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Introduction: Calciphylaxis is a condition that causes vascular calcification and intimal proliferation with thrombotic occlusion of small-to-medium-sized vessels. Case Presentation: We describe a case of a 64-year-old woman who presented with a clinical picture that was suggestive of anterior arteritic ischemic optic neuropathy due to giant cell arteritis (GCA), but was found to have calciphylaxis confirmed by histologic examination. When calciphylaxis affects the blood supply to the eye, commonly it causes sudden vision loss, pallid optic disk edema, and a relative afferent pupillary defect, all of which were observed in our patient. Conclusion: There is no known cure for calciphylaxis, while in GCA, high-dose corticosteroid therapy is essential to prevent involvement of the contralateral eye. As the management approaches for these two diseases are different, it is important to have performed a thorough clinical examination along with detailed histopathological testing to rule out calciphylaxis of the temporal artery in patients suspected to have GCA.

The aim of this study was to report a unique case of microsporidial keratitis over deep anterior lamellar keratoplasty after transepithelial photorefractive keratectomy surgery that was successfully treated with therapeutic lamellar keratoplasty without recurrence at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia. The patient presented with recurrent attacks of eye pain, redness, photophobia, and decreased vision. The patient was initially treated as a case of presumed herpetic keratouveitis using antiviral medication and topical steroids with partial improvement. During the last episode, the condition deteriorated and patient underwent therapeutic lamellar keratoplasty. Histopathology indicated an infected graft with evidence of microsporidial infection. The patient was discharged with complete corneal epithelial healing and no signs of recurrence during follow-up. Microsporidial infection is a rare cause of stromal keratitis that affects both immunocompetent and immunosuppressed patients. Microsporidia should be suspected after surface ablation refractive surgery if the patient presents with recurrent symptoms of keratoconjunctivitis or stromal keratitis that are partially responsive to topical steroid therapy.

OBJECTIVES: The objective of this study was to estimate the prevalence and risk factors of methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) carriers among staff of a tertiary eye hospital in Saudi Arabia. METHODS: This retrospective study was conducted in 2019. Nasal and axillary swabs of health-care staff were used to determine carriers of MRSA. Bacteria were identified by culture and sensitivity tests. These isolates were grouped as antibiotic resistant, sensitive, and others not in the S. aureus group. Demographics and other determinants were associated with carrier status. RESULTS: We evaluated the carrier status of 430 staff. There were 110 (24.9%; 95% confidence interval [CI]: 21.5, 29.7) S. aureus-positive staff, 21 (11.7%; 95% CI: 11.7, 26.4) of who carried the MRSA strain. Carrier status was significantly higher among physicians (31%) compared to nurses (22.5%) and other staff (5.7%) (P < 0.001). MRSA carrier status was significantly associated with >5 years of employment at the eye hospital (P = 0.02). MRSA was significantly associated with staff who were of Indian nationality (75%) compared to other nationalities (P = 0.04) and those who were at the hospital for

Juvenile xanthogranuloma (JXG) is an idiopathic granulomatous inflammatory condition that usually affects children. Intraocular involvement, especially bilateral, is rare in JXG. Most patients with ocular lesions are typically infants and usually present with hyphema, iridocyclitis, and secondary glaucoma. We report a case of a 3-month-old baby girl who presented to our emergency department with bilateral hyphema that started 3 weeks ago. She was medically free with no history of any recent trauma or preceding febrile illness. General physical examination showed a quiet baby with multiple hyperpigmented macules over the inner thigh and right upper arm, with one pinkish nodule over the occiput. She also had high intraocular pressures. A detailed ophthalmic assessment was done under general anesthesia. The nodular lesion was excised and sent for histopathological evaluation, which confirmed the diagnosis of JXG. Treatment of JXG cases present a challenge to ophthalmologist due to rebleeding and refractory glaucoma. Our case was admitted multiple times for rebleeding and refractory glaucoma and was treated with full antiglaucoma drops, steroid drops and peribulbar injection of steroid.

Oncocytoma of the lacrimal sac is an extremely rare tumor. In this report, we present the case of an 82-year-old woman who presented with swelling in the region of the lacrimal sac. Systemic examination and ophthalmic examination of both eyes were unremarkable. Computed tomography of the brain and orbits revealed a mass lesion involving the right lacrimal sac with expansion of the related nasolacrimal duct. Neither bone destruction nor tissue invasion was observed. Right external dacryocystectomy and debulking of the tumor were performed. Histopathological examination of the surgical specimen showed oncocytic cells arranged in an adenomatous fashion, and a diagnosis of benign oncocytoma was made. Three years later, the same patient presented with a similar complaint that was pathologically proven to be a recurrent benign oncocytoma of the lacrimal sac.

Purpose: To provide clinical and pathological features of posterior persistent fetal vasculature (PFV) presenting with vitreous hemorrhage. Observations: Case 1 was a one-year old male with PFV reaching up to the posterior lens capsule. Case 2 and 3 both had history of blunt trauma. B-scans in cases 2 and 3 revealed vitreous hemorrhage and an intravitreal tissue attached to the optic disc. Pre-operative visual acuity in cases 1, 2 and 3 was undetermined due to age, hand motion and light perception, respectively. During vitrectomy, a fibrotic stalk attached to the optic nerve was removed, which consisted of fibrovascular tissue enveloping pockets of hemorrhage histopathologically. The fibrovascular tissue contained smooth muscle actin (SMA) positive spindle-shaped myofibroblasts in one case and hemosiderin-laden macrophages in another case. Glial fibrillary acidic protein (GFAP) stain was focally positive in two specimens. The proliferation index was low using Ki-67 stain in all cases. Post-operative visual acuity in case 3 remained unchanged, while improved in case 2 from hand motion to 20/70. There was no recurrence of the vitreous hemorrhage. Conclusion and Importance: Vitreous hemorrhage may occur in cases of PFV with or without history of blunt trauma. Hemorrhage within the persistent fetal vasculature may become organized with reactive process in the hyaloid stalk. The fibrovascular stalk contained astrocytes and myelofibroblasts which contribute to the formation and contractile function of PFV, respectively. The outcomes following vitrectomy seemed to be satisfactory.

Purpose: We report 6 patients who received a hydroxyapatite (HA) orbital implant in the socket and developed chronic orbital inflammation unresponsive to conventional medical therapy. Case Reports: We assisted 6 cases (4 males, 2 females) who received an HA orbital implant in the socket between 2015 and 2016 at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, and developed chronic orbital inflammation with chronic discharge, redness, and pain (onset from weeks to over 2 decades after surgery). Computed tomography evaluation indicated inflammation in the orbital tissues, and histological examination showed a foreign body granulomatous reaction mainly localized around and blanching the HA implant. The condition was unresponsive to usual medical treatment and was resolved immediately after implant removal. Conclusions: Chronic inflammation can occur decades after placement of an HA implant in the orbit and can be successfully treated with implant removal.

Two case reports are used to illustrate the signs and symptoms, complications and treatments of chronic socket inflammation due to intraorbital implants. The ophthalmic examination, surgeries and treatments are documented. Two anophthalmic cases that underwent enucleation and multiple orbital surgeries to enhance the anophthalmic socket volume developed pain, intense discharge and contracted cavities with chronic inflammation in the socket which was nonresponsive to medical therapy. Computed tomography indicated a hypodense foreign body in both cases causing an intense inflammatory reaction. The implants were removed by excisional surgery and a room temperature vulcanized silicone implant was retrieved in both cases. Socket inflammation resolved in both cases after implant removal. An intraorbital inflammatory reaction against an intraorbital implant can cause chronic socket inflammation in patients with a history of multiple surgeries. Diagnosis requires imaging and the definitive treatment is implant removal.

Impervious encapsulation around Ahmed glaucoma valve (AGV) results in surgical failure raising intraocular pressure (IOP). Dysregulation of extracellular matrix (ECM) molecules and cellular factors might contribute to increased hydraulic resistance to aqueous drainage. Therefore, we examined these molecules in failed AGV capsular tissue. Immunostaining for ECM molecules (collagen I, collagen III, decorin, lumican, chondroitin sulfate, aggrecan and keratan sulfate) and cellular factors (αSMA and TGFβ) was performed on excised capsules from failed AGVs and control tenon's tissue. Staining intensity of ECM molecules was assessed using Image J. Cellular factors were assessed based on positive cell counts. Histopathologically two distinct layers were visible in capsules. The inner layer (proximal to the AGV) showed significant decrease in most ECM molecules compared to outer layer. Furthermore, collagen III (p = 0.004), decorin (p = 0.02), lumican (p = 0.01) and chondroitin sulfate (p = 0.02) was significantly less in inner layer compared to tenon's tissue. Outer layer labelling however was similar to control tenon's for most ECM molecules. Significantly increased cellular expression of αSMA (p = 0.02) and TGFβ (p = 0.008) was detected within capsular tissue compared to controls. Our results suggest profibrotic activity indicated by increased αSMA and TGFβ expression and decreased expression of proteoglycan (decorin and lumican) and glycosaminoglycans (chondroitin sulfate). Additionally, we observed decreased collagen III which might reflect increased myofibroblast contractility when coupled with increased TGFβ and αSMA expression. Together these events lead to tissue dysfunction potentially resulting in hydraulic resistance that may affect aqueous flow through the capsular wall.