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A brief case report of extremely long ocular axial length (AL) is being reported. Contact a-scan ultrasound gave a mean AL of 38.34mm. To the best of our knowledge, this is the longest reported AL of a human eye. 15mls of silicone oil were needed to fill the vitreous cavity during surgery for retinal detachment., peer-reviewed

Background: To compare the intra-operative analgesic benefit of cataract surgery under topical anesthesia with and without pre-operative NSAIDs, namely nepafenac 0.1% (Alcon Laboratories Inc, Nevanec® , Fort Worth, TX, USA) Method: In a study carried out at Mater Dei Hospital, Ophthalmic department, Malta, 199 patients with a cataract were divided into two groups. 100 eyes received nepafenac 0.1% pre-operatively while 99 eyes did not. Intra-operative discomfort was judged by assessing facial grimacing, restlessness, irritability and distress and the results were noted. Patients were divided into refractive error groups, namely myopic, hypermetropic and emmetropic. Results: Pre-operative nepafenac 0.1% produced significantly more pain free cataract surgeries, resulting in a discomfort rate of 9% vs 28% in the group where pre-operative nepafenac 0.1% was not used. Pain was also most evidently observed on insertion of the phaco handpiece. This may be said for patients in all refractive errors groups. Conclusions: The analgesic efficacy of nepafenac 0.1% pre-operatively is significant in reduced intra-operative discomfort during cataract surgery repair under topical analgesia., peer-reviewed

Background: Silicone oils of different viscosities are used in the treatment of retinal detachments of varying pathology. Method: Seventy-two cases of retinal detachments managed with silicone oil were reviewed in a retrospective chart analyses. Eighty nine patients were reviewed from which data on primary pathology, type of silicone oil, duration of oil “in situ” and complications (including emulsification, increased intraocular pressure (IOP), re-detachment, cataract and presence of CME) were compiled. Of this number, 72 patients with post- operative follow-up of two years or more and documentation of the above parameters were included. The data was carefully analysed in an effort to determine the primary factor or factors of the varying silicone oil substitutes utilized responsible for the successful or non-successful re- attachment of the retina. Results: Retinal re-detachment rate is greater when Silicone Oil (SO) is removed before 12 months. Complex vs non-complex retinal re- detachments in sub-group analysis indicates superiority of retention of SO for greater than 12 months. Emulsification is greater in low viscosity SO (1300cts). Conclusion: The complication rates witnessed in this retrospective study are comparable to the findings of published studies present in the ophthalmic literature on an international scale. The findings of this study support the hypothesis that it is the duration of the SO “in situ” as opposed to the viscosity or other SO attributes which ultimately influences the re-detachment rate., peer-reviewed

Introduction: Posterior Reversible Leukoencephalopathy Syndrome (PRES) is caused by ischaemia commonly affecting the posterior cerebral vasculature. It presents with sudden decreased vision, headaches, nausea, vomiting, seizures, and altered mental status. Case presentation: A 19-year-old male presented to the ophthalmic emergency complaining of sudden bilateral loss of vision, which was down to light perception He reported headaches, nausea, and drowsiness since the previous day. He was a known case of hypertension secondary to IgA nephropathy. Magnetic resonance imaging (MRI) with STIR and FLAIR sequences showed foci of hyperintensity within the occipital lobes bilaterally. This confirmed the suspected diagnosis of PRES. Discussion: Aetiological factors of PRES include sudden increase in blood pressure, eclampsia, porphyria, renal disease, and Cushing syndrome. These lead to blood-brain barrier injury either by hyper- or hypoperfusion, endothelial dysfunction, changes in blood vessel morphology, hypocapnea, or immune system activation. Histopathological changes in PRES include activated astrocytes, scattered macrophages and lymphocytes, often in the absence of inflammation or neuronal damage. Conclusion: PRES is usually a reversible neuroophthalmological condition, however prompt recognition and appropriate management is important to prevent permanent brain injury or even death., 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