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A 32-year-old gentleman with underlying hypertension presented with left eye ptosis and diplopia for two weeks. He also complained of the left eye progressive blurring of vision. One week of left-sided toothache, headache, and fever preceded these symptoms. He visited a dental clinic for the toothache and was prescribed oral metronidazole before scheduling tooth extraction. However, the disease progressed with ocular symptoms. On examination, his visual acuity was 20/20 on the right and perception to light on the left. The left eye pupil was sluggish, and relative afferent pupillary reflex was positive. There was partial ptosis, mild proptosis, and ophthalmoplegia involving cranial nerve III, IV, and VI over the left. Hypoesthesia over the left V1 region was also present. Bilateral anterior and posterior segments were unremarkable. Blood investigations revealed an elevated total white cell count and C-reactive protein.Hence, an urgent computed tomography of the brain was requested and demonstrated left cavernous sinus thrombosis with diffuse thickening and enhancement extended anteriorly to the left orbital apex. He was admitted for intravenous ceftriaxone and subcutaneous enoxaparin. He was hemodynamically stable and allowed home with new direct anti-coagulants. He sustained the permanent sequelae of a left blind eye and residual cranial nerve palsies despite the treatment.

Keratomycosis is a significant cause of mono-ocular blindness, especially in tropical regions. Fungal keratitis developing in corneal incisions is very rare. We report the experience of treating two patients diagnosed with recalcitrant candida keratitis post-phacoemulsification with anterior chamber washout and deep debridement. The first patient was a 68-year-old woman who underwent left eye phacoemulsification nine months ago with a postoperative best corrected visual acuity of 6/6. The second patient was a 73-yearold man who had uneventful right eye phacoemulsification six months prior with a postoperative best corrected visual acuity of 6/9. Both patients used topical steroids postoperatively for more than three months and noted a drop in vision. Both patients had deep stromal infiltration and endothelial plaque at the primary corneal wound. They were unresponsive to topical, intracameral, and systemic antifungal therapy. Both patients underwent anterior chamber evacuation of hypopyon and endothelial plaque removal. Evacuation of hypopyon and removal of endothelial plaque was done with a 23G vitrectomy cutter using a low-powered vacuum controlled at 200 mmHg. The fluid inside the tubing was sent for culture analysis. We used viscoelastic coating on the endothelium to minimize the damage during the operations. Intracameral amphotericin B 15 µg/0.1 ml was given at the end of the operation. Postoperatively, both patients had clear corneas. The first patient's visual acuity improved 6/18, and the second patient's visual acuity improved to 6/9. Both cultures isolated Candida parapsilosis sensitive to amphotericin. These patient cases highlight that evacuation of the anterior chamber infiltration in recalcitrant fungal keratitis and intracameral injection of amphotericin B can be an effective adjuvant therapy.

ABSTRAK Rawatan konvensional laser argon menyebabkan ketebalan sementara pada lapisan saraf retina (RNFL). Tetapi kesan dari 'pattern scanning laser' (PASCAL) tidak banyak diketahui. Kajian ini dilakukan untuk membandingkan kesan selepas konvensional laser argon dibandingkan dengan & Health 2016;11(2): 199-208 Maimunah M. et al. The principle by which the laser exerts its therapeutic effects relies on the destruction of the outer retina. This reduces the oxygen demand while maintaining a constant oxygen input. Laser burns may also serve as physiological windows through which oxygen diffuses from the choroid, increasing vitreous oxygenation and induced vasoconstriction (VelezMontota et al. 2010). However, despite the efficacy for preventing severe visual loss, laser PRP is often associated with substantial ocular side effects, such as ABSTRACT Conventional argon laser causes transient thickening of retinal nerve fibre layer (RNFL). The effect of pattern scanning laser (PASCAL) has not been well described. We compared the immediate changes in peripapillary RNFL thickness post-panretinal photocoagulation between conventional argon lasers and PASCAL in patients with diabetic retinopathy changes. A total of 32 subjects were recruited. There were 16 patients in the argon group and 16 patients in PASCAL group. Diabetic patients were recruited from Ophthalmology Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Complete eye examinations and fundus photographs were performed at baseline prior to laser treatment, and post-laser treatment at two and four months. RNFL thickness was measured using time domain optical coherence tomography. Both groups were comparable with respect to clinical characteristics and demographics. There was no significant difference in average RNFL thickness between the two groups prior to treatment (p= 0.323). RNFL post-laser treatment for patients receiving conventional argon laser remained unchanged with no significant differences in all quadrants at any time-point (two and four months). However, for the PASCAL group, significant thickening occurred at four months for average RNFL and the inferior quadrant (p <0.05). The other quadrants similarly demonstrated increasing thickness at four months but this did not reach statistical significance. Transient RNFL thickening occurs in both conventional and PASCAL laser patients. The PASCAL laser induces a greater increase in RNFL thickness than the argon laser group. Important events, such as laser eye treatments and even type of laser used, are worthy of consideration when evaluating RNFL.

Intraorbital foreign bodies are a common complication of eye trauma. If improperly managed, it may lead to severe complications. In this case series, the first case is an intraconal foreign body after being hit by a stone, and the second case is an intraconal foreign body from a metallic piece of a crane wheel. We discuss the role of imaging in confirming the presence of the foreign body, localizing it, and guiding when surgery is indicated. Our two cases showed differences in the management approach, as the first case had multiple issues requiring multiple procedures. However, the second case had a relatively specific pathology, management, and outcome. With adequate treatment and a bit of luck, the visual outcome can be satisfactory.