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Purpose: To review the results of the Moorfields Safer Surgery System (MSSS) for trabeculectomy, recently introduced in Malta. Methods: Patient files were reviewed from data collected over an 18 month period, from the Maltese national teaching hospital, Mater Dei Hospital. Files of all patients undergoing primary trabeculectomy with a minimum of 12 months follow up data available were reviewed. Primary outcome measure of success was defined as a 30% drop in final post-operative intraocular pressure (IOP) at 1 year. Secondary outcome measure of success was final post-op IOP of less than 21mmHg. Unqualified success was defined as satisfactory IOP without the need of anti-glaucoma medication, while qualified success was defined as satisfactory IOP in those patients requiring anti-glaucoma medication. Results: 43 eyes (mean age = 66.2 yrs ± 11.7) were analysed. The mean pre-operative IOP was 27.0mmHg ± 4.6. Mean post-op IOP at one year was 15.3mmHg ±2.7. Unqualified success for the primary outcome measure was achieved in 64.1% of patients while the qualified success was achieved in 82.1%. Unqualified success for the secondary outcome measure was achieved in 72.7% and a qualified success, of 94.8% was obtained. There was 6.8% failure rate. Conclusions: The results from this first review using the Moorfields safe surgery system for Trabeculectomy surgery in the Maltese islands compares well to the current literature., peer-reviewed

A fifty-eight year old male patient presented to the ophthalmic department with a 3 day history of reduced visual acuity, blurred vision and floaters, associated with recent lethargy, headaches and behavioural changes. Fundal examination revealed a bilateral vitritis. Steroid therapy was started. MRI of the brain revealed multiple hypodense and hyperdense lesions. Vitrectomy was performed in view of the poor response to steroids. A biopsy showed non-hodgkin B-Cell lymphoma. The patient was started on intravenous Methotrexate and Cytarabine. Repeat vitreous cavity biopsies were performed in order to assess response to therapy. All biopsies to date have revealed evidence of on-going lymphoma., peer-reviewed

A twenty-two year old female patient presented with new onset bilateral hard orbital masses and progressively worse tear lake problems. Computed tomography of the orbits revealed poorly differentiated bilateral orbital masses. Laboratory investigation revealed ANCA positivity. Routine biochemical investigations were all within normal limits. CXR was also normal. Biopsy of the orbital masses revealed non-specific histological findings. An initial diagnosis of Granulomatosis with Polyangitis (GPA) was postulated. Oral steroids were given followed by a rapid response to steroid therapy. The working diagnosis of GPA was abandoned and a diagnosis of idiopathic orbital inflammation (IOI), or orbital pseudotumour was made owing to the benign, non-infective, inflammatory pathology with no evident systemic or local cause. Tailoring off of steroids resulted in repeated flare ups, resulting in the initiation of methotrexate therapy. The patient is in remission and is currently on combined steroid and methotrexate treatment. IOI is a diagnosis of exclusion and a rapid response to steroids serves as a diagnostic aid but is not in itself diagnostic., peer-reviewed