Outcomes of initial-onset acute uveitis associated with Vogt-Koyanagi-Harada disease occurred during pregnancy.

PURPOSE: To investigate the outcomes of initial-onset acute uveitis associated with Vogt-Koyanagi-Harada (VKH) disease that occurred during pregnancy. METHODS: This is a retrospective case series. RESULTS: During the period between January 2001 and December 2021, we identified 112 patients with initial-onset acute uveitis associated with VKH disease, 67 (59.8%) were females. Among the female patients, 10 (14.9%) patients (20 eyes) were pregnant. Of these patients, 5 patients presented in the first trimester, 3 in the second trimester and 2 in the third trimester. The follow-up period ranged from 8 to 108 months (mean 35.2 ± 28.3 months). At presentation, 8 (80%) patients had initial-onset acute VKH disease with anterior segment (AS) inflammation and 2 (20%) initial-onset acute VKH disease without AS inflammation. All patients were initially treated with systemic corticosteroids combined with cyclosporine. During follow-up period, none of the patients with initial-onset acute VKH disease without AS inflammation developed any complications. Complications including "sunset glow fundus" in 8 (40%) eyes, cataract in 2 (10%) eyes and subretinal fibrosis in 1 (5%) eye were recorded in patients with initial-onset acute VKH disease with AS inflammation. Four (40%) patients developed pregnancy-related complications, including abortion in 1 patient, systemic hypertension in 1 patient and premature rupture of membrane in 2 patients. There were no documented congenital anomalies in all born babies. Best-corrected visual acuity of ≥ 20/20 was achieved in 16 (80%) eyes at the final follow-up. CONCLUSION: Primary treatment with combined systemic corticosteroids and cyclosporine in initial-onset acute uveitis associated with VKH disease was safe and effective.

Leptospermum Medical Grade Manuka Honey Ointment in the Treatment of Persistent Corneal Epithelial Defect.

BACKGROUND: To study the efficacy of 100% Leptospermum medical grade Manuka honey ointment in persistent corneal epithelial defects (CEDs). METHODS: Case series. RESULTS: Case 1 was a 25-year-old female patient who presented to the cornea clinic with a persistent CED (3.5 mm), following acanthamoeba keratitis, that had failed to respond to heavy, frequent lubrication drops and ointment. Two weeks later, after starting Leptospermum honey ointment (4 times per day), the CED healed totally. Case 2 was a 48-year diabatic, single-eyed female patient who presented with a persistent CED (1.5 × 1.5 mm) that had failed to respond to heavy, frequent lubrication drops and ointment. The CED healed three weeks after starting Leptospermum honey ointment (4 times per day). CONCLUSIONS: Leptospermum honey ointment can be a potential treatment for persistent epithelial defect.

Peripapillary Retinal Haemorrhages in Wernicke's Encephalopathy Following Bariatric Surgery in a Young Patient.

Wernicke's encephalopathy (WE) is an acute neuropsychiatric syndrome resulting from thiamine deficiency (vitamin B1). It is characterised classically by a triad of ophthalmoplegia, confusion, and ataxia. WE is classically associated with alcoholism but increasingly has been observed due to other causes, particularly in undernourished post-bariatric surgery patients. Herein, we describe a case of WE following laparoscopic sleeve gastrectomy in a young male patient who presented with binocular horizontal diplopia and was found to have preretinal peripapillary haemorrhages. This case raises the awareness that posterior segment findings can occur in WE but have been under-reported previously.

Coexistence of Idiopathic Intracranial Hypertension with Unilateral Duane Retraction Syndrome Type 1 in an Adult Female.

Idiopathic intracranial hypertension (IIH) is a poorly understood condition, and its presentation can coexist with other diseases. Simultaneous IIH and Duane retraction syndrome (DRS) type 1 have never been reported to coexist in an adult patient. Herein, we report a 32-year-old obese female with a history of chronic renal failure who had a renal transplant rejection 6 years prior to presentation and was treated with oral steroids and immunosuppressive medications. She began to experience signs and symptoms of increased intracranial pressure (morning headache and binocular horizontal diplopia) and had limited abduction of one eye on examination. The case was later diagnosed as IIH with DRS type 1.

Unilateral Subhyaloid Hemorrhage as a Presenting Sign of Chronic Myeloid Leukemia.

BACKGROUND Chronic myelogenous leukemia (CML) is a malignant myeloproliferative neoplasm of pluripotent stem cell origin. Ophthalmic manifestation as an initial presentation in cases of CML is extremely rare. Frequently, ocular lesions in CML are asymptomatic. However, vitreous or foveal involvement can result in a symptomatic visual loss and earlier presentation. Here, we report a rare case of monocular vision loss due to subhyaloid hemorrhage in a case of CML. CASE REPORT A 19-year-old healthy woman presented to the Emergency Department with sudden painless decrease in vision in her left eye for 1 day. Fundus examination revealed multiple intraretinal hemorrhages with some white-centered hemorrhages in 4 quadrants in both eyes, and subhyaloid hemorrhage involving the fovea in the left eye. Complete blood count and peripheral blood smear were consistent with the diagnosis of chronic myeloid leukemia. After referral to the hematology service, the diagnosis was confirmed based on bone marrow aspiration and chromosomal analysis. The patient then received the appropriate management and continued to follow up with the hematology service. CONCLUSIONS This case report highlights the rarity of ocular involvement as an initial manifestation of chronic myeloid leukemia, and the importance of systemic work-up for the diagnosis of this entity. A multidisciplinary team approach involving ophthalmologists, hematologists, and oncologists is paramount for the diagnosis and management of CML.

Ectopic ocular tissue in testicular teratoma: A case report and review of the literature.

INTRODUCTION AND IMPORTANCE: Teratoma is a common neoplasm in prepubertal and post-pubertal periods. It consists of various types of tissues arising from different germinal layers, endoderm, mesoderm, and ectoderm. Ectopic ocular tissue is a rare phenomenon, with only few reported cases in other locations. CASE PRESENTATION: This is a 10-month-old boy who presented with a painless scrotal mass. Following orchidectomy, the excised mass confirmed the presence of uveal and retinal tissues originating in a benign testicular teratoma by histopathological examination. DISCUSSION: Choroidal and retinal tissue are the most frequently encountered ectopic ocular tissue, while the least observed tissue is the lens. Most of the reported cases of ectopic ocular tissue present in ovarian teratomas. The only 2 previously reported cases of ocular-like tissue in testicular teratoma lack well-defined medullary epithelium, uveal, and retinal tissue as in our case. CONCLUSION: To our knowledge, developing ocular tissue in a testicular teratoma is extremely rare. Herein we report a unique case with mature defined ocular tissue within a testicular teratoma in an infant, which should not be overlooked.

Periocular intravascular papillary endothelial hyperplasia: A retrospective study.

INTRODUCTION: Intravascular papillary endothelial hyperplasia (IPEH) is a rare proliferation of endothelial cells with uncertain etiology related to thrombus formation. Diagnosis is usually confirmed histopathologically. This condition has been previously described in the periocular region but not in the conjunctiva. METHODS: It is a retrospective case series in which we evaluated seven patients with histopathologically confirmed IPEH cases. Data regarding the demographics, clinical presentation, radiological description, histopathological features including any IHC staining, suspected underlying vascular etiology, management options, and follow up outcome were collected. RESULTS: A total of seven cases of histologically confirmed IPEH were included. Five out of seven patients were male (71.4%). The age range was between 6 and 69 years with a median age of 36 years. Three cases involved the eyelid (42.8%) and another three were found in the conjunctiva (42.8%). Pre-existing underlying vascular lesions were observed in all patients, five malformations (mostly lymphatic-venous) and two conjunctival hemorrhagic lymphangiectasis. All cases were treated with excisional biopsy with no signs of recurrence within an average of 7 months follow up. CONCLUSIONS: Periocular IPEH is a rare tumor that is likely to coexist with underlying vascular lesions and thrombus formation. We are reporting its existence in the conjunctiva for the first time. Therefore, pathologists should be aware of the histopathological spectrum of this lesion.

Paraneoplastic pemphigus associated with rapidly progressing endophthalmitis caused by Morganella Morganii: A case report.

INTRODUCTION: The ocular presentation of paraneoplastic pemphigus (PNP) has rarely been reported in the literature. In this report, we describe a 61-year-old male presenting with eruptive skin lesions associated with underlying non-Hodgkin's lymphoma who had rapid progressive corneal perforation with secondary endophthalmitis in the setting of PNP. CASE DESCRIPTION: A 61-year-old male presented to the emergency department complaining of skin eruption mimicking Stevens-Johnson syndrome, which was later found to be related to PNP. Initially, the patient complained of progressive ocular surface dryness in both eyes. Meanwhile, he developed mild pain in the right eye associated with blurry vision in both eyes and was managed with lubricants and topical antibiotics. A few days later, he was found to have corneal perforation with features suggestive of left endophthalmitis with possible early panophthalmitis. Intravenous antibiotic was administered, and primary evisceration of the left globe was performed. Histopathology revealed acute necrotizing keratitis and endophthalmitis. Vitreous analysis showed numerous gram-negative bacilli and a positive culture of Morganella morganii. The patient continued to be managed with frequent lubrications and punctual plugs in the fellow eye during the follow-up period. CONCLUSION: We describe the first case of endophthalmitis developing secondary to PNP-induced corneal melting and perforation. Anticipating unusual infectious sequelae in the setting of PNP might be warranted to actively detect and successfully manage dry eye disease before devastating complications develop.

Fate of Abstracts Presented at the Saudi Ophthalmology Society Conferences 2015-2018.

PURPOSE: The aim of the study was to determine the publication rates of abstracts presented at the annual Saudi Ophthalmology Society (SOS) Conferences from 2015 to 2018. METHODS: This is a cross-sectional study on abstracts collected from the scientific programs for the SOS meetings from 2015 to 2018. Titles and first authors' names were used in the search process on PubMed. A Chi-square test was conducted to compare between the categorical variables. Kruskal-Wallis test was used for nonnormally distributed variables. RESULTS: A total of 365 abstracts were presented in the SOS Conferences from 2015 to 2018. In the SOS meetings (2015-2018), the publication rate was 45.7%. Seventy-two (43.1%) of the published abstracts were published in journals with an impact factor. The mean impact factor was 1.4 ± 1.9. The median time to publication was 12.0 months (range: 0-60 months). On univariate analysis, basic science (P < 0.001), abstracts on rare diseases (P = 0.003), affiliation with eye hospitals (P < 0.001), and public hospitals (0.007) were associated with a higher publication rate. On multivariate analysis, basic science studies (odds ratio [OR]: 4.23, confidence interval [CI]: 1.77-10.12, P = 0.001), rare topic-related abstracts (OR: 2.03, CI: 1.22-3.38, P = 0.007), and eye center affiliation (OR: 1.67, CI: 1.03-2.68, P = 0.036) were associated with a better publication rate. The factors associated with publication in high impact factor journals were oral abstracts (P = 0.007) and noncase report abstracts (P = 0.023). CONCLUSION: Basic science studies, rare topic-related abstracts, and first author affiliation with an eye center were all associated with a higher publication rate. Orally presented and noncase report abstracts increased the chance of publication in higher impact factor journals.

Branch Retinal Artery Occlusion Following Cocaine Inhalation: Case Report and Review of the Literature.

Cocaine abuse has been reported to cause devastating systemic and ocular side effects. Retinal vascular occlusion following cocaine abuse has been scarcely reported in the literature. Herein, we are describing a rare case of branch retinal artery occlusion (BRAO) following intranasal cocaine use in a young female. She presented to the emergency department 1 month after having blurred vision in the left eye, which started 1 day after cocaine nasal inhalation. Fundus examination of the left eye showed an inferotemporal BRAO. In conclusion, cocaine should be considered in the differential diagnosis of retinal arterial occlusion in young healthy patients.

Successful Pars Plana Vitrectomy with Zonulo-hyaloidectomy Performed 4 Years after the Onset of Chronic Low-Grade Aqueous Misdirection.

In aqueous misdirection, the interval between diagnosis and surgical intervention is inversely proportional to the success of the surgery. Here, we report a successful outcome of pars plana vitrectomy (PPV) with irido-zonulo-hyaloidectomy 4 years after the onset of the disease. A 34-year-old female, known to have primary angle closure glaucoma, underwent trabeculectomy with mitomycin C in the right eye for uncontrolled intraocular pressure (IOP). Six weeks after the surgery, the patient presented with a shallow anterior chamber centrally and peripheral iridocorneal touch along with a patent peripheral iridectomy. Ultrasound biomicroscopy showed a shallow AC centrally with peripheral iridocorneal touch, and the ciliary body was rotated forward confirming the diagnosis of aqueous misdirection. The patient refused surgical management and was managed medically, which was unsuccessful. Four years after the diagnosis, the patient underwent PPV with irido-zonulo-hyaloidectomy because of progressive shallowing of the AC and corneal edema. One month postoperatively, visual acuity improved from 20/200 to 20/60, and the AC maintained appropriate depth. In conclusion, PPV with irido-zonulo-hyaloidectomy may result in a complete resolution of a chronic low-grade form of aqueous misdirection.

Olanzapine-Induced Acute Angle Closure.

BACKGROUND Drug-induced acute angle closure glaucoma is an uncommon ocular emergency that may follow the administration of certain topical and systemic medications. Acute angle closure can be triggered by various classes of drugs, including adrenergic agonists, anticholinergics, and serotonergic medications. Here, we report a rare case of drug-induced acute angle closure glaucoma secondary to olanzapine. CASE REPORT A 59-year-old male patient of Arabian Peninsula descent, known to have schizophrenia, presented to our Emergency Department with a 3-day history of right ocular pain and decrease in vision. He was started recently on olanzapine 5 mg once daily by his psychiatrist 1 week prior to the onset of his symptoms. The diagnosis of drug-induced pupillary block was made based on clinical and radiological findings. The patient was started on topical and systemic IOP-lowering agents. A therapeutic Nd: YAG laser peripheral iridotomy for the right eye was performed. On follow-up, his symptoms alleviated and clinical examination showed significant improvement. CONCLUSIONS The reported case highlights the importance of systemic medical history in secondary acute angle closure glaucoma. Physicians from other specialties should be aware of drugs triggering pupillary block and therefore be able to educate patients about symptoms of acute angle closure glaucoma.

Presumed acute suppurative bacterial dacryoadenitis with concurrent severe acute respiratory syndrome coronavirus-2 infection.

Acute suppurative bacterial dacryoadenitis (ASBD) was not reported to occur following severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. We are presenting a unique case of concurrent presumed ASBD with SARS-CoV-2 infection. A 23-year-old previously healthy male presented with right upper eyelid swelling and pain over the lacrimal gland area for 3 days. Before his visit, the patient was tested positive for SARS-CoV-2 infection after experiencing mild flu-like symptoms, despite being vaccinated 2 months ago. He was found to have clinical and radiological features highly suggestive of ASBD with concurrent SARS-CoV-2 infection. He was admitted and initiated on systemic and topical antibiotic, followed by incision and drainage of an abscess collection. The patient showed dramatic clinical improvement with no recurrent signs of infection during the follow-up period. This acute dacryoadenitis is presumed to represent a secondary bacterial infection possibly aided by immune-related factors that may coexist in SARS-CoV-2-positive patients.

Effect of 2019 Coronavirus Pandemic on Ophthalmologists Practicing in Saudi Arabia: A Psychological Health Assessment.

PURPOSE: To assess the psychological impact and mental health outcomes including depression, anxiety, and insomnia during COVID-19 crisis among ophthalmologists. METHODS: This was a simple random study in which ophthalmologists practicing in Saudi Arabia were asked to fill in a self-administered online survey during the period from March 28, 2020, to April 04, 2020. Four validated psychiatric assessment tools were used to detect symptoms of depression, anxiety, insomnia, and stress perception. RESULTS: One hundred and seven participants successfully completed the survey with a response rate of 30.6%. Males constituted 56.1% (n = 60). Ophthalmology residents constituted the majority (n = 66, 61.7%). About half of the physicians exhibited symptoms of depression (n = 56, 50.5%), anxiety (n = 50, 46.7%), and insomnia (n = 48, 44.9%). Symptoms of stress ranged between low (28%), moderate (68.2%), and high (3.7%). According to the cutoff values for severe symptoms, 29% were identified as having depression, 38.3% had anxiety, and 15% had insomnia.Depression was found to be more common among female ophthalmologists (P = 0.06), those living with an elderly (P = 0.003), and fellows (P = 0.006). Female ophthalmologists suffering from anxiety were significantly more than male ophthalmologists (P = 0.046). There was a trend toward suffering from anxiety in frontline health-care providers (P = 0.139) and in ophthalmologists who are living with an elderly (P = 0.149). Female participants exhibited significantly more moderate-to-high symptoms of stress (P = 0.018). CONCLUSIONS: Ophthalmologists' psychological needs, females in particular, should be addressed appropriately during the COVID-19 pandemic. Establishing psychological support units, especially for high-risk individuals, should be considered to minimize psychological adverse effects.

Brown Syndrome from Local Anesthesia for Inferior Orbital Fat Decompression.

BACKGROUND Vertical diplopia that follows local anesthesia is usually due to inferior rectus muscle fibrosis. Here, we report a rare case of acquired Brown syndrome following local anesthesia. CASE REPORT A 36-year-old woman underwent right inferior orbital fat decompression under local anesthesia. On the first postoperative day, she developed vertical diplopia. She had left hypertropia, which increased on left gaze, with limitation of elevation of the right eye on attempted adduction. Forced duction test of the right eye revealed resistance on elevation in adduction. Magnetic resonance imaging showed signal alteration, thickening, and irregularity involving the right superior oblique tendon and trochlea region. The diagnosis of iatrogenic Brown syndrome was made. Then, a single dose of 10 mg triamcinolone injection was given near the intratrochlear region. On follow-up, complete resolution of diplopia on primary gaze occurred 12 weeks after the incident. CONCLUSIONS The reported case highlights that local anesthesia carries a risk of Brown syndrome. We believe bupivacaine-induced superior oblique hypertrophy is the underlying mechanism. The patient showed excellent outcome after medical management, with no surgical intervention required after 3 months of follow-up.