Sequential argon-YAG laser membranotomy of extensive persistent pupillary membrane with visual loss.

A 20-year-old woman, a registered nurse, presented with best-corrected visual acuity of 6/15 (20/50) due to bilateral extensive persistent pupillary membrane. Sequential argon laser photocoagulation of the iris strands at the pupillary membrane iris collarette followed by neodymium:YAG laser lysis resulted in partial clearing of the central visual axis without bleeding. Best-corrected visual acuity improved to 6/9 (20/30) bilaterally without complications noted 1 year after combined laser therapy.

The effects of intravitreal bevacizumab in infectious and noninfectious uveitic macular edema.

Background/Aims. To assess the effect of intravitreal bevacizumab injection (IVBI) for the treatment of macular edema due to infectious and noninfectious uveitides. Design. Retrospective interventional case series. Methods. A chart review was performed on all the patients who were diagnosed with uveitic macular edema (UME) and received 1.25 mg of IVBI at two referral centers in Riyadh, Saudi Arabia. All included patients had their visual acuity and macular thickness analyzed at baseline and at 1 and 3 months following IVBI and any sign of reactivation was noted. Results. The mean age of patients was 41 ± 16 years with a mean followup of 4 ± 1 months. Ten patients had idiopathic intermediate uveitis, 9 patients had Behcet's disease, 10 had idiopathic panuveitis, and twelve patients had presumed ocular tuberculosis uveitis. Following IVBI, the mean LogMAR visual acuity improved from 0.8 ± 0.8 at baseline to 0.4 ± 0.5 at 1 month and 0.3 ± 0.5 at 3 months (P < 0.002, at 3 months). The mean macular thickness was 430 ± 132 µm at baseline. Following IVBI macular thickness improved to 286 ± 93 µm at 1 month and to 265 ± 88 µm at 3 months of followup (P < 0.001, at 3 months). Conclusion. Bevacizumab was effective in the management of UME associated with both infectious and noninfectious uveitides. Intravitreal bevacizumab induced remission of UME with infectious uveitis and had no immunosuppressive effect against infectious agents.

The association of systemic disorders with Vogt-Koyanagi-Harada and sympathetic ophthalmia.

BACKGROUND: The aim of this work is to determine the systemic diseases and malignancy associated with Vogt-Koyanagi-Harada (VKH) disease compared to sympathetic ophthalmia (SO). METHODS: We conducted a retrospective comparative observational clinical study where the medical records of patients with the diagnosis of VKH and SO from 1999-2009 were reviewed. The study was carried out at the King Khaled Eye Specialist Hospital and The Eye Center in Riyadh, Saudi Arabia. Investigators recorded the age, gender, history of trauma, associated systemic disorders, and ocular and systemic manifestations. Patients were examined by an ophthalmologist as well as an internist. RESULTS: A total of 316 patients were included: 256 patients had VKH and 60 patients had SO. The age range in the VKH group was 3-62 years with a mean age of 29 ± 13 years. The age range in the SO group was 4-90 years with a mean age of 36 ± 20 years. The mean follow-up period of patients with VKH was 58 ± 50 months and patients with SO was 61 ± 54 months. Out of 256 patients with VKH, there were 41 (16%) with systemic disorders. Comparatively, out of 60 patients with SO, no associated systemic autoimmune disorders or tumors were encountered. The difference between the VKH and SO groups was statistically significant (p = 0.003). CONCLUSIONS: VKH and SO are autoimmune disorders targeting melanin-bearing cells. Both diseases are characterized by immunologic dysregulation. We found a statistically significant association of systemic disorders and malignancy with VKH compared to SO. This finding may suggest that the two disorders may have different etiology with similar ocular and systemic manifestations.

Late onset corneal ectasia after LASIK surgery.

PURPOSE: To report late onset corneal ectasia following myopic LASIK. METHODS: A retrospective cohort case series. Nineteen patients with late onset corneal ectasia following LASIK procedure were examined at The Eye Center, Riyadh, Saudi Arabia. Patients underwent LASIK for myopia with spherical equivalent ranging from -1.4 to -13.75 diopters. Age and gender, history of systemic or local diseases, and time of onset of corneal ectasia were recorded. Eye examination and corneal topographical analyses were done before and after LASIK surgery. RESULTS: Nineteen patients (29 eyes) with late onset corneal ectasia were identified from 1998 to 2008 in 13 male and six female patients. The mean follow-up period was 108 ± 23 months (range 72-144 months). No patient had pre-operative identifiable risk factors for corneal ectasia and the mean time of onset was 57 ± 24 months (range 24-120 months after LASIK). The pre-operative values included mean central pachymetry 553 ± 25 µm, mean keratometry reading of 42.9 ± 1.5 diopters, average oblique cylinder of 1.4 ± 1.2 diopters, posterior surface elevation of 26 ± 2.1 diopters, corneal flap thickness of 160 µm, mean spherical equivalent of -5.6 ± 3.6 diopters, and calculated residual corneal stromal bed thickness was 288 ± 35 µm. Three (5 eyes) patients developed ectasia after pregnancy. Three (4 eyes) patients developed corneal ectasia following severe adenoviral keratoconjunctivitis and had positive PCR for adenovirus type 8. CONCLUSIONS: Corneal ectasia may develop many years after LASIK surgery and symptoms could go undetected for some time. Pregnancy and adenoviral keratoconjunctivitis occurred post-operatively in six patients.

Complications of presumed ocular tuberculosis.

PURPOSE: To determine the effect of steroid treatment on visual outcome and ocular complications in patients with presumed ocular tuberculosis. METHODS: Retrospective review of patients with presumptive ocular tuberculosis. The clinical diagnosis was made based on ocular findings, positive purified protein derivative (PPD) testing of more than 15 mm induration, exclusion of other causes of uveitis and positive ocular response to anti-tuberculous therapy (ATT) within 4 weeks. Group 1 included patients who had received oral prednisone or subtenon injection of triamcinolone acetonide prior to ATT. Group 2 included patients who did not receive corticosteroid therapy prior to administration of ATT. RESULTS: Among 500 consecutive new cases of uveitis encountered in 1997-2007 there were 49 (10%) patients with presumed ocular tuberculosis. These comprised 28 (57%) male and 21 (43%) female patients with a mean age of 45 years (range 12-76 years). Four (20%) patients in group 1 had initial visual acuity of 20/40 or better, in comparison to eight (28%) patients in group 2. At 1-year follow-up, six (30%) patients in group 1 had a visual acuity of 20/40 or better compared with 20 (69%) patients in group 2 (p = 0.007). Of 20 eyes (26%) in group 1 that had visual acuity of < 20/50 at 1-year follow up, 14 (70%) eyes developed severe chorioretinal lesion (p = 0.019). CONCLUSION: Early administration of corticosteroids without anti-tuberculous therapy in presumed ocular tuberculosis may lead to poor visual outcome compared with patients who did not receive corticosteroids prior to presentation. Furthermore, the severity of chorioretinitis lesion in the group of patients given corticosteroid prior to ATT may account for the poor visual outcome.

Causes of uveitis at a referral center in Saudi Arabia.

PURPOSE: The main purpose of this study was to determine the causes of uveitis at the Eye Center in Saudi Arabia. METHODS: A retrospective review. The causes of uveitis were analyzed according to various patient characteristics. RESULTS: A total of 488 cases were encountered. The age range was 3 to 99 years (mean age: 38 years). The most common causes of uveitis included anterior uveitis 60%, panuveitis 24%, posterior uveitis 11%, and intermediate uveitis 6%. CONCLUSIONS: The authors found a high prevalence of acute anterior nongranulomatous uveitis. The most commonly encountered infectious uveitis included herpes virus, tuberculosis, and toxoplasmosis.

Bilateral lower eyelid margin erosion associated with lichen planus.

A 32-year-old woman presented with bilateral lower eyelid margin erosion and erythema of several years' duration. She reported no improvement with the use of topical corticosteroid therapy. A full-thickness excisional biopsy was performed, and the histopathology of the specimens was consistent with lichen planus.