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Ocular siderosis bulbi is a rare but significant cause of vision impairment in patients with a retained ferrous intraocular foreign body (IOFB). In this report, we present two cases of ocular manifestations suggestive of siderosis bulbi. Both cases presented with a significant reduction in vision and were found to have a dense cataract, a small healed corneal scar, and siderotic pigments in the anterior chamber. The first case denied any past ocular injury, yet CT scans confirmed the presence of an IOFB. The second case, who had a high suspicion of ocular trauma, did not have a radiologically detectable IOFB. Both cases underwent combined cataract extraction surgery with pars plana vitrectomy and IOFB removal, resulting in a favorable visual outcome despite developing siderosis.
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A 66-year-old male presented with a three-month history of subacute painless decreased vision in the left eye. His ocular history included complicated phacoemulsification surgery of the left eye more than 20 years prior to the presentation. Slit lamp examination revealed a retained lens nuclear fragment in the superonasal quadrant. Surgical removal of the lens nuclear fragment improved the patient's condition. The retained lens nuclear fragments were presumably lodged behind the iris during the phacoemulsification surgery and spontaneously displaced downward due to liquefaction of the vitreous body with age. To the best of our knowledge, this case involves one of the longest reported time periods from phacoemulsification surgery to the clinical presentation of retained lens material without causing inflammation. We recommend detailed ocular assessment post complicated phacoemulsification surgery to ensure that no lens materials are retained.
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OBJECTIVE: To evaluate the incidence of ocular surface disease (OSD) and to determine the effects of topical pressure-lowering drugs on ocular surface disease in primary angle closure patients. METHODS: This was a cross-sectional comparative study comparing primary angle closure glaucoma (PACG) patients (Group A) with primary angle closure and primary angle closure suspect (Group B). Group A was treated with topical pressure-lowering drugs; Group B was not. Data on ocular diagnosis and details of treatment were obtained from medical records. Ocular surface disease incidence was assessed using the Ocular Surface Disease Index (OSDI) questionnaire and from clinical signs using Schirmer's test, tear break-up time and corneal fluorescein stain. Predictive Analytic Software 20 and STATA analysis software were used for statistical analyses. RESULTS: Group A demonstrated a higher rate of OSD (OSDI 52.3%, Schirmer's test 70.5%, tear break-up time (TBUT) 75%, corneal staining 77.3%) compared to Group B (OSDI 39.0%, Schirmer's test 73.2%, TBUT 58.5% and cornea staining 14.6%) except for Schirmer's test. There was a significant difference in mean score of OSDI (p=0.004), TBUT (p=0.008) and cornea staining (p<0.001) between two groups. Primary angle closure glaucoma treated with more than two medications and for more than three years had worse ocular surface disease parameters but without statistical significant difference. CONCLUSION: Ocular surface disease is common in PACG patients treated with topical pressure-lowering drugs. Topical pressure-lowering drugs caused significant OSD symptoms and signs except for tear production in PACG patients. Thorough evaluation of ocular surface disease is important to ensure appropriate treatment and intervention in PACG patients.
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Behçet's disease (BD) is a multisystemic disease that is very rare in Malaysia. About 5% of patients develop central nervous system involvement, termed neuro-Behçet's. Neuro-Behçet's is one of the most serious causes of long-term morbidity and mortality. We report two cases of neuro-Behçet's associated with uveitis (ocular BD) highlighting the clinical presentation, diagnostic measurement, and therapeutic management of these cases.
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INTRODUCTION: Hyphema and orbital apex syndrome occurring concurrently in a patient with herpes zoster ophthalmicus have not been reported previously. We present a case with these unique findings and discuss the pathogenesis of these conditions and their management. PRESENTATION OF CASE: A 59-year-old Malay lady with underlying diabetes mellitus presented with manifestations of zoster ophthalmicus in the left eye. Two weeks later, she developed total hyphema, and complete ophthalmoplegia suggestive of orbital apex syndrome. She was treated with combination of intravenous acyclovir and oral corticosteroids, and regained full recovery of ocular motility. Total hyphema persisted, and she required surgical intervention. DISCUSSION: Hyphema is postulated to occur due to an immune vasculitis affecting the iris vessels. Orbital apex syndrome is probably due to an occlusive vasculitis affecting the vasculature of the extraocular muscles and optic nerve, resulting from a direct invasion by varicella zoster virus or infiltration of perivascular inflammatory cells. Magnetic Resonance Imaging of the brain is essential to exclude possibility of local causes at the orbital apex area. CONCLUSION: Herpes zoster ophthalmicus is an uncommon ocular presentation. Managing two concurrent complications; persistent total hyphema and orbital apex syndrome is a challenging clinical situation. Early diagnosis and prompt treatment are essential to prevent potential blinding situation.
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Hearing loss is rarely associated with sympathetic ophthalmia. We describe a young man who presented with sympathetic ophthalmia and concurrent hearing loss one month post globe rupture. The presentation was very subtle and atypical. However, the patient recovered fully after two weeks of prompt oral corticosteroid therapy which resulted in good visual and hearing outcomes. This patient demonstrated that the acute phase of sympathetic ophthalmia is reversible with early recognition of features, timely diagnosis, and rapid initiation of corticosteroid therapy.