Search

Background: To evaluate risk factors for developing endophthalmitis after repair of open globe injuries., Methods: Retrospective chart analysis of 1303 patients from May 1996 till December 2019., Results: All patients received prophylactic intravenous broad-spectrum antibiotics for 5-7 days. Endophthalmitis was clinically suspected in 37 (2.8%) eyes and was culture proven in 14 of these eyes (1.1%). Univariate analysis identified poor initial visual acuity at presentation, rural setting of injury, contaminated wound and lens injury as significant predictors for the development of clinically suspected endophthalmitis. Intravitreal antibiotics at the time of primary repair in eyes with high-risk characteristics decreased risk of developing endophthalmitis (OR: 2.28;95% CI,1.07-4.86; p = .033)., Conclusions: Poor initial visual acuity, rural setting of injury, contaminated wound, and lens injury increased risk of suspected posttraumatic endophthalmitis. Prophylactic intravitreal antibiotics at the time of primary repair in eyes with high-risk characteristics reduced the risk of posttraumatic endophthalmitis.

Purpose: To investigate the frequency, clinical findings and outcomes of occlusive retinal vasculitis in patients with multiple sclerosis (MS)., Methods: A retrospective case series., Results: During the period between January 2000 and December 2021, we identified 24 patients who were diagnosed to have uveitis associated with MS. Among them, four (16.6%) patients presented with bilateral occlusive retinal vasculitis who were diagnosed to have MS prior to presentation. All patients were treated successfully with a combination of systemic corticosteroids combined with mycophenolate mofetil. In addition, scatter laser photocoagulation was applied to the ischemic retina in all eyes., Conclusions: Early recognition and prompt treatment with systemic immunosuppressive agents and scatter laser photocoagulation prevent complications and improve outcomes in MS patients with occlusive retinal vasculitis.

Purpose: To investigate the outcomes of uveitis associated with Vogt-Koyanagi-Harada (VKH) disease in pediatric age group (aged 16 years and under)., Methods: A retrospective review of patients with VKH disease., Results: Among the 244 patients identified, 38 (76 eyes) were children. Among them, five had insulin-dependent diabetes mellitus. 21 presented with initial-onset acute disease and 17 with chronic recurrent disease. The mean follow-up period was 59.1 months. At presentation, chronic recurrent disease was associated with more severe inflammation as indicated by the presence of mutton-fat keratic precipitates ( p < .001), iris nodules ( p = .005) and posterior synechiae ( p < .001). During follow-up, the rate of complications was higher in children with chronic recurrent disease compared with initial-onset acute disease ( p < .001). 92.4% of the eyes with initial-onset acute disease achieved a final visual acuity of ≥20/40 compared with 70.6% of the eyes with chronic recurrent disease ( p = .013)., Conclusions: Chronic recurrent VKH disease in children is associated with worse outcomes.

Purpose: To describe the first case of varicella zoster virus (VZV) retinitis following chimeric antigenic response (CAR) T-cell therapy., Methods: Case review., Results: A 53-year-old male was treated with CAR T-cell therapy for refractory diffuse large B-cell lymphoma. Nine months after CAR T-cell therapy, he developed VZV skin infection and retinitis. The retinitis responded to systemic acyclovir therapy and intravitreal ganciclovir., Conclusion: VZV retinitis can occur following CAR T-cell immunotherapy.

Purpose: To evaluate the efficacy of B cell depletion therapy with the chimeric mouse/human anti-CD20 monoclonal antibody rituximab for refractory chronic recurrent granulomatous uveitis associated with Vogt-Koyanagi-Harada (VKH) disease., Methods: Retrospective study of 9 patients (18 eyes) who failed to respond to conventional combination immunosuppressive therapy., Results: All the patients received 3 rituximab infusions. The follow-up period after initiation of rituximab therapy ranged from 9 to 36 months (mean ±SD, 19.2 ± 10.1). All patients achieved remission and visual acuity significantly improved ( p < .001). Rituximab provided corticosteroid-sparing effect along with control of inflammation. No rituximab-related complications were observed., Conclusions: Rituximab is effective for the treatment of refractory chronic recurrent granulomatous uveitis associated with VKH disease.

Purpose : To investigate risk factors and surgical outcomes of cataract in Vogt-Koyanagi-Harada (VKH) disease. Methods : Review of 187 patients (374 eyes). Results : At presentation, cataract was diagnosed in 56 (14.9%) eyes all had chronic recurrent VKH. During follow-up, cataract developed in additional 51 (13.6%) eyes. Fifteen (13.6%) of these had initial-onset acute VKH with anterior segment (AS) inflammation and 36 (19.4%) had chronic recurrent VKH. No patient with initial-onset acute VKH without AS inflammation developed cataract. Risk factors for cataract development during follow-up included female gender, keratic precipitates, anterior chamber reaction ≥2+, chronic recurrent VKH, posterior synechiae, iris nodules, glaucoma, glaucoma surgery, choroidal neovascular membrane, "sunset glow fundus" and chorioretinal atrophy. Thirty-two eyes underwent cataract extraction. Fourteen (43.8%) eyes achieved ≥20/40. Posterior segment complications of chronic recurrent VKH accounted for <20/40 outcome. Conclusions : Poor outcome after surgery is secondary to posterior segment complications of chronic recurrent VKH.

Purpose: To investigate the expression of IL-11 and its receptor IL-11Rα and to quantify density of CD163 + M2 macrophages in proliferative diabetic retinopathy (PDR)., Methods: Vitreous samples from 29 PDR and 19 nondiabetic patients, epiretinal fibrovascular membranes from 15 patients with PDR and Müller cells were studied by enzyme-linked immunosorbent assay, immunohistochemistry and Western blot analysis., Results: We showed a significant increase in expression of IL-11, soluble(s) IL-11Rα, sCD163 and VEGF in vitreous samples from PDR patients compared to nondiabetic controls. Significant positive correlations were found between levels of VEGF and levels of IL-11 and sCD163. Significant positive correlations were found between microvessel density and number of blood vessels and stromal cells expressing IL-11, IL-11Rα and CD163 in PDR epiretinal membranes. The hypoxia mimetic agent cobalt chloride induced upregulation of IL-11 and IL-11Ra in cultured Müller cells., Conclusions: IL-11/IL-11Rα signaling and CD163 + M2 macrophages might be involved in PDR angiogenesis.

Purpose : To evaluate expression of cytokines GM-CSF, IL-11, IL-12p40, IL-12p70, IL-27p28, IL-35, APRIL, BAFF, TWEAK, and LIGHT in uveitis. Methods : Aqueous humor samples from patients with active uveitis associated with Behçet's disease (BD), sarcoidosis, HLA-B27-related inflammation, and Vogt-Koyanagi-Harada (VKH) disease and control patients were assayed with a multiplex assay. Results : Comparing all patients to controls, GM-CSF, IL-11, IL-12p40, APRIL, and BAFF were significantly increased, whereas LIGHT was significantly decreased. IL-11 and BAFF were the most strongly upregulated, being elevated 19.7-fold and 14.1-fold, respectively, compared with controls. IL-11 was significantly highest in HLA-B27 uveitis. GM-CSF, IL-11, and IL-12p40 were significantly higher in nongranulomatous uveitis (BD and HLA-B27) than in granulomatous uveitis (sarcoidosis and VKH), whereas APRIL and TWEAK were significantly higher in granulomatous uveitis. Conclusions : IL-11-driven immune responses might be more potent in nongranulomatous uveitis, particularly in HLA-B27 uveitis. BAFF and APRIL might contribute to B cell-driven autoimmune response in uveitis.

Purpose : High-mobility group box-1 (HMGB1) mediates inflammation and breakdown of blood-retinal barrier (BRB) in diabetic retina. Sirtuin-1 (SIRT1) has protective effects against inflammation and oxidative stress. The aim of this study was to investigate the interaction between HMGB1 and SIRT1 in regulating BRB breakdown in diabetic retina. Methods : BRB breakdown was assessed in vivo with fluorescein isothiocyanate-conjugated dextran. Vitreous samples from 47 proliferative diabetic retinopathy (PDR) and 19 nondiabetic patients, and epiretinal membranes from 13 patients with PDR were studied by enzyme-linked immunosorbent assay and immunohistochemistry. Retinas from 4-week diabetic rats and from normal rats intravitreally injected with HMGB1 were studied by spectrophotometric assay, Western blot analysis, and RT-PCR. We also studied the effect of the HMGB1 inhibitor glycyrrhizin and the SIRT1 activator resveratrol on diabetes-induced biochemical changes in the retina. Results : HMGB1 levels in vitreous samples from PDR patients were significantly higher than in nondiabetic controls, whereas SIRT1 levels were significantly lower in vitreous samples from patients with inactive PDR than those in patients with active PDR and nondiabetic controls. In epiretinal membranes, SIRT1 was expressed in vascular endothelial cells and stromal cells. Diabetes and intravitreal injection of HMGB1 in normal rats downregulated SIRT1expression, whereas glycyrrhizin and resveratrol normalized diabetes-induced downregulation of SIRT1. Resveratrol significantly attenuated diabetes-induced downregulation of occludin and upregulation of HMGB1 and receptor for advanced glycation end products in the retina and breakdown of BRB. Conclusions : Our findings suggest that a functional link between SIRT1 and HMGB1 is involved in regulating of BRB breakdown in diabetic retina.

Purpose : To investigate incidence, risk factors, and surgical outcomes of cataract among uveitis patients. Methods : Retrospective review of 1000 patients (1582 eyes). Results : At initial presentation, cataract was diagnosed in 290 (18.3%) eyes and was most common in eyes with anterior uveitis. Fuchs' uveitis, herpetic uveitis, and presumed tuberculous uveitis were leading clinical entities associated with cataract at presentation. During follow-up, cataract developed in additional 200 (12.6%) eyes and was most common in eyes with anterior uveitis. Significant risk factors at presentation included age >18 years, female gender, presence of keratic precipitates, hypopyon, and posterior synechiae. Among the 490 eyes with cataract, 204 underwent cataract extraction during follow-up period. Best corrected vision of ≥20/40 was achieved in 122 (60.1%) eyes. Conclusions : Incidence of cataract differed depending on anatomic and etiologic diagnoses of uveitis. There is a significant association between severity of inflammation at presentation and development of cataract.

Purpose: We investigated the expression of the proinflammatory and proangiogenic factor osteoprotegerin (OPG) and its ligands, receptor activator of nuclear factor-κB ligand (RANKL), tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), and the receptor RANK in proliferative diabetic retinopathy (PDR)., Materials and Methods: Vitreous samples from PDR and nondiabetic control patients and epiretinal membranes from PDR patients were studied by enzyme-linked immunosorbent assay, immunohistochemistry, and Western blot analysis., Results: Vascular endothelial growth factor, OPG, and soluble RANK levels in vitreous samples from PDR patients were significantly higher than that in nondiabetic controls. Soluble TRAIL levels were significantly lower in PDR patients than that in nondiabetic control, whereas soluble RANKL levels did not differ significantly. RANKL, RANK, and TRAIL were expressed in vascular endothelial cells, myofibroblasts, and CD45-expressing leukocytes in PDR epiretinal membranes., Conclusions: Dysregulated expression of OPG/RANKL/RANK pathway and TRAIL might be related to inflammation and angiogenesis in PDR.

Purpose: To investigate the expression of the leukocyte proteins myeloid-related protein (MRP)-8 and MRP-14 in proliferative diabetic retinopathy (PDR) and the effect of MRP-8/MRP-14 (calprotectin) heterodimer on induction of proinflammatory factors in human retinal microvascular endothelial cells (HRMEC)., Methods: Epiretinal membranes from 20 patients with PDR and 10 patients with proliferative vitreoretinopathy (PVR), vitreous fluid samples from PDR and non-diabetic subjects and HRMEC were studied by immunohistochemistry and Western blot analysis., Results: MRP-14 expression was localized in endothelial cells, leukocytes and myofibroblasts in all PDR membranes. MRP-8 expression was limited to intravascular leukocytes in 42% of the studied membranes. In PVR membranes, MRP-14 was expressed in leukocytes and myofibroblasts, whereas MRP-8 immunoreactivity was limited to leukocytes. MRP-14 was significantly upregulated in vitreous from PDR patients. MRP-8/MRP-14 (calprotectin) increased expression of intercellular adhesion molecule-1, but attenuated vascular cell adhesion molecule-1 expression in HRMEC., Conclusions: Increased MRP-14 levels are associated with inflammation in PDR.

Purpose: To investigate prognostic factors for retinal sensitivity assessed by microperimetry in patients with Vogt-Koyanagi-Harada (VKH) disease., Methods: In total, 34 patients with initial-onset acute disease and 19 patients with chronic recurrent disease were retrospectively evaluated., Results: The mean follow-up period was 40.4 ± 40.5 months. Sensitivity was significantly worse in eyes with more severe anterior segment inflammation at presentation, as indicated by the presence of mutton-fat keratic precipitates, anterior chamber reaction ≥2+, and posterior synechiae. Chronic recurrent presentation, development of complications, and 'sunset glow fundus' were significantly associated with worse sensitivity. Using logistic regression analysis, better sensitivity was significantly associated with initial-onset acute presentation (odds ratio, OR = 6.9; 95% confidence interval, CI = 1.53-9.66)., Conclusions: Chronic recurrent presentation and development of complications and 'sunset glow fundus' are associated with a worse sensitivity outcome.

Purpose: Selective proteolytic activation of protease-activated receptor-1 (PAR1) by thrombin and matrix metalloproteinase-1 (MMP-1) plays a central role in enhancing angiogenesis. We investigated the expression levels of thrombin, MMP-1, and PAR1 and correlated these levels with vascular endothelial growth factor (VEGF) in proliferative diabetic retinopathy (PDR). In addition, we examined the expression of PAR1 and thrombin in the retinas of diabetic rats and PAR1 in human retinal microvascular endothelial cells (HRMEC) following exposure to high-glucose, the proinflammatory cytokines interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and the hypoxia mimetic agent cobalt chloride (CoCl 2 )., Methods: Vitreous samples from 32 PDR and 23 nondiabetic patients, epiretinal membranes from 10 patients with PDR, retinas of rats, and HRMEC were studied by enzyme-linked immunosorbent assay (ELISA), immunohistochemistry, and Western blot analysis. An assay for in vitro cell migration angiogenesis was performed in HRMEC., Results: In epiretinal membranes, PAR1 was expressed in vascular endothelial cells, CD45-expressing leukocytes, and myofibroblasts. ELISA and Western blot assays revealed significant increases in the expression levels of thrombin, MMP-1, and VEGF in vitreous samples from PDR patients compared to nondiabetic controls. Significant positive correlations were found between the levels of VEGF and the levels of thrombin (r = 0.41; p = 0.006) and MMP-1 (r = 0.66; p < 0.0001). Significant increases of cleaved PAR1 (approximately 50 kDa) and the proteolytically active thrombin (approximately 50 kDa) were detected in rat retinas after induction of diabetes. The proinflammatory cytokines IL-1β and TNF-α, but not high-glucose and CoCl 2 , induced upregulation of cleaved PAR1 (approximately 30 kDa) in HRMEC. In addition, thrombin and MMP-1 induced VEGF in HRMEC and vorapaxar, a PAR1 inhibitor, inhibited thrombin-induced migration in HRMEC., Conclusions: Interactions among thrombin, MMP-1, PAR1, and VEGF might facilitate angiogenesis in PDR.

Purpose: To investigate the incidence and risk factors of secondary glaucoma among uveitis patients., Methods: Retrospective review of medical records of 642 patients (1220 eyes)., Results: Glaucoma was diagnosed in 169 (13.9%) eyes and was most common in eyes with anterior uveitis (19.1%) (p < 0.001). HLA-B27-positive anterior uveitis (27.6%), Fuchs' uveitis (23.3%), juvenile idiopathic arthritis (23.1%), herpetic uveitis (20.3%), and Vogt-Koyanagi-Harada disease (16.3%) were the leading clinical entities associated with glaucoma (p < 0.001). Significant risk factors at presentation included worse visual acuity, elevated intraocular pressure, keratic precipitates, granulomatous inflammation, anterior chamber reaction≥ 2+, posterior synechiae, and cataract. Female gender and iris nodules significantly predicted the need for glaucoma surgery. Visual outcome was worse in eyes with glaucoma than in eyes without glaucoma., Conclusions: Incidence of glaucoma differed depending on anatomic and etiologic diagnoses of uveitis. There is a significant association between severity of inflammation at presentation and development of glaucoma.

Purpose: To investigate the referral patterns and diagnosis of uveitis in a university-based tertiary referral center in Riyadh, Saudi Arabia., Methods: We retrospectively reviewed the medical records of 642 patients (1220 eyes)., Results: There were 295 (46%) males and 347 (54%) female patients, with a mean age of 36.4 ± 16.1 years at presentation. Panuveitis was most common (47.1%), followed by anterior uveitis (36.8%), posterior uveitis (10.7%), and intermediate uveitis (5.4%). Nongranulomatous (85.2%) and noninfectious (69.3%) were the most frequent types of uveitis. The most identifiable specific diagnoses were Vogt-Koyanagi-Harada (VKH) disease (19.6%), presumed tuberculous uveitis (PTU) (17.8%), Behçet disease (BD) (8.4%), and toxoplasmosis (6.9%). After a mean follow-up period of 31.3 ± 31.5 months, 73.5% of the eyes achieved visual acuity of 20/40 or better., Conclusions: The most common anatomic diagnosis was panuveitis. VKH disease, PTU, BD, and toxoplasmosis are the most frequently diagnosed entities.

Purpose/aim: Endocan is a proteoglycan specifically secreted by endothelial cells, is a marker of angiogenesis and endothelial cell activation in response to proangiogenic signals. The aim of this study was to measure the levels of endocan in the vitreous fluid from patients with proliferative diabetic retinopathy (PDR) and to correlate its levels with clinical disease activity and the levels of the angiogenic biomarkers vascular endothelial growth factor (VEGF), soluble vascular endothelial-cadherin (sVE-cadherin) and soluble endoglin (sEng). In addition, we investigated the expression of endocan and correlated it with the level of vascularization in PDR epiretinal membranes., Materials and Methods: Vitreous samples from 44 PDR and 29 non-diabetic patients were studied by enzyme-linked immunosorbent assay. Epiretinal membranes from 14 patients with PDR were studied by immunohistochemistry., Results: Endocan, VEGF, sVE-cadherin and sEng levels were significantly higher in PDR patients than in non-diabetic patients (p < 0.001; p = 0.002; p < 0.001; p = 0.001, respectively). Endocan levels were significantly higher in patients with active PDR than in patients with inactive PDR and non-diabetic patients (p < 0.001). There were significant positive correlations between endocan levels and the levels of VEGF (r = 0.574, p < 0.001) and sVE-cadherin (r = 0.498, p < 0.001). In epiretinal membranes, vascular endothelial cells and myofibroblasts expressed endocan. There was a significant positive correlation between the number of blood vessels expressing CD34 and the number of blood vessels expressing endocan (r = 0.933, p < 0.001)., Conclusions: Our findings suggest that upregulation of endocan expression in PDR could be a reflection of endothelial cell activation associated with angiogenesis.

Purpose: To assess long-term efficacy and safety of deep sclerectomy (DS) in uveitic glaucoma., Patients and Methods: Thirty-three consecutive eyes (21 patients) with uveitic glaucoma underwent DS with mitomycin C and implant. Goniopuncture (GP) was done for uncontrolled postoperative intraocular pressure (IOP)., Results: Mean (± SD) follow-up was 33.2 (± 19.8) months. IOP was reduced from a mean preoperative value of 37.2 to postoperative value of 14.7 mmHg (p < 0.0001). Complete success was achieved in 24/33 eyes (72.7%); qualified success was obtained in 7/33 eyes (21.2%). Neodymium:YAG GP was performed in 12 eyes. Postoperative complications included cataract progression in 9 eyes, transient hypotony in 6 eyes, shallow choroidal effusions in 4 eyes, hypotony with persistent maculopathy in 1 eye, hyphema in 1 eye, and decompression retinopathy in 1 eye., Conclusion: DS is safe and effective in patients with uveitic open-angle glaucoma. However, laser goniopuncture is frequently needed to improve the outcome.

Purpose: The expression of high-mobility group box-1 (HMGB1) is upregulated in epiretinal membranes and vitreous fluid from patients with proliferative diabetic retinopathy and in the diabetic retina. HMGB1 mediates inflammation, breakdown of the blood-retinal barrier and apoptosis in the diabetic retina. Here, we investigated inflammatory and angiogenic signaling pathways activated by HMGB1 in diabetic retina., Methods: Human retinal microvascular endothelial cells (HRMEC) and retinas from 1-month diabetic rats and normal rats intravitreally injected with HMGB1 were studied using RT-PCR, Western blot analysis and co-immunoprecipitation. We also studied the effect of the HMGB1 inhibitor glycyrrhizin on diabetes-induced biochemical changes in the retina., Results: Diabetes and intravitreal injection of HMGB1 in normal rats induced significant upregulation of the mRNA levels of the chemokine stromal cell-derived factor-1 (SDF-1/CXCL12) receptor CXCR4 and protein levels of hypoxia-inducible factor-1α, early growth response-1, tyrosine kinase 2 and the CXCL12/CXCR4 chemokine axis. Constant glycyrrhizin intake from onset of diabetes did not affect the metabolic status of the diabetic rats, but it restored these increased mediators to control values. Stimulation of HRMEC with HMGB1 and intraviteral injection of HMGB1 significantly increased the expression of vascular endothelial growth factor (VEGF) and VEGF receptor-2. Co-immunoprecipitation studies showed that diabetes increased the interaction between CXCL12 and CXCR4 and between HMGB1 and receptor for advanced glycation end products (RAGE), but not between HMGB1 and the CXCL12/CXCR4 chemokine axis., Conclusions: Our findings suggest that HMGB1 activates inflammatory and angiogenic signaling pathways in diabetic retina mediated by RAGE.

Ocular involvement in Behçet disease (BD) is characterized by recurrent inflammatory attacks and spontaneous resolution of acute inflammatory signs. Both frequency and severity of uveitis attacks determine the magnitude of irreversible damage to intraocular structures and long-term visual prognosis. Recurrent attacks of occlusive retinal vasculitis lead to vision-threatening complications such as cystoid macular edema, retinal neovascularization, optic atrophy and retinal atrophy. This manuscript updates about the role of various drugs in the management of BD, discussing corticosteroids, disease modifying immunosuppressive drugs, and finally biologicals (anti-TNF-blocking agents and alpha interferon) which seem to be superior compared to all other available drugs in preventing loss of vision. Also recent findings from new biologicals will be summarized, and especially the role of these drugs in children will be discussed in detail. The authors suggest that at least moderate to severe retinal involvement should become treated with biologicals whenever available.

Purpose: To assess long-term efficacy and safety of infliximab for refractory Behçet disease (BD) uveitis and to evaluate the effect of withdrawal of infliximab after achieving long-term remission., Methods: Retrospective study of 19 patients., Results: Mean follow-up was 44.1 ± 36.5 months and mean number of infliximab infusions was 21.6 ± 14.6. At end of follow-up, there was significant improvement of visual acuity and reduction of central macular thickness. All patients achieved remission, 14 of whom were able to discontinue corticosteroids. Ten patients developed autoantibodies and 1 patient developed infusion reactions. Eight eyes underwent intraocular surgery without exacerbation of quiescent uveitis. After achieving complete remission, 5 patients discontinued infliximab and maintained remission during a mean of 24.6 ± 5.5 months., Conclusions: Infliximab is effective and safe for long-term treatment for refractory BD uveitis. Repeated infusions are required to maintain long-term remission, which may be sustained despite withdrawal of infliximab. Induction of autoantibodies is common.

Purpose: To analyze clinical patterns, causes, and systemic disease associations among patients with uveitis admitted to King Abdulaziz University Hospital., Methods: The authors retrospectively reviewed the medical records of 351 patients (600 eyes)., Results: The study subjects consisted of 183 (52.1%) males and 168 (47.9%) females, with a mean age of 39.9 ± 14.2 years at presentation. The most common anatomic diagnosis was panuveitis (68.6%), followed by posterior uveitis (12.7%), anterior uveitis (12.7%), and intermediate uveitis (6.0%). The most common identifiable specific diagnoses were presumed tuberculous uveitis (PTU) (28.2%), Vogt-Koyanagi-Harada (VKH) disease (19.4%), Behçet disease (BD) (12.5%), and toxoplasmosis (8.2%). After a mean follow-up period of 29.5 ± 22.1 months, 63.5% of the eyes achieved visual acuity of 20/40 or better. Eyes from patients with PTU had the worst final visual outcome., Conclusions: The most common anatomic diagnosis was panuveitis. PTU, VKH disease, BD, and toxoplasmosis were the most frequent specific diagnoses.

Purpose: To identify the microbiological spectrum and visual outcome of bleb-associated endophthalmitis., Methods: The medical records of patients treated for bleb-associated endophthalmitis were reviewed., Results: Seventy-five patients were identified. Vitreous cultures were positive in 48 (64%) patients. The most common isolates were Streptococcus species in 24 (50%) eyes, gram-negative bacteria in 10 (20.8%) eyes, and Staphylococcus epidermidis in 7 (14.6%) eyes. Good visual outcome was achieved in 33 (44%) patients. On univariate analysis, shorter interval from onset of symptoms and treatment (p = .005), better initial visual acuity (p = .004), clear cornea at presentation (p = .048), isolation of less virulent organisms (p < .001), and absence of diabetes mellitus (p = .048) were significant positive predictors for good visual outcome., Conclusions: Bleb-associated endophthalmitis is associated with severe visual impairment. Clinical features associated with better visual outcome include early presentation, better presenting visual acuity, clear cornea at presentation, culture of a less virulent organism, and absence of diabetes mellitus.

Purpose: To identify the microbiological spectrum and visual outcome of exogenous infectious endophthalmitis in the pediatric age group., Methods: We reviewed the medical records of all children 14 years and younger with culture-positive endophthalmitis treated at King Khaled Eye Specialist Hospital and King Abdulaziz University Hospital between January 1, 1980, and December 31, 2004., Results: Forty-nine children were identified. There were 32 males and 17 females with a mean age of 5.7 +/- 2.8 years (range 1-13 years). Thirty-five (71.4 %) cases occurred after penetrating open globe injuries and the remaining 14 (28.6%) followed ocular surgery. Primary vitrectomy was performed on 29 (59.2%) eyes. The mean follow-up was 28.4 +/- 28.4 months (range 1.2-98.5 months). A single species was isolated in 42 (85.7%) eyes, and multiple organisms in seven (14.3%) with a total of 56 infecting organisms. The most common isolates were Streptococcus species and coagulase-negative Staphylococci comprising 44.6% and 21.4% of the isolates, respectively. Final visual acuity was 20/200 or better in 15 (34.1%), counting fingers in 8 (18.2%), light perception to hand motions in 8 (18.2%), no light perception in 13 (29.5%) eyes, including 3 that have been enucleated or eviscerated, and not available in 5 patients. None of the children who had nonvirulent organisms had a final visual acuity of no light perception compared with 39.4% of children who had virulent organisms (p = 0.011). Visual outcome of counting fingers was attained in 26% of children who were treated with primary vitrectomy compared with 5.9% of children treated with antibiotics alone on presentation (p = 0.0484). Visual outcome was no light perception in 18.5% of children who underwent primary vitrectomy compared with 47.1% of children treated with antibiotics alone., Conclusions: The most common organisms identified were Streptococcus species and coagulase-negative Staphylococci. Culture of a nonvirulent organism, and treatment with primary vitrectomy were associated with better visual outcomes. Visual outcomes were generally poor.

Retinal vasculitis is a sight-threatening intraocular inflammation affecting the retinal vessels. It may occur as an isolated ocular condition, as a manifestation of infectious or neoplastic disorders, or in association with a systemic inflammatory disease. The search for an underlying etiology should be approached in a multidisciplinary fashion based on a thorough history, review of systems, physical examination, and laboratory evaluation. Discrimination between infectious and noninfectious etiologies of retinal vasculitis is important because their treatment is different. This review is based on recently published articles on retinal vasculitis and deals with its clinical diagnosis, its link with systemic diseases, and its laboratory investigation.

Purpose: To characterize the extracellular matrix and cellular components of a 'snowbank' removed during vitreous surgery for treatment of retinal detachment complicating pars planitis., Methods: The 'snowbank' was examined using immunohistochemical techniques and a panel of monoclonal and polyclonal antibodies directed against glial fibrillary acidic protein (GFAP), cytokeratin, alpha smooth muscle actin, tenascin, laminin, fibronectin, and collagen types I, II, and III., Results: The 'snowbank' was acellular except on the uveal side where there were cytokeratin-positive retinal pigment epithelial cells. There were no cells positive for the glial cell marker GFAP and the myofibroblast cell marker alpha smooth muscle actin. The extracellular matrix of the 'snowbank' contained tenascin and collagen types I, II, and III. There was no immunoreactivity for laminin and fibronectin., Conclusion: These results on the immunohistochemical components of the 'snowbank' may be useful in clarifying the nature of the chronic inflammatory process in pars planitis. They indicate extensive tissue repair and remodeling, leading to major loss of function.