Manifestations of ocular rosacea in females with dark skin types.

BACKGROUND: Current knowledge about ocular rosacea in dark skin individuals is lacking. The prevalence of ocular rosacea varies considerably among studies and is probably higher than previously presumed. OBJECTIVE: To estimate the prevalence and pattern of ocular rosacea among dark skinned female patients, compare it with fair skinned, and to correlate the severity of cutaneous disease with ocular findings. METHOD: Female patients diagnosed with rosacea between 2011 and 2013 were studied prospectively. They were referred to ophthalmology for clinical observations and slit lamp examination. In all patients Schirmer and Tear break up time tests to diagnose dry eye were performed. RESULT: Fifty six consecutive female patients, joined the study with different skin types ranging from skin type 4 to 6. A total of 43 patients (76.8%) were positive for ophthalmologic findings. The most frequent symptoms were itching, burning sensation and redness, while the most frequent signs were meibomian gland dysfunction, dry eyes, eyelid telangiectasia and irregular margin. Significant correlation was noted between meibomian gland dysfunction and irregular lid margin (P = 0.003). Dry eye and Schirmer test significantly correlated with eye lid telangiectasia (p = 0.004; 0.015) respectively. No significant correlation was found between the severity of cutaneous disease and ocular findings. CONCLUSION: Ocular rosacea in dark skinned females is a common presentation and is comparable to that reported for fair skin, with eyelid telangiectasia and meibomian gland dysfunction being early phenomena. Earlier onset and more benign course were seen compared to other studies. Ocular and cutaneous rosacea are independent of each other.

Bacterial Profile and Antibiotic Susceptibility Pattern of Bacterial Keratitis at a Tertiary Hospital in Riyadh.

BACKGROUND: The most common cause of ocular infections worldwide is bacteria; therefore, bacterial keratitis requires rapid and proper intervention because it is a major cause of loss of vision and ocular morbidity. Resistance studies have found increases in the resistance to ciprofloxacin, cefazolin, and gentamicin in bacterial keratitis cases that are caused by gram-positive organisms. AIM: To identify the common predisposing factors, causative organisms, and antibiotic profile of bacterial keratitis (BK) in a tertiary care hospital in Riyadh, Saudi Arabia. METHOD: This is a retrospective study of the microbiological record of all patients diagnosed with BK at KAUH. From the first of May 2015 until the first of January 2018. Demographic data, diabetes mellitus, contact lens use, history of eye trauma, ocular surface disorders, recent ocular surgeries, current and recent medications, initial and final visual acuity, and location and size of the infiltrate were all used in the study. VA was converted to the logarithm of the minimum angle of resolution (LogMAR) for statistical analysis. RESULTS: 177 cases positive for BK were included. 100 (56.5%) were males, and 77 (43.5%) were females. The mean age was 43.15. Trauma was the most common predisposing factor, which was observed in 68 (38.4%) cases, followed by Ocular surface disease [52 (29.4%)]. Staphylococcus epidermidis was the most commonly isolated organism [61 (34.5%)], followed by Streptococcus pneumoniae [23 (13%)], and Staphylococcus aureus [18 (10.2%)]. All gram-positive cases were Vancomycin sensitive. Staphylococcus epidermidis showed only 4 resistant cases to chloramphenicol (7.27%), and resistance to penicillin and ampicillin was found in 55 (90%) and 53 (89.83%) cases, respectively. All Streptococcus pneumoniae cases were resistant to gentamicin (100%). Staphylococcus aureus showed high sensitivity for erythromycin [18 (100%)]. CONCLUSION: The most common cause of bacterial keratitis was Staphylococcus epidermidis (N=61), followed by Streptococcus pneumoniae (N=23). Trauma was the most common predisposing factor (38.4%), while contact lens use was only identified in 14 cases (7.9%). All organisms tested were sensitive to vancomycin, and there was high resistance toward penicillin (90%).

Glaucoma After Open-globe Injury at a Tertiary Care University Hospital: Cumulative Causes and Management.

PURPOSE: To investigate causes and treatment modalities of traumatic glaucoma after open-globe injury (OGI). MATERIALS AND METHODS: The medical records of all patients with postrepair follow-up of OGI at a tertiary care university hospital from January 1996 to December 2010 were reviewed. These patients had persistent elevated intraocular pressure (IOP) of >21 mm Hg at 2 consecutive visits, with or without optic disc damages. RESULTS: Over the 14-year study period, 41 eyes of 41 patients with repaired OGI that developed glaucoma were identified. In the early stage (within 1 mo), high IOP levels occurred owing to the presence of unremoved lens particles in 11 patients (26.8%), inflammation in 6 patients (14.6%), and hyphema in 3 patients (7.3%). In the intermediate stage (2 to 6 mo), the IOP increased owing to the presence of synechial angle closure in 9 patients (21.9%) and ghost cells in 3 patients (7.3%). In the late stage (>6 mo), the IOP rose owing to the presence of unremoved lens particles in 2 patients (4.8%), angle recession in 4 patients (9.7%), and synechial angle closure in 3 patients (7.3%). Surgical interventions included trabeculectomy in 9 eyes (22%), lens aspiration in 9 eyes (22%), cyclophotocoagulation (CPC) in 5 eyes (12.2%), anterior chamber washout in 3 eyes (7.3%), and tube surgery in 2 eyes (4.9%). CONCLUSIONS: Traumatic glaucoma is not uncommon long-term complication after OGI. It is important to inspect the association between the initial cause and achieving a successful treatment. Surgical intervention may be crucial in the majority of cases.

Glaucoma after open globe injury at a tertiary care university hospital in Central Saudi Arabia. Cumulative incidence and risk factors.

OBJECTIVE: To investigate the incidence and risk factors of glaucoma after open globe injury (OGI). METHODS: The medical records of all patients admitted with the diagnosis of OGI at the Department of Ophthalmology, King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia and had undergone primary repair from January 1996 to December 2011 were retrospectively reviewed. RESULTS: For the 15-year study period, 775 patients who underwent repair of an OGI were identified. The overall risk of post-traumatic glaucoma was 5.3% (41/775) with a mean +/- SD follow-up period of 12+/-6.5 months. Univariate analysis revealed that Zone II injury (p=0.027), penetrating ocular injury (p=0.0008), lens injury (p=0.011), vitreous hemorrhage (p=0.002), and presence of intraocular foreign body (p<0.0001) were significantly associated with glaucoma. Age of more than 18 years was critical (p=0.054). Following logistic regression, penetrating ocular injury (p=0.019), lens injury (p=0.002), and vitreous hemorrhage were significant (p=0.037). CONCLUSION: Glaucoma after OGI is not uncommon. Zone II injury, penetrating ocular injury, lens injury, presence of vitreous hemorrhage, and presence of an intraocular foreign body were significant risk factors for developing post-traumatic glaucoma.

Self-repositioned intraocular lens in a vitrectomized eye.

A 40-year-old man had phacoemulsification through microincisions with placement of a foldable single-piece acrylic intraocular lens (IOL) (Acri. Smart 48S, Acri.Tech) in a previously vitrectomized eye, and the IOL sank into the vitreous space through a capsule tear. The patient remained aphakic postoperatively, with the IOL moving around due to gravity. He had frequent follow-up visits for close observation. During evaluation 4 months after surgery, the vision was better and examination revealed that the IOL had returned to the front of the capsule.

A study of bacterial isolates from corneal specimens and their antibiotic resistance profile.

OBJECTIVE: We aim to examine the spectrum of bacteria causing corneal infections and their antibiotic susceptibility patterns. This will serve as a guideline for empiric therapy of corneal infections. METHODS: We conducted the study over a period of 18 months from March 2001 through December 2002 in King Abdul-Aziz University Hospital, Riyadh, Kingdom of Saudi Arabia. Corneal specimens taken from 200 patients were inoculated directly onto different types of media. The isolates were identified and then tested against the appropriate topical or systemic antibiotics. RESULTS: Sixty-seven (33.5%) of the total specimens were culture positive and 133 (66.5%) were culture negative. Fourteen (7%) of these showed organisms in the Gram stained smears and correlated well with the culture reports. Of the 67 positive cultures, 53 (79.1%) were Gram-positive bacteria mostly coagulase-negative Staphylococci 29 (43.3%) followed by Streptococcus pneumoniae (S. pneumoniae) 13 (19.4%). Among Gram-negative bacteria 14 (20.9%), Pseudomonas aeruginosa (P. aeruginosa) 10 (14.9%) was the predominant isolate. All the isolates were sensitive to ofloxacin and the commonly used ocular antibiotics. CONCLUSION: All the isolated bacteria were sensitive to ofloxacin, a fluoroquinolone. Having marked potency for broad-spectrum activity against both Gram-positive and Gram-negative bacteria, make the fluoroquinolones especially the newer generations, a potential single drug therapy for corneal infections.