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Background: Although cosmetic contact lenses are ideally indicated for patients with corneal and iris abnormalities, they are currently fashionable among the younger generation of emmetropes to enhance their physical appearance. Cosmetic contact lens wearers carry a greater risk of microbial keratitis, even more so with counterfeit ones.Case presentation: Here, we report two cases of counterfeit cosmetic contact lens wearers with Acanthamoeba keratitis (AK) who were misdiagnosed as herpes simplex virus (HSV) keratitis.Conclusion: AK is a sight-threatening complication among contact lens wearers. Since clinically AK may masquerade as HSV, early diagnosis of AK is often delayed. As both microorganisms can mimic each other, determining the co-existence of both infections can be challenging. Delay in initiating proper treatment can lead to blinding complications.

Background Badminton-related ocular injuries are among the commonest causes of blunt trauma to the eye, which can lead to significant damage to the ocular structures. This study aimed to assess the clinical presentations, complications, and visual outcomes of patients who sustained ocular injuries related to badminton treated in a single tertiary center in Malaysia. Materials and methods A retrospective clinical audit was conducted in Hospital Universiti Sains Malaysia (HUSM), Malaysia, involving patients diagnosed with ocular injuries related to badminton, either as players or spectators, between January 1, 2003 and December 31, 2017. The demographic data, mechanism of injury, and clinical presentation were recorded. In addition, visual acuity, anterior and posterior segment, and intraocular pressure (IOP) measurements were recorded at the initial presentation and at the present recruitment period. Management at the initial presentation was also obtained and recorded. The final visual outcome and complications were based on the finding of the most recent follow-up. Visual acuity was categorized as follows: mild or no visual impairment (6/18 or better), moderate and severe visual impairment (6/18 and worse). Results A total of 23 patients (23 eyes) were included in this clinical audit. The average age was 24 years, with a range of 6-56 years, with the highest incidence occurring at the age of 20 years old and younger. The majority of the injuries were sustained during the single-player game. All the injuries were caused by shuttlecock hits. In 18 cases (78%), the trauma was caused by an opponent, in four cases (17%) by a partner, and in one case involving a bystander. Most of the patients in this series were not using any protective eyewear while playing the game 96% (22). Most injuries (22 eyes) involved the anterior segment, with hyphaema as the commonest clinical presentation. The mean IOP at presentation was 23.5 (11.2) mmHg. Angle recession was detected as early as one-week post initial presentation in 17 eyes. Commotio retinae (5 eyes) and vitreous hemorrhage (4 eyes) were the common posterior segment findings. There were eight eyes with visual acuity of worse than 6/18 at the initial presentation, but only three eyes had poor final visual acuity. There was a statistically significant improvement in visual acuity at the last follow-up compared to the initial presentation (Fisher's exact test) (p=0.032). Conclusion Ocular injuries related to badminton is common and cause a detrimental effect on the long-term visual outcome. Traumatic hyphaema and commotio retinae are the most common presenting signs related to poor visual outcomes. Therefore, protective eyewear and promoting awareness of badminton-related ocular injuries are essential to prevent monocular blindness in young adults.

Posterior capsular rupture (PCR) is a common and serious complication of cataract surgery. It complicates the process of inserting posterior chamber intraocular lens and affects the visual outcome. This study is a review on visual acuity of patients that had PCR during cataract surgery in Hospital Melaka, risk factors of PCR, and factors that cause poor visual outcome. The record of all patients that had PCR during cataract surgery from 1 January 2014 till 31 March 2017 was traced using National Eye Database (NED) and the patients’ folders were reviewed retrospectively. Data collected was demographic data, type of cataract surgery, status of surgeon, underlying ocular diseases, risks factors for PCR, postoperative visual acuity, and factors that cause poor visual outcome. There were 238 eyes that had PCR during cataract surgery, from 126 (53%) female and 112 (47%) male patients. The mean age was 66.62 years old, ranging from 9 to 87 years old. Major risk factors identified were hard cataract, polar cataract, uncooperative patients, extended continuous capsulorhexis, subluxated lens, myopia, vitrectomised eyes, and poor pupil dilatation. From 153 cases that had no pre-existing ocular diseases, 119 (78%) cases had normal vision (best corrected visual acuity – BCVA) two months after surgery, 10 (7%) cases had moderate visual impairment, and four (2%) cases had severe visual impairment. Causes of BCVA poorer than 6/18 were high astigmatism, CMO, and prolonged inflammation. Cataract surgery, even complicated by PCR, is compatible with good visual outcome if the complications are managed promptly.

Glaucoma is a complex disease with intraocular pressure (IOP) playing an important role in its diagnosis and management. IOP has shown diurnal and nocturnal variations, which may affect the course of the disease.The objective of this study was to determine the effectiveness of clinic-based office hour phasing in the diagnosis and management of glaucoma and glaucoma suspect (GS).A retrospective clinical audit was conducted on patients who were subjected to office hour phasing in a glaucoma clinic, Hospital Universiti Sains Malaysia, Kelantan, Malaysia, between January 2015 and December 2019. The office hour phasing was conducted for various indications such as confirmation of diagnosis, screening, and effectiveness of treatment. IOP was recorded every two hours between 0800 and 1600 using an air puff tonometer by a trained nurse. Measurement of IOP was repeated with Goldmann applanation tonometer at sitting position by a trainee when the IOP ≥ 20 mmHg or discrepancy of IOP2 mmHg between two eyes. Other investigations including a Humphrey visual field and gonioscopy were conducted in between the IOP measurements. Diagnosis and clinical decisions on management were made at the end of the office hour clinic phasing.A total of 83 patients (163 eyes) were included in this clinical audit. Their mean age was 59.3 (16.5) years with 59% of male patients. Both eyes showed an almost similar pattern of mean IOP over five daytime readings in the clinic. A total of 35 eyes (21.5%) showed fluctuation ≥ 6 mmHg, and 128 eyes (78.5%) showed stable IOP during the clinic hour phasing. There was a significant difference in the mean IOP pattern between groups with stable and fluctuating IOP based on repetitive measure analysis of variance (RM ANOVA) (p = 0.008). The final diagnosis was made for 39 eyes (21 OD [right eye] and 18 OS [left eye]) out of 131 eyes (29.8%) with GS. Confirmation of diagnosis was achieved in all eyes (100%) with suspected ocular hypertension (OHT) and normal-tension glaucoma (NTG). Progression of glaucoma was confirmed in four eyes (2 OD and 2 OS) out of 17 eyes (23.5%) with suspected progression.Clinic hour IOP phasing provides a practical approach in confirmation of diagnosis and adjustment in the management of patients with glaucoma and GS.