The aim of this study was to measure and compare the effect of topical insulin (0.5 units, 4 times per day) versus artificial tears (Vismed, sodium hyaluronate 0.18%, 4 times per day) for the healing of postoperative corneal epithelial defects induced during vitreoretinal surgery in diabetic patients.Methods: This is a double-blind randomized controlled hospitalbased study involving diabetic patients with postoperative corneal epithelial defects after vitreoretinal surgery. Diabetic patients were randomized into 2 different groups and received either 0.5 units of topical insulin (DTI) or artificial tears (Vismed, sodium hyaluronate 0.18%; DAT). The primary outcome measured was the rate of corneal epithelial wound healing (mm 2 /h) over a preset interval and time from baseline to minimum size of epithelial defect on fluorescein-stained anterior segment digital camera photography. The secondary outcome measured was the safety of topical insulin 0.5 units and artificial tears (Vismed, sodium hyaluronate 0.18%). Patients were followed up until 3 months postoperation.Results: A total of 38 eyes from 38 patients undergoing intraoperative corneal debridement during vitreoretinal surgery with resultant epithelial defects (19 eyes per group) were analyzed. DTI was observed to have a significantly higher healing rate compared with the DAT group at rates over 36 hours (P = 0.010), 48 hours (P = 0.009), and 144 hours (P = 0.009). The rate from baseline to closure was observed to be significantly higher in the DTI group (1.20 6 0.29) (mm 2 /h) compared with the DAT group (0.78 6 0.20) (mm 2 /h) as well (P , 0.001). No adverse effect of topical insulin and artificial tears was reported.Conclusions: Topical insulin (0.5 units, 4 times per day) is more effective compared with artificial tears (Vismed, sodium hyaluronate 0.18%, 4 times per day) for the healing of postoperative corneal epithelial defects induced during vitreoretinal surgery in diabetic patients, without any adverse events.

Purpose: To determine the central corneal thickness in myopic adult patients scheduled for laser corneal refractive surgery and to explore its correlation with degree of refractive error. Materials and Methods: The case records of 130 myopic patients who underwent laser corneal refractive surgery in a military hospital over a period of two years were reviewed to determine the central corneal thickness. All patients had 6/6 vision with best correction, and did not have any other anterior segment or fundus diseases in both eyes. The central corneal thickness was measured with Visante Carl Zeiss anterior segment optical coherence tomography instrument.                                                                                                                        Results: Out of 130 patients, males were more (73, 56.2%); mean age of patients was 33.8 years (range 18-60 years) and majority were Malays (110, 84.6%).  The spherical power of myopia ranged from – 0.5 to – 10.00 D, and the cylindrical power ranged from – 0.25 to – 3.25 D. The mean central corneal thickness of both eyes was 528.2 µm (range 331- 615 µm); in the mild degree of myopia (- 0.50 to - 2.00 D) 527.9 µm, moderate degree (- 2.25 to -5.00 D) 529.4 µm, and high degree (-5.25 to -11.00 D) 523.9 µm. Conclusion: The anterior segment optical coherence tomography provides noncontact, rapid, pachymetry mapping of the corneal thickness. In Malaysian patients, the mean central corneal thickness of both eyes in myopia was 528.1 µm (range 331- 615 µm). There was no correlation between the mean central corneal thickness and degree of myopia, different genders, age groups, ethnic groups and two eyes.

Hypotony is defined as low intraocular pressure (IOP) which leads to functional and structural changes of the eye, mainly optic nerve, choroid and retina in the posterior pole. There are two types of hypotony which are clinical and statistical hypotony. “Statistical hypotony” refers to IOP which is less than 6.5 mmHg, more than 3 standard deviations below the mean IOP, 1 whereas, “Clinical hypotony” refers to IOP that is low enough to result in loss of vision and it can be caused by structural changes such as astigmatism, corneal oedema, cystoid macular oedema or maculopathy.2 Hypotony maculopathy is characterised by chorioretinal folds, acute optic nerve head oedema and tortuous retinal veins.3 The aetiologies can be due to either increased outflow of aqueous humour, for example in surgical wound leak, over filtrating bleb and cyclodialysis cleft or reduced aqueous humour production, for example in inflammatory conditions.4,5 The risk factors are male gender, young age, myopia, primary glaucoma filtering surgery, especially with the usage of antifibrotic agents, multiple ocular surgeries, vitrectomy and elevated preoperative intraocular pressure.6,7,8 In the present report, we describe a case of a middle-aged gentleman with a background of high myopia who underwent multiple ocular surgeries and presented with postoperative persistent clinical hypotony

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