The Relationship Between Choroidal and Photoreceptor Layer Thickness With Visual Acuity in Highly Myopic Eyes.

PURPOSE: The aim of this study was to evaluate the choroidal and photoreceptor thickness in highly myopic eyes and its correlation with visual acuity. METHODS: This is a cross-sectional, observational study involving 57 eyes of 57 highly myopic subjects [spherical equivalent ≥ -6 diopters (D) or axial length ≥ 26 mm] seen in a tertiary institutional center. Eyes with any clinical evidence of maculopathy or amblyopia were excluded. All subjects underwent a refraction assessment, visual acuity, axial length measurement using the IOL Master, and full ocular assessment. Eyes were imaged using Spectralis Optical Coherence Tomography by one experienced operator. Two independent investigators manually measured subfoveal choroidal thickness (SFCT) and foveal photoreceptor thickness (FPT). RESULTS: The mean SFCT was 195.88 ± 87.63 µm (range: 32-373) and mean FPT was 96.68 ± 11.23 µm (range: 67-100), after correction for ocular magnification. The best corrected visual acuity (BCVA) in LogMAR was negatively correlated with SFCT (r = -0.510, p = 0.001) and FPT (r = -0.397, p = 0.002) and positively correlated with age (r = 0.418, p = 0.001) and axial length (r = 0.551, p = 0.001). Multiple linear regression analysis showed that age, axial length, and corrected FPT were significant risk factors for poorer BCVA (p = 0.021, < 0.001, and 0.02, respectively). CONCLUSION: FPT, age, and axial length are significant moderate predictive factors for poorer visual acuity in highly myopic eyes without myopic maculopathy. Thinner SFCT does not translate into poorer vision.

Randomized Controlled Trial of Topical Insulin for Healing Corneal Epithelial Defects Induced During Vitreoretinal Surgery in Diabetics.

PURPOSE: To determine the effect of topical insulin of 3 concentrations [0.5, 1, and 2 units per drop 4 times per day (QID)] on postoperative corneal epithelial wound healing in diabetic patients. DESIGN: A double blind randomized controlled hospital-based study involving diabetic patients with postoperative corneal epithelial defect after vitreoretinal surgery. METHODS: Diabetic patients were randomized to 3 different concentrations of topical insulin (DTI 0.5, DTI 1, and DTI 2) or placebo in the control group (DNS). Primary outcome measure was the rate of corneal epithelial wound healing (mm² per hour) over pre-set interval and time from baseline to minimum size of epithelial defect on fluorescein stained anterior segment digital camera photography. Secondary outcome measure was any adverse effect of topical insulin. Follow-up was 1 month. RESULTS: Thirty-two eyes of 32 patients undergoing intraoperative corneal debridement with resultant epithelial defect (8 eyes per group) were analyzed. DTI 0.5 was superior to other concentrations achieving 100% healing rate within 72 hours of treatment compared with 62.5% in DNS, 75% in DTI 1, and 62.5% in DTI 2. Statistically, DTI 0.5 achieved significant results (P = 0.036) compared with the diabetic control group (DNS) in terms of mean rate of corneal epithelial wound healing from maximum to minimum defect size. No adverse effect of topical insulin was reported. CONCLUSIONS: Topical insulin 0.5 units QID is most effective for healing corneal epithelial defect in diabetic patients after vitrectomy surgery compared with placebo and higher concentrations. Topical insulin is safe for human ocular usage.

Enucleation for haemophthalmus secondary to choroidal neovascularisation in polypoidal choroidal vasculopathy: a therapeutic and diagnostic dilemma.

We report a case of enucleation for painful blind eye secondary to recurrent bleeding from choroidal neovascularisation in an eye that was irradiated following presumed metastatic breast carcinoma to the choroid. A 58-year-old woman with a history of treated breast malignancy presented with haemophthalmus and intractable glaucoma in the right eye. One year previously she had presented with right vitreous haemorrhage with subretinal mass that had been irradiated given her history of breast carcinoma. Following irradiation, vitrectomy was performed to clear the blood. Intraoperative and postoperative angiography findings suggested a diagnosis of breakthrough bleeding secondary to polypoidal choroidal vasculopathy. At this presentation, however, the intraocular bleeding was recurrent resulting in elevated intraocular pressure and pain. Despite repeat surgery and medical therapy, the eye had to be enucleated. Histopathology showed choroidal neovascularisation.

Bilateral retinal vein occlusion and rubeosis irides: lessons to learn.

Uncontrolled hypertension is well- known to give rise to systemic complications involving multiple central organs. Artherosclerosis leads to damage of the retinal vessels wall, contributing to venous stasis, thrombosis and finally, occlusion. Retinal vein occlusions compromise vision through development of ischaemic maculopathy, macular oedema, and rubeotic glaucoma. Laser photocoagulation remains the definitive treatment for ischaemic vein occlusion with secondary neovascularization. Timely treatment with anti- vascular endothelial growth factor prevents development of rubeotic glaucoma. We hereby report an unusual case of bilateral retinal vein occlusion complicated by rubeosis irides, which was successfully managed to improve vision and prevent rubeotic glaucoma.

Intravitreal ranibizumab in the management of stage 2B Coats disease in a young adult Malay man.

This paper describes a rare case of Coats disease with late presentation in a young adult. The condition improved with a combination of focal photocoagulation, cryotherapy and intravitreal ranibizumab.

Unilateral visual loss after spine surgery in the prone position for extradural haematoma in a healthy young man.

This case reports a patient who developed central retinal artery occlusion following spinal surgery in the prone position. When placed in this position, especially as a result of malposition of the head, the patient may develop external compression of the eye which leads to central retinal artery occlusion. Therefore, a special precaution must be given for adequate eye protection during prolonged prone-positioned spine surgery.