Primary Conjunctiva Tuberculosis and Review of Literature.

The causes of chronic conjunctivitis are exhaustive, infection being the commonest. Primary tuberculosis(TB) involving the conjunctiva is rare. History of chronicity, worsening symptoms with steroids and clinical signs of subconjunctiva nodules could point towards the diagnosis of primary conjunctiva tuberculosis especially in endemic countries. Clinicopathological diagnosis is imperative to confirm this diagnosis. We report a case of a young lady who presented with a non-resolving chronic conjunctivitis that was proven to be TB and responded well to anti-tuberculosis treatment.

Low nocturnal ocular perfusion pressure as a risk factor for normal tension glaucoma.

OBJECTIVES: In the absence of raised intraocular pressure (IOP), haemodynamic parameters have been implicated in the development of normal tension glaucoma (NTG). The purpose of this study is to compare 24-hour IOP and haemodynamic parameters in NTG patients and non-glaucoma patients. METHODS: This is a cross sectional study involving 72 NTG patients from University of Malaya Medical Centre eye clinic glaucoma registry. The non-glaucoma patients were volunteers selected from eye clinic patients. All enrolled patients underwent 24-hour IOP and blood pressure monitoring via 2-hourly IOP and blood pressure (BP) measurements. All readings were taken in the sitting position during the diurnal period and in the supine position during the nocturnal period RESULTS: Comparison of the haemodynamic parameters, the nocturnal mean systolic BP, nocturnal mean diastolic BP and nocturnal mean arterial pressure (MAP) were significantly lower in the NTG group. The systemic ocular perfusion pressures (OPP), diastolic OPP and mean OPP taken at night were also significantly lower in the NTG group. The differences between the groups were still manifest after controlling for age and presence of hypertension. CONCLUSION: Our findings show that the nocturnal supine blood pressure parameters (systolic, diastolic and mean) and OPP were significantly lower in the NTG group compared to normals. This may reflect defective autoregulatory mechanisms in NTG patients.

Visual outcome in open globe injuries.

OBJECTIVE: To determine the factors affecting the visual outcome in patients with open globe injuries of eye. MATERIALS AND METHODS: In a prospective interventional study of consecutive patients with open globe injuries, the age, gender, place of injury, object causing injury and safety precautions taken were recorded. A detailed examination of the eye was done with a slit-lamp. X-rays of the orbits were taken in order to determine the presence of a foreign body. The injuries were classified as simple or complicated depending on the involvement of the pupil/iris, lens and retina. Finally, post operative best-corrected visual acuity at last follow up was noted. RESULTS: Fifty-two patients (52 eyes) were included in the study. The mean age of patients was 27.25±12.62 years (range 9-73 years). The majority of injuries occurred in the workplace (36.5%); nail (15.4%) and glass (15.4%) were the most common objects causing injury. Of those with good initial visual acuity, 90% maintained good visual outcome. Patients with corneal lacerations of less than 5 mm had significant good visual outcome. The number of corneal lacerations and visual axis involvement did not affect the visual outcome. Those with corneoscleral lacerations had significantly poor visual outcomes compared to those with corneal or scleral lacerations alone. CONCLUSION: Predictors of good visual outcome are good initial visual acuity, a corneal laceration wound of less than 5mm, a deep anterior chamber, and simple lacerations. Age, gender, place of injury, object causing injury, presence of hyphema or intraocular foreign body, and the use of safety precautions did not affect the visual outcome.

Intravitreal injection of recombinant tissue plasminogen activator and pneumatic displacement of submacular haemorrhage.

We report a case of a patient with hypertension and ischaemic heart disease on anti-platelet treatment, who developed uniocular profound visual loss from a submacular haemorrhage secondary to valsalva retinopathy. He was treated with a combination of intravitreal recombinant tissue plasminogen activator (rtPA) and sulphur hexafluoride (SF6) gas followed by strict prone positioning. He demonstrated significant displacement of the haemorrhage and improvement of vision postoperatively.

Effect of haemodialysis on intraocular pressure.

AIMS: To study the effect of haemodialysis on intraocular pressure (IOP) of patients at the University Malaya Medical Centre, Kuala Lumpur, and the influence of anterior chamber angles, surgery, and diabetes on the change in IOP after haemodialysis. METHODS: Prospective, single centre study on patients undergoing haemodialysis with a sample size of 98 eyes (49 patients). Ocular examination was performed before haemodialysis. Pre- and post-haemodialysis IOP measurements were taken. Plasma osmolarity changes and volume of fluid removed were noted. Patients on antiglaucoma treatment or who have had earlier laser or surgical procedures for it were excluded. Student's t-test and Pearson's coefficient test were used to determine the statistical significance. RESULTS: Plasma osmolarity decreased significantly (-11.6+/-10.0 m Osm/l, P<0.001). In eyes with occludable angles (8% of cases), IOP decreased significantly (-3.63+/-1.92 mmHg, P<0.001). In non-occludable angle eyes (92% of cases), no significant changes (P>0.05) in all subgroups of non-operated/operated and diabetic/non-diabetic eyes were seen. CONCLUSIONS: Haemodialysis does not cause significant changes in IOP in non-glaucomatous and non-occludable angle eyes.

Post viral acute multifocal posterior placoid pigment epithiopathy in a teenage child.

We report a rare case of a young boy presenting with bilateral blurring of vision following a viral like illness. Fundus examination revealed multiple pale cream-coloured lesions scattered across the posterior pole of both eyes. Fundus fluorescein angiography showed characteristic features of early hypofluorescence and late hyperfluorescence, further confirming the diagnosis of acute posterior placoid pigment epitheliopathy (AMPPPE). He was treated with topical steroids for the accompanying mild anterior uveitis. He had a prompt visual recovery with no adverse sequelae.

The association between body mass index and age related cataract.

This study was carried out to determine the association between body mass index and age related cataract among patients attending eye clinic. We conducted a case control study. The outcome of clinical eye assessment determined the patient's status. Mean body mass index among the cases was shown to be higher (25.4 +/- 4.5) than the control group (24.4 +/- 3.9) (p < 0.01). Crude analysis showed that only obese respondents were 2.4 times more likely to develop age related cataract, however this association was not seen in the multivariate analysis after adjusting for other determinants (aOR 1.81; 95% CI 0.91 - 3.62). We conclude that there is no association between body mass index and age related cataract.

Nail-patella syndrome and its association with glaucoma: a review of eight families.

BACKGROUND: Nail-patella syndrome (NPS) is a rare autosomal dominant syndrome, characterised by dysplasia of the nails, patellae, elbows and iliac horns. Mutations in the LMX1B gene were found in four North American families in whom glaucoma cosegregated with NPS. AIMS: To investigate the association of glaucoma with NPS in Australian families and to determine how common NPS is in Australia. METHODS: One family with NPS and glaucoma was identified from the Glaucoma Inheritance Study in Tasmania. A further 18 index cases of NPS were identified from the genetics database for southeastern Australia. Eight of these pedigrees were available for comprehensive glaucoma examination on available family members. DNA was sequenced for mutations in LMX1B. RESULTS: In total, 52 living cases of NPS were identified suggesting a minimum prevalence of at least 1 in 100 000. 32 subjects from eight NPS pedigrees (four familial and four sporadic cases) were examined. 14 subjects had NPS alone. 4 subjects had NPS and glaucoma or ocular hypertension. Five pedigrees with NPS had a reported family history of glaucoma, although some of these people with glaucoma did not have NPS. LMX1B mutations were identified in 5 of the 8 index cases-three sporadic and two familial. Two of the six (33%) participants over 40 years of age had developed glaucoma, showing increased risk of glaucoma in NPS. CONCLUSION: Patients with NPS should be examined regularly for glaucoma. However, because the families with NPS are ascertained primarily from young probands or probands who are isolated cases, the exact level of risk is unclear.

Ocular biometry in the subtypes of primary angle closure glaucoma in University Malaya Medical Centre.

Thirty-seven consecutive patients (41 eyes) diagnosed with primary angle closure glaucoma (PACG) attending the Glaucoma Clinic in University Malaya Medical Centre, over a period of 6 months were categorized into acute, subacute and chronic PACG from their clinical presentation. Each case was subjected to automated refraction, A-scan biometry for anterior chamber depth, axial length and lens thickness, keratometry and corneal diameter measurement. Calculations for the relative lens position and the lens thickness: axial length index were performed. The data collected was analysed by the nonparametric test (Kruskal-Wallis), one way analysis of variance (ANOVA), chi-square test, Spearman's nonparametric correlations and regression analysis. For controls 15 eyes from 15 normal subjects matched for age, sex, refractive error and race were chosen and subjected to the same examinations. Chronic PACG was the predominant subtype (53.6% of patients and 58.5% of eyes). The ocular biometric measurements of acute PACG eyes deviated most from normals in having the shallowest anterior chamber depth, shortest axial length, smallest corneal diameter, steepest corneal radius, thickest and most anteriorly situated lens, and the greatest lens thickness: axial length index. The subacute subtype was closest to normal and chronic PACG subtype fell in between in most of the biometric characteristics. These findings were not statistically significant. All PACG eyes as a group however showed statistically significant shallower anterior chamber depth (p < 0.05), and a more anterior relative lens position (p < 0.05) compared to normals.