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Purpose Current treatment paradigms for macular edema associated with retinal vein occlusions (RVO) often involve initial treatment with anti-vascular endothelial growth factor (VEGF) agents, then switching to intravitreal dexamethasone implant (IDI; Ozurdex, Allergan, Parsippany, NJ) for poor responders. However, many patients undergo multiple injections prior to being declared a nonresponder. We devised a method for prediction of poor anti-VEGF response after one injection, and show that these patients subsequently respond well to IDI. Methods This study is a retrospective consecutive interventional case series of patients with RVO receiving anti-VEGF agents that were switched to IDI. Patients were categorized as nonresponders to anti-VEGF agents (edema did not improve) or responders (edema improved, but switched to IDI for longer treatment duration). Receiver operating characteristics (ROC) curve analysis was used to determine cutoffs of reduction in central retinal thickness (CRT) to predict poor response to anti-VEGF treatment. Results Twenty-three patients met inclusion criteria. There were 14 nonresponders and 9 responders. The ROC curve analysis found that the maximal sensitivity and specificity in correctly identifying responders to anti-VEGF therapy was those with >25% reduction in CRT 1 month after 1 anti-VEGF treatment (sensitivity 0.89, specificity 0.79, area under the curve 0.93). After IDI placement, anti-VEGF nonresponders showed significant improvement in visual acuity (VA) (p = 0.02) and CRT (p = 0.01). Conclusions In patients with macular edema secondary to RVOs, a reduction in CRT by ≤25%, 1 month after 1 anti-VEGF injection, is predictive of poor response to anti-VEGF treatment. These patients may benefit from earlier conversion to IDI treatment, which in our study, resulted in improved VA and CRT.

To study prognostic spectral domain optical coherence tomography parameters in diabetic cystoid macular edema after anti-vascular endothelial growth factor therapy.Retrospective cohort study included 49 eyes with the new onset diabetic cystoid macular edema that had to have a macular spectral domain optical coherence tomography and fluorescein angiography at presentation. The baseline optical coherence tomography scans were analyzed for variables indicative of the extent of retinal involvement by the cystoid change and its location about the center. Univariate and multivariate analyses were performed comparing the optical coherence tomography findings between the two groups of eyes: the "No improvement" and the "Improvement" groups, based on at least two Snellen lines improvement after treatment.There were 30 and 19 eyes in the No improvement and Improvement groups, respectively. In the univariate analysis, the baseline optical coherence tomography parameters associated with visual improvement included the photoreceptor inner segments thickness centrally (P = 0.009) and within the central 1-mm subfield (P0.0001), and the presence of bridging retinal processes centrally (P = 0.004). Multivariate analysis showed both presence and central location of bridging retinal processes within the central 1-mm subfield to be significantly associated with visual improvement (P = 0.041 and 0.005, respectively), with an odds ratio of 13.4 (95% confidence interval, 1.336-636.18; P = 0.010) for their central location.In diabetic cystoid macular edema, visual improvement after anti-vascular endothelial growth factor therapy is more likely to occur in eyes with residual central retinal processes on baseline macular spectral domain optical coherence tomography. This finding may be helpful in patient counseling, case selection, and clinical trial planning.

Diabetic retinopathy (DR) is the most common complication of diabetes. It causes vision loss, and the incidence is increasing with the growth of the diabetes epidemic worldwide. Over the past few decades a number of clinical trials have confirmed that careful control of glycemia and blood pressure can reduce the risk of developing DR and control its progression. In recent years, many treatment options have been developed for clinical management of the complications of DR (e.g., proliferative DR and macular edema) using laser-based therapies, intravitreal corticosteroids and anti-vascular endothelial growth factors, and vitrectomy to remove scarring and hemorrhage, but all these have limited benefits. In this review, we highlight and discuss potential molecular targets and new approaches that have shown great promise for the treatment of DR. New drugs and strategies are based on targeting a number of hyperglycemia-induced metabolic stress pathways, oxidative stress and inflammatory pathways, the renin-angiotensin system, and neurodegeneration, in addition to the use of stem cells and ribonucleic acid interference (RNAi) technologies. At present, clinical trials of some of these newer drugs in humans are yet to begin or are in early stages. Together, the new therapeutic drugs and approaches discussed may control the incidence and progression of DR with greater efficacy and safety.

A population-based survey of the prevalence of major causes of blindness and visual impairment was conducted in Bisha region, Saudi Arabia. Overall, 2882 people were examined. The prevalence of blindness (visual acuity of < 3/60 in the better eye with best available correction) was 0.7% and the prevalence of visual impairment (visual acuity < 6/12 but ≥ 3/60 in the better eye with best available correction) was 10.9%. Cataracts were responsible for 52.6% of blindness and 20.6% of visual impairment. Refractive errors accounted for 67.9% of visual impairment. Proper management of cataracts and correction of refractive errors will cure 73.6% of blind subjects and 88.5% of visually handicap people in this part of the world.

In early summer, 1990, 3590 schoolboys from the Al-Baha region of Saudi Arabia were assessed for their ocular status. Children from 15 schools were randomly selected to assess eye problems and visual defects. Of the boys examined 3521 (89.7%) had visual acuity of 20/30 or better and 3443 (95.9%) achieved 20/30 or better after correction. The main causes of visual impairment were refractive error in 260 (7.2%) and amblyopia in 58 (1.6%). Seventeen (0.5%) boys had strabismus. Vernal keratoconjunctivitis was found in 204 (5.7%). Four hundred and forty-nine (26.4%) had nonspecific conjunctivitis, 173 (4.8%) had bacterial conjunctivitis, and 28 (0.8%) had blepharitis. Of the five geographical areas surveyed, trachoma was only found in the Aqeek area among 49 (1.4%) schoolboys. Earlier detection and treatment of visual impairment is of paramount importance in decreasing the rate of visual loss among schoolchildren.

We investigated the efficacy of cyclocryotherapy, a procedure which destroys the ciliary epithelium, thereby decreasing the production of aqueous humor, by retrospectively studying 109 eyes with advanced primary congenital glaucoma that had undergone the procedure. The eyes were divided into two groups: group I comprised 75 eyes (69%) that had undergone conventional surgical procedures for congenital glaucoma prior to cyclocryotherapy; group II, 34 eyes (31%) that had not undergone any such previous procedures. All eyes were followed for at least 12 months after the last cyclocryotherapy. With "success" defined as "having an IOP greater than or equal to 8 mmHg, greater than or equal to 19 mmHg with or without medication," the success rate in all eyes was 30%, with no significant difference between the success rates in groups I and II (P greater than .05). Chronic hypotony (IOP less than 8 mmHg) was found in seven eyes (6%). Six eyes (6%) developed cataract during the course of treatment with cyclocryotherapy. Cyclocryotherapy appears to be a reasonable addition to the treatment of eyes with advanced, uncontrolled, primary congenital glaucoma.

Acute hemorrhagic conjunctivitis (AHC) is a viral infection caused by enterovirus type 70 but can occasionally be caused by coxsackie virus type A-24. We report an epidemic of AHC in Gizan which, t...

A 17-year-old female patient was examined and found to have Brucella-sp.-induced endophthalmitis in her left eye. The specific organism was Brucella melitensis, biotype 3, a known virulent organism. Serum agglutination titres from two independent laboratories were positive, yet of different levels: 1:320 and 1:1,280. Although brucellosis is thought to be eradicated in many countries, it prevails in agrarian environments, where it can be transmitted to man. This report is the first evidence to confirm that B. melitensis is a definitive causative organism of endogenous ocular infection.

Cataract is the leading cause of blindness in Saudi Arabia. The author studied 1383 patients who had undergone cataract extraction (total of 1520 procedures) from October 1985 to March 1986 at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. All patients were observed for at least two months. Of 1520 eyes 555 (37%) achieved a visual acuity of 20/40 or better, 309 (20%) a visual acuity of 20/50-20/60 after surgery, and 656 (43%) eyes a visual acuity of 20/70 or less. The number of eyes that had intraoperative complications was 176 (12%). The number of eyes that had postoperative complications was 539 (35%). Some eyes had more than one complication. The main factors responsible for failure to achieve visual acuity of 20/40 or better were: (1) error of refraction in 492 (32%) eyes; (2) pre-existing corneal scarring and opacity in 211 (14%) eyes; (3) climatic droplet keratopathy in 134 (9%); and (4) presumed visual loss due to glaucoma in 134 (9%) eyes.

Secondary cysts of the iris or anterior chamber follow penetrating trauma or surgery of the cornea. These can lead to some serious complications. We describe a case of an intraocular implantation dermoid cyst of the iris that followed a perforating injury of the cornea in a seven-year old Saudi child. The cyst was surgically removed and proved histologically.

Trachoma remains one of the world's leading causes of blindness. A population based survey of the prevalence of trachoma was conducted in the South Western part of Saudi Arabia in the period of between July and November 1991. Overall, 7126 people were examined. Of these, 19 (0.26%) persons had active trachoma and 35 (0.5%) people had inactive trachoma. Sequelae of trachoma included conjunctival scarring, trichiasis and corneal scarring. Among 635 subjects with visual impairment, 6 (0.95%) patients had visual impairment due to trachoma. Trachoma does not seem to be a major ophthalmic problem in this area and proper management of the complications of trachoma will exclude it from the causes of blindness and visual impairment in this part of Saudi Arabia.

The authors studied 1,681 consecutive patients who attended their ophthalmic outpatient clinics over a period of 12 months to determine the patients' visual acuity status and the causes of any visual loss. Using the World Health Organization criteria for definition of visual acuity status, 1004 (59.7%) patients had normal vision. Four hundred and thirty-one (25.6%) patients had low vision or visual impairment and 246 (14.6%) patients were blind. Twenty-eight (1.9%) patients had no light perception in both eyes. Cataract, both in isolation and co-existing with other ocular pathology, was the major cause of both low vision and blindness (58.5% and 81.7%, respectively). A concerted attack on cataract alone will markedly reduce blindness and low vision in this region.

Background: Eyelids of patients with trachoma may be thickened. This thickening could be attributed to trachomatous changes in the conjunctiva and tarsus. Methods: Biopsies of tarsal plates and palpebral conjunctivae were obtained from 17 upper eyelids of 11 patients with inactive trachoma who underwent posterior tarsotomy procedures for entropion repair. Results: Light microscopy studies showed a thick and compact subepithelial fibrous membrane adherent to the tarsal plate. This membrane caused apparent thickening of the tarsus when measured intraoperatively (range, 1.25–2.00 mm). Other histopathologic findings include atrophy of the meibomian glands with thickening of the acinar basement membrane, loss of goblet cells, retention cysts, and hyaline degeneration of the tarsal plate with focal replacement by adipose tissue. Conclusion: The contraction of the subepithelial fibrous membrane formed by vertically oriented parallel collagen fibers is one of the main factors contributing to the entropion formation.

We studied 39 blind painful eyes in 39 patients who were treated with retrobulbar injection of absolute (96%) alcohol for their severe ocular pain at the King Khaled Eye Specialist Hospital from January 1984 to January 1987. There were 21 (54%) male and 18 (46%) female patients; all were followed for at least three months. The protracted ocular pain was mainly due to: end-stage (absolute) glaucoma in 31 (80%) eyes, uveitis or endophthalmitis in four (10%) eyes, or corneal ulcer in two (5%) eyes. One eye had painful phthisis bulbi, and one eye had infraorbital neuralgia. The complications encountered were transient and included blepharoptosis in eight (21%) eyes, external ophthalmoplegia, and corneal epithelial defect. The effective time of the injection to relieve pain ranged from two weeks to two years (mean, 29 weeks). The authors believe that there is still a place for retrobulbar alcohol injection for blind painful eyes when enucleation or evisceration is not possible.

We investigated the efficacy of cyclocryotherapy, a procedure which destroys the ciliary epithelium, thereby decreasing the production of aqueous humor, by retrospectively studying 109 eyes with advanced primary congenital glaucoma that had undergone the procedure. The eyes were divided into two groups: group I comprised 75 eyes (69%) that had undergone conventional surgical procedures for congenital glaucoma prior to cyclocryotherapy; group II, 34 eyes (31%) that had not undergone any such previous procedures. All eyes were followed for at least 12 months after the last cyclocryotherapy. With "success" defined as "having an IOP greater than or equal to 8 mmHg, greater than or equal to 19 mmHg with or without medication," the success rate in all eyes was 30%, with no significant difference between the success rates in groups I and II (P greater than .05). Chronic hypotony (IOP less than 8 mmHg) was found in seven eyes (6%). Six eyes (6%) developed cataract during the course of treatment with cyclocryotherapy. Cyclocryotherapy appears to be a reasonable addition to the treatment of eyes with advanced, uncontrolled, primary congenital glaucoma.