Eye South East Asia

Comparison of assessment and follow-up for benign eyelid lesions: Tele-oculoplastic application versus face-to-face visits in Thammasat hospital.

Gaanchisa Vongchaiyakit, Yada Sukumalpaiboon, Navapol Kanchanaranya — Tue, 30 Jun 2026 00:00:00 +0700

Objective: To evaluate the accuracy and feasibility of a tele-oculoplastic application for monitoring benign eyelid lesions compared with face-to-face outpatient follow-up.

Design: Prospective cohort pilot study.

Methods: Thirty adult patients diagnosed with benign eyelid lesions at the outpatient clinic of Thammasat Hospital between March 1^st and August 31^st, 2024 were prospectively enrolled. After diagnosis, patients were registered in a tele-oculoplastic application, and baseline lesion photographs were obtained. Follow-up assessments were conducted using both the application and in-person clinic visits. Within 24 hours before or after the clinic visit, patients submitted updated symptoms and photographs via the application. Two consultant oculoplastic surgeons independently evaluated the cases: one through face-to-face examination and the other through the application. Management decisions were categorized as discharge, continued follow-up, or surgery.

Results: Concordance between telemedicine-based and face-to-face assessments was observed in 25 of 30 patients (83.3%), while discordance occurred in 5 patients (16.7%). Patient satisfaction with symptom monitoring via the application was high (mean ± SD, 4.10 ± 0.85), and ease of use was rated favorably (mean ± SD, 3.90 ± 0.96).

Conclusion: This pilot study suggests that a tele-oculoplastic application is a feasible option for monitoring selected benign eyelid lesions and may reduce unnecessary outpatient visits. Larger, multicenter studies are required to validate these findings and assess broader applicability.

Quality of life in keratoconus patients in a tertiary hospital in Thailand.

Tue, 30 Jun 2026 00:00:00 +0700

Background: Keratoconus is a progressive corneal ectatic disease that significantly impacts visual function and quality of life (QoL) in affected individuals.

Objective: This primary objective of this study aimed to evaluate the QoL of keratoconus patients in Thammasat University Hospital and compare it with a control group. The secondary objective was a subgroup analysis aimed to compare the QoL between keratoconus patients who underwent collagen cross-linking (CXL) with those who received supportive treatment. The study was conducted at Thammasat University Hospital, Pathumthani Province, Thailand.

Methods: Keratoconus patients were recruited from Thammasat University Hospital by random sampling. Control patients were recruited by

consent at the General Practice Outpatient Department. The Thai version of the National Eye Institute of Visual Functioning Questionnaire (T-NEI-VFQ-25) was used to assess quality of life in both groups. The questionnaire had 25 items grouped into seven categories related to quality of life. For every response, choices of worded answers were converted into integer scores ranging 1 to 5 associated with the lowest to highest quality of life respectively. Two-sample two-tailed t-test was used to determine statistical significance at alpha = 0.05.

Results: The results showed that all QoL domains were negatively impacted in keratoconus patients, with the most significant compromise observed in mental health (mean score = 3.961, s.d. = 0.711). The least disrupted component were social aspects (mean score = 4.597, s.d. = 0.382). The domain with the greatest difference between keratoconus and control were social aspects (p = 0.00000420). Subgroup analysis revealed no statistically significant difference between the two groups of keratoconus patients regarding QoL, though the CXL group reported lower scores in mental health (mean score of 4.175 versus 3.733, s.d. 0.903 versus 0.827, p = 0.000162). Those who underwent CXL had better scores in ocular symptoms, activities of daily living and transportation.

Conclusions: These findings suggest that keratoconus affects various aspects of QoL, with mental health being a key concern. The study underscores the importance of integrating QoL assessments into clinical management to tailor treatments, including the consideration of mental health in treatment plans. Further research is needed to explore the long-term effects of collagen cross-linking and other surgical treatments on QoL in keratoconus patients.

Outcomes of bleb needling with 5-fluorouracil post trabeculectomy among glaucoma patients in Kelantan.

Premalatha Marthay, Mohd Azmi Bin Suliman, Norhalwani Husain — Tue, 30 Jun 2026 00:00:00 +0700

Purpose: To evaluate the outcomes of bleb needling with 5-FU post-trabeculectomy among glaucoma patients in Kelantan.

Methods: A retrospective analysis of glaucoma patients undergoing bleb needling with 5-FU from January 2020 to December 2023 was conducted at Hospital Raja Perempuan Zainab II with at least one year of follow-up post-needling. Outcomes were assessed based on intraocular pressure (IOP), use of anti-glaucoma medication (AGM), complications, and overall success rates. Statistical comparisons were made using Fisher’s exact test and Mantel-Haenszel chi-square.

Results: Twenty-four patients completed the one-year follow-up, all of whom were predominantly Malay (100%) with a median age of 54 years. Primary open-angle glaucoma accounted for 45.8% of cases. The median IOP was significantly reduced from 22 mmHg pre-needling to 12 mmHg at 12 months post-needling. AGM use decreased substantially, with nearly two-thirds requiring no AGM after one year. Complete and qualified success rates were 62.5% and 20.8%, respectively. Subconjunctival haemorrhage (87.5%) was the most common complication, while hypotony occurred more frequently in failed cases. Success was significantly associated with a reduction in AGM use (p = 0.018).

Conclusion: Bleb needling with 5-FU demonstrates high efficacy and acceptable safety in managing failing trabeculectomy blebs among glaucoma patients in Kelantan. Sustained IOP reduction and reduced AGM use highlight its potential in resource-constrained settings. Prior AGM usage and patient age might influence surgical success. Vigilance regarding complications like hypotony is essential for optimizing outcomes. Larger, prospective studies are recommended to validate predictive factors of success.

A primary dermatofibrosarcoma protuberans of the orbit.

Tue, 30 Jun 2026 00:00:00 +0700

Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue sarcoma known for its local aggressiveness and high recurrence rate after surgical excision. While DFSP most frequently involves the trunk and extremities, rare cases of orbital DFSP have been reported.

Here we describe the case of a 40-year-old Asian male who presented with a slow-growing mass over the right lacrimal sac area. MRI revealed an enhancing mass in the anteromedial orbit abutting the globe and nasolacrimal duct. The excised lesion was firm and well-circumscribed. Histopathology showed pleomorphic spindle cells positive for CD34, S-100, and vimentin, confirming a diagnosis of DFSP. The surgical margin was involved. After exploring treatment options, the patient opted for adjuvant orbital radiation. He remained recurrence-free at 1 year follow-up.

This case highlights the challenge of diagnosing and treating DFSP arising in an unusual location like the orbit. The nonspecific clinical presentation can delay recognition, while the orbit's complex anatomy complicates achieving clear margins. A high index of suspicion, careful histopathologic examination with immunostains, and long-term monitoring are crucial for managing this rare orbital neoplasm. Advances in molecular diagnostics and targeted therapy are expanding treatment possibilities for orbital DFSP.

Bilateral eye Dengue maculopathy: A hidden threat to vision.

Nur Najwa Saat, Henry Ngoo Qi Zhe — Tue, 30 Jun 2026 00:00:00 +0700

Background: Dengue maculopathy is a rare but potentially cause sight-threatening ocular complication of dengue fever. This case report highlights a case of a healthy 19 years old adult with bilateral eye dengue maculopathy.

Methodology: Case report

Result: We present a case of a 19-year-old boy with dengue fever presented with bilateral eye sudden, painless blurring of vision. On examination, visual acuity was 6/6 in both eyes. Anterior segment was unremarkable. Fundus examination revealed bilateral macula edema with mild hyperemia of the left optic disc superiorly. On examination, visual acuity was 6/6 in both eyes, with no relative afferent pupillary defect (RAPD) detected. Assessment of the right optic nerve showed a superior nasal visual field defect on confrontation testing, along with decreased light brightness and red saturation (about 70%) in the right eye. Colour vision remained normal in both eyes. Optical coherence tomography (OCT) of the macula confirmed bilateral macula edema, more pronounced in the right eye. Vision drop two days after admission, right eye 6/24 and left eye 6/24 ph 6/18. The patient was started on intravenous methylprednisolone 250mg four times daily for three days followed by oral prednisolone 60mg OD for 11 days after infection has been ruled out. At the one-month follow-up, her visual acuity both eye improved to 6/6 and OCT macula showed resolution of macula edema in either eye.

Conclusion: This case emphasizes the importance of early diagnosis with the help of OCT and visual field testing to assess the severity of dengue maculopathy. Prompt treatment with intravenous steroid can help prevent permanent visual loss.

When squint and proptosis signal more: A case of probable paediatric myelin oligodendrocyte glycoprotein antibody-associated disease presenting as optic neuritis.

Tue, 30 Jun 2026 00:00:00 +0700

Background: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an inflammatory demyelinating disorder of the central nervous system affecting individuals of all age groups.^1,2 Although optic neuritis, acute disseminated encephalomyelitis, and transverse myelitis are typical presentations, paediatric patients demonstrate a distinct clinical phenotype with age-related variation in disease expression.² Orbital manifestations are uncommon and may lead to diagnostic uncertainty.

Case Presentation: A previously healthy 4-year-old boy presented with acute-onset outward deviation and apparent proptosis of the right eye following a recent episode of pneumonia. Visual acuity was 20/600 in the right eye and 20/40 in the left eye, with a right relative afferent pupillary defect and marked right optic disc swelling with perivascular sheathing. Initial evaluation focused on excluding orbital cellulitis, inflammatory orbital disease, orbital tumour, and orbital apex syndrome. Computed tomography of the orbit and brain was performed to exclude an orbital mass or infectious orbital pathology and demonstrated enlargement of the right optic nerve. Subsequent magnetic resonance imaging revealed optic nerve enhancement consistent with optic neuritis, along with large, poorly defined T2/FLAIR hyperintense lesions involving the bilateral frontal and parietal white matter and the hemicerebellum, suggestive of an inflammatory demyelinating process. Aquaporin-4 antibody was negative, while serum MOG-IgG was reported as borderline positive with a reference cut-off of 1:10 using indirect immunofluorescence antibody testing. However, the quantitative titre and specific criteria for borderline interpretation were unavailable. The patient was treated with intravenous methylprednisolone followed by intravenous immunoglobulin because of an inadequate initial response. Significant clinical improvement was observed at the three-week follow-up, with visual acuity improving to 20/40 in the right eye and resolution of ocular deviation, relative afferent pupillary defect, and optic disc swelling. The patient completed immunotherapy and remained free from ocular relapse or neurological deterioration during two years of follow-up.

Conclusion: This case highlights that optic neuritis associated with MOGAD may present with atypical orbital features, including proptosis and ocular deviation, mimicking primary orbital disease. Early recognition of inflammatory demyelinating optic neuropathy and appropriate neuroimaging are essential for timely diagnosis and treatment. Although definitive serological confirmation was limited by borderline MOG-IgG positivity, the clinical-radiological features and favourable response to immunotherapy supported a diagnosis of probable MOGAD.