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BACKGROUND: Eye removal surgeries, also called anophthalmic surgeries, are usually performed for a painful blinded eye due to various underlying causes. In this case review, we intended to study the indications, the types of anophthalmic surgeries, and post-operative complications related to eye removal surgeries. METHOD: Five years of retrospective case review of surgical eye removals was conducted from 1st June 2018 to 31st May 2023 at Hospital Canselor Tuanku Muhriz (HCTM), University of Kebangsaan Malaysia (UKM). Medical record files were used to analyse the age, gender, affected eye, types of surgeries, and indications of the eye removal surgery. RESULTS: Fourteen eyes underwent anophthalmic surgeries inclusive of evisceration (78.57%, n = 11), enucleation (14.29%, n = 2), and exenteration (7.14%, n = 1). Among the evisceration group, 63.64% (n = 7) were due to endophthalmitis, 27.27% (n = 3) were due to ocular trauma, and 9.09% (n = 1) were done for a painful blind due to neovascular glaucoma. Two enucleation surgeries were performed for retinoblastoma and one exenteration for orbital metastatic malignancy. CONCLUSION: The preferred choice of anophthalmic surgery was in favour of evisceration, especially when the underlying causes were due to benign conditions. The most common indications of anophthalmic surgeries were endophthalmitis, trauma, and malignancies. Enucleation and exenteration were performed mainly for the blinded eye due to the intraocular malignancies and malignancy with an extraocular spread. A fairly lesser number of anophthalmic surgeries over the five years could imply an improvement in the conservative management approach of a painful blinded eye.
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Cerebral venous thrombosis (CVT) is a rare condition characterized by the obstruction of cerebral venous sinuses or cortical veins, leading to stroke-like symptoms. This case report presents a case of a 74-year-old male with isolated unilateral abducens nerve palsy as the sole sign of CVT, without accompanying symptoms or focal deficits. Neuroimaging, including CT and magnetic resonance venography, confirmed the diagnosis of CVT with a thrombus in the right transverse sinus. The patient was co-managed with the medical team and initiated on anticoagulation therapy. Follow-up showed resolution of diplopia and improvement in extraocular muscle movements. Unilateral abducens nerve palsy in CVT is rare, with most cases presenting as bilateral palsy. The case report emphasizes the importance of considering CVT in the differential diagnosis of isolated abducens nerve palsy and highlights the role of neuroimaging in early detection. Timely diagnosis and appropriate management are crucial for favorable outcomes in CVT cases. Further research is needed to enhance understanding of the pathophysiology, prognosis, and optimal management of this uncommon presentation.
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Retinitis pigmentosa is one of the risk factors for intraocular lens dislocation post cataract surgery which can lead to many complications. A 64-year-old Chinese female with bilateral pseudophakia and retinitis pigmentosa was referred for the continuation of care in 2009 with baseline visual acuity of hand movement bilaterally due to the retinitis pigmentosa. The cataract surgeries with posterior chamber intraocular lens (PCIOL) implantation in her early 50s were uneventful. In 2011, her right eye PCIOL dislocated anteriorly into the anterior chamber spontaneously and touched the cornea. It was complicated with bullous keratopathy and corneal decompensation. Intraocular pressure (IOP) was normal. PCIOL explantation, anterior vitrectomy and surgical peripheral iridotomy were performed. However, the cornea remained decompensated postoperatively. Her left eye was stable until 2019 when she developed acute angle closure secondary to complete anterior dislocation of PCIOL with pupillary block glaucoma. She underwent left eye PCIOL explantation, anterior vitrectomy and surgical peripheral iridotomy when IOP was optimised medically. Finally, both eyes were left aphakic due to poor prognosis with light perception (PL) vision, IOP was stable on single topical antiglaucoma and bilateral decompensated corneas were maintained with topical hypertonic saline. This case highlights the different serious sequelae of bilateral eyes in an unfortunate retinitis pigmentosa patient.
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Incidence of cornea melting or perforation is commonly seen in variety of cornea conditions. It can cause debilitating vision loss and impair patient's daily activity. Several techniques have been described to surgically treat cornea perforation and melting. In this article, a series of corneal diseases treated with corneal patch graft are highlighted to relate different approach of cornea patch graft surgery. Post-operative management and complications are discussed.