Incidence and Risk Factors for Retinal Detachment Following Pediatric Cataract Surgery.

Background: Retinal detachment is a major postsurgical threat in pediatric cataract surgery; however, the effect of axial length remains unclear. This study aimed to assess the relationship between axial length and detachment risk in vulnerable patients. Methods: This retrospective cohort study analyzed 132 eyes of 84 pediatric cataract surgery patients aged <20 years old. Axial length was measured preoperatively, and the incidence of retinal detachment was recorded over a median follow-up of 4 years. Logistic regression analysis was used to examine the axial length-detachment relationship. Results: Twenty eyes had postoperative retinal detachments. The median axial length was longer in the detachment group (23.6 mm) than in the non-detachment group (21.6 mm). Eyes with axial length ≤23.4 mm had 0.55-fold decreased odds of detachment compared to longer eyes. Preexisting myopia and glaucoma confer heightened risk. Approximately half of the patients retained some detachment risk eight years postoperatively. Conclusion: Shorter eyes (axial length ≤23.4 mm) appear to be protected against pediatric retinal detachment after cataract surgery, whereas myopia, glaucoma, and axial elongation > 23.4 mm elevate the postoperative risk. Understanding these anatomical risk profiles requires surgical planning and follow-up care of children undergoing lensectomy.

This study investigated the protective role of a shorter axial length in preventing retinal detachment after pediatric cataract surgery. This highlights the correlation between smaller eye sizes and reduced detachment risk, emphasizing the need for careful consideration of anatomical factors in surgical planning and patient monitoring, particularly for patients with preexisting myopia or postoperative glaucoma.

Postoperative Aspergillus Endophthalmitis With Iris Granuloma: A Case Report.

This report describes a rare case of a fungal iris granulomatous lesion in a 67-year-old female who underwent cataract surgery in the left eye and, one month later, developed culture-positive postoperative Aspergillus endophthalmitis. On initial presentation in the emergency room, slit-lamp examination of the left eye revealed subconjunctival hemorrhage, 360-degree subconjunctival hemorrhage, mild corneal edema with Descemet's folds, a deep anterior chamber with a fibrinous reaction causing pupillary membrane formation, and an in situ intraocular lens with no view of the fundus. A bright-scan (B-scan) ultrasound revealed mild vitreous opacities with a vitreal membrane, shallow choroidal detachment, and no significant retinal and choroid layer thickening. The patient was admitted into the anterior segment division for anterior chamber (AC) tap culture and AC washout for suspected retained cortical matter removal, intracameral antibiotics (vancomycin and ceftazidime), and IOL explantation in the left eye. The initial aqueous tap culture had no growth. Nine days later, repeat aqueous tap and pupillary membrane cultures were positive for Aspergillus spp. Intravitreal voriconazole was administered along with topical natamycin and amphotericin B eye drops. There was a resolution of the clinical picture, and three weeks later a rebound occurred, for which AC washout, pars plana vitrectomy (PPV), capsulectomy, and intravitreal vancomycin, ceftazidime, and voriconazole were given. A week later, the patient developed a fungal granuloma behind the iris, which was successfully managed with an AC washout, removal of the granuloma, and repeated intravitreal and intracameral voriconazole administration. The best-corrected visual acuity (BCVA) during the last visit was 20/80 in the affected eye, with a plan for a secondary IOL implant. Endophthalmitis is a rare but serious intraocular infection, with fungal endophthalmitis having a lower prevalence than bacterial endophthalmitis, which explains the lack of well-established guidelines for diagnosing and managing exogenous fungal endophthalmitis. This case highlights the rare presentation of post-cataract Aspergillus endophthalmitis with a fungal iris granuloma and demonstrates how the chronicity of this infection, along with surgical manipulation, may accelerate the seeding of these organisms into the anterior chamber structures.

Central Retinal Artery Occlusion in a Young Patient With a Hidden Unusual Sickle Cell Trait.

Sickle cell trait is considered a benign condition. Ophthalmic manifestations are infrequent but can result in significant visual deterioration. We present a case of a 33-year-old male, not known to have any medical illnesses, who presented to the ophthalmological emergency room complaining of a sudden onset of painless and profound left eye vision loss for 12 hours. The patient denied any medication use, past eye trauma, or surgery. On detailed ophthalmologic examination, the best-corrected visual acuity (BCVA) was 20/20 in the right eye and hand movement in the left eye. Dilated fundus examination of the left eye showed a central retinal artery occlusion (CRAO) with pale, white retinal swelling and a macular cherry-red spot. Fundus fluorescein angiography showed delayed arterial filling with persistently reduced macular perfusion. CRAO was diagnosed in an otherwise healthy young male. Systemic workup was negative except for protein electrophoresis, which showed sickle cell trait, and HbA1C was 7.8%. Later, atrophic macular changes with a pale optic disc were observed, and BCVA was reduced to light perception. CRAO in young patients amounts to diverse causes, which require extensive systemic workup. In addition, the concurrence of the sickle cell trait with diabetes mellitus might have a role in CRAO development.

Epiretinal Membrane and Vitreomacular Traction Associated With Vasoproliferative Tumor in Macular Telangiectasia Type 2: A Case Report.

We report a case of a 62-year-old man who presented with blurred and distorted vision in both eyes. Fundus examination revealed a fibrous band-like membrane emanating from the disc to the foveal center in the right eye, aneurysmal gray parafoveal lesions in both eyes, and an inferotemporal peripheral vascular tumor in the right eye. The presence of an epiretinal membrane with vitreomacular traction in this patient has led to the diagnosis of an incidental peripheral vascular tumor. To our knowledge, there are no reports describing an association between macular telangiectasia type 2 and epiretinal membrane formation with vitreomacular traction due to a vasoproliferative tumor.

Optical Coherence Tomography Based Choroidal Thickness and Its Determinants in Healthy Saudi Population: A Cross-Sectional Study.

Purpose To study choroidal thickness (CT) and its determinants based on optical coherence tomography (OCT) in the healthy adult Saudi population. Materials and methods This cross-sectional study was conducted in 2021 at a tertiary eye hospital in Saudi Arabia. The autorefractor-based refractive status (spherical equivalent) of each eye was documented. CT was measured from the enhanced depth OCT images at the fovea to the 1500 µm nasal and temporal to the fovea. CT was defined as the distance from a hyper-reflective line representing retinal pigment epithelium (RPE)-Bruch's membrane to the choroid-scleral junction. The CT was correlated with demographic and other variables. Results The study sample included 288 eyes of 144 participants (mean age 31.5±8.3 years; males 94, 65.3%). Emmetropia, myopia, and hypermetropic spherical equivalent were noted in 53 (18.4%), 152 (52.5%), and 83 (28.8%) eyes, respectively. The mean sub-foveal (SFCT), nasal, and temporal CT were 329.4±56.7µm, 302.3±63.5 µm, and 312.8± 56.7µm, respectively. CT varied significantly by location (p <0.001). CT was negatively correlated with age (r = -0.177, P <0.001). CT in emmetropic and myopic eyes was 319.7±53 µm and 313.1±53 µm, respectively. The difference in CT based on refractive status (p = 0.49) or sex was non-significant (p = 0.6). Regression analysis suggested that age (p <0.001), refractive error (p = 0.02), scanning time (p <0.001), and scanning location (p = 0.006) were significant predictors of CT. Conclusion CT measurements of the eyes of healthy Saudis can be used as reference values for studies evaluating CT changes due to various chorioretinal diseases.

Unilateral Retinitis Pigmentosa Associated with Possible Ciliopathy and a Novel Mutation.

Unilateral retinitis pigmentosa (URP) is a rare retinal dystrophy. We describe the clinical course of two patients with (URP) unilateral retinitis pigmentosa confirmed by genetic testing, indicating ciliary dysfunction. Methods: The methods used in this study included a detailed ophthalmic examination, multimodal retinal imaging, Goldmann visual fields, full-field electroretinography (ffERG) and targeted next-generation sequencing. Results: A 32-year-old female (patient 1) and 65-year-old male (patient 2) were found to have URP. ffERG showed a non-recordable response in the affected eye and a response within normal limits in the fellow eye of patient 1, while patient 2 showed non-recordable responses in the apparently unaffected eye and a profound reduction in the photopic and scotopic responses in the affected eye. Next-generation sequencing revealed novel compound heterozygous c.373 C>T (p.Arg125Trp) and c.730-22_730-19dup variants in AGBL5 in patient 1, and a novel hemizygous c.1286 C>T (p.Pro429Leu) in patient 2; both gene mutations were 0%. Segregation analysis was not possible for either of the mutations. Conclusion: This report expands the clinical and molecular genetic spectrum of URP.

Orbital and periorbital migration of silicone oil associated with emphysema development after retinal detachment repair - Case report and literature review.

PURPOSE: To report a very rare case of silicone oil (SO) migration and emphysema development in the orbit and periorbital tissue, including the lids and subconjunctival space, after a fourth pars plana vitrectomy (PPV) for retinal detachment (RD) treatment. OBSERVATIONS: A 53-year-old woman with a recurrent rhegmatogenous RD in the right eye underwent a fourth PPV under local anesthesia and 23-gauge vitrectomy with fluid-air exchange and SO injection. Localized choroidal detachment occurred during fluid-air exchange near the end of the surgery. High-pressure infusion of air was used as a temporary control measure prior to SO injection. In the early postoperative period, the patient developed hemifacial and periorbital swelling and the air trapped in the upper lid was associated with lid ptosis and conjunctival chemosis. The emphysema resolved with clinical management, and the mechanical ptosis subsided after partial SO removal from the lid. CONCLUSIONS AND IMPORTANCE: The SO migration and emphysema in our case were presumably related to the multiple previous sclerotomies. Periorbital emphysema can show spontaneous resolution, but the migrated SO requires surgical management.

CULTURE-POSITIVE ACUTE POSTVITRECTOMY ENDOPHTHALMITIS IN A SILICONE OIL-FILLED EYE.

BACKGROUND/PURPOSE: The aim of this report was to present the details of a case of culture-positive endophthalmitis in a silicone oil-filled eye. METHODS: This report includes the description of the preoperative, intraoperative, and postoperative findings of the case. PATIENT: A 73-year-old male patient presented to our emergency department with complaints and symptoms indicative of acute postvitrectomy endophthalmitis. RESULTS: Aqueous, silicone oil, and vitreous washout samples tested positive for Streptococcus pneumoniae after a culture test. CONCLUSION: Culture-positive endophthalmitis in a silicone oil-filled eye has rarely been described in literature. The reported cases were culture-negative cases, possibly because they were cases of acute inflammatory reactions to silicone oil. In the present case, an otherwise healthy patient developed acute endophthalmitis after pars plana vitrectomy plus silicone oil tamponade. The case was successfully managed with conventional silicone oil removal, antibiotic injection, and silicone oil reinjection.

The Effectiveness of Propranolol in Managing Hemorrhagic Choroidal and Exudative Retinal Detachment following Ahmed Glaucoma Valve Implantation in Sturge-Weber Syndrome: Case Report and Literature Review.

Sturge-Weber syndrome (SWS) is a congenital neurological disorder that is characterized by hamartomas involving the skin, brain, and eyes and marked by the presence of the facial port-wine stain, which consequently leads to various ocular complications. Among all ocular comorbidities, glaucoma is the most frequently witnessed in SWS patients with a prevalence of 30%-70%. If glaucoma is refractory to conventional medical management, surgical intervention can be considered. Common complications of glaucoma procedures in SWS are choroidal detachment and suprachoroidal hemorrhage. Moreover, we report a 6-year-old girl, known case of unilateral congenital glaucoma secondary to SWS. Despite being on maximal antiglaucoma drops and undergoing multiple surgical interventions, the patient had uncontrolled intraocular pressure of her right eye. A decision to proceed with Ahmed glaucoma valve implantation (AGVI) to the right eye was made. In the immediate postoperative period, the patient developed hemorrhagic choroidal detachment and exudative retinal detachment. A trial of oral propranolol (1.5-2 mg/kg/day) was then initiated for 4 months. After 30 days from oral propranolol course initiation, we started noticing a significant improvement of the hemorrhagic choroidal and exudative retinal detachment. Spontaneously, a marked reduction in subretinal fluid and suprachoroidal hemorrhage was also seen. Thus, the improvement was correlated with the propranolol therapy. Here, we report a significant improvement of the postoperative complications of AGVI in a patient with SWS, following 4 months of oral propranolol course (1.5-2 mg/kg/day). Further studies are needed to determine the dosage, duration, and optimal mechanism by which propranolol works in this situation.

Bilateral endogenous Trichoderma endophthalmitis in an immunocompromised host.

PURPOSE: To report a case of bilateral endogenous endophthalmitis, caused by the Trichoderma species, in a severely immunocompromised patient. OBSERVATIONS: A 39-year-old man with acute myeloid leukemia, in a relapsed state on high-dose chemotherapy, experienced profound neutropenia and immunosuppression. The patient reported two weeks of severe bilateral vision loss. The diagnosis of bilateral endogenous endophthalmitis was initially established based on the patient's history, immune status, clinical findings, and confirmed positive vitreous culture.The patient was initially managed with vitreous tap, pars plana vitrectomy with silicone oil injection in the left eye, and vitreous tap and antibiotic injection of the right eye. Eventually, the right eye underwent pars plana vitrectomy as well. Cultures of the vitreous sample grew a filamentous fungus, identified as the Trichoderma species. His blood and urine culture tested negative. The patient was kept on systemic amphotericin B over 52 weeks, and his condition improved dramatically. Three months post phacoemulsification and silicone oil removal, best-corrected visual acuity values were 20/50 in both eyes. CONCLUSION AND IMPORTANCE: This is the first reported case of bilateral endogenous endophthalmitis, caused by the Trichoderma species, in an immunocompromised patient. Early recognition and intervention were associated with good functional and anatomical outcomes.

Comparison of Posterior Hyaloid Assessment Using Preoperative Optical Coherence Tomography and Intraoperative Triamcinolone Acetonide Staining During Vitrectomy.

PURPOSE: To compare the specificity of diagnosing posterior vitreous detachment (PVD) using preoperative optical coherence tomography (OCT) versus intraoperative triamcinolone acetonide (TA) staining in patients undergoing vitrectomy. PATIENTS AND METHODS: This retrospective cohort study included patients undergoing pars plana vitrectomy for diverse retinal pathologies. Intraoperatively, surgeons evaluated the posterior hyaloid status with TA staining and compared it with preoperative OCT findings. RESULTS: One hundred six patients underwent intraoperative assessments of posterior hyaloid status, with 72% (76/106) of the eyes showing positive staining. Sixty-two patients had also undergone preoperative OCT. Of the patients diagnosed with PVD on preoperative OCT, 50% (15/30) showed positive TA staining intraoperatively. The sensitivity of preoperative OCT assessment was 83.3%, and its specificity was 65.9%. CONCLUSION: Preoperative OCT imaging is associated with lower sensitivity and specificity for diagnosing PVD when compared to intraoperative TA staining.

Endophthalmitis Post Pars Plana Vitrectomy Surgery: Incidence, Organisms' Profile, and Management Outcome in a Tertiary Eye Hospital in Saudi Arabia.

PURPOSE: To determine the incidence of endophthalmitis after pars plana vitrectomy (PPV), organisms' profile, and management outcomes at a tertiary eye hospital in a Middle East country. METHODS: In this single-arm cohort study conducted in 2020, medical records of patients who underwent PPV not accompanied by any other intraocular surgery were reviewed; those with a diagnosis of acute endophthalmitis in the immediate postoperative period (within 6 weeks) during the past 6 years were analyzed. RESULTS: A total of 8153 records of PPV surgeries were reviewed. Five cases had endophthalmitis post-PPV with an incidence of 0.061%. Three (0.037%) had positive cultures, all of them for Staphylococcus epidermidis. The interval between PPV and diagnosis of endophthalmitis ranged from 3 to 25 days (mean, 15.8 days). Final vision after treatment ranged from 20/400 to no light perception, and one eye was eviscerated. CONCLUSION: The incidence of endophthalmitis post PPV is low. Despite prompt diagnosis and standard management, visual prognosis seems to be poor. The infective agents for endophthalmitis were commensals from the ocular surface.

Surgical Management of Hemorrhagic Retinal Detachment Secondary to Peripheral Exudative Hemorrhagic Chorioretinopathy.

The purpose of the study is to report a case of peripheral exudative hemorrhagic chorioretinopathy (PEHCR), managed surgically with favorable visual outcome. A 66-year-old female presented with painless visual loss due to dense vitreous and subretinal hemorrhage extending from the far periphery to the macula. Pars plana vitrectomy (PPV) with subretinal tissue plasminogen activator (TPA) injection was performed resulting in good anatomical and visual outcome. PEHCR can present with severe visual loss. Surgical management with PPV and subretinal TPA injection might result in favorable anatomical and visual outcome.

Analysis of Complications for Epiretinal Membrane and Macular Hole Surgery Performed by Vitreoretinal Fellows and Consultants.

PURPOSE: The aim of this study was to report the intraoperative and postoperative complications of vitrectomy for epiretinal membrane (ERM) and macular hole (MH) performed by retinal fellows under direct faculty supervision compared with experienced faculty members. PATIENTS AND METHODS: A total of 271 eyes that underwent pars plana vitrectomy (PPV) for MH and ERM from January 2014 to December 2019 at King Khaled Eye Specialist Hospital were analyzed. PPV for ERM and MH was performed by vitreoretinal fellows and consultants. RESULTS: The outcome measures assessed were the intraoperative complications rates, such as posterior lens touch, retinal breaks (RBs), retinal detachments, and vitreous hemorrhage. Moreover, the postoperative complications and optical coherence tomography (OCT) changes were assessed upon a minimum follow-up of 6 months. The rate of iatrogenic RB was more common in the ERM than in the MH surgery (15.5% vs 11.2%). Fellows and consultants had a rate of 20.5% of RB during the ERM surgery and 14.6% during MH surgery, respectively. However, these differences were not statistically significant (p = 0.12 for MH and p = 0.236 for ERM). Postoperative OCT analysis revealed an MH closure rate of 72.2%, and complete removal of the ERM was achieved in 88.6% in cases performed by fellows, while consultants achieved 61.8% closure rate of MH, and 83.3% of the patients achieved complete removal of ERM. CONCLUSION: Macular surgery is overall a safe procedure and the complication rates between fellows and consultants are comparable. With proper supervision, vitreoretinal fellows can achieve equally high anatomical outcomes with few complications.

Saudi Arabia Guidelines for diabetic macular edema: A consensus of the Saudi Retina Group.

Diabetes mellitus (DM) and its complications are major public health burdens in Saudi Arabia. The prevalence of diabetic retinopathy (DR) is 19.7% and the prevalence of diabetic macular edema (DME) is 5.7% in Saudi Arabia. Diabetic macular edema is a vision-threatening complication of DR and a major cause of vision loss worldwide. Ocular treatments include retinal laser photocoagulation, anti-vascular endothelial growth factor (anti-VEGF) agents, intravitreal corticosteroids, and vitreoretinal surgery when necessary. The present consensus was developed as a part of the Saudi Retina Group's efforts to generate Saudi guidelines and consensus for the management of DME, including recommendations for its diagnosis, treatment, and best practice. The experts' panel stipulates that the treatment algorithm should be categorized according to the presence of central macula involvement. In patients with no central macular involvement, laser photocoagulation is recommended as the first-line option. Patients with central macular involvement and no recent history of cardiovascular (CVS) or cerebrovascular disorders can be offered anti-VEGF agents as the first-line option. In the case of non-responders (defined as an improvement of <20% in optical coherence tomography or a gain of fewer than 5 letters in vision), switching to another anti-VEGF agent or steroids should be considered after 3 injections. Within the class of steroids, dexamethasone implants are recommended as the first choice. In patients with a recent history of CVS events, the use of anti-VEGF agents is not recommended, regardless of their lens status. The experts' panel recommends that a future study be conducted to provide a cut-off point for early switching to steroid implants in pseudo-phakic eyes.

Incidence and Natural History of Retinochoroidal Neovascularization in Enhanced S-Cone Syndrome.

OBJECTIVE: We examined the incidence and natural history of macular retinochoroidal neovascularization (RCN) in enhanced S-cone syndrome (ESCS). DESIGN: Retrospective case series. METHODS: This single-center study included 14 of 93 patients with ESCS who had signs of active or inactive RCN in ≥1 eye. We conducted multimodal retinal imaging, full-field electroretinography, and molecular genetic analysis of NR2E3 gene. Our main outcome measures included the cumulative incidence of RCN in ESCS, type of RCN, and mode of evolution of RCN. RESULTS: Fourteen (15.1%) of 93 patients with ESCS had RCN in ≥1 eye at 2 to 27 years of age. All 22 RCNs (21 eyes of 14 patients) were macular. Twelve of the RCNs were active with exudates/hemorrhages. Of these, 5 appeared de novo in a subretinal location, with photographic evidence of no pre-existing lesions. The latter were compatible with type 3 neovascularization or retinal angiomatous proliferation and subsequently evolved into unifocal fibrotic nodules. The remaining active lesions all had some degree of pre-existing fibrosis and remained stable. Ten inactive fibrotic nodules, identical to end-stage de novo lesions, were found and were presumed to represent healed RCNs. CONCLUSIONS: RCN, a treatable condition, may occur as early as 2 years of age and may be much more common in patients with ESCS than previously estimated. It may be the primary cause of the unifocal submacular fibrosis that is commonly observed in this condition. Additional research is needed to establish the pathogenesis of RCN in patients with ESCS and its optimal management.

Minimally interface vitrectomy for rhegmatogenous retinal detachment with a single break in young patients.

PURPOSE: This study evaluates a new surgical technique consisting of minimal vitreous removal under air (minimal interface vitrectomy; MIV) to reduce postoperative complications while preserving the ability to address surgical factors at the retinal break. METHODS: This retrospective analysis examined the outcomes of minimal interface vitrectomies in consecutive cases, with a minimum 12-month follow-up period, of primary rhegmatogenous retinal detachment (RRD), recurrent RRD after pars plana vitrectomy (PPV), or failed surgery after primary scleral buckling surgery (SBS). RESULTS: Twelve eyes of 12 patients with RRD underwent MIV. The total surgical duration was 190-300 s (mean, 245.25 s). Eight (66.7%) eyes were treated with cryotherapy, and 4 (33.3%) with endolaser to seal the retinal break. Successful, complete retinal reattachment was achieved in all eyes and maintained during follow-up. No intra- or postoperative complications occurred and no patients developed inflammation or cataract during follow-up. CONCLUSION AND IMPORTANCE: We effectively removed traction and subretinal fluid and treated breaks with endolaser or cryotherapy by using a novel minimal interface vitrectomy technique in this selected population.

Updated Systematic Review and Clinical Spectrum of Peripheral Exudative Hemorrhagic Chorioretinopathy.

Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is a rare retinal vasculopathy that might cause subretinal and/or vitreous hemorrhages. Although the primary etiology is still unknown, choroidal neovascularization is mainly involved in the pathogenesis. The main risk factors are age and systemic hypertension. Ancillary testing such as fluorescein angiography, indocyanine green angiography and ultrasonography can be of great value for diagnosing this entity and distinguishing PEHCR from other lesions as choroidal melanoma and retinal vasoproliferative tumor. Various treatments have been reported including photocoagulation, cryotherapy, intravitreal injection of anti-vascular endothelial growth factor (Anti-VEGF) and surgical intervention as pars plana vitrectomy. This review handles an up-to-date perspective regarding PEHCR.