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Hao Chi Ho,1,2 On Heong Liew,2 Swee Sew Teh,2 Hashim Hanizasurana,2 Mohtar Ibrahim,1 Ismail Shatriah1 1Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, 2Department of Ophthalmology, Hospital Selayang, Lebuhraya Selayang-Kepong, Selangor Darul Ehsan, Malaysia Abstract: Rhino–orbital–cerebral mucormycosis (ROCM) is an uncommon but fatal fungal infection. We report a rare case of unilateral ROCM with ipsilateral central retinal artery occlusion and contralateral choroiditis, which later progressed to endogenous fungal endophthalmitis. The patient was successfully treated with sinuses debridement, systemic liposomal amphotericin B, and intravitreal amphotericin B. The endophthalmitis completely resolved with good vision, but the ROCM eye remained blind due to central retinal artery occlusion. Keywords: rhino–orbital–cerebral mucormycosis, central retinal artery occlusion, chorioditis, endogenous fungal endophthalmitis, Rhizopus

Background: Recent advancements in cataract surgery and local anaesthesia administration has led to the majority of cataract surgeries been performed under local anaesthesia. This has further intensified the search for the ideal anaesthesia. The use of topical anaesthetic agents in cataract surgeries has brought us closer to finding that ideal anaesthesia. Objective: The objective of this study is to determine the viability of topical anaesthesia as a comparable mode of anaesthesia to subtenon anaesthesia in cataract surgery. Methods: This is a randomized double-blinded placebocontrolled clinical trial. 118 subjects undergoing small incision cataract surgery were allocated to either a topical anaesthesia group (topical anaesthesia with placebo subtenon’s injection of balanced salt solution, n=40) or subtenon’s group (sub-tenon’s anaesthesia with placebo topical balanced salt solution, n=78). Pain experienced during and after the operation was assessed using the numerical rating scale, aided with a visual analogue graphic pain score chart. Results: There was no significant difference in mean pain score between the two groups during anaesthesia administration (P=0.48), during cataract surgery (P=0.37), immediately after surgery (P=0.77) and 30 minutes after surgery (P=0.17). Conclusion: Topical anaesthesia is comparable to subtenon’s anaesthesia in patients undergoing cataract surgery.