Purpose: Macular edema, serous retinal detachment, and retinal pigment epithelial detachment have been reported in patients with nephrotic syndrome. However, there is limited data about macular thickness in children with nephrotic syndrome. The aim of this study was to compare the mean macular thickness in children with nephrotic syndrome and in a control group and to correlate it with visual acuity and level of proteinuria. Methods:The comparative cross-sectional study included 66 children aged 6-17 years with nephrotic syndrome and healthy control seen in two tertiary centers in Malaysia. We recorded demographic data, as well as visual acuity, level of proteinuria, and the mean macular thicknesses in both groups. The mean macular thickness was measured using Stratus optical coherence tomography according to nine areas of the Early Treatment Diabetic Retinopathy Study map. Results:The mean foveal thickness was 238.15±22.98 µm for children with nephrotic syndrome and 237.01 ± 22.60 µm for the control group. There was no significant difference in the mean macular thickness between the groups (p=0.843). A significant correlation with visual acuity was observed in the superior outer macula (r=-0.41, p=0.019) the nasal outer macula (r=-0.41, p=0.019) and the inferior outer macula (r=-0.41, p=0.021). There was no significant correlation between the mean macular thickness and level of proteinuria (p=0.338), although those with higher levels of proteinuria demonstrated a trend towards increased macular thickness. Conclusion:The mean macular thickness in children with nephrotic syndrome was similar to that of healthy children. A significant correlation between the mean thickness of the outer macular layer and the presenting visual acuity was observed. There was no correlation between the mean macular thickness and the level of proteinuria.

Endogenous endophthalmitis is a very rare but potentially devastating intraocular inflammation resulting from hematogenous dissemination into the eye from a remote focus of infection. We present a case of a 49year-old Vietnamese gentleman with underlying hypertension and ischemic heart disease who presented with sudden onset bilateral eye blurring of vision for five days associated with fever, chills, and rigors. He started to have a chesty cough with right-sided pleuritic chest pain for three days as well as shortness of breath, which developed one day prior to admission. Bilateral ocular examinations and B-scan ultrasonography were consistent with endophthalmitis. A systemic workup was performed and showed multiloculated liver abscess and right lung empyema seen radiologically. Bilateral eye vitreous tap and intravitreal antibiotic injection were performed. He underwent ultrasound-guided pigtail catheter insertion and drainage of the subcapsular and pelvic collection. Microbiological findings revealed Klebsiella pneumoniae infection obtained from vitreous and endotracheal aspirate samples. There were no cultures yielded from the intraabdominal collection and peripheral blood. The right eye infection rapidly progressed to panophthalmitis, which subsequently led to globe perforation despite prompt treatment and eventually required evisceration. Thus, despite culture-negative pyogenic liver abscess in a non-diabetic patient, a high index of suspicion, emergent radiographic evaluation, and prompt intervention and treatment are crucial in salvaging the globes.