Morphologically aggressive appearance of a human papilloma virus (HPV)-related conjunctival papilloma that was clinically suspicious for malignancy - A case report.

INTRODUCTION AND IMPORTANCE: Conjunctival squamous papilloma is a benign tumor that might be linked to Human papillomavirus (HPV) infection. The most common appearance is a pedunculated fleshy mass. We are reporting a unique of HPV-related conjunctival papilloma that was excised with the suspicious of malignancy. CASE PRESENTATION: A 35-year-old Saudi male who has been investigated for a suspicious pancreatic lesion and presented with a concurrent right eye conjunctival yellowish cystic mass. The mass was excised for diagnostic purpose to rule out malignancy in view of the history, the clinical appearance of the lesion, and the adjacent conjunctival severe congestion. The histopathological examination concluded a viral-related conjunctival papilloma. There was no evidence of recurrence of the lesion 2 years postoperatively. CLINICAL DISCUSSION: The common clinical appearance of a benign conjunctival papilloma is usually described as fleshy pedunculated mass with irregular grayish red surface. Such a lesion might be related to several etiologies, one of which is HPV. The mass in our case was highly vascularized and cystic with yellowish areas, which raised the suspicion of a malignant lesion. The histopathological findings, however, confirmed the benign nature of the lesion and supported the viral etiology by HPV. CONCLUSION: HPV-related conjunctival papilloma may have various morphological appearances. Histopathological examination is the key for final diagnosis of such types of lesions.

Successful management of a retained host Descemet's membrane after penetrating keratoplasty (PKP) - A case report.

INTRODUCTION AND IMPORTANCE: To report the 21st case showing the rare occurrence of retained Descemet's membrane (DM) following penetrating keratoplasty (PKP). We intend to investigate possible etiologies, expected sequelae, and outcome of neodymium-dpoed yttrium alumnium garnet (Nd: YAG) laser membranectomy. CASE PRESENTATION: Our case is a 74-year-old male who underwent PKP surgery in the right eye secondary to corneal decompensation following cataract surgery in addition to corneal thinning secondary to superficial keratectomy related to the pre-existing climatic droplet keratopathy (CDK). Postoperative assessment revealed a retro-corneal membrane within the anterior chamber, which was affecting his vision. CLINICAL DISCUSSION: Based on the post-operative course and the decreased vision as an indication for intervention, it was decided to excise the retained DM. Membranectomy with Nd: YAG laser was performed, and the patient's visual acuity measurement improved from 20/400 to 20/25. However, the endothelial cell count decreased from 1479 to 520 cells/mm2 (35 % loss) at 15 months post YAG membranectomy with clear graft. Histopathological examination confirmed the clinical suspicion of a retained DM, since it was absent in the submitted host corneal tissue in addition to the pre-existing CDK. CONCLUSION: Retention of DM following PKP is a rare but possible complication and high index of suspicion is required for proper diagnosis and management to obtain better visual outcome. Nd: YAG laser membranectomy was effective in excising the retained DM and improving vision. Endothelial cell loss following Nd: YAG laser membranectomy as a complication was observed and should be addressed during the treatment plan.

Preoperative universal screening of coronavirus disease 2019 during Omicron outbreak in patients undergoing ophthalmic surgeries: Experience from a tertiary eye care center in Saudi Arabia.

PURPOSE: This study aims to determine the frequency of coronavirus disease 2019 (COVID-19) during Omicron outbreak among patients scheduled for elective and emergency ophthalmic surgeries in a tertiary eye care center in Saudi Arabia. METHODS: This observational retrospective study was performed between December 1, 2021, and February 28, 2022, in a single tertiary eye care center in Riyadh, Saudi Arabia. All patients who were given appointments for elective or emergency surgeries were included. All patients underwent preoperative nasopharyngeal and oropharyngeal reverse transcription-polymerase chain reaction testing for the severe acute respiratory syndrome coronavirus 2. A retrospective chart review of all patients who tested positive for COVID-19 during Omicron outbreak was performed for the demographic and clinical information, presence of symptoms upon presentation, nature and urgency of the scheduled surgical intervention, and the overall outcomes. RESULTS: A total of 851 patients were scheduled for elective and emergency ophthalmic surgeries during the study period. The mean age of all patients was 58.2 years; 451 were males (52.9%) and 400 were females (47%). Of 851 patients tested for the COVID-19 during Omicron outbreak, the test was positive in 65 (7.6%) patients. All patients who tested positive for the COVID-19 during Omicron outbreak were asymptomatic at the time of swabbing. No patient-related perioperative complications or health-care workers' affection secondary to exposure to positive cases was documented. CONCLUSION: The study showed that almost 1 in 13 patients scheduled for elective or emergency ophthalmic surgeries may test positive for the COVID-19 during Omicron outbreak. All positive cases were asymptomatic at the time of swabbing, highlighting the importance of routine preoperative screening for COVID-19.

Three-year clinical outcomes of phacoemulsification combined with excisional goniotomy using the kahook dual blade for cataract and open-angle glaucoma in Saudi Arabia.

PURPOSE: The aim of this study was to describe the changes in intraocular pressure (IOP), IOP-reducing drugs, and visual acuity (VA) through up to 3 years of follow-up in patients undergoing combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade (KDB-phaco) by a single surgeon in Saudi Arabia. METHODS: The health records of 55 eyes of 47 patients undergoing KDB-phaco by a single surgeon were reviewed. Data were extracted from visits occurring preoperatively (n = 55), intraoperatively (n = 55), and 1-day (n = 55), 2 weeks (n = 55), 4-6 weeks (n = 49), 2-3 months (n = 55), and 6 (n = 55), 9 (n = 55), 12 (n = 55), 18 (n = 49), 24 (n = 46), and 36 months (n = 16) postoperatively. Data collection included IOP, IOP-lowering medications, and VA at each time point. Adverse events were also collected. Paired t-tests were used to compare IOP, medications, and VA at each time point to preoperative values. RESULTS: Mean (standard error) baseline IOP was 20.4 (0.7) mmHg and through up to 36 months of follow-up (minimum 12 months, mean 26.1 [1.0] months) ranged from 13.6 to 14.1 mmHg; significant reductions (P < 0.0007) of 5.7-7.0 mmHg (23.0%-29.5%) were achieved at every time point. Medications were reduced from 3.2 (0.1) to 0.2-2.0 (reductions of 1.2-3.1 medications [50.0%-94.9%]; P < 0.0001 at every time point). At months 24 and 36, the mean IOP was 13.9 (0.3) and 13.9 (0.5) mmHg and mean medications were 1.4 (0.2) and 2.0 (0.4). Mean logMAR VA improved from 1.0 (0.1) preoperatively to (0.2 [0.0]; P < 0.001) by month 6 and remained stable thereafter through the duration of follow-up. CONCLUSION: KDB-phaco significantly lowered IOP approximately 30% by day 1 with consistency and durability through 3 years. Medication use was reduced by >50% through 36 months. Mean logMAR VA improved from 1.0 to 0.2 (Snellen equivalent 20/200-20/32). This procedure provides meaningful long-term reductions in IOP and the need for IOP-lowering medications without compromising visual rehabilitation in Saudi Arabian eyes with cataract and glaucoma.

Long term outcome of combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade in different subtypes of glaucoma.

To characterize changes in intraocular pressure (IOP) and IOP-lowering medications through up to 2 years of follow-up in patients undergoing combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade (phaco-KDB), with simultaneous goniosynechialysis in cases of angle-closure glaucoma. Prospective, non-comparative, interventional case series. Consecutive patients with medically-treated glaucoma and visually-significant cataract underwent combined surgery. Analysis was conducted on open-angle (OAG) and angle-closure (ACG) glaucoma groups separately. Thirty-seven patients with OAG (24 with primary OAG and 13 with pseudoexfoliation glaucoma) and 11 with ACG were enrolled. In OAG eyes, mean (standard error) baseline IOP was 21.1 (0.9) mmHg and through 24 months of follow-up was reduced by 6.4-7.7 mmHg (24.6-32.1%; p ≤ 0.0001 at all time points). In ACG eyes, mean baseline IOP was 20.8 (1.6) mmHg and was reduced by 6.1-8.77 mmHg (23.4-39.0%; p ≤ 0.0353). Mean medications were reduced by 61.9-89.1% (p ≤ 0.0001) in OAG eyes and by 56.3-87.3% (p ≤ 0.0004) in ACG eyes. Phaco-KDB significantly lowered IOP ~ 30% and medications by > 50% through 24 months. This combined procedure provides meaningful long-term reductions in IOP and need for IOP-lowering medication and does not adversely affect visual rehabilitation in eyes with cataract and glaucoma.

A novel variant of autosomal recessive best vitelliform macular dystrophy and management of early-onset complications.

To report an adult with autosomal recessive Best vitelliform macular dystrophy with a new homozygous BEST1 mutation, the management of a cystoid macular edema with intravitreal aflibercept in the proband, and the findings in the parents, carriers of heterozygous BEST1 mutations. A 28-year-old female presented with blurry andreduced vision in her both eyes with bilateral vitelliform macular lesions. The patient's parents were also examined. Examinations included electrooculogram (EOGs), imaging studies, and BEST1 gene testing. Interventions included treatment with intravitreal aflibercept for both eyes. The patient presented with visual acuity of 20/20 OD 20/30 OS, RPE changes, multifocal subretinal yellowish deposits resembling vitelliform deposits and subretinal fluids. Cystoid macular edema developed after one month, causing vision reduction (20/28 OD 20/30 OS). Visual acuity recovered to 20/20 OU after serial intravitreal aflibercept injections. The proband showed subnormal EOG Arden ratios. Molecular testing showed the homozygous missense variant c.695T>G p. (IIe232Ser) In exon 6 of the BEST1 mutations and to the best of our knowledge, this variant, which was confirmed by conventional Sanger sequencing, has neither been annotated in databases nor been described in the literature so for (Human Genome Molecular Database 2018.1). In the heterozygous parents, EOGs were subnormal, and minimal autofluorescence changes were seen. Clinical Relevance: Prompt recognition and treatment of cystoid macular edema management effectively restore vision. Awareness and recognition of recessive inheritance permit correct diagnosis and counseling.

Surgical removal of inadvertent intralenticular sustained-release dexamethasone implant (ozurdex) and implant one-piece posterior capsule intraocular lens.

To report the therapeutic efficacy and results of an accidentally injected intralenticular sustained-release dexamethasone implant (Ozurdex) in a patient with macular edema secondary to diabetic macular edema. Dexamethasone intravitreal implant is an approved formulation in the management of macular edema. The most common adversarial effects are an elevation of intraocular pressure (IOP) and cataract, but the unintentional injection of the dexamethasone implant into the lens is a particularly rare event.We report a case of a 72-year-old man treated for resistant Diabetic macular edema (DME) with dexamethasone intravitreal implant (Ozurdex, Allergan, Inc., Irvine, CA, USA) in which the technique was complicated by accidental implantation into the lens body and review the management. The patient underwent phacoemulsification of the lens, removal of the Ozurdex, intravitreal Avastin injection, and implant of a one-piece lens in the posterior capsule.