Abstract:Diabetes is a complex and heterogeneous disorder presently affecting more than 100 million people worldwide and causing serious socio-economic problems. Spontaneous rodent models of diabetes mellitus have proved invaluable in understanding the pathogenesis, complications, and genetic or environmental influences that increase the risks of diabetes. We have reviewed here in the development and characterization of spontaneous rodent models that displayed most features commonly associated with diabetic retinopathy.

Abstract:AIM: To study the effects of naringenin eye drops on NaIO3-induced retinal pigment epithelium (RPE) degeneration and laser-induced choroidal neovascularization (CNV) in rat eyes. · METHODS: The 35mg/kg NaIO3-induced RPE degeneration was prevented by 10g/L naringenin eye drops 3 times a day for 7 days in advance of NaIO3 injection, and then 2 to 4 weeks thereafter, RPE function was measured with C-wave of electroretinogram (ERG). The laser-induced CNV rats were treated with laser to break the Bruch's membrane and the CNV formation was prevented by 10g/L naringenin eye drops instilled 3 times a day for 2 to 4 weeks. The CNV formation was measured with fluorescein angiography (FA) and flat mount. · RESULTS: Two weeks after NaIO3 injection, the amplitude of ERG C-wave fell markedly in NaIO3 group to 53% of normal group (P <0.01). No apparent difference was observed in naringenin+NaIO3 group. Four weeks later, the NaIO3 group fell to 37% of normal group (P <0.01), while the naringenin+ NaIO3 group fell to only 57% of normal group (P <0.01). There was a 52% reversal of the ERG C-wave by naringenin as compared to NaIO3 treated group (P <0.05). Two weeks and four weeks after laser treatment, naringenin reduced the CNV formation to 53% and 49% of control group (100%) measured by FA (P <0.01). Four weeks after laser treatment, naringenin reduced the CNV formation by 47% as compared to control group measured with flat mount(P <0.01). · CONCLUSION: Naringenin can significantly protect RPE from NaIO3 induced degeneration and also prevent CNV formation.

Abstract:AIM: To investigate the mechanism of proliferation effect induced by (R,R)-XY-10 and (S,S)-XY-10 on retinal pigmented epithelial cells (ARPE-19). · METHODS: Human retinal pigmented epithelial cells (ARPE-19) and human umbilical vein endothelial cells (HUVECs) were used to investigate the effect of (R,R)-XY-10 and (S,S)-XY-10 on cell growth, and their mechanisms of proliferative action by using ERK, AKT, PI3K, Protein kinase C (PKC) and Nitric oxide synthase (NOS) inhibitors. · RESULTS: (R,R)-XY-10 and (S,S)-XY-10 dose-dependently increased ARPE-19 cell proliferation, but not on HUVECs. When treated with proliferative inhibitors, H-7 (5μmol/L), hypericin (20μmol/L), PD98059 (2μmol/L), LY294002 (50μmol/L), SH-5 (10μmol/L) and L-NAME (100μmol/L), the proliferative effect was reduced by H-7, hypericin, PD98059 and LY294002, but not by SH-5 and L-NAME. · CONCLUSION: (R,R)-XY-10 and (S,S)-XY-10 can induce cell proliferation through MAPK and PI3K dependent pathway.

Abstract:AIM: To investigate the incidence of oculocardiac reflex (OCR) with two anesthetic regimens and its prevention using topical anesthetics in a rabbit model, and to explore the effect of topical anesthetics on corneal healing. · METHODS: Forty-eight clinically healthy adult New Zealand white rabbits of either sex were divided into two groups (Group A and B) and anesthetized with either ketamine (Group A, n =24) or propofol (Group B, n =24). he incidence of OCR was recorded in each group with a variety of ocular manipulation with or without the use of topical anesthetics (40g/L lignocaine, 5g/L proparacain, 5g/L bupivacaine). Corneal toxicity and healing following the use of each topical anesthetic was assessed one day after surgery and up to 7 days postoperatively by clinical examination of the eye, histopathology and collagen staining and transmission electron microscopy. · RESULTS: No incidence of OCR was recorded with ocular manipulation under ketamine anesthesia, whereas significant reduction in heart rate (P <0.01) was recorded under propofol anesthesia. Topical anesthetics could successfully prevent the OCR without affecting the corneal healing. · CONCLUSION: Topical anesthetics may be recommended for prevention of OCR without any local adverse effect.

Abstract:AIM: To study plasma levels of vascular endothelial growth factor (VEGF), endothelin-1(ET-1) and nitric oxide (NO) in patients with proliferative diabetic retinopathy (PDR) before and after pan-retinal photocoagulation (PRP). · METHODS: Forty patients (23 females and 17 males, mean age 48.5±12.2 years) with PDR without previous PRP therapy were studied. Blood samples were obtained before and 3 months after the last PRP session. Baseline (prelaser) plasma levels of VEGF, ET-1 and NO were compared with their levels in 30 healthy age- and sex- matched controls and also with plasma levels 3 months post-PRP. · RESULTS: Patients with PDR had significantly raised plasma VEGF (375±89ng/L), ET-1(20±5ng/L) and NO (135±53μmol/L) when compared with healthy control group (P <0.01). After PRP, there was a significant reduction in plasma VEGF (179±66ng/L), ET-1 (11±5ng/L) and NO (91±49μmol/L) levels at 3 months' follow-up but still significantly higher than healthy controls. · CONCLUSION: Patients with PDR demonstrate elevated VEGF, ET-1 and NO, which decrease after successful laser treatment.

Abstract:AIM: To detect the differentiation effects of retinal cells or extracts on bone marrow-derived mesenchymal stem cells (BMSC). · METHODS: Human fetal BMSC were previously labelled by carboxyfluorescein succinimidyl ester (CFSE), and co-cultured with retinal pigment epithelial (RPE) cells which were pre-treated with ultraviolet irradiation at a ratio of 1:1 to induce the differentiation of BMSC for up to 14 days. In some assays, a retinal extract of bovine retinal extract (BRE) was added to detect the potential effects of retinal component on the differentiation of BMSC. In addition, Neuron-specific enolase (NSE), Nestin and Glial fibrillary acidic protein (GFAP) immunostaining were performed to determine the characteristics of BMSC. · RESULTS: The results indicated that by co-cultured with RPE cells, fetal BMSC were differentiated into neural-like cells expressing special neuronal markers Nestin, GFAP and NSE. And the expression of these markers was obviously increased by BRE. · CONCLUSION: Retina derived cells and extracts can induce the differentiation of BMSC into neural-like cells.

Abstract:AIM: To study the effects of geranylgeranylacetone (GGA) on the expression of heat shock protein70 (HSP70) on retinal ganglion cells (RGC) in rats with chronic intraocular pressure (IOP) elevation. · METHODS: Seventy Wistars were divided into blank control group (10 rats), chronic hypertension group (30 rats) and GGA group (30 rats). Chronic hypertension was created by cauterizing the superficial scleral veins. 800mg/kg/d GGA was given by oral daily after cauterization. Immunohis- tochemistry was used respectively to observe the changes of expression of HSP70 in the model rats and GGA interference rats at different time points during the course of chronic IOP elevation. · RESULTS: The successful model was identified as the IOP over 40% of normal rats. The retinal thickness was significantly reduced in model group and model+GGA group compared with normal rats from 21 days through 28 days after cauterization (P <0.05), and that of model rats was obviously decreased in comparison with model+GGA rats (P < 0.05). The number of ganglion cells was significantly decreased in model rats and model+GGA rats compared with normal rats from 21 days and 28 days. The stronger expression intensity (IOD) value was seen for HSP70 in the model+GGA rats by immunochemistry (P <0.01). · CONCLUSION: Systemic administration of GGA protects retina from chronic IOP elevation by regulating the expression of HSP70.

Abstract:AIM: To explore the effect of Buddleia flavonoids drug-containing plasma and androgen receptor (AR) blocker on the expression of STAT1 phosphoprotein. · METHODS: In vitro lacrimal gland epithelial cells were cultivated with H2O2 to establish the dry eye apoptosis state. Blank plasma group, Buddleia officinalis plasma total flavonoids interfere with drug-containing group, and the intervention group of testosterone propionate were set. The expressions of STAT1 phosphoprotein of each group were observed by Western blot. AR blocker flutamide was used to explore the intended androgen effect of Buddleia flavonoids. · RESULTS: After the intervention of drug-containing plasma, the expression of STAT1 phosphoprotein in Buddleja officinalis drug-containing plasma intervention group (0.353±0.494) and testosterone propionate intervention group (0.502±0.036) were enhanced and the differences between the two groups were significant (P <0.01). After using AR blocker, the expression of STAT1 phosphoprotein in each group (0.268±0.061, 0.283±0.106, 0.213±0.071) had no difference. · CONCLUSION: Buddleja officinalis drug-containing plasma total flavonoids can promote the expression of STAT1 phosphorylation.

Abstract:AIM: To analyze single nucleotide polymorphisms (SNP) of primary open angle glaucoma- and metabolic syndrome-related genes in primary open angle glaucoma (POAG), in order to elucidate the roles of metabolic syndrome as a risk factor in POAG progress. · METHODS: SNP genotypes and alleles of interleukin-6 (IL-6), IL-6 receptor (IL-6R), dopamine D2 receptor (DRD2), beta-fibrinogen (FGB), peroxisome proliferator-activated receptor-γ2 (PPARG), transforming growth factor-β1 (TGF-β1), E-selectin (E-Sel), apolipoprotein A-5 (APOA5), C-reactive protein (CRP), ectonueleotide pyrophosphatase/ phosphodiesterase 1 (ENPP1), hepatic lipase (LIPC), adiponectin (ADIPOQ), paraoxonase 1 (PON1) and serine protease inhibitor E (SERPINE1) genes in POAG (n =37) and normal control (n =100) groups were measured with ABI Prism 7900HT Fluorescence Quantitative PCR and TaqMan SNP Genotyping fluorescence probe kit. · RESULTS: Genotypes and allele frequencies of IL-6R, IL-6, FGB, CRP, ENPP1, LIPC, ADIPOQ, PON1, and SERPINE1 in total POAG group were significantly different compared to the control group. · CONCLUSION: Metabolic syndrome as a risk factor for POAG may be associated with genotypes and allele frequencies of the related genes. The corresponding gene expression and function can affect POAG progress, including roles of SERPINE1 in extracellular matrix, ENPP1 in insulin inhibition, IL-6 in endogenous neuroprotection, IL-6, IL-6R and E-Sel in autoimmune response, LIPC and FGB in blood hyperviscosity syndrome, ADIPOQ in NOS/NO production, PON1 in vascular endothelial protection.

Abstract:AIM: To evaluate the effects of the extract of Buddleja officinalis eye drops in basic tears secretory volume, tear film stability, expression of androgen receptors (AR) in castrated rats with dry eye, and to investigate the therapeutic effects of the extract of Buddleja officinalis on dry eye caused by gonadal hormones level imbalance. · METHODS: Forty-five Wistar masculinity rats were divided at random into nine groups, including normal groups (A1, A2 and A3); model groups (B1, B2 and B3); therapy groups with extract of Buddleja officinalis eye drops (C1, C2 and C3). The "1" stood for being fed for 1 month, and "2" for 2 months, and "3" for 3 months. The dry eye model was established with orchiectomy on groups B and C. Group C was treated with Buddleja officinalis extract eye drops for one month. All rats were checked with Schirmer I test (SIT) and tear film break-up time (BUT). Expression of AR was analyzed by flow cytometer (FCM). · RESULTS: The SIT value of group C was significantly higher than that of group B (P <0.01) and the BUT value of group C was significantly longer than that of group B (P < 0.01), which indicated the eye drop could significantly keep basic tears secretory volume and tear film stability. And the expression of AR of group C was much higher than that of group B, which showed that available composition of the eye drops maybe display androgen-like activity. · CONCLUSION: The main components of the extract of Buddleja officinalis is the flavonoids that can significantly inhibit happening of dry eye of rat after androgen level lowered. Its mechanism is like androgen's and it can display androgen-like activity to keep basic tears secretory volume and tear film stability

Abstract:AIM: To elucidate a simple method for isolating endothelial progenitor cells (EPCs) from human umbilical cord blood mononuclear cells and observe the endothelial cell-specific expression profile during proliferation and differentiation in vitro. · METHODS: Human umbilical cord blood were isolated by Percoll density gradient centrifugation from human cord blood and cultured in vitro. The adherent cells were then identified by immunohistochemical staining and flow cytometric analysis. CD34, vascular endothelial growth factor receptor-2 (VEGFR-2), EPCs specific antigen CD133, as well as endothelial cell specific markers CD31 and vWF were used. The cells were characterized by acetylated LDL(acLDL) up-taking and lectin binding by direct fluorescentstaining. · RESULTS: During culture, the attached cells exhibited spindle-shape in early stage, and gradually display endothelium- like cobblestone morphology with outgrowth. On day 7, flow cytometric analysis showed that the positive staining rate of attached cells for CD133, CD34 and VEGFR-2 were 17.8%±3.7%, 22.1%±4.4% and 81.5%±5.0%, respectively. While, immunohistochemical staining showed that the adherent cells were positive to CD31 and vWF at the rate of 92.7%±2.2% and 73.3%±4.2%, respectively. By direct fluorescentstaining, we observed that 83.0%±4.3% of the attached cells were double positive for DiI-acLDL and FITC-UEA-I. · CONCLUSION: EPCs can be separated from human cord blood under certain conditions in vitro. This observation may provide a basis for study of relationship between EPCs and retinal neovascularization, as well as further clinical application of EPCs in ischemic retinal lesions.

Abstract:AIM: To investigate the inhibitory effect of rabbit lens epithelial cell (RLEC) survival and growth by propylene glycol mannate sulfate (PGMS) on the rabbit capsular bag in vitro. · METHODS: Capsular bags were prepared from rabbit eyes after extracapsular cataract extraction (ECCE) and incubated in 0.2, 0.4, 0.8g/L PGMS in 2, 5, 10 minutes incubation periods. After treatment, the capsular bags were cultured for 7 days in Dulbecco minimum essential medium (DMEM) supplemented with 50mL/L fetal calf serum (FCS). The specimens were examined with light microscopy and transmission electron microscopy (TEM). Capsular bags without receiving PGMS only served as controls. · RESULTS: PGMS inhibited the proliferation of RLEC in the manner of concentration and time dependent. At the threshold protocol of incubation in PGMS at 0.8g/L for 5 or 10 minutes, proliferative activity of cells were largely arrested and nearly no RLEC was seen on the posterior capsule (P < 0.05). Control group had no effect on structure and proliferative activity of RLEC, and the growth proceeded rapidly so that the posterior capsule were totally covered by a confluent monolayer of cell by the end of 7 days. Under TEM, the cells in the control group were tightly arrayed with clearly defined cellular boundary and structure; while cellular deformity and undefined intracellular structure could be seen in the 0.4g/L and 0.8g/L experimental groups. · CONCLUSION: PGMS can effectively inhibit the proliferation of RLEC.

Abstract:AIM: To study the differences of basic fibroblast growth factor (bFGF) gene expression in lens epithelial cells (LECs) between fetuses and cataract patients. · METHODS: In situ hybridization was used to detect bFGF mRNA in the LECs that were cultured and in tissue sections from fetuses and in the LECs from the anterior capsule of cataract patients. Image analysis was used for the relative quantitative analysis of bFGF mRNA. · RESULTS: bFGF gene existed in the LECs that were cultured and in tissue sections from fetuses and in the LECs from the anterior capsule of cataract patients. The integral absorbance for the fetal cultured cells, the fetal tissue sections and the capsule membrane cells of cataract patients were 627.1±268.7, 131.5±42.8 and 79.2±26.3 respectively. The integral absorbance of fetal cultured LECs was significantly higher than that of fetal section LECs (P <0.01). The integral absorbance of cataract LECs was significantly lower than that of fetal LECs (P <0.01). · CONCLUSION: The in vitro culture of LECs can improve bFGF gene expression. The bFGF gene expression in fetal LECs is significantly higher than that in cataract LECs.

Abstract:AIM: To observe the effect of endothelin-1 (ET-1) on the cytoskeleton protein F-actin of cultured human trabecular meshwork (HTM) cells. · METHODS: Cultured HTM cells were randomly divided into four groups: control group, low-dose ET-1 (10-9 mol/L) treatment group, middle-dose ET-1 (10-8 mol/L) treatment group, and high-dose ET-1(10-7 mol/L) treatment group. After treated with ET-1, the expression of cytoskeleton protein F-actin in trabecular meshwork was analyzed with Western-blot and the distribution of F-actin was detected with FITC-Phalloidin probe. · RESULTS: ET-1 dose-dependently and significantly increased F-actin in trabecular meshwork cells (P <0.05). The F-actin stress fiber and periphery actin fiber highly increased and manifested mild reorganization after treated with ET-1; and there were much more cell-to-cell and cell-to-extracellular matrix attachments formation in ET-1 treated HTM cells than that in the untreated HTM cells. · CONCLUSION: ET-1 promotes the expression of cytoske- leton protein F-actin and induced the trabecular meshwork actin cytoskeleton reorganization.

Abstract:AIM: To analyze the demography, presenting clinical features, spread of the disease of retinoblastoma in patients who were treated in two tertiary hospitals in Malaysia. · METHODS: In this retrospective study, information of gender, age, race, presenting clinical features, findings of CT scan orbits and brain, lumbar puncture and bone marrow aspiration results were collected from the medical records of retinoblastoma patients diagnosed in Hospital of Universiti Sains Malaysia and General Hospital of Kuala Lumpur over a period of ten years. The data were collected in the same type of proforma from both hospitals. · RESULTS: A total of 64 patients were treated in both hospitals together, of whom boys and girls were almost equally affected. The mean age of children at presentation was 24.2 (range 3-84) months, 53 (82.8%) children were under 36 months old. The disease was unilateral in 39 (60.9%) patients. The most common presenting signs were leukocoria in 46 (71.8%), followed by proptosis in 21 (32.8%) patients. Routine screening of the siblings of affected children revealed retinoblastoma in 2 patients. There was intracranial extension in 8 (12.5%) and metastasis in bone marrow in 6 (9.3%) patients. · CONCLUSION: Leukocoria is the most common presentation of retinoblastoma in Malaysia. However, the disease was intraocular in 40 (62.5%) and extraocular (orbital involvement, intracranial and distant metastasis) in 24 (37.5%) patients.

Abstract:AIM: To evaluate the surgical outcome of congenital upper eyelid coloboma repair. · METHODS: All patients underwent complete ophthalmic and general examination before going to surgery, and then examination under anesthesia was performed to assess the site and size of eyelid defect, conjunctival involvement. The status of cornea and ocular motility with forced duction test was also being noted. The surgical procedure was performed according to the size of defect. · RESULTS: Out of 21 cases of congenital upper eyelid coloboma, 18 occurred in isolation with upper eyelid medial defect, 13 were bilateral and 5 were unilateral. Others were associated with Goldenhar syndrome and CHARGE syndrome with bilateral upper lid medial defects. All patients were presented for surgical corrections during age of 2.5-4.0 years except one that presented at 25 years of age. Cosmetically surgical results were acceptable, except one that was already presented with opaque corneal. · CONCLUSION: In this study, overall surgical results were satisfactory except one that was presented late with compromised cornea.

Abstract:AIM: To describe the involvement in relatives of keratoconus (KCN) patients with corneal topography map. · METHODS: A total of 150 siblings of 300 eyes of 75 KCN patients referred to corneal clinic were studied and experienced complete slit-lamp, refraction examinations and topographic cornea maps provided by videophotoker- atography. ANOVA, Fisher exact and Chi-square tests performed to compare of results. · RESULTS: Of 150 siblings, 56% were female and 44% were male with average age of 21 (range 15-39) years. KCN and suspect KCN diagnosed in 12.3% and 6.6% respectively. The central keratometry (CK) was 46.5±4.51 dioptr (D) in KCN and 45.66±1.52D in suspect KCN. Inferior-superior value (I-S) was 3.51±2.5D in KCN and 1.56±1.22D in suspect KCN. In KCN condition the oval pattern was 67.6% (n = 25) and Round pattern detected 32.4% (n =12). In suspect KCN these patterns detected 90% and 10% respectively. Refractive errors in KCN were -7.5 to +1.25 dioptr (-1.25±1.83), in suspect KCN 0.45 to -4.2 dioptr (-0.68±0.76) and in healthy group 2.75 to -7.5 dioptr (-0.6±1.12). Astigmatism was mild in 22.7%, moderate and sever astigmatism in 18.3% in KCN and suspect KCN · CONCLUSION: Increasing KCN condition in healthy siblings of KCN patients shows require to screening plan to early diagnose and cautionly treatment of contact lens in these individuals.

Abstract:AIM: To examine the relationship between corneal lymphangiogenesis and hemangiogenesis after keratoplasty. · METHODS: Nineteen human corneas were obtained from 19 patients undergoing a second corneal transplantation in Zhongshan Ophthalmic Center in 2005. Blood and lymphatic vessels in human transplanted corneas were identified by lymphatic vessel endothelial receptor (LYVE-1) and platelet endothelial cell adhesion modecule-1 (PECAM-1) immunohi- stochemistry, and double enzyme-histochemistry; then the association of corneal blood vessel counting (BVC) with lymphatic vessel counting (LVC) was examined. · RESULTS: Corneal hemangiogenesis was present in 12 cases (63%), and lymphangiogenesis occurred in 5 cases (26%) human transplanted corneas. In addition, corneal lymphangiogenesis was only present in vascularized corneas. LVC was strongly and positively correlated with BVC(r=0.725, P <0.01). · CONCLUSION: Corneal lymphangiogenesis develops after keratoplasty and strongly associates with hemangiogenesis.

Abstract:AIM: To analyze the risk factors of age, sex, course, best corrected visual acuity (BCVA), diopter and fundus features of high myopes with progressive high myopia. · METHODS: A total of 167 patients with high myopes were categorized into four groups: group 1, age 10-29 years; group 2, age 30-49 years; group 3, age 50-69 years and group 4, age 70-89 years. The refractive errors of all patients were measured without cycloplegia with an autorefractometer. Data of the spherical equivalent (SE) of the refractive errors in diopters (D) and fundus examined by direct ophthalmoscope were used in statistical analysis. · RESULTS: The number of female was statistically larger than that of male (P＜0.01), also the disease course was correlated to the age. The visual acuity of high myopes significantly decreased as they grew older including the higher incidence of lacquer cracker, submacular hemorrhage, Fuchs spots, chorioretinal atrophy. · CONCLUSION: Female maybe a risk factor of high myopia, advanced age is an important factor of visual acuity decreased. High myopes ought to be treated early to delay the progress of myopia and development of macular degeneration.

Abstract:AIM: To describe the prevalence and causes of low vision and blindness in a population within Sichuan province in southwestern China. · METHODS: A stratified, multi-phased and cluster probability sampling design was employed to enumerate 125641 participants from 40351 households within 38 counties/cities. Participants underwent a comprehensive eye examination, including standardized visual acuity (VA) tests using logarithm of the minimum angle resolution charts. Prevalence was age- and gender-standardized to the 2000 China Census. · RESULTS: Population-weighted prevalence of blindness was 0.77% (95%CI: 0.72-0.82, n=966) and low vision was 1.22% (95%CI: 1.14-1.27, n=1513). Overall, the prevalence of visual disability was 1.40% in the urban population, and 2.22% in the rural population (P<0.01). Cataract was the leading cause of visual disability (55.7%, n =1381), and was of similar frequency in both urban and rural populations. Retinal disease was the second leading cause(9.7%, n =236), but was more common in urban than in rural participants (34.3% vs 2.7%, P <0.01). Corneal disease accounted for 6.5% (n=161) of cases of visual disability, and was more common in the rural population (7.2% vs 3.9%, P =0.006). · CONCLUSION: We estimate that 1.72 million people suffer from visual disability within Sichuan province, of which 525000 are blind, the focus of blindness prevention should be in rural area.

Abstract:We report a case of retinal detachment in morning glory syndrome(MGS). We think that identification of the retinal break, removal of the traction force by vitrectomy, the use of long-acting gas as endotamponade, all contributed to the successful treatment of the disease. The pathogenic mechanisms of the disease and the function of B-scan to the diagnosis are included.

Abstract:AIM: To report a case of cryptococcus meningitis in an immunocompetent teenager that presented early with diplopia and bilateral poor vision. · METHODS:A case report · RESULTS:A 17-year-old boy presented with blurring of vision in both eyes and diplopia for 3 weeks. It was associated with severe throbbing headaches, nausea and vomiting. He was also having low grade fever. On physical examination he was afebrile with no sign of meningism. His vision was 6/15 in both eyes with constricted visual field. Anterior segment was normal in both eyes. Extraocular muscles movement showed bilateral sixth nerve palsies. Fundoscopy revealed bilateral hyperaemic and slightly elevated optic disc. CT scan of the brain was normal with no evidence of intracranial mass or abnormal ventricles. Lumbar puncture revealed high opening pressure >300mmH2O. Cerebrospinal fluid(CSF) microscopically and culture showed presence of cryptococcus neoformans. This case was combinedly managed with neuro-medical team. Patient was started on intravenous Amphotericin B and fluconazole. His neurological symptoms recovered after a week. His vision was improved to 6/6 in both eyes with recovery of peripheral visual field. The diplopia improved with recovery of sixth nerve palsies in both eyes. Unfortunately, patient developed nosocomial lower respiratory tract infection and was treated for the problem. · CONCLUSION: This case highlights the indolent nature of cryptococcus meningitis and the fact that the overt signs of meningism may not be present even in immunocompetent person. Diplopia may be one of the early presentations of meningitis patient.