Successful Collagen Crosslinking in a Patient With Keratoconus and Systemic Scleroderma.

Scleroderma is an autoimmune disease that affects connective tissue. Keratoconus (KC) is a rare ocular condition that may appear alongside scleroderma. Contact lenses are an essential visual aid for KC patients, especially in advanced cases. However, scleroderma patients may face difficulties using them due to finger-related disabilities. Corneal collagen cross-linking (CXL) is a crucial treatment used to prevent corneal thinning and visual deterioration in progressive KC. However, the potential trigger of corneal melt and delayed healing following CXL in KC patients with scleroderma is a matter of concern. We present a case of a patient with KC and scleroderma who underwent CXL without any complications.

Dry Eye Disease in the Middle East and Northern Africa: A Position Paper on the Current State and Unmet Needs.

In the Middle East and Northern Africa (MENA), dry eye disease (DED) is often misdiagnosed or overlooked. This review summarizes a series of conversations with ophthalmologists in the region around a variety of climatic, lifestyle, and iatrogenic factors that contribute to specific features of DED in the MENA region. These considerations are further classified by patient lifestyle and surgical choices. All statements are based on discussions and formal voting to achieve consensus over three meetings. Overall, a deeper understanding of the disease characteristics of DED specific to MENA can better guide local eyecare practitioners on appropriate management and follow-up care. Additionally, population-based studies and patient and physician education on ocular surface diseases, together with the use of culturally appropriate and language-specific questionnaires can help ease the public health burden of DED in this region.

Splinter Cataract in Patients with Keratoconus and Frequent Eye Rubbing: A Novel Finding.

BACKGROUND Patients with keratoconus are at increased risk of developing cataract at a younger age compared to the normal population. Predisposing factors include atopy and topical steroid use. In this case series we report the novel observation of splinter-shaped cortical cataract in 16 eyes of 14 patients with keratoconus in the absence of other risk factors of cataract development from a single center in Riyadh, Saudi Arabia. CASE REPORT This is a retrospective review of 16 eyes of 14 patients diagnosed with keratoconus and found to have splinter cortical cataract. Twelve patients had unilateral and 2 patients had bilateral splinter cortical cataract in the inferotemporal quadrant of the crystalline lens. Thirteen eyes (81.25%) had clinically proven keratoconus and 3 eyes (18.75%) were keratoconus suspects. All patients affirmed frequent eye rubbing and 62.5% of eyes had a history of vernal keratoconjunctivitis. Best corrected visual acuity (BCVA) by the logarithm of the minimum angle of resolution (LogMAR) was reported between 0 to 0.2 in 69% of eyes (11 eyes) and 4 eyes (25%) had BCVA of 0.3 to 0.6, and 1 eye (6%) had BCVA of 1.3. CONCLUSIONS Splinter-shaped cortical cataract could be a sign of frequent eye rubbing. Careful examination of the crystalline lens with dilated pupil may reveal peripheral cortical opacities in the inferotemporal quadrant, which can alert the physician that the patient has habitual eye rubbing and is at increased risk of keratoconus development or progression.

Penetrating Keratoplasty Versus Descemet Stripping Automated Endothelial Keratoplasty in Children With Congenital Hereditary Endothelial Dystrophy: Long-Term Results.

PURPOSE: The purpose of this study was to compare the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PKP) in patients with congenital hereditary endothelial dystrophy (CHED). METHODS: This was a retrospective, comparative study of all the patients with a histopathological diagnosis of CHED who underwent PKP or DSAEK between January 1, 1990, and December 31, 2016. All the cases were included except those patients who had clear grafts but did not complete 2 years of postoperative follow-up. The main outcome measure was graft clarity 2 years after surgery. RESULTS: There were 111 eyes of 63 patients. Seventy-six eyes underwent PKP, and 35 eyes underwent DSAEK. The median age at surgery was 6.8 years in the PKP group and 10.32 years in the DSAEK group. At 2 years postoperatively, clear grafts were noted in 66 of 76 (86.8%) eyes in the PKP group and 30 of 35 (85.7%) eyes in the DSAEK group. At the last follow-up, 80.3% of PKP grafts and 82.8% of DSAEK grafts were clear ( P =0.5). The type and timing of complications differed between the 2 groups. The PKP group had a statistically significant higher rate of graft rejection (19.5%) versus the DSAEK group (0%) ( P =0.01). DSAEK complications were mainly lenticule detachment that developed within one month postoperatively. There was no statistically significant difference in the visual outcomes at the last follow-up between the groups. CONCLUSION: Endothelial keratoplasty is a safe alternative to conventional PKP in CHED. The visual outcome and survival rates were comparable, but DSAEK had a lower rejection rate and fewer suture-related complications.

The Iris Thickness in a Healthy Saudi Population.

Purpose Iris thickness (IT), a known risk factor for angle closure glaucoma, has not been evaluated in the normal Saudi population. Methods Quantitative information on IT was evaluated in healthy Saudi eyes using anterior segment optical coherence tomography (ASOCT). IT and iris volume was measured with the room 'light on' (LON) and 'light off' (LOFF) using Image J software. IT in the nasal and temporal iris was measured at 500 µm (IT500) and 750 µm (IT750) from the scleral spur (SS). Differences in IT measurements by age, gender and type of refractive error were evaluated. Results We included 100 eyes of 50 healthy adult Saudis without ocular disease other than refractive errors. The mean age of 56 males and 44 females in the study group was 41.7 ± 14.5 years. The refractive status was as follows: emmetropia (35 eyes), mild/moderate myopia (33 eyes), high myopia (17 eyes) and hyperopia (15 eyes). The IT750 with LON was significantly more than IT500 both nasally (P = 0.03) and temporally (P < 0.001). The difference in IT750 and IT500 with LOFF was significantly more nasally (P = 0.03), temporally (P = 0.02), and with LON nasally (P = 0.005). IT was thicker in males when compared to females and variation of IT by refractive error was significant but not by age. The mean pupil diameter and anterior chamber depth decreased with age (P < 0.001). Anterior chamber width was not affected by age or illumination. Conclusion The baseline iris thickness in the Saudi eyes could be used to compare iris thickness in eyes with angle closure glaucoma among the Arab population.

Intraocular lens opacification after descemet stripping automated endothelial keratoplasty.

PURPOSE: Intraocular lens (IOL) opacification is a rare but serious complication that may necessitate its exchange. The use of intraocular gases is a known precipitant. Descemet stripping endothelial keratoplasty (DSAEK) involves injecting air into the anterior chamber. IOL opacification has been described after this procedure; however its incidence is currently unknown. METHODS: A retrospective review of case notes from a single center of all patients undergoing DSAEK, who were either already pseudophakic or had simultaneous cataract surgery. Cases with IOL opacification were analyzed, and any risk factors were identified. RESULTS: One hundred sixty-eight DSAEK were performed on 154 eyes of 137 patients. Fifty-four cases had simultaneous cataract surgery with implantation of an IOL. Fifteen (9.7%) eyes developed IOL opacification. This had a distinctive pattern, being limited to the anterior lens surface, in the pupillary zone. Median time interval from keratoplasty to the first observation of IOL opacification was 17 months (range, 4-34 months). The only statistically significant risk factor was rebubbling of detached endothelial grafts. Rebubbling was performed in 62.5% (10/15) of cases with IOL opacification, compared with 23% (32/139) with no opacification (P = 0.0009). CONCLUSIONS: This is the first study to report the incidence of IOL opacification after undergoing DSAEK. Although the mechanism is unknown, multiple injections of air into the anterior chamber statistically increase the risk of IOL opacification.

Randomized Controlled Study of Ocular Lubrication Versus Bandage Contact Lens in the Primary Treatment of Recurrent Corneal Erosion Syndrome.

PURPOSE: To investigate the efficacy of bandage contact lenses (BCLs) in comparison with that of ocular lubricants (OLs) in the initial management of recurrent corneal erosion syndrome. METHODS: A randomized controlled trial of 29 patients with recurrent corneal erosion syndrome presenting to the ophthalmology departments of the Oxford Eye Hospital and the Royal Berkshire Hospital, United Kingdom. The patients were randomized to wear either BCLs (for a 3-month duration, replaced every 30 days) or use OLs (4 times a day, with Lacri-Lube ointment at night for 3 months). The patients were assessed monthly for 4 months, and their symptoms were graded by visual analog scores. The main outcome measure was the complete resolution of symptoms with no noticeable corneal surface abnormality. Patients with a complete resolution were followed up for another 3 months to check for recurrence. RESULTS: Fourteen patients were randomized to the BCL arm, and 15 were randomized to the OL arm. After 3 months, a complete resolution was achieved in 71% of the patients (10/14) with BCLs compared with that achieved in 73% of the patients (11/15) on OLs (P > 0.05). Partial resolution was noted in 7% of the patients with BCLs versus 13% of the patients on OLs. Twenty-one percent of the patients in the BCL group and 13% of the patients in the OL group failed to respond to the treatment. Patients on BCLs had earlier resolution of symptoms, with a mean time of 5 weeks compared with 9 weeks for OLs (P = 0.02). None of the patients with BCLs developed adverse side effects. CONCLUSIONS: BCLs do not increase the likelihood of complete resolution when compared with OLs in the initial management of RCES. However, BCL treatment seems safe, and some patients experience earlier relief from symptoms.

Association between heat shock protein 70/Hom genetic polymorphisms and uveitis in patients with sarcoidosis.

PURPOSE: The predisposition to sarcoidosis, a systemic granulomatous disorder of unknown etiology, is genetically determined, and genetics appears also to drive the disease down distinct phenotypic pathways. This study was undertaken to test the hypothesis that sarcoidosis-related uveitis represents a genetically distinct disease subset, by investigating single nucleotide polymorphisms (SNPs) in the HSP-70/1 and HSP-70/Hom genes. HSP70 molecules play a key role in the immune response by functioning both as chaperones and as inducers of proinflammatory cytokine secretion. METHODS: By sequence-specific primers-polymerase chain reaction (SSP-PCR) five SNPs were evaluated in 270 white patients with sarcoidosis, including 88 with sarcoid-related uveitis, and in 347 matched control subjects. One hundred twenty-five patients with idiopathic anterior uveitis (IAU) and 56 with idiopathic intermediate uveitis (IIU) were also included in the study as disease control subjects. RESULTS: The HSP-70/Hom rs2075800 G allele frequency was higher in the sarcoid-uveitis group than in both the sarcoid-non-uveitis and control groups (83% vs. 71%, OR = 2.00, P(c) = 0.01; and 83% vs. 66%, OR = 2.45, P(c) = 0.00005, respectively). Similar results were observed when considering the carriage frequency of the associated haplotype (HSP-70 haplotype 2) across the three study groups (47% vs. 29%, OR = 2.17, P(c) = 0.03; and 47% vs. 21%, OR = 3.26, P(c) = 0.0003, respectively). In addition, the carriage frequency of the HSP-70 haplotype 2 discriminated among sarcoid-related uveitis, IAU, and IIU (47% vs. 19%, OR = 3.26, P(c) = 0.001; and 47% vs. 23%, OR = 2.81, P(c) = 0.04, respectively). CONCLUSIONS: A strong association was found between HSP-70/Hom rs2075800 G and uveitis in patients with sarcoidosis. Further studies are needed to understand the molecular mechanisms underlying this association.

Polymorphisms of chemokine and chemokine receptor genes in idiopathic immune-mediated posterior segment uveitis.

PURPOSE: Chemokines are important inflammatory mediators that play a crucial role in uveitis. Polymorphisms in chemokine genes can alter the expression of these genes in the inflammatory cells, which, in turn, can affect the clinical phenotype of the disease. The purpose of this study was to identify polymorphisms in chemokine genes that can predict visual outcome in patients with immune-mediated posterior segment uveitis. METHODS: This is a case-control study of 141 Caucasians with idiopathic immune-mediated posterior segment uveitis and 282 controls matched by age and ethnicity. Six polymorphisms in four genes, (MCP-1-2518A/G, RANTES-403G/A, RANTES-28C/G, CCR2 V64I, CCR5-59029G/A, and CCR5 32 bp deletion) were analyzed by sequence specific primers polymerase chain reaction. RESULTS: Patients with G allele at MCP-1-2581 developed the disease at an early age as compared to patients with A allele corrected p value pc=0.003. Also patients with A allele at RANTES-403 position developed less severe disease and had better visual outcome when compared with patients with G allele (pc=0.02) Final visual acuity after 18 months was better in patients with 32 bp deletion of the CCR5 gene and in patients with the CCR2 wild-type genotype pc=0.02 and pc=0.04, respectively. Patients with the CCR2 64I allele also had a higher risk of developing an elevated intraocular pressure as compared to patients with the wild-type genotype (pc=0.007). CONCLUSIONS: Though the utility for prediction of disease susceptibility of the studied polymorphisms in chemokine genes is in general not robust, we have found that polymorphisms in chemokine genes can influence the outcome of patients with idiopathic immune-mediated posterior segment uveitis. These associations require further analysis in other groups of patients.

Chemokine gene polymorphisms in idiopathic anterior uveitis.

OBJECTIVES: The aim of this study was to determine whether there are any associations between single nucleotide polymorphisms of the chemokine genes IL-8, MCP-1, their corresponding receptors CXCR1 and CCR2 and disease outcome in patients with acute idiopathic anterior uveitis. METHODS: 60 Caucasian patients with idiopathic acute recurrent anterior uveitis together with 120 healthy Caucasian control subjects were tested for the presence of 16 bi-allelic polymorphisms and HLA-B27 using polymerase chain reaction in association with sequence-specific primers with mismatches at the 3' end. The genetic data was then compared between patients and controls, and within the patient group itself for association with clinical disease outcome. RESULTS: As expected, the frequency of HLA-B27 was significantly higher in the patient group than the control group (63.33% versus 15.83%; Pearson's P<0.0001, Fisher's P<0.0001). In addition, the frequency of the T allele of MCP-1 63555 was found to be significantly higher in the control group when compared to the patient group (P=0.0160). CONCLUSION: This study describes an association between acute anterior uveitis and MCP-1 63555 polymorphisms where the T allele may be a protective marker against the disease.

Increased ocular pulse amplitude revealing aortic regurgitation.

PURPOSE: To report a case in which observation of increased ocular pulse amplitude (OPA) estimates in both eyes lead to a diagnosis of, and was presumably due to, aortic regurgitation. DESIGN: Case report. METHODS: An incidental finding of high OPA estimates in both eyes lead to a finding of widened arterial pulse pressure and aortic regurgitation. OPA estimates were taken after aortic valve surgery when arterial pulse pressure was normal. RESULTS: OPA estimates were 9 mm Hg in both eyes when arterial pulse pressure was high and 3 mm Hg in each eye when normal. CONCLUSION: Widened arterial pulse pressure may lead to increased OPA.