Effect of silicone oil versus gas tamponade on macular layer microstructure after pars plana vitrectomy for macula on rhegmatogenous retinal detachment.

PURPOSE: To analyze structural changes in the macular retinal layers and sub-foveal choroidal thickness (SFCT) in eyes after macula-on rhegmatogenous retinal detachment (RRD) repair by pars plana vitrectomy with either silicone oil (SO) or gas tamponade, and the effect of these changes on visual acuity. PATIENTS AND METHODS: Retrospective study which included 26 eyes in the SO Group and 32 in the Gas Group. Optical coherence tomography (OCT) scans of the affected eyes were obtained before surgery, and 3 months after PPV in the Gas Group, and during silicone oil in situ and 3 months after SO removal, in the SO Group. Qualitative assessment of photoreceptor layer and foveal contour, along with quantitative assessment of macular retinal thickness and SFCT was performed. Postoperative OCT macular microstructural changes were recorded and correlated to corrected distance visual acuity (CDVA). Intraocular pressure (IOP) was measured preoperative and at 3 months post operative. RESULTS: There was a 2-line loss (from 20/28 preoperatively to 20/40 at final follow-up) of CDVA in the SO Group (p=0.051), while there was no statistically significant change in CDVA in the Gas Group (p=0.786). There was no significant correlation between CDVA loss and duration of silicon tamponade (r=-0.031, p=0.893). There was a statistically significant increase in IOP from its baseline to final follow-up of 0.7 mmHg in the SO Group (p=0.023) while there was no statistically significant change in IOP in the Gas Group. During silicone oil tamponade, there was approximately 11% and 5% of retinal and sub-foveal choroidal thinning respectively, which was moderately resolved following silicone oil removal. 20% (5/24) of eyes in the SO Group had qualitative flattening of foveal contour during SO tamponade that resolved after SO removal. CONCLUSION: Thinning of the macula was noticed after macula-on RRD repair with SO tamponade. Such thinning was only partially reversible after the removal of SO.

INADVERTENT GLOBE PENETRATION AND SUBRETINAL INJECTION OF BOTULINUM TOXIN IN A PATIENT WITH OCULOCUTANEOUS ALBINISM.

PURPOSE: To present a case of localized retinal detachment and mild vitreous hemorrhage in a patient with oculocutaneous albinism after accidental intraocular injection of botulinum toxin A. METHODS: Botulinum toxin A injection was administered to a 5-year-old patient with oculocutaneous albinism with esotropia and resulted in an ocular penetration. Dilated fundus examination indicated a nasal retinal tear causing a mild vitreous hemorrhage and a localized retinal detachment. RESULTS: No treatment was required for the retinal detachment, and we observed the patient at regular intervals. On Day 1, the detachment resolved spontaneously without sequelae. On follow-up, scarring at the lesion site was detected at one month after the incidence, and the patient's vision was stable. CONCLUSION: In this instance, observation was sufficient for our patient with complete resolution of retinal detachment and no long-term complication. Botulinum toxin A did not seem toxic to intraocular tissues. However, intramuscular botulinum toxin A injection should be administered carefully. Oculocutaneous albinism did not seem to affect the final outcome in our case.

Pediatric intussusception due to basidiobolomycosis: a case report and literature review.

BACKGROUND: Pediatric gastrointestinal basidiobolomycosis is an unusual fungal infection caused by Basidiobolus ranarum, an environmental saprophyte found worldwide. Typically, basidiobolomycosis presents as a subcutaneous infection or soft tissue tumor-like lesion, and rarely involves the gastrointestinal tract. Gastrointestinal basidiobolomycosis is most common in young infants. It has no definitive clinical presentation, and almost all cases are misdiagnosed during the initial presentation. CASE PRESENTATION: We report the case of a 4-year-old Saudi boy who presented to the emergency department with abdominal pain, nausea, vomiting, and weight loss. Ultrasonography revealed a target sign. Based on the ultrasonography findings, surgery was performed, which revealed the presence of intussusception. Eventually, the patient was diagnosed with intussusception secondary to intra-abdominal basidiobolomycosis based on the histological findings. The patient was readmitted and intravenous voriconazole therapy was initiated. One week after the second admission, the patient developed abdominal pain, nausea, vomiting, inability to hold down food, and constipation. Computed tomography of the abdomen was suggestive of small bowel obstruction, which was managed conservatively. The patient responded well and was subsequently discharged with a prescription of oral voriconazole. CONCLUSIONS: This case reveals that gastrointestinal basidiobolomycosis can cause intussusception. This report will inform clinicians of the importance of considering gastrointestinal basidiobolomycosis in the differential diagnosis of chronic abdominal pain in children, even in the absence of fever or a clinically obvious abdominal mass, especially in countries such as Saudi Arabia, where cases have been reported.

Reasons for the Late Presentation of Diabetic Retinopathy in Saudi Arabia: A Survey of Patients Who Presented with Advanced Proliferative Diabetic Retinopathy to a Tertiary Eye Hospital.

Purpose: This study aimed to understand the barriers that contribute to diagnostic and therapeutic delays in patients with advanced proliferative diabetic retinopathy (PDR). Patients and Methods: This cross-sectional study targeted patients with advanced PDR who never received any ocular intervention at King Khaled Eye Specialist Hospital in Saudi Arabia. An Arabic-language questionnaire was used to interview the participants over a period of 6 months. The questionnaire comprised sociodemographic questions followed by several sections to assess the causes of delay in diagnosis and management. Variables were analyzed descriptively and reported as numbers and percentages using SPSS 22. Results: A total of 338 patients were included in the study. Most patients were older than 50 years (60.4%), and decreased vision was the main complaint at presentation (81%). Vitreous hemorrhage was the most common diagnosis (46%). Patients' lack of knowledge about the importance of DR screening programs and problems with healthcare system screenings were the most frequent causes of delay in diabetic retinopathy (DR) diagnosis and management. Conclusion: DR is still a major cause of permanent blindness that is treatable with regular follow-up and timely management. Even though DR screening and treatment in Saudi Arabia have improved drastically over the last years, socioeconomic and health system factors remain barriers to the improvement of outcomes of DR.

Fractured dexamethasone implant (OZURDEX®) following intravitreal injection.

Dexamethasone implant (Ozurdex™) is a relatively safe medication with few adverse events can happen. We demonstrate clinical course and images of a rare case of fractured intravitreal Ozurdex™ implant that observed immediately following injection and its final outcome.

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.

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.

Topiramate-induced acute bilateral angle closure glaucoma confirmed by ultrasound biomicroscopy.

Topiramate is a sulfamate-substituted monosaccharide used in the treatment of epilepsy and migraines. This case report demonstrates a 29-year-old female who complained of severe bilateral loss of vision 14 days after using topiramate for her migraine. On initial examination, visual acuities were counting fingers in both eyes. Intraocular pressures were 55 mmHg and 58 mmHg in the right and left eyes, respectively. Anterior segment examination showed bilateral conjunctival chemosis, mild corneal edema, and markedly shallow anterior chambers with closed angles on gonioscopy. Ultrasound biomicroscopy revealed bilateral anterior rotation of ciliary body with choroidal effusion. Topiramate was immediately discontinued, topical and systemic anti-glaucomatous treatment was administered. After 1-week follow-up, the patient had fully recovered.

Barrier to Access and Dental Care Utilization Behavior with Related Independent Variables in the Elderly Population of Saudi Arabia.

OBJECTIVES: The study aimed to evaluate barriers associated with access and utilization of dental services among the elderly population of Saudi Arabia. MATERIALS AND METHODS: A systematic random sample of 350 elderly people recruited from various gathering places of the elderly including all nursing home residents (n = 73) was included in this study. The data were collected through face-to-face structured interviews related to access and utilization of dental services, and sociodemographic, behavioral, medical, and financial barriers to dental services. Statistical analysis included frequency distributions, chi-squared tests, and regression analysis using the Statistical Package for the Social Sciences (SPSS) program. RESULTS: Approximately 37% of the elderly had proper access to and utilization of dental services. Independent variables that affect access and utilization of dental services were low income (odds ratio [OR] = 2.23, confidence interval [CI] = 1.34-3.72), unmarried participants (OR = 3.25, CI = 1.75-6.05), community residents (OR = 5.15, CI = 2.52-10.53), smokers (OR = 1.93, CI = 1.02-3.68), irregular users of toothbrushing (OR = 3.53, CI = 2.09-5.95), no dental insurance (OR = 1.88, CI = 1.06-3.37), and unaffordable price (OR = 2.55, CI = 1.38-4.69) in the bivariate analysis. In logistic regression analysis, the significant variables that were associated with proper access and utilization of dental services were having dental insurance (OR = 2.24, CI = 1.15-3.82), affordable prices (OR = 2.19, CI = 1.21-3.70), brushing regularly (OR = 3.58, CI = 2.01-6.37), higher education (OR = 1.87, CI = 1.10-3.20), and being married (OR = 1.68. CI = 0.97-2.91). CONCLUSION: Lack of perceived need, no dental insurance, unaffordable price, transportation, and fear from dental treatment were the most common significant barriers to dental services.

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.