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Huda Al Ghadeer,1 Rajiv Khandekar2,3 1Emergency Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 2Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 3Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, CanadaCorrespondence: Huda Al Ghadeer, Emergency Department, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh, 11462, Saudi Arabia, Tel +966 1 4821234 ext. 2500, Email hghadeer@kkesh.med.saPurpose: To discuss the characteristics, etiological factors, and visual outcomes of open globe injuries (OGIs) in children at a tertiary eye hospital in Riyadh, Central Saudi Arabia.Methods: This was a hospital-based cohort study conducted in 2021. Children aged ≤ 16 years with OGI based on the Birmingham Eye Trauma Terminology classification were included. The age, gender, type, cause of OGI, and vision were recorded, as well as uncorrected and best corrected visual acuity (UCVA and BCVA, respectively). There was a change in the UCVA and BCVA one year after management. BCVA following management was linked to a variety of factors.Results: There were 664 eyes with OGI. [median age 5.1, 461 (69.6%) boys]. UCVA at presentation was < 20/400 in 525 (79%) of eyes with OGI. Injuries were mainly due to metallic objects in 195 (29.4%), glass in 102 (15.4%), and fireworks in 62 (9.4%). The Change in visual impairment grade in UCVA and BCVA after management compared to the initial presentation was significant (p < 0.001). Improvement of two lines of BCVA was noted in 345 (52%), no change in (

Purpose: To discuss the characteristics, etiological factors, and visual outcomes of open globe injuries (OGIs) in children at a tertiary eye hospital in Riyadh, Central Saudi Arabia.Methods: This was a hospital-based cohort study conducted in 2021. Children aged ≤ 16 years with OGI based on the Birmingham Eye Trauma Terminology classification were included. The age, gender, type, cause of OGI, and vision were recorded, as well as uncorrected and best corrected visual acuity (UCVA and BCVA, respectively). There was a change in the UCVA and BCVA one year after management. BCVA following management was linked to a variety of factors.Results: There were 664 eyes with OGI. [median age 5.1, 461 (69.6%) boys]. UCVA at presentation was < 20/400 in 525 (79%) of eyes with OGI. Injuries were mainly due to metallic objects in 195 (29.4%), glass in 102 (15.4%), and fireworks in 62 (9.4%). The Change in visual impairment grade in UCVA and BCVA after management compared to the initial presentation was significant (p < 0.001). Improvement of two lines of BCVA was noted in 345 (52%), no change in (<± 2 lines) 299 (45%) and deteriorated in 10 (1.5%).Conclusion: OGI was identified as a leading cause of unilateral blindness. Children with OGIs who receive standard treatment have better outcomes. Many children could not achieve normal, functional vision despite the intervention of skilled care providers. [ABSTRACT FROM AUTHOR]

Mohammad Al Amry,1 Lamia AlHijji,2 Sahar M Elkhamary,3 Ahmed Mousa,4 Abdulrahman AlGaeed,3 Huda AlGhadeer1 1Emergency Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 2Ophthalmology Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 3Radiology Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 4Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi ArabiaCorrespondence: Huda AlGhadeer, Emergency Department, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh, 11462, Saudi Arabia, Tel +966 1 4821234 extension 2500, Email hghadeer@kkesh.med.saPurpose: Optic nerve avulsion (ONA) is a rare but serious presentation of ocular trauma. This study investigates the presenting characteristics and etiologies of all cases of ONA over an 8-year-period at a tertiary eye care center in the Middle East.Methods: The medical records of patients diagnosed with ONA at an Ophthalmic Emergency Department between November 2014 and November 2022 were analyzed in this retrospective cohort study. Data were collected on patient age, sex, affected eye, cause of injury and imaging studies. The best-corrected visual acuity (BCVA) at presentation and at the last follow-up visit, and the duration of follow-up were documented.Results: The study sample was comprised of 44 eyes of 43 patients with ONA with median age of 16.5 (9.3– 26.8) years ranging from 2 years old to 70 years old. There were (35;79.5%) males and (9; 20.5%) females. Most cases presented with an affected left eye (27; 61.4%) followed by the right eye (16; 36.4%) and only one patient (2.3%) had bilateral ONA. The most common cause of trauma resulting in ONA was a metallic object (8;18.2%). This study demonstrates the value of multi-sequence Magnetic resonance imaging (MRI) in the setting of unexplained vision loss when other modalities are inadequate or inconclusive.Conclusion: Ophthalmic morbidity resulting from ONA can be devastating. Metallic object injuries were the most prevalent cause of ONA. The presence of associated media opacities challenges the initial diagnosis of ONA. In the vast majority of cases, the vision ended as no light perception (NLP), indicating permanent vision impairment.Keywords: avulsion, ocular, optic nerve, trauma

Purpose: Optic nerve avulsion (ONA) is a rare but serious presentation of ocular trauma. This study investigates the presenting characteristics and etiologies of all cases of ONA over an 8-year-period at a tertiary eye care center in the Middle East.Methods: The medical records of patients diagnosed with ONA at an Ophthalmic Emergency Department between November 2014 and November 2022 were analyzed in this retrospective cohort study. Data were collected on patient age, sex, affected eye, cause of injury and imaging studies. The best-corrected visual acuity (BCVA) at presentation and at the last follow-up visit, and the duration of follow-up were documented.Results: The study sample was comprised of 44 eyes of 43 patients with ONA with median age of 16.5 (9.3– 26.8) years ranging from 2 years old to 70 years old. There were (35;79.5%) males and (9; 20.5%) females. Most cases presented with an affected left eye (27; 61.4%) followed by the right eye (16; 36.4%) and only one patient (2.3%) had bilateral ONA. The most common cause of trauma resulting in ONA was a metallic object (8;18.2%). This study demonstrates the value of multi-sequence Magnetic resonance imaging (MRI) in the setting of unexplained vision loss when other modalities are inadequate or inconclusive.Conclusion: Ophthalmic morbidity resulting from ONA can be devastating. Metallic object injuries were the most prevalent cause of ONA. The presence of associated media opacities challenges the initial diagnosis of ONA. In the vast majority of cases, the vision ended as no light perception (NLP), indicating permanent vision impairment. [ABSTRACT FROM AUTHOR]

James E Deom,1,2 Shane Kannarr,3 Patrick Vollmer4,5 1The Dry Eye Center of Northeastern Pennsylvania, Hazleton, PA, USA; 2Hazleton and Stroudsburg Eye Specialists, Hazle Township, PA, USA; 3Kannarr Eye Care, LLC, Pittsburg, KS, USA; 4Vita Eye Clinic, Shelby, NC, USA; 5Synvenio Group, Shelby, NC, USACorrespondence: James E Deom, Hazleton Eye Specialists, 281 Airport Road, Hazle Township, PA, 1820, USA, Tel +1 570 453 2020, Fax +1 570 453 1020, Email dr.deom@gmail.comPurpose: Use of a combination corticosteroid/antibiotic product is common in ocular surface inflammatory conditions for which corticosteroid therapy is indicated and there exists a risk of superficial bacterial infection. Combination loteprednol etabonate 0.5% and tobramycin 0.3% (LE/T) has been evaluated for blepharokeratoconjunctivitis in two trials, but there has been limited reporting on its real-world use.Patients and Methods: This was a retrospective chart review conducted at three optometry practices in the USA. Data were collected from cases in which LE/T was used and data were recorded for the period commencing with therapy with a minimum of one follow-up visit (within 2 months). Data abstracted included patient demographics, diagnosis, LE/T dosing regimen, pre- and post-treatment ocular signs and symptoms, intraocular pressure (IOP) measurements, adverse event (AE) reports, visual acuity (VA), and any notations as to resolution of baseline condition. Primary outcomes of interest included IOP changes and AEs.Results: Ninety-six patient charts were extracted, and data from 87 charts (115 LE/T-treated eyes) were included. Mean (SD) years of age was 45.6 (19.7), most patients were white (83.9%), and just over half were female (58.6%). Common baseline conditions were conjunctival injury/corneal abrasion (25.3%), keratitis (18.4%), viral conjunctivitis (16.1%), and blepharitis/eyelid inflammation/MGD (11.5%). The most common LE/T dosing regimen was one drop QID. Mean (SD) IOP was 15.2 (4.4) mm Hg at baseline and 15.7 (4.4) mm Hg at the first follow-up visit (p = 0.2467). No AEs were recorded, and there were no significant changes in mean VA. Where recorded, most patients (83%) were noted as having their condition resolved/resolving at the first or second follow-up visit.Conclusion: LE/T appears to have a high level of safety when used for the management of various ocular surface inflammatory conditions encountered in optometric practice.Keywords: corticosteroid, ocular, retrospective, intraocular pressure, blepharokeratoconjunctivitis, real-world

Hany Mahmoud,1 Ahmed Hamody,2 Hesham M Hefny,3 Dalia Tohamy,4 Islam Awny5 1Department of Ophthalmology, Faculty of Medicine, Sohag University, Sohag, Egypt; 2Anesthesia Department, Sohag University, Sohag, Egypt; 3Clinical Pathology Department, Sohag University, Sohag, Egypt; 4Ophthalmology Department, Assiut University, Assiut, Egypt; 5Department of Ophthalmology, Sohag University, Sohag, EgyptCorrespondence: Hany MahmoudDepartment of Ophthalmology, Faculty of Medicine, Sohag University, EgyptTel +20 1024368111Email drhanymahmoud@gmail.comPurpose: To assess the presence of anti-SARS-CoV-2 IgA in the conjunctival secretions of confirmed COVID-19 patients by nasopharyngeal swabs and correlate its presence with the severity of the disease, patient’s age, sex and ocular symptoms.Methods: This study included 44 positive COVID-19 patients confirmed with nasopharyngeal swabs during the period 17– 28 February 2021 at Sohag Tropical Medicine Hospital. Tears and conjunctival secretions were examined for the presence of anti-SARS-CoV-2 IgA.Results: While non-reactive results are strongly correlated to low titre and vice versa, severity showed significant correlation with neither IgA reactivity nor titre. Meanwhile, IgA reactivity did not show significant correlation with either age or sex. The reactivity and IgA titre are correlated with ocular symptoms.Conclusion: The anti-SARS-CoV-2 IgA could be found in ocular secretions in SARS-CoV-2 patients. There is no correlation with age or sex or severity of the disease; however, they are correlated with ocular symptoms.Keywords: anti-SARS-CoV-2 IgA, ocular, secretions, swab

Ranju Kharel Sitaula,1 Anadi Khatri,2 MK Janani,3 Rajendra Mandage,4 Soumen Sadhu,5 HN Madhavan,6 Madan Prasad Upadhyay,7 Jyotirmay Biswas8 1Department of Ophthalmology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; 2Birat Eye Hospital, Biratnagar, Nepal; 3Sankara Nethralaya Referral Laboratory, Medical Research Foundation, Chennai, India; 4Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India; 5Department of Optometry, The SankaraNethralaya Academy, Unit of Medical Research Foundation, Chennai, India; 6Larson & Turbo Microbiology Research Center, Sankara Nethralaya Referral Laboratory, Chennai, India; 7Children Hospital for Eye, Ear Nose Throat and Rehabilitation Services, Bhaktapur, Nepal; 8Department of Uvea and Ocular Pathology, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, IndiaCorrespondence: Anadi Khatri Department of Vitreoretina ServicesBirat Eye Hospital, Biratnagar, NepalTel +977841767205Email anadikc@gmail.comImportance: An observant Chinese doctor Li Wenliang became the first physician to alert the world about COVID-19. Being an ophthalmologist himself, he has put the additional onus on us. The fact that the ocular manifestation could be the first presenting feature of novel coronavirus pneumonia should not be ignored and the possibility of spread of SARS-CoV-2 through the ocular secretions cannot be ruled out. However, with breakthroughs still evolving about this disease, the calls are now louder for closer examination on the pathogenesis of conjunctivitis associated with it. Hence, we conducted a scoping review of all available literature till date to fill in the “potential” gaps in currently available knowledge on ocular manifestations of SARS-CoV-2 infection in an attempt to establish continuity in the “chain of information” from December 2019 till April 2020. We also summarize a possible hypothesis on much less understood and highly debated topics on regard to the etiopathogenesis of ocular involvement in SARS-CoV-2 based on either presence or absence of ACE2 receptor in the ocular surface.Methods: We conducted a scoping review search of published and unpublished SARS-CoV-2-related English language articles from December 2019 till mid of April 2020 from the online databases. The findings were summarized using text, tables, diagrams, and flowcharts.Results: The commonest ocular manifestation in SARS-CoV-2 infection is follicular conjunctivitis and has been the first manifestation of SARS-CoV-2 infection in 3 reported cases till date. The ocular surface inoculated with the SARS-CoV-2 leads to the facilitation of the virus to the respiratory system via the lacrimal passage. RT-PCR analysis of the ocular secretions has shown the presence of the SARS-CoV-2 nucleotides indicating the possibility of infection of ocular secretions. ACE2 receptors and its expression on the ocular mucosal surface are linked behind the etiopathogenesis of conjunctivitis.Conclusion: Conjunctivitis can be the presenting manifestation but may go unnoticed due to its mild nature. The ocular surface could serve as the entry gateway for the virus and ocular secretions could play a role in virus shed. The eye care personnel, as well as the general people, need to be more vigilant and adopt protective eye measures.Keywords: ACE2 receptor, conjunctiva, coronavirus, COVID-19 infection, ocular, ophthalmic, 2019-nCOV, SARS-CoV-2

Asad Loya,1 Talha Ayaz,2 Christina Y Weng3 1School of Medicine, Baylor College of Medicine, Houston, TX, USA; 2School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, USA; 3Department of Ophthalmology,Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USACorrespondence: Christina Y WengDepartment of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USATel +1 713 798-6100Email christina.weng@bcm.eduBackground: An ocular or periocular malignancy can profoundly impact patients’ lives as they cope with the challenges of a potentially life-threatening diagnosis and the exhaustive treatment process it entails. An amalgam of biopsychosocial factors can influence prognosis. This study aims to determine whether marital status impacts the long-term survival of patients with these malignancies.Methods: A retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER) database was performed. Patients with ocular and periocular malignancies diagnosed between 1973 and 2015 were included. The association between survival and marital status was assessed using univariate and multivariate Cox regression. Adjusted covariates included demographic, tumor, and treatment data.Results: A total of 3159 patients with a mean±SD follow-up period of 6.47± 4.62 (range 0– 17.9) years were studied. At the time of diagnosis, 63.4% (2004/3159) of the cohort were married, 12.9% (409/3159) were single, 16.3% (514/3159) were widowed, and 7.3% (232/3159) were divorced. The mean±SD age of the cohort was 64.4± 15.17 (range 26– 100) years, with histology distributed as 14.6% (462/3159) melanoma, 84.5% (2669/3159) lymphoma, and 0.9% (28/3159) plasmacytoma. Adjusted all-cause mortality risk was higher in single (HR, 1.885, 95% CI 1.535 to 2.314; P< 0.001), widowed (HR, 1.382, 95% CI 1.169 to 1.635; P< 0.001), and divorced (HR, 1.637, 95% CI 1.271 to 2.109; P< 0.001) individuals compared to married individuals. Similarly, adjusted cause-specific mortality risk was higher in single (HR, 1.835, 95% CI 1.332 to 2.528; P< 0.001), widowed (HR, 1.376, 95% CI 1.025 to 1.847; P=0.033), and divorced (HR, 1.873, 95% CI 1.272 to 2.758; P=0.001) individuals compared to married individuals.Conclusion: Unmarried (single, widowed, and divorced) individuals with ocular or periocular malignancies have unmet social support needs resulting in poorer long-term outcomes. Understanding the prognostic role of such psychosocial factors is necessary to improve the identification of and care for patients with inadequate support.Keywords: oncology, ocular, cancer, SEER, relationship, database

Thomas R Walters,1 Robert J Smyth-Medina,2 Paul C Cockrum31Keystone Research, Austin, TX, 2University of California, Los Angeles, CA, 3Health Kinetics, Fort Worth, TX, USAPurpose: The purpose of this study was to quantify the concentration of bromfenac in the aqueous humor utilizing high-performance liquid chromatography mass spectrometry between two commercial nonsteroidal anti-inflammatory drugs, using aqueous humor concentrations to characterize pharmacokinetic proportional differences between 0.075% bromfenac ophthalmic solution in DuraSite (BromSite®) and 0.09% bromfenac ophthalmic solution (Bromday®).Methods: In this multicenter, randomized, double-masked, two-arm, parallel-group, comparative, Phase II clinical trial, subjects were assigned to receive bromfenac in DuraSite or bromfenac ophthalmic solution in a 1:1 ratio. One drop of the masked test article was instilled into the study eye once a day for 2 days prior to and 3 hours prior (last instillation) to the subject’s cataract surgery. Aqueous humor samples were collected upon initial cataract incision for analysis of bromfenac levels. The primary end point was aqueous humor concentration of bromfenac at Day 3, at the initiation of cataract surgery. Aqueous humor samples were collected and analyzed for bromfenac levels.Results: A total of 60 subjects completed the study, 30 in each group. The mean bromfenac aqueous humor concentration in subjects who received bromfenac in DuraSite was more than twice (49.33±41.87 ng/mL, P=0.004) that of subjects who received bromfenac ophthalmic solution (23.65±16.31 ng/mL) after three doses.Conclusion: Mean bromfenac aqueous humor concentration in subjects receiving the DuraSite-containing bromfenac in DuraSite (0.075%) was significantly higher compared to subjects receiving bromfenac ophthalmic solution (0.09%) after 3 days of dosing.Keywords: pharmacokinetics, PK, ocular, NSAID, aqueous humor

Diego Alejandro Valera Cornejo,1 Abel Flores Boza2 1Research Department, Vista Clinic, 2Pediatric Ophthalmology Department, National Institute of Ophthalmology of Peru, Lima, Peru Objective: To determine the relationship between the preoperative axial length and the myopic shift over 3 years after congenital cataract surgery with primary intraocular lens implantation and other related factors. Methods: In this retrospective cohort study, the axial length was measured and assigned into 2 groups (>21.5 mm and ≤21.5 mm), visual axis obscuration, laterality of cataract, age of surgery and follow-up time were assessed and compared to the myopic shift. Results: The mean myopic shift was 3.6 (standard deviation [SD]: 2.3) diopters (D) in all patients; 3.2 (3.3) and 3.9 (3.2) D for each group respectively (p=0.359). In unilateral cataracts the mean myopic shift was 6.3 D and in bilateral cases was 3.0 D (p=0.001). In bilateral cataracts, the shift was 2.6 D (SD: 2.0) and 3.4 D (SD: 1.8), respectively (p=0.098). Conclusion: There was no relationship between the initial axial length and the myopic shift in all patients. Unilateral cataracts had a greater myopic shift over 3 years. Keywords: axial length, eye, refraction, ocular, cataract, congenital, pseudophakia, child

Objective: To determine the relationship between the preoperative axial length and the myopic shift over 3 years after congenital cataract surgery with primary intraocular lens implantation and other related factors. Methods: In this retrospective cohort study, the axial length was measured and assigned into 2 groups (.21.5 mm and ≤21.5 mm), visual axis obscuration, laterality of cataract, age of surgery and follow-up time were assessed and compared to the myopic shift. Results: The mean myopic shift was 3.6 (standard deviation [SD]: 2.3) diopters (D) in all patients; 3.2 (3.3) and 3.9 (3.2) D for each group respectively (p=0.359). In unilateral cataracts the mean myopic shift was 6.3 D and in bilateral cases was 3.0 D (p=0.001). In bilateral cataracts, the shift was 2.6 D (SD: 2.0) and 3.4 D (SD: 1.8), respectively (p=0.098). Conclusion: There was no relationship between the initial axial length and the myopic shift in all patients. Unilateral cataracts had a greater myopic shift over 3 years. [ABSTRACT FROM AUTHOR]

Cystinosis is a rare autosomal recessive disorder characterized by the accumulation of cystine within the cells of different organs. Infantile nephropathic cystinosis is the most common and severe phenotype. With the success of renal transplantation, these patients are now living longer and thus more long-term complications within different organs are becoming apparent. Ophthalmic manifestations range from corneal deposits of cystine crystals to pigmentary retinopathy. With increasing age, more severe ocular complications have been reported. Photophobia is a prominent symptom for patients. With prolonged survival and increasing age, this symptom, along with corneal erosions and blepharospasm, can become debilitating. This review revisits the basic pathogenesis of cystinosis, the ocular manifestations of the disease, and the treatment of corneal crystals. [ABSTRACT FROM AUTHOR]

We report a case of a newborn male child with congenital toxoplasmosis. During pregnancy seroconversion occurred and positive titers of antitoxoplasmic antibodies (immunoglobulin M and G) were found in the mother, in the third trimester. She received treatment with spiramycin. After birth, the neonate presented with chorioretinitis and intracranial calcifications. The neonate received treatment with pyrimethamine, sulfadiazine, and leucovorin for 1 year. In addition to using a previously described method, we report for the first time in Greece an estimation regarding the percentage of ocular toxoplasmosis caused by congenital or acquired infection. We estimate that ocular toxoplasmosis in Greece is caused in 7% of the cases by congenital infection, and in 93% of the cases by acquired infection. [ABSTRACT FROM AUTHOR]

Ocular involvement by plasmablastic lymphoma is extremely rare with very few reports in the literature. Its morphological and immunological resemblance to plasma cell myeloma makes it a diagnostic challenge, while its clinical course, which is characterized by recurrence and death, makes therapy a challenge for clinicians. We present three cases of plasmablastic lymphoma, each of which has distinct clinicoradiological features, and we also review the literature on orbital plasmablastic lymphomas. [ABSTRACT FROM AUTHOR]