Ocular Cicatricial Pemphigoid in a Young Filipino Male: The First Biopsy-Proven Case Report from the Philippines
Objective: To describe the first biopsy-proven case of ocular cicatricial pemphigoid (OCP) in a young, Filipino male – an atypical presentation for this disease. Methods: This is a case report. Case Presentation: A 34-year-old healthy Filipino male presented with a 2-year history of intermittent eye redness, foreign body sensation, and tearing. Slit lamp examination revealed symblepharon formation and fornix shortening of both eyes. Excision of symblepharon with ocular surface reconstruction using amniotic membrane graft was performed, and the conjunctival specimen was sent for immunohistochemical analysis. Direct immunofluorescence was performed which confirmed strong linear deposits of IgG and fibrinogen along the basement membrane zone, confirming diagnosis of OCP. Early diagnosis and prompt treatment is even more important in the younger population as OCP tends to progress more rapidly, and is associated with more severe manifestations. If left untreated, OCP may progress to symblepharon or, in severe cases, ankyloblepharon formation. Conclusion: OCP is a rare, sight-threatening, chronic, autoimmune disease that involves inflammation and cicatrization of the conjunctiva, which typically affects older females and is rarely seen in younger populations. This case report highlights the need for increased awareness among clinicians in the Philippines to consider OCP as a differential diagnosis for chronic conjunctivitis, even in patients outside the typical demographic. Early recognition and confirmatory biopsy are essential to prevent progressive ocular surface scarring and vision-threatening complications.
Copyright (c) 2026 Philippine Journal of Ophthalmology https://creativecommons.org/licenses/by-nc/4.0
Diffuse Intraretinal and Optic Disc Edema in a Case of Reversed Vaulted Sulcus-Implantation of a Multi-Piece Intraocular Lens in a 7-Year-Old Child
Objective: This paper reports a rare presentation of diffuse intraocular inflammation following reversed vaulted multipiece intraocular lens (IOL) implanted in the sulcus of a 7-year-old child. Methods: This is a case report. Case presentation: A 7-year-old child presented with persistent posterior pole inflammation and optic disc swelling after an improperly placed multipiece intraocular lens in the sulcus. Comprehensive eye and wholebody evaluations were performed with the aid of optical coherence tomography (OCT), magnetic resonance imaging (MRI) and systemic work-up to rule out other causes of uveitis to definitively diagnose the case. The reverse-vaulted lens was eventually explanted. After 1 week post-explantation, the visual acuity improved markedly to 20/100 with the appropriate spectacle prescription. The patient recovered from the ocular inflammation 8 months postoperatively. Conclusion: This paper reports significant posterior pole inflammation as an uncommon yet potentially visually-disabling consequence of a reverse-vaulted sulcus placement of a multipiece intraocular lens in a child. Careful attention is warranted to ensure proper IOL orientation during implantation, especially in pediatric cataract surgery. Visual rehabilitation is important postoperatively
Orbital Apex Syndrome secondary to Chronic Invasive Fungal Rhinosinusitis and its Diagnostic Challenges: A Case Report
Objective: To present a case of chronic invasive infection rhinosinusitis (CIFRS) complicated by orbital apex syndrome, highlighting the significant diagnostic challenges and delays encountered before establishing the diagnosis. Methods: This is a case report. Case Presentation: This patient is a 65-year-old diabetic female, status post-kidney transplantation with immunosuppressant use presented with headache and sudden painless vision loss and extraocular limitation of the right eye. Magnetic resonance imaging (MRI) revealed a right-sided ill-defined nasopharyngeal mass, with nasopharyngeal carcinoma as the radiologic consideration. Biopsy revealed bacterial and fungal elements. During admission, antibiotics, antifungals, and tumor debulking was done but symptoms persisted. Histopathology showed reactive inflammatory tissue; hence, a short course of intravenous high-dose steroids was given. Overall health declined and patient eventually expired. Conclusion: This case highlights the importance of maintaining high clinical suspicion for fungal infection despite non-specific radiologic findings in immunocompromised patients with vague, localized symptoms. Prompt recognition and tissue diagnosis are critical for early intervention.
Globe-sparing Surgery and Adjuvant Radiotherapy for Lacrimal Gland Adenoid Cystic Carcinoma in a 37-Year-Old Filipino Female
Objective: To report a case of lacrimal gland adenoid cystic carcinoma in a 37-year-old female managed with globe-sparing surgery and adjuvant radiotherapy. Methods: This is a case report. Case Presentation: This report details a 37-year-old Filipino female who presented with a 4-month history of right eye pain and non-axial proptosis. Computed tomography (CT) scan showed a right heterogenous extraconal mass with orbital roof remodeling. Lateral orbitotomy with excision biopsy was performed. Final histopathologic diagnosis of adenoid cystic carcinoma of the lacrimal gland was made based on the classic morphology and distinct arrangement of the neoplastic cells. Systemic surveillance revealed absence of metastases. Patient completed adjuvant radiotherapy four months post-operatively. Vision was preserved at 20/20 without signs of tumor recurrence five months post-operatively. Conclusion: Adenoid cystic carcinoma is an aggressive lacrimal gland malignancy; hence, meticulous examination and high index of suspicion cannot be over-emphasized. Globe-sparing surgery with adjuvant radiotherapy could significantly preserve quality of life.
A Case of Pachymeningitis Presenting as Optic Perineuritis and Multiple Cranial Neuropathies
Objective: To discuss the clinical presentation and management of idiopathic hypertrophic pachymeningitis that presented with multiple cranial neuropathies. Methods: This is a case report. Case Presentation: A 37-year-old female presented with right-sided headache and ipsilateral cranial nerve (CN) I, II, III, IV, and V deficits which improved with nonsteroidal anti-inflammatory drugs (NSAIDs). Six months later she developed bilateral blurring of vision with pain on eye movement, which progressed to severe bilateral affectation that prompted admission and treatment with high-dose methylprednisolone therapy followed by prolonged oral steroid treatment which was gradually tapered. Recurrence was treated with oral steroids and azathioprine. Diagnostic modalities included an initial cranial contrast computed tomography (CT) scan which was inconclusive; contrast magnetic resonance imaging (MRI) clinched the diagnosis, as well as demonstrated thickening of the optic nerve perineurium. Visual field analysis 30-2 as well as optic nerve head optical coherence tomography (OCT) were used to support the diagnosis and document optic nerve affectation. Biologic testing was used to rule out tuberculosis, syphilis, fungal infection, granulomatosis with polyangiitis, polyarteritis nodosa, and rheumatoid arthritis. The patient had complete vision recovery in the left eye but only partial vision recovery in the right eye. Conclusions: Pachymeningitis should be a diagnostic consideration in patients with headache and multiple cranial neuropathies. Clinicians should always perform independent evaluation of diagnostic modalities with the patient’s clinical presentation in mind. Pachymeningitis can involve the perineurium through contiguous spread of the lesion and present as optic perineuritis as well, with more insidious progression and lasting deficits than isolated optic perineuritis.
Correlation of Cone- and Rod-Derived Retinal Nonperfusion on Ultrawide Field Fluorescein Angiography with Diabetic Retinopathy Severity and Diabetic Macular Edema
Objective: To evaluate cone- and rod-specific nonperfusion indices (CPI, RPI) on ultrawide field fluorescein angiography (UWF-FA) and their correlation with diabetic retinopathy (DR) severity and center-involving diabetic macular edema (ciDME). Methods Sixty-nine eyes of 43 patients with diabetes underwent UWF color photography (UWF-CP), UWF-FA, and macular optical coherence tomography (OCT). DR severity was graded by a masked reader on UWF-CP. UWFFA images were segmented into posterior pole (≤10 mm from fovea), mid-periphery (10–15 mm) and far periphery (>15 mm), and into the macula, within ETDRS fields and extended peripheral fields. Ischemic areas were quantified using ImageJ to calculate nonperfusion index (NPI), CPI, and RPI. ciDME was determined on OCT. Correlations were analyzed using Pearson coefficients (r). Results DR severity correlated significantly with global NPI (r=0.56, p<0.0001) and across all retinal zones (r=0.35– 0.57). Both CPI (global: r=0.56, p<0.0001; zones: r=0.42–0.59) and RPI (global: r=0.55, p<0.0001; zones: r=0.40–0.59) showed similar associations. ciDME presence was also correlated with NPI (global: r=0.40, p=0.0014; zones: r=0.42–0.54), CPI (global: r=0.47, p=0.0001; zones: r=0.32–0.55), and RPI (global: r=0.46, p=0.0002; zones: r=0.33–0.54). Conclusions Cone- and rod-related retinal nonperfusion strongly correlate with DR severity and ciDME. UWF-FA may help identify high-risk eyes and guide surveillance of ischemia-related progression. Further studies are needed to define ischemic thresholds predictive of vision-threatening complications.
The Research Agenda-Setting for the Department of Health National Specialty Center for Eye Care
‎Objective: To describe in detail the research agenda-setting process of the Department of Health National Specialty Center for Eye Care with the guidance of the National Institute of Health (NIH) - Department of Clinical Epidemiology. Methods: A research agenda technical working group (TWG) was organized to spearhead the research agenda setting, in collaboration and guidance of the NIH. After identifying relevant internal and external stakeholders, the TWG drafted a contextual map that served as an overarching framework. Research topics were obtained from the stakeholders and the TWG collated, reviewed and summarized prior to ranking them systematically. Each topic was prioritized through a weighted ranking system evaluating its feasibility, public health benefit, and resource/cost requirements. A final en banc session including the stakeholders was held to formalize the approval of the research agenda. An infographic was developed to serve as a visual guide for consultants and trainees in initiating research. Results: The TWG tallied 85 unique research topics from both the internal and external stakeholders. These topics encompassed a broad range of areas, including epidemiology, surgical, and medical management, health systems research, economic evaluations of interventions, and occupational/environmental factors. Conclusions: The 2024-2027 research agenda of the Department of Health National Specialty Center for Eye Care was crafted, with the guidance of the NIH Department of Clinical Epidemiology. The goal was to improve the center's research output by aligning it with stakeholders thereby serving as a research benchmarking tool for the local ophthalmology community
Bridging Genetics and Ophthalmology: The Emerging Role of Ophthalmic Genetic Counseling in the Philippines
Seeing Further: Vision for the Next Chapter of the Philippine Journal of Ophthalmology
Recivall P. Salongcay, MD, MPM, DPBO, FPAO, FVRSP
Five-Year, Private Sector Cost Comparison of iStent inject® W, Trabeculectomy, Glaucoma Medications for Primary Open-Angle Glaucoma With and Without Phacoemulsification: A Filipino Patient Perspective
Objective: To perform a cost comparison of the 5-year total direct medical costs of iStent inject® W vs. trabeculectomy vs. glaucoma medications for the treatment of primary open-angle glaucoma, with and without phacoemulsification, from the perspective of Filipino patients. Methods: This cost-comparative analysis compared total private sector costs of surgery, post-operative care, and medication usage over 5 years on combined phacoemulsification (combined) or standalone (SA) procedures using iStent inject W, trabeculectomy, and glaucoma medications for the general population and senior citizens/individuals with disabilities. Data, including unit costs and frequencies, were obtained from published literature and local primary research. Scenario analysis consisted of three payment models: 100% out-of-pocket (OOP), coverage from PhilHealth public health insurance, and combined subsidies from both private and PhilHealth insurance. Results: iStent inject W was less costly than glaucoma medications in all scenarios and patient populations. When compared with trabeculectomy, iStent inject W, was less costly in all patient populations in the OOP scenario, providing savings of 5% for SA procedures and 5% to 6% for combined procedures. It was also less costly as a combined procedure in all populations in the combined private health and PhilHealth insurance scenario, offering 6% savings in the general population and 9% in elderly and disabled patients. However, it was costlier by 1% in the PhilHealth scenario. As an SA procedure, it was costlier vs. trabeculectomy in both populations in the PhilHealth and PhilHealth plus private health insurance scenarios by 18% to 22% and 101% to 109%, respectively. The highest incremental cost for iStent inject W was US$1,662 vs. trabeculectomy as an SA procedure in the general population under the combined private health and PhilHealth insurance scenario. Conclusion: For Filipino glaucoma patients who are treated in the private sector, iStent inject W, whether combined or as an SA procedure, may be cost-saving compared with glaucoma medications over a 5-year period; however, it may be costlier compared with trabeculectomy depending on health insurance coverage scenarios.
Copyright (c) 2025 Philippine Journal of Ophthalmology https://creativecommons.org/licenses/by-nc/4.0
Non-arteritic Anterior Ischemic Optic Neuropathy and Semaglutide Use: An Advisory to Ophthalmologists and Other Health Care Professionals
Neuro-Ophthalmology Society of the Philippines
Metastatic Adenocarcinoma Presenting as an Orbital Mass with Orbital Apex Involvement: Application of Immunohistochemistry in Diagnostic Ophthalmic Pathology
Objective: To report a case of orbital apex syndrome due to metastatic adenocarcinoma of the orbit in an adult male. Methods: This is a case report. Results: A 52-year-old male presented with a subacute onset of ophthalmoplegia, ptosis, and vision loss secondary to an optic neuropathy. Orbital apex syndrome was the primary consideration. Laboratory workup ruled out infectious and inflammatory etiologies. Neuroimaging revealed an irregular, intraconal mass in the left orbit. During the disease course, a new supraorbital mass lesion was noted. Incisional biopsy, histopathology and immunohistochemistry (IHC) revealed positive Cytokeratin 7 and negative Cytokeratin 20 expression, suggestive of metastatic adenocarcinoma. Conclusion: Diagnosis of orbital apex syndrome requires careful integration of clinical evaluation, laboratory testing, and imaging. When a mass lesion is present, biopsy and IHC staining can be critical in determining the primary origin of a malignancy.
Surgical Resection and Postoperative Chemotherapy for Optic Nerve Glioma with Intracranial Extension in a 10-year-old Male: A Long-term Follow-up Case Report
Objective: To present a long-term follow-up report of a 10-year-old male with optic nerve glioma who underwent surgical removal and postoperative chemotherapy. Methods: Case report. Results: A 10-year-old Filipino boy was referred to a tertiary institution for a five-year history of progressive right eye proptosis with vision loss. Pertinent findings included right eye proptosis, lagophthalmos, and limited elevation and adduction. He also had several hyperpigmented lesions on the abdomen and upper torso. Vision on the right was no light perception, with a relative afferent pupillary defect, exposure keratopathy, and optic nerve pallor. Vision on the left eye was 20/20 with a temporal visual field defect. Cranial and orbital computed tomography (CT) scan showed a circumscribed enhancing mass within the right intraconal space with widened right optic nerve canal. Additional magnetic resonance imaging (MRI) revealed a heterogeneously enhancing mass diffusely involving the intraorbital and intracanalicular segments of the right optic nerve suspicious for optic nerve glioma. He underwent excision of the orbital portion of the mass via lateral orbitotomy. Histopathology showed pilocytic astrocytoma. Eight cycles of chemotherapy with carboplatin and vincristine was completed. Significant improvement of globe position and resolution of ocular exposure was achieved postoperatively with residual right ptosis. These findings remained stable at six years after treatment. Conclusion: Optic nerve gliomas with intracanalicular and chiasmal extension can be managed with surgical removal of the orbital component and postoperative chemotherapy. This can result in improvement of proptosis and long-term remission.
Objective: To present a rare case of nine syndrome in a middle-aged patient with stage IV chronic kidney disease presenting with hypertensive emergency at a tertiary government hospital, and to discuss its clinical presentation, diagnostic approach, and management within the realities of limited-resource settings. Method: This is a case report. Result: A 45-year-old woman with uncontrolled hypertension and stage IV chronic kidney disease came to the emergency department with acute dizziness and vomiting. On neurologic examination, she had left horizontal conjugate gaze palsy and an adduction deficit of the left eye with intact abduction and an abducting nystagmus of the right eye consistent with one-and-a-half syndrome. In addition, she had left-sided facial weakness and right lower limb weakness suggesting nine syndrome. Brain imaging confirmed a left posterior pontine infarct. Treatment for neuroprotection and blood pressure control led to significant improvement in ocular symptoms and muscle strength. Conclusion: This report describes a rare case of nine syndrome. Careful bedside neuro-ophthalmologic examination, supported by MRI, enabled accurate localization to the paramedian pons. Early recognition allowed timely stroke management and initiation of secondary management, even in a resource-limited setting.
Isolated Oculomotor Nerve Palsy as the Initial Manifestation of CNS Tuberculoma in an HIV-Positive Adult: A Case Report
Objective: To describe the clinical presentation, management and outcome of a rare case of isolated oculomotor nerve palsy in an immunocompromised adult secondary to a central nervous system (CNS) tuberculoma. Methods: This is a case report. Results: A Filipino male in his 30s developed severe throbbing headache followed by binocular diplopia and drooping of the right upper eyelid. Findings were compatible with a neurologically-isolated pupil-involving, complete oculomotor nerve palsy on the right. Brain magnetic resonance imaging demonstrated enlargement and contrast enhancement of the cisternal portion of the right oculomotor nerve. Serologic testing was positive for the human immunodeficiency virus (HIV) and syphilis. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis and elevated protein. CSF polymerase chain reaction was positive for Mycobacterium tuberculosis (TB). The patient was treated with penicillin, quadruple anti-Koch’s, and anti-retrovirals. Eyelid position and ocular motility improved after treatment. Aberrant regeneration of the right oculomotor nerve was observed with elevation of the right eyelid on downgaze (pseudo-Graefe sign). Conclusion: CNS tuberculoma may present as a neurologically-isolated oculomotor nerve palsy, particularly in immunocompromised individuals. In TB-endemic countries, like the Philippines, it should be considered in the differential diagnosis. Early recognition and appropriate antimicrobial therapy can lead to neurologic improvement.
Dengue-Associated Neuroretinitis: A Case Report
Objective: To describe a case of dengue-associated bilateral neuroretinitis in a young female adult. Methods: This is a case report. Results: A 25-year-old female was referred for evaluation of bilateral blurring of vision during the convalescent stage of dengue fever. Visual acuity was 20/80 in each eye. Fundoscopy showed mild optic disc swelling, macular thickening, and hard exudates bilaterally. Dengue-associated neuroretinitis was considered. Intravenous methylprednisolone treatment for three days resulted in significant improvements in visual function and resolution of fundus abnormalities. Conclusion: Dengue is a potential etiology of neuroretinitis in endemic areas, especially in those who develop visual symptoms during the convalescent phase. Prompt recognition and treatment may prevent long-term visual impairment.
Correlation of Color Vision Impairment and Capillary Blood Glucose in Diabetic Patients without Retinopathy vs. in those with Mild Non-Proliferative Diabetic Retinopathy
Objective: To compare the frequency and severity of color vision defects between diabetes mellitus (DM) patients without retinopathy and those with mild non-proliferative diabetic retinopathy (NPDR), and to evaluate the relationship between these color vision defects and capillary blood glucose (CBG) levels. Methods: This was a cross-sectional, hospital-based study conducted over a seven-month period at the Ophthalmology Outpatient Department of Cardinal Santos Medical Center. Thirty-five (35) DM patients (70 eyes) aged 50 to 75 years with best-corrected visual acuity of ≥20/50 and no more than mild NPDR were included. Patients with moderate or severe NPDR, macular edema, optic nerve pathology, or significant cataracts were excluded. All participants underwent visual acuity testing, fundus examination, and color vision assessment using the Ishihara pseudoisochromatic plates and Farnsworth D-15 tests conducted under standardized lighting conditions. CBG was measured using the finger-prick method. Main outcome measures included the proportion and type of color vision defects, their association with DR classification, and CBG levels. Statistical analyses included descriptive statistics, the Fisher exact test, the Mann-Whitney U test for the Farnsworth D-15 Color Confusion Index (CCI), and Spearman correlation between CBG and CCI. Results: Tritan-type defects were the most common, accounting for 36.2%. Color vision defects were observed in 91.3% (64 eyes) of patients with no DR, while defects were seen in all eyes (100%) with mild NPDR (5 eyes). However, this difference was not statistically significant (p = 1.000). There was no significant correlation between CBG levels and color vision scores. Mean CCI scores were similar between groups (p = 0.394), indicating no substantial difference in defect severity. Conclusions: Color vision defects may be more prevalent in early NPDR compared to no DR, but this difference was not significant in this sample. No correlation was found between CBG levels and color vision performance. Color vision testing may serve as a useful adjunctive screening tool for early diabetic retinal changes; however, further studies with larger sample sizes are necessary.
Correlation of Glycosylated Hemoglobin Level with Pupillary Parameters using the Reflex PLR© Mobile Application in Type 2 Diabetes Mellitus Patients
Objective: To determine the pupillary parameters of adult patients with type 2 diabetes mellitus (DM) using the Reflex PLR© mobile application and to correlate these parameters with glycosylated hemoglobin (HbA1C) levels. Methods: This was a single-center, prospective, observational, cross-sectional study conducted at Ospital ng Makati from June to August 2024. Study participants were patients with type 2 DM without diabetic retinopathy and non-diabetics who served as the control group. Participants underwent blood chemistry testing and pupillometry using the Reflex PLR© mobile app. The study outcomes were maximum and minimum pupillary diameters, amplitude, and latency. Results: There were 44 study participants: 26 non-diabetics and 18 diabetic patients. The two groups had similar pupillary baseline diameters (p = 0.72; p = 0.30), maximum pupillary diameters (p = 0.82; p = 0.89), minimum pupillary diameters (p = 0.85; p = 0.89), pupillary amplitudes (p = 0.88; p = 0.55), and pupillary latencies (p = 0.53; p = 0.47) for the right and left eyes, respectively. The relationship between pupillary parameters and HbA1C levels showed no significant variations in baseline diameter (p = 0.21; p = 0.45), maximum diameter (p = 0.65 for the right eye; p = 0.46 for the left eye), minimum diameter (p = 0.77; p = 0.46), amplitude (p = 0.89; p = 0.83), and latency (p = 0.31; p = 0.22). Conclusion: The study did not demonstrate any significant correlation between pupillary parameters and HbA1C levels. Pupillary changes in diabetes may have been more dependent on factors such as disease duration and the presence of complications rather than glycemic control alone.
Etiology and Clinical Profile of Non-Glaucomatous Optic Neuropathy in a Tertiary Government Hospital in the Philippines
Objective: This study described the etiology and clinical profile of non-glaucomatous optic neuropathy (NGON) cases in a tertiary government hospital in Quezon City, Philippines. Method: This was a retrospective, cross-sectional study of patients seen at a neuro-ophthalmology clinic of a tertiary referral center in Quezon City, Philippines from January 01, 2008 to December 31, 2020. The patients’ medical records were reviewed and the following data were extracted and analyzed: demographic data, mechanism of NGON, and clinical profile. Results: A total of 911 patient records were reviewed. Most patients were males (61.3%) within the economically productive age group (72.7%). Overall, the top three mechanisms that contributed to NGON were (1) trauma-related (25.9%), (2) ischemic (19.8%), and (3) inflammatory causes (18.0%). When patients were stratified by age, the most common causes in the pediatric group were traumatic (33.9%), inflammatory (28.6%), and papilledema-related (11.3%) optic neuropathies. In the middle age group, traumatic (29.1%), inflammatory (18.5%), and ischemic (17.8%) etiologies predominated. Among the elderly, ischemic (44.0%), drug-induced (26.1%), and compressive (17.9%) causes were most frequently identified. Conclusion: Traumatic optic neuropathy emerged as the leading cause of vision loss from NGON in both pediatric and middle aged groups. In the absence of trauma, further investigations should focus on inflammatory and papilledema-related etiologies in the pediatric and middle aged groups. Among the elderly, ischemia and drug-induced toxic optic neuropathies were the most prevalent, with thorough history-taking being crucial for identifying medication-related causes.
Leonides Karlo C. Melendres III, MD, DPBO
The Importance of Neuro-Ophthalmology Subspecialty in the Current Healthcare Landscape
Choroidal Melanoma Treated with Linear Accelerator-based Hypofractionated Stereotactic Radiotherapy: First Case of Globe Conservation in Uveal Melanoma from the Philippines
Objective: This is a case report of a 60-year-old woman with a juxtapapillary choroidal melanoma who underwent globe-sparing treatment using linear-accelerator (LINAC)-based hypofractionated stereotactic radiotherapy (FSRT). Methods: Clinical data, ophthalmologic findings, and imaging results were obtained through retrospective chart review. Results: At three months and nine months post-treatment, tumor thickness decreased by 20.5% (from 13.00 mm to 10.34 mm) and 33.2% (to 8.69 mm), respectively. Partial resolution of subretinal fluid and vitreous hemorrhage was confirmed clinically and by B-scan. No metastatic spread was detected on liver ultrasound and chest radiography. Best-corrected visual acuity in the treated eye remained stable at hand motion. Radiation-induced dry eye was managed effectively with preservative-free sodium hyaluronate eye drops. Conclusion: LINAC-based hypofractionated FSRT achieved marked local control and tumor regression in this case of a medium-large, juxtapapillary choroidal melanoma, while preserving the globe and the baseline vision. In regions without access to plaque brachytherapy, this technique offers a practical, cost-efficient, and multidisciplinary approach to eye-conserving therapy.
Intimate Partner Violence (IPV) - Associated Ophthalmologic Injuries among Women: A Systematic Review
Objectives: This study aims to describe patterns of IPV-associated ophthalmic injuries among women: Specifically, it seeks to identify factors associated with ophthalmic injuries in women secondary to IPV, determine practices and/or protocols in identifying IPV-associated ophthalmic injuries, and to examine practices in referral to ancillary services for IPV survivors with such injuries. Methods: A systematic literature search was conducted for observational studies published from 2009 to 2022 using PubMed, Google Scholar, HERDIN, and the Cochrane Library. Studies were screened and appraised using the Newcastle-Ottawa Quality Assessment Scale (NOS) for risk of bias. Relevant data on injury types, screening protocols, and referral practices were extracted and synthesized. Analysis of risk of bias (ROB) for each study utilizing the NOS scale indicated that four studies exhibited a good ROB. Results: A total of 567 female patients with IPV-related facial injuries were included in the selected studies. Of these, 98 cases (17.28%) involved ophthalmic injuries, including orbital fractures, subconjunctival hemorrhages, and contusions. Factors associated with these injuries included delayed healthcare-seeking behavior, bilateral and recurrent trauma, and psychological distress. Current practices in IPV identification were found to be inconsistent, with a lack of standardized screening protocols, especially in ophthalmology settings. Referral to ancillary services was often suboptimal due to poor interdepartmental coordination and absence of formal pathways. Conclusion: There is a significant gap in the recognition and management of IPV-associated ophthalmic injuries among women. Establishing standardized screening protocols and improving referral systems can enhance care outcomes and provide holistic support for survivors, particularly in low-resource settings.
Impact of Prolonged Exposure to Video Display Terminals on Macular Pigment Optical Density in Young Adult Filipinos
Objective: This study assessed the correlation of macular pigment optical density (MPOD) and varying levels of exposure to video display terminals (VDT) among young adult Filipinos. Methods: This cross-sectional, analytical, single-center study compared the MPOD, measured using the Zeiss VISUCAM 500, between two groups of individuals aged 20 to 35 years old with differing VDT exposure. The more exposed group consisted of individuals who spent at least 8 hours per day on VDTs for the past 1 year, while the less exposed group spent less than 6 hours per day. Student’s t-test and chi-square test were used to compare the two groups, while Pearson's r coefficient was utilized to determine the relationship between MPOD and VDT exposure. Results: A total of 80 individuals (40 in each group) were included in the study. Both groups had similar profiles, except for refractive errors, which were significantly higher in the prolonged VDT exposure group (p = 0.02). The prolonged exposure group averaged 10 hours of VDT use per day, compared to 3 hours in the low VDT exposure group. The MPOD level, particularly the maximum optical density (Max OD), was significantly lower in the prolonged VDT exposure group (0.2034 DU) compared to the low VDT exposure group (0.2467 DU) (p = 0.0051). A negative weak correlation was observed between the VDT exposure hours and MPOD levels (Max OD r = –0.387, p = 0.0005). Conclusion: This study found a weak but significant negative correlation between prolonged VDT exposure and lower MPOD levels, suggesting that extended screen time may contribute to reduced macular pigment density. While the correlation was weak (r = –0.387), these findings underscore the potential risk of diminished macular health with increased VDT use. The results highlight the importance of promoting protective strategies, such as reducing screen time and encouraging dietary or lifestyle changes that support eye health, especially among individuals with high VDT exposure.
Variability of Foveal Avascular Zone Measurements Among Filipino Eyes Using Optical Coherence Tomography Angiography
Objective: To determine the foveal avascular zone (FAZ) thickness and other FAZ measurements in eyes of healthy Filipino adults aged 20-49 years. Methods: This single-center, cross-sectional, observational study evaluated 186 subjects (372 eyes) of Filipino adults 20 to 49 years of age. Using Angioplex®, the automated software of the optical coherence tomography angiography (OCTA) machine, the FAZ area, perimeter, circularity, vascular density, and perfusion in the superficial FAZ were recognized. Statistical analysis was done using SPSS version 23. The mean and standard deviation of the values of superficial capillary free zone measurements were calculated. Results: The mean FAZ area was 0.297 ± 0.112 mm2, the mean circularity was 0.667 ± 0.080, and the mean perimeter was 2.316 ± 0.80 mm. These parameters were all larger in the female population (p <0.001, p = 0.043 and p <0.001, respectively). No significant correlation was found between the FAZ area and age and between perimeter and age, but the circularity of the FAZ was inversely correlated with age (p = 0.002). The mean vessel density and vessel perfusion central were 9.767 ± 3.470 mm/mm2 and 17.008 ± 6.457 %; both were significantly lower in the female population (p = 0.005 and p = 0.003). The mean central macular thickness (CMT) was 245.895 ± 20.769 μm. CMT was noted to be higher in the male population (p <0.001). The CMT was directly correlated with age (p = 0.024). Conclusions: In eyes of healthy Filipino adults aged 20-49 years, females exhibited larger FAZ area, higher circularity, and lower CMT, compared to males. Additionally, females displayed lower central vessel density and perfusion. While FAZ area and perimeter remained stable with age, circularity decreased, and CMT increased.
optical coherence tomography angiography
Clinical Profile and Outcomes of Central Microbial Keratitis in the Philippines
Objective: Despite being a preventable and treatable condition, central microbial keratitis (CMK) and its complications remain to be a significant cause of vision loss in our country. This study presents the demographic profile, risk factors, etiologies, treatments, and outcomes of CMK in the Philippines. Methods: The study was a two-center, prospective, non-randomized clinical study involving the patients of the External Disease and Cornea Clinics of two tertiary eye referral centers in the Philippines. It was conducted as the Philippine leg of the Asia Cornea Society Infectious Keratitis Study (ASCIKS).1 Patients with a clinical diagnosis of CMK rendered by a cornea specialist, and who signed the consent form, were recruited into the study. They underwent uniform sample collection and culture techniques as described in the ACSIKS. All patients were followed-up for 6 months. Data collected included demographics, risk factors, culture results, management, and treatment outcomes. Descriptive statistics and frequency were used to analyze the data. Results: A total of 348 patients diagnosed with CMK were included. Trauma (65.5%) among the middle-aged (42.9 ± 17.9 years) male population was the most significant risk factor for development of CMK, followed by contact lens wear (12.9%), prior ocular surgery (6.0%), and ocular surface diseases (3.4%). Bacterial keratitis (53.2%) was still the most common etiology of CMK, followed by fungal keratitis (27.0%), Acanthamoeba keratitis (5.7%), and viral keratitis (2.0%). Aspergillus species (18.3%) were the most common microbial isolates. Pseudomonas species (13.9%) were the most common bacterial isolates. The median time from onset of symptoms to consultation with the study centers was 2 weeks. Medical treatment was enough to treat the infection in 34.8% of cases. Surgical intervention was necessitated in 22.6% with evisceration/enucleation done in 1 out of 3 patients who had surgery. Conclusion: Bacterial infection remains the most common cause of CMK in the Philippines, followed by fungal infection. Significant risk factors include trauma and contact lens wear. Aspergillus species and Pseudomonas species were the most common fungal and bacterial isolates, respectively. Despite medical treatment, almost a quarter of the cases still required surgical intervention
Dry Eye Cross-Sectional Study – Philippines: Comparison with the Asia Dry Eye Society Criteria and OCULUS Keratograph 5M Findings
Objective: This study compared the proportion of dry eye disease (DED) diagnosed using the Philippine criteria with that diagnosed using the Asia Dry Eye Society (ADES) criteria among participants, and characterized DED features using clinical tests and the OCULUS Keratograph® 5M (K5M; OCULUS Optikgeräte GmbH, Wetzlar, Germany). Methods: This multicenter, cross-sectional study included participants with and without DED. Participants completed the Ocular Surface Disease Index (OSDI) questionnaire and underwent fluorescein tear breakup time (FTBUT) measurement, fluorescein staining of the cornea, lissamine green staining of the conjunctiva, Schirmer 1 test without anesthesia, and basal tear secretion test (BST). The OCULUS K5M was used to measure noninvasive tear breakup time (NIKBUT) and tear meniscus height (TMH), and to perform meibography. Results: The analysis included 344 eyes from 172 patients with DED and 44 eyes from 22 normal participants. Patients with DED were mostly female (66.3%). Compared to normal participants, patients with DED were older (42.7 ± 14.6 years) and had higher OSDI scores (28.6 ± 21.0). Among those diagnosed with DED using the Philippine criteria, 53.2% met the ADES criteria. Evaporative DED was the predominant type (53.2%). DED eyes had lower FTBUT (5.0 ± 3.3 seconds) and NIKBUT (12.3 ± 5.9 seconds) than controls (p <0.001). The correlation between FTBUT and NIKBUT was weak in the overall sample (r = 0.27, p < 0.001). The DED group also had a lower BST value (12.7 ± 9.8 mm) than the control group (p <0.001), while TMH (0.29 ± 0.15 mm) of the DED group did not differ from that of the control group (p = 0.421). BST and TMH also showed weak correlation (r = 0.21, p <0.001). Conclusion: There were disparities between the Philippine and ADES criteria for DED diagnosis and differences in tear measurements using clinical tests and the OCULUS Keratograph, indicating the need to harmonize diagnostic standards