Neovascular Glaucoma Complicating Central Retinal Artery Occlusion Despite Cilioretinal Artery Sparing.

This case report aims to describe a case of unilateral central retinal artery occlusion (CRAO) with cilioretinal artery sparing, which was complicated by neovascular glaucoma (NVG). A 75-year-old Indian woman with underlying normal tension glaucoma presented with the sudden onset of painless generalized blurring of the right eye's vision for a week. Her right eye vision was hand motion with the presence of a right relative afferent pupillary defect. Fundus examination revealed retinal whitening over the macula sparing the papillomacular bundle with generalized retinal arteriolar attenuation, which was suggestive of right CRAO with cilioretinal artery sparing. Systemic examination revealed high blood pressure (175/75 mmHg) without ocular bruit or audible murmur on auscultation. Optical coherence tomography of the macula showed inner retinal thickening over the temporal macula. Ultrasound carotid Doppler and computed tomography angiography of the carotid showed more than 75% stenosis over the right distal internal carotid artery. Unfortunately, she developed rubeosis iridis over her right eye two weeks after her presentation, which required pan-retinal photocoagulation. She subsequently progressed to NVG, requiring maximum anti-glaucoma medications to stabilize intraocular pressure. In conclusion, CRAO is a sight-threatening medical emergency. Thorough investigations are required to determine the underlying cause so that early intervention can be done to reduce the risk of a similar attack in the fellow eye and the risk of a cerebrovascular event or cardiac ischemia, which could be life-threatening. The presence of a cilioretinal artery does not prevent ocular neovascularization in CRAO. Hence, patients should also be closely monitored after the initial diagnosis to prevent devastating complications such as NVG.

Eyelid Tumours in Northern Malaysia: A Five-Year Review.

Background The majority of eyelid tumours are benign in nature and constitute 82%-98% of all eyelid tumours. This study aimed to explore the prevalence and frequency of histopathological diagnoses of eyelid tumours encountered in Hospital Sultanah Bahiyah (HSB), Malaysia, from 2016 to 2020. Method This study is a case series of 136 patients with eyelid tumours who underwent eyelid biopsy. Result Twenty-three (17%) patients were below 18 years old, 64 (47%) patients were between 19 and 64 years old and 49 (36%) patients were more than 65 years old. The mean age in this study was 47.9 ± 25.4 years. The most common benign eyelid tumours were dermoid cyst (31, 22.8%), melanocytic nevus (19, 14%), granuloma (17, 12.5%), squamous cell papilloma (13, 9.6%) and epidermal cyst (12, 8.8%). Most of the benign eyelid tumours occurred at the upper lids (79.8%), and most of the malignant eyelid tumours occurred at the lower lids (81.8%). The most common malignant eyelid tumours were basal cell carcinoma (BCC) (6, 14.3%), followed by malignant lymphoma (3, 6.1%) and sebaceous gland carcinoma (2, 4.1%). Eight out of nine cases of BCC were located at the lower lids. All malignant lymphomas were primary lymphoma. Five were extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT), and one was follicular lymphoma. All cases with benign and malignant tumours required only a single surgery for excision, and none of the cases had a recurrence. Conclusion There were limited references to the epidemiology of histopathological diagnoses of eyelid tumours in Malaysia. Although benign lesions comprise the majority of eyelid tumours, it is essential to delineate between benign and malignant eyelid tumours.

Orbital Tumours in Northern Malaysia: A Five-Year Review.

BACKGROUND: This study was conducted with the objective to examine demographic statistics and histopathological diagnoses of orbital biopsies from cases referred to the Oculoplastic subspecialty of the Ophthalmology department in Hospital Sultanah Bahiyah, Kedah, from 2016 to 2020. METHOD: This study is a case series of 28 patients who underwent orbital biopsy. RESULT: A total of 34 orbital biopsies from 28 patients were recorded. The mean age was 48.3 ± 19.1 years old. 22 (78.4%) cases manifested unilaterally and six (21.4%) manifested bilaterally. The commonest presentations were orbital mass (36.6%) and proptosis (24.4%). The mean duration of the presentation was 16.2 ± 19.5 months. Fourteen (50.0%) patients underwent orbital biopsy within six months of symptoms. 52.8% of the tumours are situated at supero-temporal region of the orbit. 53.0% (18) situated in extraconal space of orbit. Out of all, 23 (67.6%) cases were benign and 11 (32.4%) cases were malignant. All were primary in origin (100%). The commonest orbital tumours reported were malignant lymphoma (29.4%), reactive lymphoid hyperplasia (14.7%), non-caseating granulomatous inflammation (11.8%), non-granulomatous inflammation (5.9%) and cavernous haemangioma (5.9%). Of all 10 malignant lymphomas from eight patients (two were bilateral eyes) were all mucosa-associated lymphoid tissue (MALT) of primary non-Hodgkin lymphomas. None of the cases were reported to be metastasis from the systemic spread. The majority of patients' eyes (20, 58.8%) remained the same visual acuity post-biopsy while six (17.6%) eyes had improvement in visual acuity and eight (23.5%) eyes had reduced postoperative visual acuity. CONCLUSION: Malignant tumours are more common in the elder age group especially malignant lymphoma which is in contrast to Caucasian populations. Understanding the relative incidence of these various orbital tumours is essential to patient evaluation and management.

Isolated Infiltrative Optic Neuropathy in an Acute Lymphoblastic Leukemia Relapse.

Optic nerve infiltration as the first sign of isolated central nervous system relapse of acute lymphoblastic leukemia (ALL) is rare. A seven-year-old girl with standard-risk B-cell ALL who was in remission presented with sudden onset of left eye pain and loss of vision. Examination revealed no perception to light in the left eye with positive relative afferent pupillary defect. The optic disc was hyperemic and swollen with total obscuration of the disc margin associated with central retinal artery and vein occlusion. Magnetic resonance imaging of the brain and optic nerve showed left intraorbital optic nerve thickening associated with perineural enhancement and intraconal fat involvement. Lumbar puncture revealed leukemic infiltration with blast cells after a week of eye symptoms, while bone marrow aspiration was negative for malignant cells. A diagnosis of left leukemic optic nerve infiltration with central retinal artery and vein occlusion was made. A high index of suspicion with repeat cerebrospinal fluid sampling is crucial to confirm the diagnosis as vitreous biopsy may fail to reveal infiltrative cells.