Patterns of Uveitis in a Tertiary Care Referral Institute in Saudi Arabia.

PURPOSE: To present the pattern, causes and complications of uveitis in one of the tertiary eye centers in Saudi Arabia. METHODS: In this retrospective study, clinical records of randomly selected cases of uveitis attending the King Khaled Eye Specialist Hospital, Saudi Arabia, from 2001 to 2010, were reviewed. RESULTS: Our series included 888 out of 1286 cases of uveitis. Among them, there were 390 men (43.9%) with a mean age of 39.6 ± 11 (range: 6-94 years). The prevalence of uveitis among all eye patients was 1.5% and the annual incidence was 129 cases. Uveitis was bilateral in 567 patients (63.8%), mainly anterior in 27.3%, intermediate in 12.7%, posterior in 7.1%, while 52.9% were panuveitis. Infective etiology was seen in 180 patients (20.3%), of which presumed tuberculous uveitis (PTU) was the commonest cause in 94 patients (52%), followed by herpetic in 46 (26%) and toxoplasmosis in 29 (16%). Vogt-Koyanagi-Harada (VKH) 22%, Behçet uveitis (BU) 14.6%, idiopathic anterior uveitis 12.5%, presumed tuberculous uveitis (PTU) 10.6%, and idiopathic intermediate uveitis (10.1%) accounted for the majority of cases, whereas other diagnostic entities accounted for 30%. The most common cause of anterior uveitis was idiopathic uveitis (101; 41.7%), followed by herpetic (46; 19%). Toxoplasmosis was the most frequent cause of posterior uveitis (29; 46.3%). Intermediate uveitis was most commonly idiopathic (86; 76.1%). VKH disease was the most common cause of panuveitis (195; 41.5%), followed by Behçet disease (118; 25.1%). The common complications of uveitis were glaucoma (34.1%), posterior synechiae (22.3%) and cataract (15.1%). CONCLUSIONS: The most common anatomic diagnosis was panuveitis. VKH disease and Behçet disease were the most frequent causes and glaucoma was the most common complication of uveitis.

Spectral-domain optical coherence tomography findings in polypoidal choroidal vasculopathy suggest a type 1 neovascular growth pattern.

PURPOSE: To report spectral-domain optical coherence tomography (SD-OCT) findings in polypoidal choroidal vasculopathy (PCV). PATIENTS AND METHODS: Seventeen eyes of 15 consecutive patients diagnosed with PCV based on typical clinical and angiographic findings were imaged with macular SD-OCT including line scans passing through the polyps. RESULTS: SD-OCT findings included typical and atypical retinal pigment epithelial (RPE) detachments and subretinal and intraretinal fluid in all eyes. In the areas corresponding to the polypoidal lesions, well-delineated round-oval, sub-RPE cavities were present and were adherent to the posterior surface of the detached RPE above Bruch membrane. No retinal or choroidal connections to the cavities were noted. CONCLUSION: These SD-OCT findings document that the vascular lesions in PCV are not located in the inner choroid, but in the sub-RPE space, suggesting that PCV is a variant of type 1 choroidal neovascularization rather than a distinct clinical entity as initially thought.

Idiopathic juxtafoveolar retinal telangiectasis: a current review.

Idiopathic juxtafoveolar retinal telangiectasis (IJFT), also known as parafoveal telangiectasis or idiopathic macular telangiectasia, refers to a heterogeneous group of well-recognized clinical entities characterized by telangiectatic alterations of the juxtafoveolar capillary network of one or both eyes, but which differ in appearance, presumed pathogenesis, and management strategies. Classically, three groups of IJFT are identified. Group I is unilateral easily visible telangiectasis occurring predominantly in males, and causing visual loss as a result of macular edema. Group II, the most common, is bilateral occurring in both middle-aged men and women, and presenting with telangiectasis that is more difficult to detect on biomicroscopy, but with characteristic and diagnostic angiographic and optical coherence tomography features. Vision loss is due to retinal atrophy, not exudation, and subretinal neovascularization is common. Group III is very rare characterized predominantly by progressive obliteration of the perifoveal capillary network, occurring usually in association with a medical or neurologic disease. This paper presents a current review of juxtafoveolar retinal telangiectasis, reviewing the classification of these entities and focusing primarily on the two most common types encountered in clinical practice, i.e., groups I and II, describing their clinical features, histopathology, natural history, complications, latest results from imaging modalities and functional studies, differential diagnosis, and treatment modalities.

Neovascular glaucoma at king khaled eye specialist hospital - etiologic considerations.

BACKGROUND: Neovascular glaucoma (NVG) is a severe form of secondary glaucoma caused by the growth of new vessels over the trabecular meshwork. The principal causes are associated with retinal ischemia. Ablative treatment of the retina can prevent, halt, and even reverse the growth of new vessels on the iris and angle. It is an essential part of the management in most cases. AIMS: To determine the causes of NVG among Saudi patients, presented at the King Khaled Eye Specialist Hospital. METHODS: A retrospective review of 337 Saudi patients with NVG was obtained. All cases were reviewed for the evidence and causes of the disease, and their basic demographic information. A subset of 100 diabetic patients with PDR was further studied in greater detail for clinical findings and treatment history. RESULTS: The most common primary etiologic associations for NVG included diabetic retinopathy (DR) (56.06%), retinal venous obstruction (26.40%), and chronic retinal detachment (03.56%). A history of diabetes mellitus was reported in 65.04%, systemic arterial hypertension was noted in 61.00%, and evidence of renal impairment was documented in 22.00%. Vision was markedly reduced in most eyes with NVG (median: hand motion). The median best visual acuity in the fellow eye was 20/160. Among the 100 cases, with DR as a cause of NVG, 43 patients had bilateral neovascularization of the iris (NVI) and 72 had bilateral PDR. Sixty-one patients had no previous laser treatment before the diagnosis of NVG. Among these, who received treatment, the median number of total laser spots was 1,003. CONCLUSIONS: Diabetes is a major cause of NVG presented to this tertiary eye care center in the Kingdom of Saudi Arabia followed by retinal venous obstruction. Close monitoring and full pan-retinal photocoagulation (PRP) were absent in most of the diabetic cases. It is important to recognize that the "unaffected" fellow eye, particularly in diabetic patients, may require fairly urgent treatment as well.