Pediatric bacterial keratitis: clinical features, causative organisms, and outcome during a 13-year study period.

OBJECTIVE: To review the clinical features, causative organisms, complications, and outcomes of patients with pediatric bacterial keratitis at a tertiary care eye hospital. METHODS: We conducted a retrospective study at a tertiary care eye centre on clinically diagnosed pediatric patients with bacterial keratitis between 2007 and 2019. Poor outcomes were labelled if any of the following were present: final best-corrected visual acuity worse than 20/200, a drop in best-corrected visual acuity by 1 line or more, perforated corneas, endophthalmitis, and graft failure. RESULTS: The study included 43 cases of bacterial keratitis. Female and male patients represented 60.5% and 39.5% of the sample, respectively, with a mean age of 9.3 ± 5.9 years. The rate of culture positivity was 60.5%. The most common causative organisms were coagulase-negative Staphylococcus (23.1%), Pseudomonas (23.1%), and Streptococcus pneumoniae (19.2%). Culture-positive bacterial keratitis was associated with infiltrates ≥2 mm (p = 0.039), as determined by the results of multivariate analysis. Gram-positive and gram-negative bacteria exhibited 100% sensitivity to the tested fluoroquinolones. Complications included visually significant scars (55.8%), cataracts (14.0%), perforations (9.3%), corneal neovascularization (7.0%), nonhealing epithelial defects (7.0%), and endophthalmitis (4.7%). Corneal perforation was associated with the development of endophthalmitis (p < 0.001). On multivariate analysis, the only factor associated with a poor outcome was poor presenting visual acuity (p = 0.020). CONCLUSION: Gram-positive bacteria were the most common cause of pediatric microbial keratitis. Positive cultures were associated with larger infiltrates. The only adverse prognostic factor was poor presenting vision.

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.

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.

Optical coherence tomography patterns of diabetic macular edema in a Saudi population.

Purpose: The study aims to describe the patterns of diabetic macular edema (DME) and their association with visual acuity using optical coherence tomography (OCT). Patients and methods: This is a retrospective observational study with chart review of patients with DME including both type 1 and 2 diabetics seen between January 2015 and January 2016. Main Outcome Measures: Type of diabetes, diabetes duration, best-corrected visual acuity, DME pattern, central macular thickness (CMT), and stage of diabetic retinopathy. DME was classified based on OCT scans into: sponge-like diffuse retinal thickness (SLDRT), cystoids macular edema (CME), and sub-retinal fluid (SRF). Results: 227 eyes (144 patients) were included. The SLDRT represented 67.84%, CME 19.82%, and presence of SRF 2.20%. OCT scan from 21 patients (22 eyes) displayed more than a single pattern. The CMT and visual acuities varied depending on the DME morphologic patterns. SLDRT was associated with the least affected mean visual acuity of 0.2±0.21. SRF signified the worst mean visual acuities. Increase in CMT significantly correlated with reduced visual acuity (P=0.005). A statistically significant positive correlations between diabetic stage-high risk proliferative diabetic retinopathy (PDR) and severe non-proliferative diabetic retinopathy (NPDR)-with the CMT (P=0.050) and (P=0.021) respectively, were observed. A significant positive correlation between the duration of diabetes, age and type 1 diabetes with visual acuity in LogMAR (P=0.003), (P=0.03), and (P=0.0005) respectively. Conclusions: SLDRT was the most common morphological subtype of DME patterns and increasing retinal thickness impaired the visual acuity. Older ages, longer diabetic duration and type 1 diabetes are considered significant risk factors for visual acuity impairment. The study also suggests that there is a significant correlation between the DME patterns and visual acuity.

Visual outcomes and patient satisfaction after bilateral implantation of a new trifocal diffractive intraocular lens.

PURPOSE: To assess the visual outcomes, patient satisfaction and spectacle independence following implantation of new diffractive trifocal intraocular lenses. SETTING: 2 centers (university-based practice and a private practice set up). PATIENTS AND METHODS: Prospective nonrandomized study in which 74 AT LISA TRI 839MP and 8 AT LISA TORIC TRI 939MP IOLs implanted bilaterally in 41 patients following either cataract extraction or refractive lensectomy, follow-up was done at 1st, 2nd and 3rd months to assess the visual and refractive outcomes. Also, a questionnaire was used to assess patient satisfaction, spectacle independence and photic phenomena after the surgery. RESULTS: Mean uncorrected monocular distance decimal visual acuity (UDVA) was preoperatively 0.35. The averages of uncorrected monocular distance/intermediate/near (UDVA/UIVA/UNVA) postoperatively were 0.90/0.87/0.91 at 3 months. 87.5% patients had SE within ±0.50 by the 3rd month. Nearly all the patients were satisfied with the surgical outcome and the reported photic phenomena by some patients were non-disturbing with noticeable high level of patient's satisfaction by the third month. CONCLUSION: Diffractive trifocal IOLs can provide with satisfactory visual and refractive results along with positive impact on the performance of vision-related daily activities with minimal level of non-disturbing photic phenomena to patients.