An 18-year-old Malay gentleman was noted to have profound bilateral blurred vision for one month duration, associated with loss of weight, appetite, low grade fever and abdominal distension. Visual acuity on presentation was 6/60 on the right, counting finger on the left with no afferent pupillary defect. Anterior segments were unremarkable. Vitreous cells were occasional bilaterally. Fundus revealed multiple choroidal and sub-retinal Roth spots with areas of pre-retinal and intra-retinal haemorrhages, involving the macula in the left eye. Vessels were dilated and tortuous in all quadrants of the right eye. Many areas of capillary fall out at peripheral retina were demonstrated in fundus fluorescein angiogram. Further systemic and laboratory review confirmed the diagnosis of CML and chemotherapy was initiated. Both eye ischaemic retinopathy secondary to CML was confirmed and scatter pan retinal photocoagulation was performed bilaterally. Good improvement in vision noted during subsequent follow up to 6/24 on the right, 6/60 on the left. High levels of suspicion and accurate early recognition of fundus changes are vital in these types of cases to ensure the institution of prompt treatment.
Solar retinopathy is an injury of the retinal photoreceptors due to excessive
exposure to the solar radiation. Diagnosis of the disease is challenging and requires
combination of a detailed history and imaging modalities. This case report focuses
on a 55-year-old fruit picker with an irreversible central scotoma of the right eye.
A diagnosis of solar retinopathy was made based on history but mainly by several
imaging modalities, such as optical coherence tomography (OCT), infrared (IF)
imaging of the fundus and fundus autofluorescence (FAF). Electroretinogram (ERG) showed flattened and reduced waves in both scotopic and photopic response.
Fundus angiography (FA) revealed no obvious telangectatic vessels. In conclusion,
solar retinopathy is a disease where multimodal imaging may play an important
role in the diagnosis. The condition may be irreversible thus advocating protective
eyewear is mandatory in patients who are chronically exposed to the sun.
Polypoidal choroidal vasculopathy (PCV) is a retinal disorder characterized
by aneurismal polypoidal lesions in choroidal vasculature. PCV appears to
preferentially affect pigmented individuals and is considerably high among Asians.
Most reports on patterns of PCV around Asia are based on a homogenous race
(e.g. Chinese, Japanese) and very few descriptions from a multiracial population
like those seen in Malaysia. The present study aimed to describe the demographic
features, clinical and investigative characteristics of PCV in a multiracial group at
Universiti Kebangsaaan Malaysia Medical Centre (UKMMC). Ninety one eyes of 86
PCV patients, comprising of Chinese (65.1%), Malays (31.4%), Indians (2.3%) and
Eurasian (1.2%) were retrospectively reviewed. All underwent complete ophthalmic
examination and investigations. Mean patient age was 70.4 years with a male
preponderance (59.3%), and mostly unilateral presentation (94.1%). The logMAR
mean presenting visual acuity was 0.78 ± 0.64. Polypoidal vascular lesions were
located generally within the macula area (86.8%), manifesting mainly as submacular
hemorrhage (59.3%). Interestingly a number of eyes (43.9%) had associated drusen.
Optical coherence tomography largely demonstrated exudative changes (75.9%)
and almost all patients (97.7%) had loss of external limiting membrane (ELM) and
IS/OS interface. On indocyanine green angiography, majority of eyes had multiple
polyps (82.4%) with ‘cluster’ (58.2%) being the commonest configuration. In
conclusion, although the patterns of PCV in UKMMC were mainly similar to other
Asian patients, a number of our patients had associated drusen. This indicates
that PCV in our population could be a variant of neovascular age related macular
degeneration and not solely idiopathic in nature.
Selulitis orbital merupakan jangkitan tisu di sekitar mata di dalam ruangan orbit yang
termasuk saraf mata. Ia boleh menyebabkan komplikasi yang membawa kematian
sekiranya merebak melalui saraf mata dan ke otak. Penyebab utama jangkitan
adalah termasuk perebakan jangkitan sinusitis dari ruangan paranasal atau melalui
selulitis preseptal. Kes ini menggambarkan jangkitan di luar kebiasaan mengenai
jangkitan orbital selulitis yang berlaku akibat luka torehan pada konjunktiva mata
yang disebabkan oleh kemalangan. Rawatan antibiotik sistemik yang agresif
mengurangkan risiko komplikasi penglihatan. Kesemua luka pada atau sekelililng
mata haruslah dirawat dengan sebaiknya bagi mengelakkan berlakunya komplikasi
yang membahayakan.
Identification of causative organisms of clinically suspected microbial keratitis is very important so that appropriate targeted antimicrobial treatment can be offered to patients. The current routine method of corneal scraping specimens on to multiple agar culture plates for microbiological study is not really providing encouraging result. Our trial of modified technique of using BACTEC broth for three clinically suspected microbial keratitis cases worked 100% to identify the causative organisms in cases of microbial keratitis.
Keywords: culture media, cornea, keratitis