Mohtar Ibrahim

Spontaneous resolution of descemet membrane detachment after deep anterior lamellar keratoplasty.

Purpose: To describe a patient whose Descemet membrane detachment following deep lamellar keratoplasty failed to respond to 2 attempts at gas tamponade but later resolved spontaneously. Methods: A 77-year-old woman with bilateral anterior corneal stromal scarring underwent a right deep lamellar keratoplasty with the Melles technique. Postoperatively, she developed an inferior Descemet membrane detachment, presumably due to a peripheral inferior microperforation. Two attempts at gas tamponade with sulfur hexafluoride (SF6) and 12% perfluropropane (C3F8) were made. Results: Gas tamponade was unsuccessful. Five months after deep lamellar keratoplasty, the detachment resolved spontaneously. One year after deep lamellar keratoplasty, the donor cornea was clear, and best corrected visual acuity in the right eye was 20/40 with −2.75/+2.50 × 55. Conclusions: Descemet membrane detachment after deep anterior lamellar keratoplasty can resolve spontaneously, even after failed attempts at gas tamponade. Those due to peripheral inferior perforations may be less likely to respond to tamponade than central or superior perforations.

Candida glabrata endophthalmitis following penetrating keratoplasty in a patient with negative donor rim culture

BackgroundCandida glabrata endophthalmitis following keratoplasty is rare and almost always associated with positive donor rim culture.Case presentationA 63-year-old patient, diagnosed Fuchs endothelial dystrophy in both eyes underwent a penetrating keratoplasty in his right eye. He had multiple underlying medical problems, which included diabetes mellitus, hypertension, hypoadrenalism on oral dexamethasone and fatty liver secondary to hypertrigliseridemia. He developed multiple suture abscesses, corneal haziness, retrocorneal white plaques and a level of hypopyon two weeks after an uneventful penetrating keratoplasty in his right eye. Cultures of the donor button and the transport media culture were negative. Candida glabrata was isolated successfully from the aqueous and vitreous taps. He was treated with a combination of topical, intracameral, intravitreal and intravenous Amphotericin B. His final visual acuity remained poor due to the haziness of the corneal button.ConclusionCandida glabrata endophthalmitis following penetrating keratoplasty can occur in negative donor rim and transport media cultures. The growth of the organism is facilitated by the patients immunocompromised status. Awareness by the ophthalmologists and appropriate choice of antibiotics are mandatory in this challenging condition.

Unilateral rhino-orbital-cerebral mucormycosis with contralateral endogenous fungal endophthalmitis

Rhino–orbital–cerebral mucormycosis (ROCM) is an uncommon but fatal fungal infection. We report a rare case of unilateral ROCM with ipsilateral central retinal artery occlusion and contralateral choroiditis, which later progressed to endogenous fungal endophthalmitis. The patient was successfully treated with sinuses debridement, systemic liposomal amphotericin B, and intravitreal amphotericin B. The endophthalmitis completely resolved with good vision, but the ROCM eye remained blind due to central retinal artery occlusion.

Burkholderia cepacia: a rare cause of bacterial keratitis

We describe the first clinical case of Burkholderia cepacia keratitis registered in Southeast Asia. A man in his mid-70s with underlying poorly controlled diabetes mellitus came with complaints of painful red left eye for 4 days. This was accompanied with photophobia and blurring of vision after being injured by a wooden particle while cutting grass. Slit-lamp examination showed a paracentral anterior corneal stromal infiltrates with overlying epithelial defect. Culture of the corneal smear isolated B. cepacia that was sensitive to ceftazidime, meropenem and bactrim (trimethorprim and sulfomethoxazole). Topical ceftazidime was given intensively to the patient and the infection resolved after 6 weeks of treatment.

Detection of 8-hydroxydeoxyguanosine enzyme in recurrent pterygium raising a question on its role on recurrence.

AIM To detect the presence of 8-hydroxydeoxyguanosine enzyme (8-OHdG) in recurrent pterygium and its role on recurrence. METHODS Ninty-two samples were collected of which 55 from primary pterygium, 12 from recurrent and 25 from normal conjunctiva. A cross sectional study was embarked to detect the presence of the 8-OHdG enzyme in primary, recurrent pterygium and the normal conjunctival tissue by immunohistochemistry test. RESULTS THE IMMUNOHISTOCHEMISTRY TEST SHOWED POSITIVE RESULTS: 35 in primary, 2 in recurrent pterygia and 4 in normal conjunctiva, respectively. Significant association between primary pterygium and 8-OHdG enzyme (63.6% of samples are positive) and no significant relation was detected with recurrent pterygium (16.7% of samples are positive). CONCLUSION 8-OHdG enzyme is associated with primary pterygium. It is also present in normal conjunctival tissue. For the first time it is detected in recurrent pterygia. This may raise question whether 8-OHdG enzyme has a role in recurrence of pterygium.

Recurrence of peripheral ulcerative keratitis on the corneoscleral button in a young man treated successfully with oral corticosteroids.

Purpose: To describe recurrent peripheral ulcerative keratitis (PUK) on the corneoscleral graft in a young man treated successfully with oral corticosteroids. Methods: Interventional case report. Results: A 21-year-old Malay man with no previous known medical illnesses presented with a sudden onset of peripheral corneal perforation. It was temporarily sealed with a multilayer amniotic membrane followed by patching with a corneoscleral button. One month later, a recurrence of PUK on the donor button was noted. It was successfully treated with oral corticosteroids. Conclusions: PUK without systemic manifestation may recur in the donor corneoscleral graft. Prompt intensive treatment with oral corticosteroids results in a favorable outcome.

Acute proptosis: Unusual initial presentation of sinonasal inverted papilloma

Inverted papilloma is an uncommon histopathological finding of maxillary sinus tumor. We reported here a rare case of inverted papilloma of maxillary sinus presented initially with ipsilateral proptosis. A middle-aged lady with history of having allergic rhinitis presented with progressive left eye proptosis. Assessment revealed presence of orbital mass arising from paranasal sinus, in which the histopathological examination was initially inconclusive, and later it turned up to be inverted papilloma, partly with malignant transformation. High index of suspicion is necessary especially in those patients with recurrent non-specific sinonasal symptoms, which may need repeated biopsy and histopathological examination. Ocular manifestation signifies a more advance disease.

Report of a child with acute herpes zoster ophthalmicus induced partial third nerve palsy

Abstract Herpes zoster is a reactivation of the varicella zoster virus (VZV), which may remain dormant in the dorsal root ganglion of the trigeminal nerve for decades after the patients initial exposure. The ophthalmic branch of the trigeminal nerve, i.e., the innervation to the ocular structures, is one of the most commonly involved dermatomes, giving rise to herpes zoster ophthalmicus (HZO). A 10-year-old indigenous Malaysian girl presented with a complaint of painful blurring of vision in the right eye for one week. It was followed a few days later by cutaneous vesicular eruptions over the right side of her face and nose and drooping of the right upper lid, associated with double vision. In children, the disease usually follows a mild course, resolving without residual damage. However, this child achieved a best corrected visual acuity of only 6/36 in the affected eye due to corneal scarring. The rashes healed by formation of disfiguring keloids over the right nasal area. This is another rarely reported complication of HZO in immunocompetent individuals.

Bilateral idiopathic optic perineuritis with severe vision loss: A case report

Abstract Optic perineuritis is an orbital inflammatory disorder that is either idiopathic or secondary to other conditions such as infection or systemic inflammatory disorders. This condition is very similar to demyelinating optic neuritis, but certain features of the history and magnetic resonance imaging findings are characteristic for and aid in the diagnosis of optic perineuritis. Vision loss varies greatly, from minimal clouding of vision up to only light perception. We report a case of a 44-year-old female with idiopathic bilateral optic perineuritis with vision loss of up to no light perception in both eyes. Radio imaging studies were typical of optic perineuritis and she was started on systemic corticosteroids. She responded very well to steroid therapy and achieved nearly complete visual recovery. There had been no relapse despite cessation of therapy.

Indication of Penetrating Keratoplasty in Hospital Universiti Sains Malaysia

Our objective in this study is to describe the indication of penetrating keratoplasty operations in Hospital Universiti Sains Malaysia (HUSM). A retrospective study on patients admitted for perform PK operation in the Department of Ophthalmology at the University of Seines Malaysia Hospital; Kota BaharuKelantan (HUSM) from June 2005 until June 2010. . A review of the patients’ medical records for demographic data, history, clinical examinations, related laboratory investigations and PK indications, diagnosis of glaucoma, aphakia, with notification of optical and refractive parameters pre and postoperative Data collected from the process of the follow-up were also considered up to April 2010. Cases with non-corneal button transplantation had excluded. Penetrating keratoplasty was performed in twenty three eyes of nineteen patients. Twelve (63.2%) were males and 7 (36.8%) females. The mean age was of 51.7 years (±15.6) and the range of 16-72 years. Nineteen (82. 6%) eyes had primary PK and 4 (17.4%) eyes have secondary penetrating keratoplasty. The indication of PK in 7 eyes (30.4%) was infected keratitis (fungal, pseudomonas and viral), other 5 eyes (21.7%) were diagnosed with traumatic corneal injury (chemical/ non chemical). In 4 (17.4%) eyes had post Aphakic/Pseudophakic bullous keratopathy and the last three eyes (13%) with keratoconus.