CLINICAL CHARACTERISTICS AND TREATMENT OUTCOMES OF COATS DISEASE IN A SAUDI ARABIAN POPULATION.

PURPOSE: To present the clinical aspects and treatment outcomes of Coats disease in Saudi Arabia. METHODS: A retrospective chart review was performed of 92 patients (97 eyes) diagnosed with Coats disease at King Khalid Eye Specialist Hospital from 1983 to 2010. RESULTS: The most common presenting complaint was decreased visual acuity followed by strabismus and then leukocoria. Snellen visual acuity was 20/20 to 20/50 in 9 eyes (9%), 20/50 to 20/160 in 11 eyes (11%), 20/200-counting fingers in 29 eyes (30%), and hand motion to no light perception in 24 eyes (25%). Telangiectasia was located in the preequatorial area in 71 eyes (73%) and most commonly involved the temporal retina in 67 eyes (69%). In eyes with clear view to the fundus, quadrant involvement by telangiectasia had the following distribution: 1) quadrant (n = 36, 37%); 2) quadrants (n = 26, 27%); 3) quadrants (n = 8, 8%); and 4 quadrants (n = 15, 15%). Total retinal detachment was present at presentation in 28 eyes (29%) and neovascular glaucoma in 8 (8%). Based on the Shields classification, the eyes were Stage 1 (n = 1, 1%), Stage 2A (n = 7, 7%), Stage 2B (n = 23, 24%), Stage 3A1 (n = 26, 27%), Stage 3A2 (n = 12, 12%), Stage 3B (n = 16, 17%), Stage 4 (n = 11, 11%), and Stage 5 (n = 5, 1%). Stage 3A was the most commonly presented stage (39%). Primary management included cryotherapy (19%), laser photocoagulation (64%), intravitreal agents (9%), and surgical drainage (4%). Combination treatment was performed in 29% of eyes. Thirteen eyes (13%) were enucleated because of clinical suspicion of retinoblastoma or the presence of glaucoma. Factors that were associated with a poor visual outcome of 20/200 or worse included age less than 10 years (relative risk: 1.27), Stages 3 and 4 disease (relative risk: 1.40), presence of subretinal fluid in all 4 quadrants including the fovea (relative risk: 14.25), and initial visual acuity of 20/200 (relative risk: 6.72) or worse (P < 0.005 for all factors). CONCLUSION: Although rare, Coats disease is usually advanced at presentation and has a poor visual prognosis in the Saudi population, like in other populations. The findings of this study give validity and applicability to the Shields staging scheme, which we recommend using in clinical practice.

High-power handheld blue laser-induced maculopathy: the results of the King Khaled Eye Specialist Hospital Collaborative Retina Study Group.

PURPOSE: To report various types of maculopathy caused by momentary exposure to a high-power handheld blue laser. DESIGN: Consecutive case series. PARTICIPANTS: Fourteen eyes of 14 patients. METHODS: Patients with a history of eye exposure to a blue laser device (450 nm and a power range of 150-1200 mW) to a single institution were included. Evaluation included a full ophthalmic examination, fundus photography, macular spectral-domain optical coherence tomography, and fundus fluorescein angiography. MAIN OUTCOME MEASURES: Analysis of the types of maculopathy and vitreoretinal pathologic features. RESULTS: All patients were young males. The most common setting for injury was accidental at play. The types of maculopathies encountered were: a full-thickness macular hole (FTMH) in 4 eyes, a premacular subhyaloid hemorrhage in 5 eyes, premacular sub-internal limiting membrane hemorrhage in 2 eyes, an outer retinal disruption at the fovea in 1 eye, an epimacular membrane in 1 eye, and a schisis-like cavity in 1 eye. Best-corrected Snellen visual acuity at presentation ranged from 20/40 to 4/200 (mean, 20/290). Only 4 eyes (29%) improved spontaneously with increase in vision, whereas 10 eyes (71%) required intervention. The latter consisted of neodymium:yttrium-aluminum-garnet hyaloidotomy in the 5 eyes with subhyaloid hemorrhage and pars plana vitrectomy (PPV) for the eyes with FTMH and epimacular membrane. All 4 FTMH were closed successfully after PPV. Final mean best-corrected visual acuity in all cases was 20/35 (range, 20/15-20/300). CONCLUSIONS: Exposure to high-power handheld laser devices can cause a variety of maculopathies that can reduce central vision permanently. Although vision may improve spontaneously, most cases require intervention. Unrestricted access to commercially available high-power handheld laser devices is dangerous and public awareness should be encouraged.

A Case of Recurrent Acute Anterior Uveitis After the Administration of COVID-19 Vaccine.

We present a case of a 37-year-old healthy man who developed acute anterior uveitis after receiving the first and second doses of the Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine. To the best of our knowledge, this is the first report of a recurring incidence of ocular side effects associated with COVID-19 immunization. Based on the timing of the start of symptoms with the first and second vaccinations, the absence of prior medical conditions, and unremarkable investigations, we believe that the patient's anterior uveitis may have been induced by the vaccine itself. This case suggests that vaccination could be a risk factor in uveitis development and recurrence following redosing. As a result, we recommend that ophthalmologists investigate the recent immunization status in each case of uveitis with a temporal association with COVID-19 vaccine administration and record these cases to improve the quality of data tracking of potential adverse responses to vaccines.

Botulinum Toxin Injection in Horizontal Rectus Muscles Without Electromyography Using an Open Sky Versus a Closed Sky Technique.

PURPOSE: To ascertain whether electromyographic control when injecting botulinum toxin in the horizontal rectus muscles is necessary, and to compare the open sky and closed sky injection techniques that are used without electromyographic control. METHODS: The records of 135 patients with horizontal strabismus who received botulinum toxin injections were reviewed retrospectively. Sevoflurane or propofol anesthesia was used in children, and topical benoxinate hydrochloride was used in adults. Patients received a bilateral injection of 2.5 to 15 IU of botulinum toxin, without electromyographic control, into the medial or lateral rectus muscles to correct esotropia or exotropia, respectively. An open sky technique was used in 31 patients, and a closed sky technique was used in 104 patients. Postoperative alignment within 10 prism diopters (PD) of orthotropia was considered a successful outcome. RESULTS: A successful outcome at 6 months of follow-up was achieved in 47% of all patients: 59% of patients in the open sky group and 44% of patients in the closed sky group (P = .151). Botulinum toxin injection corrected a mean of 14 ± 9.705 PD in patients in the open sky group and 31 ± 20.589 PD in patients in the closed sky group to obtain mean residual angles of 21 ± 16.692 and 13 ± 11.901 PD, respectively. CONCLUSIONS: The results obtained without electromyographic assistance were not remarkably different from the studies using electromyographic control. Moreover, because the results of the open sky technique were not significantly superior to the closed sky technique, the latter was favored to shorten the operative time and postoperative convalescence, and to reduce the risk of postoperative adhesions and scarring, which made re-operations difficult. [J Pediatr Ophthalmol Strabismus. 2022;59(6):388-395.].

Ocular Coloboma With Choroidal Neovascular Membrane: A Case Report.

Ocular coloboma (OC) is a rare congenital anomaly and a product of a defect in embryogenesis. It is the result of fetal fissure closure error that ends with a persistent cleft. Colobomas are generally accompanied by visual loss. In this article, we present a case of bilateral iris, disc, and retina coloboma that was managed with an anti-vascular endothelial growth factor (ranibizumab), and as a result, caused regression of the choroidal neovascular membranes and improved the patient's visual acuity. However, The patient will need lifelong follow-up to catch any retinochoroidal changes or development of cataract or glaucoma.

Incidence of Endophthalmitis after Intravitreal Anti-vascular Endothelial Growth Factor: Experience in Saudi Arabia.

PURPOSE: To report the incidence of endophthalmitis, the clinical and microbiological aspects, after intravitreal (IVT) injection of anti-vascular endothelial growth factor. METHODS: A chart review was performed of patients diagnosed with endophthalmitis after receiving IVT injections of bevacizumab (Avastin) and ranibizumab (Lucentis) presenting to King Khaled Eye Specialist Hospital (KKESH) from May 2006 to December 2012. Endophthalmitis was diagnosed clinically as an intraocular infection with vitreous involvement that required treatment with IVT antibiotics or had undergone pars plana vitrectomy (PPV) to remove the suspected microorganism. Main outcome measures were the incidence of endophthalmitis and the clinical and microbiological features. RESULTS: Seven cases of endophthalmitis were identified, there was 1 (0.004%) case of endophthalmitis of 22674 IVT injections performed at KKESH. All cases were after IVT bevacizumab. Three (42.85%) cases were culture-positive and caused by Staphylococcus epidermidis. The initial management was vitreous tap and IVT injection of antibiotics followed by PPV in 6 (85.7%) cases. One (14.3%) case underwent evisceration. Visual acuity improved at last visit in only 2 (28.6%) cases. The rate of endophthalmitis was 0.0004% for bevacizumab. CONCLUSIONS: The rate of endophthalmitis after IVT bevacizumab and ranibizumab was very low. We recommend following a standardized injection protocol, adherence to sterile techniques, and proper patient follow-up are determinant factors for low incidence rates. In addition, endophthalmitis after IVT bevacizumab and ranibizumab have poor visual outcomes despite prompt treatment.

Full-Thickness Macular Hole Secondary to High-Power Handheld Blue Laser: Natural History and Management Outcomes.

PURPOSE: To report the natural history and management outcomes of full-thickness macular hole (MH) caused by momentary exposure to a high-power handheld blue laser device and highlight the dangers of such easily available devices. DESIGN: Retrospective consecutive case series. METHODS: A chart review of all patients presenting with full-thickness MH from exposure to blue-light high-powered lasers from January 2012 to May 2014 at 2 institutions was performed. Evaluation included a full ophthalmic examination, fundus photography, macular spectral-domain optical coherence tomography, and fundus fluorescein angiography. The main and secondary outcomes were MH closure and final visual acuity, respectively. RESULTS: There were 17 eyes of 17 patients with full-thickness MH. Best-corrected Snellen visual acuity (BCVA) at presentation ranged from 20/30 to 2/200 (mean: 20/210). The MH minimum diameter ranged from 168 µm to 620 µm (mean: 351 µm). Fourteen eyes underwent pars plana vitrectomy, internal limiting membrane peeling, and gas or silicone oil tamponade. Eleven of the 14 (78.6%) operated eyes had complete closure of the macular hole. Of the 3 unoperated eyes, only 1 eye with the smallest macular hole (minimum diameter: 168 µm) closed spontaneously with observation. Final BCVA in all cases had a mean of 20/62 (range: 20/20-4/200). CONCLUSION: Full-thickness MH can result from momentary exposure to high-power handheld laser devices. While spontaneous closure may occur in rare cases, most cases require early surgical intervention. Vitrectomy may be successful in closing the macular hole with visual acuity improvement in most of the cases.