Childhood microbial keratitis

To evaluate risk factors for pediatric microbial keratitis and to describe the clinical picture, microbial spectrum, treatment modalities, posttreatment sequelae, and visual outcome in cases with pediatric microbial keratitis. All cases of microbial keratitis that occurred in children 16 years or younger who had an initial examination between January 2000 and December 2010 at a tertiary referral eye hospital in Riyadh, Saudi Arabia, were identified. A retrospective review of medical records was conducted using a computer-based diagnosis code. Demographic data, predisposing factors, clinical course, microbial culture results, and visual outcomes were recorded. Sixty-eight eyes were included in this study. Predisposing factors were identified in 63 eyes [92.6%]. All patients had unilateral microbial keratitis. The mean +/- SD age was 4.5 +/- 4.8 years and 57.4% were male. Trauma was the leading cause [27 eyes [39.7%]], followed by systemic diseases [14 eyes [20.6%]], contact lens wear [11 eyes [16.1%]], and ocular diseases [11 eyes [16.1%]]. Corneal scraping was performed in all cases. Five patients needed general anesthesia to carry out the corneal scraping. Thirty-four [50.0%] eyes showed positive cultures. Gram-positive bacteria accounted for 67.8% and gram-negative bacteria for 38.2% of isolates. Streptococcus pneumoniae was the most commonly isolated organism [8 eyes [25.8%]], followed by Staphylococcus epidermidis [7 eyes [22.7%]]. Pseudomonas aeruginosa was the most commonly isolated gram-negative [6 eyes [17.6%]] organism. One eye had corneal perforation and required surgical intervention. Forty-five of 68 eyes [66.2%] had a best-corrected visual acuity evaluation at the last follow-up and 28 eyes [62.2%] of them had a best-corrected visual acuity of 20/40 or better. Children with suspected microbial keratitis require comprehensive evaluation and management. Early recognition, identifying the predisposing factors and etiological microbial organisms, and instituting appropriate treatment measures have a crucial role in outcome. Ocular trauma was the leading cause of childhood microbial keratitis in our study

Development and validation of an Arabic version of the visual functioning index VF-14 for cataract patients

To develop and validate an Arabic version of the Visual Functioning Index [VF-14] for patients with cataracts. The VF-14 was translated into Arabic by an epidemiologist and an ophthalmologist, both fluent in Arabic and English. The VF-14 was administered to patients diagnosed with cataract at two hospitals in Egypt and two hospitals in Saudi Arabia. Patients were also administered three other forms; the cataract symptoms score [CSS]; global measure of vision; and cataract medical form. Internal reliability and external validity were measured. Index sensitivity to visual acuity was detected and potential effective factors were investigated. Correlation analyses were performed. A p value less than 0.05 was considered statistically significant. The translated VF-14 was consistent and reliable [sigma = 0.763, p < 0.0001]. It was also statistically significantly sensitive to vision [p < 0.0001]. The mean calculated index was 62.18 +/- 19.34, and was highly correlated with; CSS and other scores [p < 0.0001, all cases]. Factors that may affect the index are; age, sex, vision, wearing glasses, type, position, and severity of cataract. The Arabic VF 14 is a reliable and valid tool for evaluation of both visual functioning and quality of visual life among cataract patients. It is also sensitive to changes in visual acuity, demographic, and clinical characteristics

Posterior polar cataract: a review

Posterior polar cataract is a rare form of congenital cataract. It is usually inherited as an autosomal dominant disease, yet it can be sporadic. Five genes have been attributed to the formation of this disease. It is highly associated with complications during surgery, such as posterior capsule rupture and nucleus drop. The reason for this high complication rate is the strong adherence of the opacity to the weak posterior capsule. Different surgical strategies were described for the handling of this challenging entity, most of which emphasized the need for gentle maneuvering in dealing with these cases. It has a unique clinical appearance that should not be missed in order to anticipate, avoid, and minimize the impact of the complications associated with it

Late graft failure due to the development of corneal guttata

Late graft failure due to the development of corneal guttata is rare. We report a case of a 58 year old patient who underwent penetrating keratoplasty [PKP] for corneal edema in the right eye. Later, he had phacoemulsification and posterior chamber intraocular lens implantation in the same eye. This was followed by graft decompensation for which a second PKP was performed. The histopathology revealed corneal guttata typical of what is seen in Fuchs' endothelial dystrophy. These findings are discussed with a review of the related literature

Nodular episcleritis in a young patient

To report a case of nodular episcleritis at the limbus associated with corenal deposits in a young patient. Observational case report. A 16-year-old Saudi girl developed a pinkish-white, soft, well-demarcated mass, 6 x 5 mm in size and 1mm in height, in the superonasal limal area of the right eye. It was associated with yellowish deposits in the adjacent cornea. histopathological evaluation of the excised lesion revealed chronic inflammation in the deep layer of the episclera with infiltration by lymphocytes and epithelioid cells, in addition to capillary proliferation. subsequently, the patient didn't develop any systemic manifistation or recurrence during the one-year follow-up period. Although nodular episcleritis tends to occure in an older age group, it can also present in young patients. Surgical excision can result in an excellent clinical outcome

Malignant glaucoma after Ahmed valve implant

To report and describe the clinical presentation of malignant glaucoma after Ahmed glaucoma valve implant [AGVI] in 2 patients. Chart review of 2 patients who developed malignant glaucoma after AGVI at the King Khaled Eye Specialist Hospital, Riyadh. Both patients developed high intraocular pressure [IOP] associated with axial shallowing of the anterior chamber despite patent iridotomies and normal posterior segment anatomy following AGVI surgery. Both of them did not respond to medical or laser treatment. However, the anterior chamber deepened and the IOP was controlled in both cases after pars plana vitrectomy and anterior chamber reformation. Malignant glaucoma can develop after AGVI. Successful clinical outcomes can be achieved with posterior segment surgery