Cytomegalovirus (CMV) is a double-stranded (dsDNA) virus of the herpesvirus family. Serological tests reveal signs of previous exposure to it in 40% to 100% of the general population. CMV anterior uveitis (AU) is the most common form of ocular manifestation of CMV in immunocompetent individuals. Clinically, it manifests mainly as anterior chamber (AC) inflammation, iris atrophy, and elevated intraocular pressure (IOP). In this study, we presented four cases of CMV AU with high IOP requiring different treatment modalities to control the IOP. All patients underwent AC paracentesis, and the aqueous sample sent for polymerase chain reaction (PCR) showed CMV DNA. They were treated with ganciclovir ophthalmic gel 0.15% for the infection. For IOP control, patients underwent different surgeries, namely microinvasive glaucoma surgery (MIGS) with XEN implant, augmented trabeculectomy (AT), glaucoma drainage device implantation (GDI), and transscleral cyclophotocoagulation (TSCPC). Patients were then followed up for a period ranging from six months to three years post-intervention to monitor for evidence of recurrence, IOP control, number of topical antiglaucoma medications required, and progression of glaucoma as evidenced by optical coherence tomography (OCT) retina nerve fiber layer (RNFL) and Humphrey visual field (HVF).
To evaluate the clinical presentations of traumatic optic neuropathy and to assess the visual outcome of three groups of patients managed differently (conservative, intravenous corticosteroids only and combination of intravenous and oral corticosteroids) at an academic tertiary care referral centre.
Although few studies concerning optic neuritis (ON) in Asian countries have been reported, there is no report about ON in Malaysia particularly within the Malay population. We aimed to determine the clinical manifestation, visual outcome and aetiology of ON in Malays, and discussed the literature of ON studies in other Asian populations. This was a retrospective study involving 31 consecutive patients (41 eyes) with ON treated at Hospital Universiti Sains Malaysia commencing from July 2005 till January 2010 with a period of follow-up ranging from 18-60 months. The clinical features, laboratory results, possible aetiology, and visual acuity after one year were analysed. Females were the predominant group. The age of the patients ranged between 3-55 years and peaked between 21-30 years old. 67.7% of the patients had unilateral involvement. Pain on ocular movement was observed in 31.7% of the affected eyes. 73.3% of 41 involved eyes showed visual acuity equal 6/60 or worse on presentation. Paracentral scotoma was the most common visual field defect noted. Optic disc papillitis proved more widespread compared to the retrobulbar type of ON. The aetiology was idiopathic in more than 50%, while the risk of multiple sclerosis was extremely low (3.2%) in our series. 66.0% demonstrating visual acuity improved to 6/12 or better at one year after the attack. 16.1% showed evidence of recurrence during follow-up. In conclusion, the clinical profile and aetiology of ON in Malay patients are comparable to other ON studies reported by other Asian countries.