Glaucoma is a group of diseases which result in a progressive loss of retinal ganglion cells, producing characteristic optic nerve head appearance with corresponding visual loss. The aetiology remains unclear until today. Previous authors had tried to associate its pathology in relation to intracranial pressure level. We review the literature on interrelation of intraocular pressure (IOP) and intracranial pressure (ICP) which gives rise to the study of translaminar pressure gradient (TLPG) in postulating its causal factor towards glaucoma. Several studies had demonstrated that ICP was reduced in patients with glaucoma, and in sequence with normal or raised IOP, leads to increased level of TLPG. The increased TLPG which acts across the lamina cribrosa may cause a posteriorly bowed lamina cribrosa, therefore leading to glaucomatous changes. This review also explores the current available methods in
measuring ICP accurately. Further studies are needed to elucidate possible disease mechanism in keeping with IOP-ICP relationship, thus confirming the findings of
previous authors.
Keywords: Glaucoma, intracranial, intraocular, pressure, pathophysiology, translaminar
'Carotid-cavernous fistula' (CCF) boleh berlaku secara spontan atau akibat kecederaan. Disebabkan komplikasi pada mata, proses mengenalpasti penyakit dan rawatan tidak harus ditangguhkan. Kami ingin melaporkan satu kes di mana seorang wanita tua yang mengalami kemerahan mata dan kemudiannya mata menjadi semakin bengkak. Beliau disyaki menghidapi penyakit CCF tetapi pemeriksaan imbasan tomografi berkomputer pada otak dilaporkan normal. Pesakit kemudiannya dijadualkan untuk cerebral angiografi dan beliau dikenalpasti menghidap penyakit CCF. Malangnya, pesakit tersebut mengalami komplikasi seperti retinopati stasis vena dan glaukoma neovascular disebabkan rawatan tergendala. Penglihatan beliau tidak dapat disembuhkan walaupun rawatan agresif telah diberikan. Kes ini bertujuan untuk menekankan kepentingan mengesyaki sesuatu penyakit melalui pemeriksaan klinikal walaupun dengan imbasan imej yang normal. Ini adalah untuk mengelakkan komplikasi seperti kebutaan yang tidak dapat disembuhkan.
Few cases of chalazia secondary to bortezomib are reported in literature. However, it is not a recognized ocular adverse effect. We hereby report a case of recurrent chalazia secondary to bortezomib. A 40-year-old male with light chain myeloma on ten weeks of chemotherapy with bortezomib was treated for left eye inflamed chalazion with bilateral meibominitis. Severe chalazia persisted despite treatment, which necessitated cessation of chemotherapy. The patient’s condition improved on oral doxycycline and chemotherapy was recommenced but his chalazia recurred, necessitating incision and curretage. His chalazia responded to oral azithromycin without further cessation of chemotherapy. Bortezomib’s association with chalazia has been characterized as a possible adverse drug reaction according to the World Health organization classification, and its recognization as an established adverse reaction to will allow earlier identification and appropriate co-management of the patient.
Posterior Polymorphous Dystrophy (PPD) is a rare, innocuous and asymptomatic condition in which corneal endothelial cells display characteristics similar to epithelium. It is often bilateral and frequently asymmetric. We report a case of a 10-year-old girl with a family history of glaucoma who presented with right eye blurring of vision since few years. She had frequent spectacle-prescription changing due to unimproved visual acuity. Cycloplegic refraction revealed high astigmatism and moderate amblyopia over the right eye. Her best corrected vision was 6/9 for the right and left eyes. Slit-lamp examination showed a vesicular-like lesion at the periphery of corneal endothelial layers in both eyes. Endothelial cell density was much reduced on the right eye compared to the left, with more severe astigmatism. Other ocular examinations were unremarkable. Patient was instructed to patch her better left eye periodically. Although patients with Posterior Polymorphous Dystrophy (PPD) present at the age of adulthood, the age at diagnosis is highly variable. It is rare and inherited through an autosomal dominant pattern. PPD may rarely lead to astigmatism, by which was present in the patient due to the features of non-keratoconic and keratoconic cornea on the right and left eye, respectively. Endothelial cell counts were reduced more on the right eye compared to the left, which later may worsen her visual acuity thus indicating corneal transplant in the future. Patient also had a strong family history of glaucoma. Hence, screening of associated disease of corneal endothelial dystrophy in the family may be necessary.
A middle-aged gentleman with history of left penetrating keratoplatsy presented with left eye perforated corneal graft secondary to infective keratitis. The affected eye was blind from absolute steroid-induced glaucoma. In view of expected poor graft survival in a blind eye, globe removal was offered. However, the patient refused the treatment and request for another corneal graft. This case highlights both the possibility of good outcome of cornea graft in such a case, and also illustrates that patient’s autonomy to refuse treatment option outweighs beneficence.
In children, most cases of optic neuritis are immune-related. Less frequently, it may also be due to
demyelinating disorders. Other secondary causes such as infection of adjacent structures or infiltration are
even rarer. The occurrence of optic neuritis in children on chemotherapy also has not being extensively
reported. We report a case of bilateral optic neuritis in a young girl with subacute visual loss after receiving
systemic chemotherapy for embryonal ovarian carcinoma.
Obstructive Sleep Apnoea (OSA) affects 2-5% of the middle-aged population and is a potentially life-threatening condition. Previous studies on OSA and glaucoma have reported mixed findings. This was a cross-sectional comparative study with a study duration of one year to compare the incidence of high intraocular pressure among OSA subjects and non-OSA subjects. This study took place in a tertiary hospital where a total of 50 subjects with OSA and 50 non-OSA subjects were recruited. The average age was 37 years (19,65) in a multiethnic study population (76% (Malay), 18% (Chinese) and 6% (Indian)). All patients underwent a full night computer-assisted polysomnogram (SOMNOCheck Effort Weinmann, Hamburg, Germany), Epworth Sleepiness Scale (ESS), Mullers manouevre (MM) to assess the level of obstruction and tonometry. The incidence of high Intra Ocular Pressure (IOP) among OSA subject was 52% with a significant difference between non-OSA and OSA subjects. Correlation between ESS and IOP were significant (p
Penilaian status kesihatan mental dalam kalangan pesakit penglihatan terhad (LV) bukan merupakan rutin pemeriksaan. Kajian ini dijalankan untuk mengenal pasti status kesihatan mental dalam kalangan pesakit LV menggunakan soal selidik "Depression Anxiety Stress Scale (DASS-21) and Hospital Anxiety and Depression (HAD) Scale". Seramai 100 pesakit LV telah dipilih secara rawak. Pemeriksaan piawai LV dan penilaian kesihatan mental menggunakan soal selidik DASS-21 dan HAD scale telah dijalankan. Purata umur subjek adalah 62.77+9.15 tahun. Subjek terdiri daripada 63% Melayu, diikuti 26% Cina dan 11% India. Purata tahap penglihatan subjek adalah 0.45+0.24 LogMAR. Keputusan kajian menunjukkan min skor kemurungan dan kerisauan bagi soal selidik HAD Scale adalah 3.11+3.35 dan 2.85+3.21. Min skor kemurungan, kegelisahan dan tekanan bagi soal selidik DASS adalah 4.83+6.90, 3.58+3.79 dan 6.18+6.92. Ini menunjukkan min skor bagi kedua-dua soal selidik adalah dalam julat normal mengikut klasikasi tahap keterukan HAD dan DASS. Soal selidik HAD Scale menunjukkan 12% daripada subjek mengalami kemurungan dan 8% mengalami kegelisahan, manakala soal selidik DASS menunjukkan 7% mengalami kemurungan, 17% mengalami kegelisahan dan 24% mengalami tekanan. Ini menggambarkan bahawa kesihatan mental pesakit LV boleh terjejas disebabkan oleh gangguan penglihatan. Kesimpulannya, status kesihatan mental pesakit LV boleh ditentukan secara objektif menggunakan soal selidik DASS-21 dan HAD Scale. Penentuan status ini juga memastikan rawatan dan rehabilitasi yang lebih optimum dapat diberikan kepada pesakit LV.
A 17-year-old male student of Indonesian parentage presented with two weeks history of progressive painless bilateral visual deterioration. There was no contact with tuberculosis (TB)-infected patients and parents claimed that all immunization including BCG was completed. However, BCG scar was not apparent. Visual acuity was 6/36 and 6/60 in the right and left eyes respectively. The anterior and vitreous chambers were quiet. Funduscopic examination revealed retinal vasculitis with perivascular exudates, branch vein occlusion, neovascularization and macular oedema. Fluorescein angiography confirmed large areas of capillary non-perfusion and leaking new vessels. Mantoux test was positive and full regime anti-TB therapy was instituted. HIV screening was negative. Three days later, an immunosuppressive dose of oral steroid was started. Both eyes received intensive laser photocoagulation.Interestingly, there was no development of vitritis throughout.