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Ectopia lentis or crystalline lens subluxation is one of the major criteria to diagnose Marfan syndrome. It may vary from mild lens subluxation to lens dislocation. Herewith is a case report of a 4-year-old autistic boy who had never been diagnosed with Marfan syndrome. He presented to the clinic after his parents noticed he had difficulty focusing on near objects. His bilateral best-corrected visual acuity was 6/60. On examination, there was bilateral lens subluxation superotemporally and lens equator blocking his visual axis. He was sent to the paediatric team and further Marfan workout showed dilated aortic root. He was then diagnosed with Marfan syndrome. He underwent bilateral lens aspiration, anterior vitrectomy, and iris-claw lens implantation. His postoperative bilateral visual acuity on day 1 was 6/30 and his best-corrected visual acuity 3 months after surgery was 6/9 for both eyes. In conclusion, ophthalmologists play an important role in diagnosing and managing Marfan syndrome. Early diagnosis is important to help preserve vision and improve quality of life.

Introduction: Glaucoma is second only to cataract as a cause of blindness worldwide and Asians account for almost half the cases. Retinal nerve fibre layer (RNFL) assessment is an important objective method for diagnosis and monitoring of glaucoma as it develops earlier than the development of visual field defects. Purpose: To estimate the proportion of primary open-angle glaucoma (POAG) patients with normal RNFL thickness (RNFLT) amongst early POAG patients who were under follow-up at the Ophthalmology Department, Hospital Melaka (Melaka, Malaysia). Study design: Observational cross-sectional study. Materials and methods: Consecutive sampling of 64 POAG patients who were diagnosed as early POAG as defined by the Glaucoma Staging System 2 (GSS 2) into stage 1 and 2 on Octopus visual field test were recruited in this study. Data collected included demographic data, refraction, slit-lamp examination, intraocular pressure (IOP), gonioscopy, peripapillary retinal nerve fibre layer thickness (RNFLT) measured by spectral-domain optical coherence tomography (SD-OCT), and fundus photography. Results: Among 64 eyes, 57.8% were found to have normal and 42.2% to have abnormal RNFLT classification. There was no difference in terms of age, gender or ethnicity between those with normal and abnormal RNFLT. Mean IOP at presentation, mean duration of POAG, and mean spherical dioptres were compared between the two groups. Only mean spherical dioptres showed a significant difference between the two groups, p < 0.001. An increase of spherical dioptres also had a moderate positive correlation with RNFLT in most optic disc quadrants except the nasal, temporal, superonasal, and inferonasal quadrants. Conclusion: OCT cannot be used as a diagnostic tool alone, especially in early glaucoma, as it showed a normal RNFLT in almost half the patients. RNFLT in early POAG had significant correlation with spherical dioptres in most quadrants.

Introduction: Cataract surgery with insufficient capsular support has become an intense challenge to surgeons in intraocular lens (IOL) selection. Anterior chamber IOL (ACIOL), iris-claw (Artisan) IOL, and scleral-fixated IOL (SFIOL) are the three common types of IOL used. However, each type of IOL has its own characteristics and different clinical requirements. IOL selection is important in ensuring good visual outcome. Purpose: The purpose is to compare the duration or surgery, visual outcomes, and complications among ACIOL, Artisan IOL, and SFIOL. Study design: Retrospective comparative analysis. Material and methods: This is a four-year retrospective analysis of patients who underwent either ACIOL, Artisan IOL, or SFIOL implantation between January 2014 and January 2018. Patients were divided into ACIOL, Artisan, and SFIOL groups. Demographic data, duration of surgery, preoperative and postoperative visual acuity, and postoperative complications were identified and compared among the different groups. Results: Sixty-four eyes from 58 patients were analysed: twenty (31.3%) eyes with ACIOL, 28 (43.8%) eyes with Artisan, and 16 (25%) eyes with SFIOL. Mean surgery times for ACIOL, Artisan, and SFIOL were: 61 ± 27.8, 64 ± 26.9, and 104.1 ± 46.8, respectively. SFIOL showed significantly longer surgery time than the ACIOL and Artisan groups (p < 0.05). There was no significant difference in surgery time between the ACIOL and Artisan groups (p > 0.05). The Artisan group showed significantly better visual recovery at postoperative 1 week than both the ACIOL and SFIOL groups (Artisan vs ACIOL: 6/18 vs 6/24, p < 0.05; Artisan vs SFIOL: 6/18 vs 6/60, p < 0.05). However, final best-corrected visual acuity (BCVA) at two months was comparable among all three groups with a median BCVA of 6/9. Elevated intraocular pressure occurred in all IOL groups, retinal detachment developedin the Artisan and SFIOL groups, epiretinal membrane developed in the ACIOL and SFIOL groups, corneal decompensation developed in the ACIOL group only. Cystoid macular oedema and IOL tilt occurred in SFIOL only. Conclusions: All three groups of IOL showed comparable good visual outcomes. The decision of IOL selection should be based on patients’ clinical condition and availability of surgical skill and resources.

Mycobacterium tuberculosis is transmitted through aerosolization, hence commonly infects the lungs. The occurrence of extrapulmonary tuberculosis is rare. We report a case of eyelid tuberculosis in a 45-year-old gentleman with a history of treated testicular tuberculosis three years ago. He had insidious onset of painless swelling in the right upper eyelid associated with erythema for one month. He did not have other constitutional symptoms. Initially, he was treated as chalazion and given topical antibiotics. However, the swelling worsened despite medication. His best corrected visual acuity was 6/9 in both eyes. Examination showed an elevated ulcerative growth with broad base which bled easily upon touch. The clinical presentation varies from an eyelid infection as an eyelid tumour can be a diagnostic challenge. A slow response to oral and topical antibiotic warrants an excision biopsy. The results showed chronic granulomatous infection in acid-fast bacilli. An antituberculosis (anti-TB) therapy was started and the patient showed a positive clinical response. Althrough rare, tuberculosis of eyelid should be considered as differential diagnosis of chalazion. Any suspicious case should be confirmed by biopsy followed by anti-TB if indicated.

This study aims to develop a novel web-based decision support system for diabetic retinopathy screening and classification of eye fundus images for medical officers. The research delivers diabetic retinopathy information with a web-based environment according to the needs of the users. The proposed research also intends to evaluate the developed system usability to the target users. The complex characteristics of diabetic retinopathy signs contribute to the difficulty in detecting diabetic retinopathy. Therefore, professional and skilled retinal screeners are required to produce accurate diabetic retinopathy detection and diagnosis. The proposed system assists the communication and consultation among the medical experts in the hospital and the primary health cares located at the health clinics. The agile software development model is the methodology used for the development of this research project. The project collaborates with the Department of Ophthalmology, Hospital Melaka, Malaysia for the medical content expertise and testing. Representative medical officers from Hospital Melaka and all the public health clinics in Melaka were involved in the preliminary study and system testing. This research study consists of a web development producing an interactive web-based application of diabetic retinopathy consultation which comprises image processing and editing features as a core of the system. It is envisaged that this research project will contribute to the management of diabetic retinopathy screening among medical officers.

Objective: The objective of this study was to investigate the effect of hormonal replacement therapy (HRT) in postmenopausal women on peripapillary retinal nerve fiber layer (RNFL) and macular thickness and macular volume and to compare them with postmenopausal women who are not on hormonal replacement therapy. Materials and Methods: The study population included postmenopausal women who are taking HRT (n = 50) and postmenopausal women who are not taking HRT (n = 50). Peripapillary retinal nerve fiber layer and macular thickness and macular volume were evaluated using spectral domain-optical coherence tomography. Results: There was no statistically significant difference in all peripapillary RNFL thickness and macular thickness and volume parameters between the two groups, HRT and non-HRT groups, except for superior outer macular thickness and volume were significantly thicker in postmenopausal women who are taking hormonal replacement therapy, P = 0.036 and P = 0.037, respectively. There was a positive correlation between duration on HRT with most of peripapillary RNFL and macular thickness and macular volume, but the correlation was only significant at superotemporal peripapillary RNFL. Conclusion: Our result does not provide strong evidence for a protective effect of postmenopausal HRT usage against ocular diseases. However, the increased macular thickness in superior outer macula and positively correlated peripapillary retinal nerve fiber layer at superotemporal encouraged us to think of promising positive effect of HRT on ocular structure.

Fuzzy image processing was proven to help improve the image quality for both medical and non-medical images. This paper presents a fuzzy techniques-based eye screening system for the detection of one of the most important visible signs of diabetic retinopathy; microaneurysms, small red spot on the retina with sharp margins. The proposed ophthalmic decision support system consists of an automatic acquisition, screening and classification of eye fundus images, which can assist in the diagnosis of the diabetic retinopathy. The developed system contains four main parts, namely the image acquisition, the image preprocessing with fuzzy techniques, the microaneurysms localisation and detection, and finally the image classification. The fuzzy image processing approach provides better results in the detection of microaneurysms.