Patients under long term treatment with anti-VEGF and concurrent glaucoma show significant decrease in macular RGLC volume. However, this decrease is comparable to reported RGCL decrease in patients under anti-VEGF treatment without underlying glaucoma and suggests that glaucoma patients may not be at a higher risk for losing macular RNFL and RGCL, at least if adequate control of intraocular pressure is maintained.

AIM: To derive a Malaysia guideline and consensus as part of the Malaysia Retina Group’s efforts for diagnosis, treatment, and best practices of diabetic macular edema (DME). The experts’ panel suggests that the treatment algorithm to be divided into groups according to involvement the central macula. The purpose of DME therapy is to improve edema and achieve the best visual results with the least amount of treatment load. METHODS: On two different occasions, a panel of 14 retinal specialists from Malaysia, together with an external expert, responded to a questionnaire on management of DME. A consensus was sought by voting after compiling, analyzing and discussion on first-phase replies on the round table discussion. A recommendation was deemed to have attained consensus when 12 out of the 14 panellists (85%) agreed with it. RESULTS: The terms target response, adequate response, nonresponse, and inadequate response were developed when the DME patients’ treatment responses were first characterized. The panelists reached agreement on a number of DME treatment-related issues, including the need to classify patients prior to treatment, first-line treatment options, the right time to switch between treatment modalities, and side effects associated with steroids. From this agreement, recommendations were derived and a treatment algorithm was created. CONCLUSION: A detail and comprehensive treatment algorithm by Malaysia Retina Group for the Malaysian population provides guidance for treatment allocation of patients with DME.

We are reporting a case of an incidental finding of an extensive Myelinated Retinal Nerve Fiber Layers (MRNFL)  in a healthy 12-year-old Malay boy. The child did not complain of any blurring of vision until he accidentally closed his seeing eye. On examination, the right visual acuity was 6/6 while the left visual acuity was 6/150. There was no Relative Afferent Pupillary Defect (RAPD). The anterior segment was unremarkable. The fundus of the right eye was normal with a pink optic disc with CDR of 0.4, however, the left eye showed extensive MRNFL involving the whole fundus but sparing the macula. The subjective refraction of the right eye was Plano with 6/6 vision, while the left was –5.50/-1.50x50 with a vision of 6/150. Bjerrum of the right eye was normal but the left eye showed tunnel field at around 20 degrees with 2mm target size. His Humphrey Visual Field (HVF) 30-2, for the right eye, was normal with MD -0.90 while the left eye showed a generalized reduction of the field with MD of -20.23. Optical Coherence Tomography (OCT) of the right eye was normal while the affected eye showed thickening of the RNFL at the peripheral. The other layers of the retina and the foveal region of anatomy were somehow preserved. The axial length of the right eye was 24.10mm while the left eye was 28.06mm. MRNFL is a benign condition. It is commonly seen as a streak of whitish patch starting from the optic disc extending to the retina following the arcuate nerve fiber layer pattern, however, extensive myelinated retinal nerve fiber layer involving the whole retina was not very common and usually associated with amblyopia, axial myopia, and squint. Even though mostly benign and solitary, MNFL can be associated with other systemic condition, therefore, clinicians must rule out other systemic diseases.