitivity swab found Burkholderia pseudomallei. He was treated with intravenous ceftazidime followed by oral trimethoprim-sulfamethoxazole and responded well to treatment.

Conclusion: Early diagnosis guided by a high index of clinical suspicion as well as prompt treatment are crucial for favorable outcomes.