Background. Corneal blindness from healed infected keratitis is one of the most preventable causes of monocular blindness in developing countries, including Malaysia. Our objectives were to identify the causative fungi, predisposing risk factors, the proportion of correct clinical diagnosis, and visual outcome of patients treated in our hospital. Methods. A retrospective review of medical and microbiology records was conducted for all patients who were treated for fungal keratitis at Hospital Universiti Sains Malaysia from January 2007 until December 2011. Results. Forty-seven patients (47/186, 25.27%) were treated for fungal keratitis during the study period. This demonstrated that the incidence of fungal keratitis has increased each year from 2007 to 2011 by 12.50%, 17.65%, 21.21%, 26.83%, and 28.57%, respectively. The most common predisposing factors were injury to the eye followed by use of topical steroid, and preexisting ocular surface disease. Fusarium species were the most common fungal isolated, followed by Candida species. Clinical diagnosis of fungal keratitis was made in 26 of the 41 (63.41%) cases of positive isolates. Of these, in eleven cases (23.40%) patients required surgical intervention. Clinical outcome of healed scar was achieved in 34 (72.34%) cases. Conclusions. The percentage of positive fungal isolated has steadily increased and the trend of common fungal isolated has changed. The latest review regarding fungal keratitis is important for us to improve patients' outcome in the future.
Aim. To report a rare case of arteriovenous malformation in temporal lobe presenting as contralateral orbital symptoms mimicking carotid-cavernous fistula. Method. Interventional case report. Results. A 31-year-old Malay gentleman presented with 2-month history of painful progressive exophthalmos of his left eye associated with recurrent headache, diplopia, and reduced vision. Ocular examination revealed congestive nonpulsating 7 mm exophthalmos of the left eye with no restriction of movements in all direction. There was diplopia in left lateral gaze. Left IOP was elevated at 29 mmHg. Left eye retinal vessels were slightly dilated and tortuous. CT scan was performed and showed right temporal arteriovenous malformation with a nidus of 3.8 cm × 2.5 cm with right middle cerebral artery as feeding artery. There was dilated left superior ophthalmic vein of 0.9 mm in diameter with enlarged left cavernous sinus. MRA and carotid angiogram confirmed right temporal arteriovenous malformation with no carotid-cavernous fistula. Most of the intracranial drainage was via left cavernous sinus. His signs and symptoms dramatically improved following successful embolisation, completely resolved after one year. Conclusion. Intracranial arteriovenous malformation is rarely presented with primary ocular presentation. Early intervention would salvage the eyes and prevent patients from more disaster morbidity or fatality commonly due to intracranial haemorrhage.
A 3-year-old boy presented with history of trauma to the left eye after he accidentally injured his eye with a broom stick made up from coconut skewers. There was history of cats as their pets but not dogs. Ocular examination revealed left superonasal conjunctival laceration and scleral perforation with prolapsed vitreous. Fundus examination showed minimal vitreous haemorrhage and flat retina. Conjunctiva swab at the wound site was sent for gram staining, culture, and sensitivity. He underwent scleral suturing, vitreous tap, and intravitreal injection of Ceftazidime and Amikacin. Vitreous tap was sent for gram stained, culture and sensitivity. Postoperatively, he was started empirically on IV Ciprofloxacin 160 mg BD, Guttae Ciprofloxacin, and Guttae Ceftazidime. Conjunctiva swab grew Pasteurella canis which was sensitive to all Beta lactams, Ciprofloxacin, Chloramphenicol, and Aminoglycoside. Post-operative was uneventful, absent signs of endophthalmitis or orbital cellulitis.