Eye South East Asia

Vitamin A Deficiency-induced Keratomalacia Due to Malabsorption Syndrome

Fitri Othman — 2025-12-15

Background: Keratomalacia is commonly reported in regions with high levels of malnutrition. We present a rare case of Vitamin A deficiency-induced keratomalacia due to malabsorption syndrome in Brunei Darussalam, a country with one of the highest per-capita gross domestic products in Southeast Asia - highlighting the importance of considering nutritional deficiencies even in affluent settings.
Case presentation: An 18-year-old Malay male presented with right eye redness, congestion and hand movement vision. He had atopic dermatitis, asthma, hyper Ig E syndrome, and multiple vitamin deficiencies, including vitamin D, vitamin B12, and iron. He was HLA dQ8 and DQ7 positive, DQ7 being a risk allele for coeliac disease. On initial examination, there was a right shield ulcer, which was treated for vernal atopic keratoconjunctivitis. Over a period of one month his skin and eye condition worsened, with xerosis of the conjunctiva, corneal thinning, perforation of corneal shield ulcer with an iris plug and shallowed anterior chamber. The clinical signs strongly suggest Vitamin A deficiency causing keratomalacia. He was admitted for systemic steroid treatment and given conservative intensive treatment of lubricants and topical antibiotics (moxifloxacin, tobramycin, and atropine). At six months review, and through a comprehensive treatment approach including Vitamin A supplements, carotenoid-rich food, the patient demonstrated a remarkable restoration of visual acuity of 6/9 in the affected eye.
Conclusion: Although Vitamin A deficiency is more common in developing countries, this case highlights that it can occur in a socioeconomically developed setting and may present with atypical features. Thorough history taking and clinical correlations are important to guide timely diagnosis and management in similar cases. Early recognition and prompt intervention are crucial to prevent irreversible visual loss.

Conjunctival Melanoma in Youth: Case Report of an Asian Female

NUR ATHIRAH BINTI ADNAN — 2025-12-15

Background: Conjunctival melanoma (CM) is a rare ocular malignancy, typically affecting Caucasian males over 50. Its occurrence in young Asian females is extremely uncommon, posing diagnostic and therapeutic challenges.
Case Presentation: A 34-year-old Asian female with no comorbidities presented with a progressively enlarging medial right eye mass over 2-3 years. Examination revealed a hyperpigmented, papilliform conjunctival lesion with feeder vessels from 2 to 5 o’clock, encroaching the nasal cornea. She underwent wide excision biopsy, cryotherapy, and amniotic membrane grafting. Histopathology confirmed CM, positive for Melan-A. Tumor markers were negative. She received three cycles of topical mitomycin C (MMC) 0.02%. At latest follow-up, there was no recurrence.
Discussion: This case illustrates an unusual presentation of CM in a young Asian female. Early diagnosis and prompt surgical and adjuvant management are vital in preventing recurrence. Clinicians should maintain suspicion for CM even in low-risk demographics.

The Visual Field Recovery Following Transnasal Transphenoidal Surgery for Pituitary Adenoma: A Case Report

Trang Hoàng Thanh — 2025-12-15

Purpose: To report a pituitary adenoma case with compression of the optic chiasma and visual field defect recovery following transnasal transphenoidal surgery.
Method: A Case report
Result: A 65-year-old female patient presented with the primary complaint of decreased visual acuity (VA) and visual field defects in both eyes. Visual field examination revealed bitemporal hemianopia, Ganglion Cell – Inner Plexiform Layer (GCIPL) atrophy in the left eye. Magnetic resonance imaging (MRI) of the sella and parasellar region showed a lesion of the optic chiasm approximately 30 mm in diameter compressing the optic chiasm and the floor of the third ventricle, eroding the sellar floor, with “snowman sign”. Transnasal transsphenoidal surgery was promptly performed following the diagnosis, leading to improvement in VA and visual field defect 25 days postoperative.
Conclusion: Clinicians should be aware that patients with non-functioning pituitary adenomas (NFPAs) usually seek ophthalmologists because of the visual disturbance, such as impaired visual acuity and visual field defects. This case report highlights the importance of early diagnosis and timely neurosurgical intervention in preventing irreversible visual impairment in patients with pituitary macroadenomas.
Conflicts of Interest: None.

Clinicopathological Findings and Treatment Outcomes of Primary Vitreoretinal Large B-cell Lymphoma: A Case Series.

Sutamas Luengvichacharoen — 2025-12-15

Objective: To report the clinicopathological findings, treatment modalities, and outcomes of primary vitreoretinal large B-cell lymphoma (PVR-LBCL).
Methods: This retrospective study recruited newly diagnosed PVR-LBCL between January 1, 2013, and December 31, 2022 at Thammasat University Hospital. We reviewed clinical presentations, diagnostic findings, treatment approaches, and outcomes.
Results: Nine PVR-LBCL cases (16 eyes) were elderly (median age 73 years, range 59-78 years), female predominant (n = 6, 67%), and bilateral involvement (n = 7, 78%). All cases presented with blurry vision, while only 3 (33%) reported floaters. Fundus examination revealed vitreous haze (n = 9, 100%), vitreous cells formed sheets (n = 8, 89%) and sub-retinal lesions (n = 5, 56%). The median time from symptom onset to pathologic diagnosis was 8 months (range 1-15 months). One patient transferred after diagnosis and did not have staging. The central nervous system (CNS) involvement was concurrent at diagnosis in 2 cases. The oldest patient did not receive treatment. The initial treatment modalities included ocular radiation (RT), intravitreal (IVT) methotrexate (MTX) or rituximab, whole brain RT, and systemic chemotherapy. The treatment complications were radiation-related cataract and maculopathy (n = 2), and keratopathy (n = 1). The outcomes were refractory disease with CNS progression (n = 1), complete remission (CR) then CNS relapse (n = 3), CR then ocular relapse (n = 1), and CR without event (n = 2).
Conclusion: PVR-LBCL presents a significant challenge in diagnosis and its management. Various modes of treatment were effective, but nearly half relapsed and died.

Factors Affecting the Success of External Dacryocystorhinostomy for the Treatment of Nasolacrimal Duct Obstruction.

Achara Chaiwiriya — 2025-12-15

Purpose: To investigate the factors influencing the success of external dacryocystorhinostomy (DCR) surgery in patients with nasolacrimal duct obstruction.
Study Design: Retrospective cohort study.
Methods: Data were retrospectively collected from patients who underwent external dacryocystorhinostomy at Maharaj Nakhon Si Thammarat Hospital and Fort Wachirawut Hospital between January 1, 2021, and December 31, 2023. Patients were followed up for at least 6 months postoperatively. Surgical failure was defined as cases where lacrimal irrigation could not pass into the throat.
Results: A total of 112 patients were included in the study, with an average age of 70.10 years in the successful group and 60.50 years in the unsuccessful group. The success rate of the surgery was 92.86%. Factors significantly associated with surgical success included patient age, which had a positive correlation with surgical success (OR 1.1186; 95%CI: 1.025-1.221, P = 0.012), while the presence of glaucoma was negatively associated with successful outcomes (OR 0.0317; 95%CI: 0.002 - 0.548, P = 0.018).
Conclusions: Factors associated with the success of external DCR surgery for nasolacrimal duct obstruction include patient age and the presence of glaucoma. Careful patient selection and well-planned treatment strategies are crucial for increasing the likelihood of surgical success.

Mini-incisional Buried Everting Suture and Transcanthal Canthopexy for Involutional Lower Eyelid Entropion: A Retrospective Study.

Petchrada Ung-aram — 2025-12-15

Background: Everting suture is a simple technique for correcting involutional lower eyelid entropion but is limited by high recurrence, ectropion from unaddressed lid laxity, and granuloma risk from exposed sutures. Combining it with transcanthal canthopexy and buried sutures may reduce these complications.
Purpose: This study aims to evaluate the clinical efficacy of the everting sutures with transcanthal canthopexy (ESTC) technique, utilizing a buried suture method, for the treatment of lower eyelid involutional entropion in Thai patients.
Methods: A retrospective, non-comparative, interventional case series was conducted by reviewing medical records at Samutprakarn Hospital, Thailand. Data were collected from patients diagnosed with involutional entropion who underwent the ESTC technique between January 2021 and December 2023. The primary outcome was the recurrence rate and complications. Secondary outcomes included demographic data, medical history, medication use, severity of eyelid laxity and meibomian gland dysfunction, operative duration, and follow-up time.
Results: Fifty-nine eyelids from 50 patients were included, with an average age of 75.69 ± 7.6 years and a male-to-female ratio of 0.92:1. Among the treated eyelids, 20 (33.9%) underwent ESTC while patients were on aspirin or warfarin. The mean postoperative follow-up period was 15.59 ± 8.13 months, with a recurrence rate of 18.64% observed at a mean follow-up of 11.91 ± 8.46 months. No perioperative or postoperative complications were reported.
Conclusion: The everting suture with transcanthal canthopexy technique demonstrates a promising lower recurrence rate compared to conventional methods for correcting involutional lower eyelid entropion in Thai patients, even in those receiving anticoagulant therapy in over 30% of cases.
Conflicts of Interest: none

Efficacy of 0.28% Sodium Hyaluronate Eye Drops in Patients with Moderate to Severe Dry Eye: A Randomized Double-blind Controlled Trial.

Pornlada Sunlakaviset — 2025-12-15

Background: Dry eye disease (DED) is a prevalent ocular condition, particularly in Asian populations, that adversely affects quality of life and visual function. While sodium hyaluronate (SH) artificial tears are commonly used, the optimal concentration remains unclear. This study compared the efficacy and safety of 0.28% versus 0.18% SH eye drops in patients with moderate to severe DED.
Methods: In this prospective, multicenter, randomized, double-blind controlled trial, patients with moderate to severe DED (OSDI ≥ 23, Oxford grading scale ≥ 2, FTBUT < 7 seconds) were randomized to receive either 0.28% or 0.18% SH eye drops in both eyes, six times daily for 30 days. The primary outcome was change in Oxford grading scale. Secondary outcomes included tear osmolarity, best corrected visual acuity (BCVA), fluorescein tear break-up time (FTBUT), ocular surface disease index (OSDI), quality of life (DEQS-Th), and adverse events, assessed at baseline and after 30 days.
Results: Forty-six patients (92 eyes) were enrolled. The 0.28% SH group showed a significantly greater reduction in Oxford grading scale scores at 30 days compared to the 0.18% group (p = 0.024), with improvement in 91.3% versus 73.9% of patients, respectively (p = 0.021). The 0.28% SH group also achieved a clinically significant reduction in tear osmolarity post-instillation. BCVA improved significantly only in the 0.28% SH group, whereas FTBUT increased in both groups. In addition, both groups improved in OSDI and DEQS-Th scores, with no significant difference between groups. Adverse events were mild and similar between groups.
Conclusions: The 0.28% SH eye drops are safe and effective for treating moderate to severe DED, significantly reducing corneal staining and dry eye symptoms, and improving visual acuity and quality of life.
Conflict of I nterest: The authors declare no competing interest.

Visual Outcome of Cataract Surgery in Patients with Pseudoexfoliative Syndrome in Kelantan - A 10 Year Review.

Nur Fadilah Azhani Mohammad — 2025-12-15

Purpose: To investigate the visual outcome and the contributing factors post cataract surgery in patients with pseudoexfoliative syndrome (PXS).
Method: This is a retrospective study among PXS patients who underwent cataract surgery with IOL implantation in a tertiary center, Kelantan, Malaysia from 2015 to 2024. Data was retrieved from the web-based Malaysian Cataract Surgery Registry (CSR). Visual outcomes w ere classified as good if visual acuity was 6/12 or better, and poor if 6/18 or worse, taken from 6 weeks postoperatively onwards. Factors affecting poor visual outcomes (age group, gender, systemic comorbidity, and presence of other complications intraoperatively) were analysed using logistic regression to produce adjusted odds ratio (OR) for variables of interest.
Results: Out of 74 patients with PXS who underwent cataract surgery, 61 (83.7%) cases were qualified. Most patients 38(62.3%) achieved a good visual outcome. In the simple logistic regression, vitreous loss (OR = 4.243, P = 0.024) and type of surgery in which Extracapsular cataract extraction (ECCE) (OR = 0.215, P = 0.017) were significantly associated with visual outcomes postoperatively.
Conclusion: Cataract surgeries in patients with PXS achieved good visual outcomes. Vitreous loss and the choice of operative technique, specifically ECCE, were the significant factors influencing postoperative visual outcomes in cataract surgery with PXS. Despite the higher complication rates associated with PXS, timely identification, careful selection of surgical approach, and adoption of appropriate precautions can reduce these risks and achieve a good visual outcome.

Anatomical and Ophthalmic Clinical Outcomes of Endovascular Treatment for Dural Arteriovenous Fistulas (DAVFs), 13 years’ Experience in a Single Institute.

Uprimporn Suthiwong — 2025-12-15

Background: Dural arteriovenous fistulas (DAVFs) are abnormal communications between the dural arteries and venous sinuses or cortical veins. Cerebral angiography remains the diagnostic and therapeutic gold standard. Variation in time to endovascular embolization may affect ocular outcomes. This study aimed to evaluate the relationship between treatment timing and clinical outcomes in DAVF patients.
Methods: This retrospective cohort included 102 eyes from 85 patients with angiographically confirmed DAVFs who underwent endovascular embolization between January 2009 and August 2022. Patients without ocular symptoms or with incomplete follow-up were excluded. Main outcomes—best corrected visual acuity (BCVA), intraocular pressure (IOP), and proptosis—were assessed at baseline, day 1, month 1, and month 3 post-treatment.
Results: Cognard types IIa (32.4%) and IIa + IIb (31.4%) were most frequent. Mean IOP improved significantly on day 1 in the < 4-week (P = 0.014) and 4-8-week (P = 0.043) groups compared with > 8 weeks. At 1 month, IOP changes were not significant in any group. At 3 months, mean IOP again improved significantly in the < 4-week (P = 0.001) and 4-8-week (P = 0.009) groups versus > 8 weeks. BCVA and proptosis showed no significant differences among duration groups.
Conclusion: Endovascular embolization yields excellent anatomical and functional outcomes in DAVFs. Early intervention within 8 weeks produces faster and greater IOP improvement, underscoring the importance of prompt diagnosis and treatment to prevent irreversible ocular damage. These findings support timely referral pathways and prospective studies to determine the optimal treatment window.
Conflicts of Interest: None