Abdullah Al-Assiri

Deep anterior lamellar keratoplasty for keratoconus.

Purpose: To assess the endothelial toxicity and the microbiological efficacy of moxifloxacin (250 μg/mL) as an additive to Optisol-GS®. Methods: Five hundred nine donor rims were studied. One half of each donor rim was placed in standard Optisol-GS® and the other half of the rim in Optisol-GS® fortified with moxifloxacin (250 μg/mL). All rims were refrigerated for 24 hours at 3°C and placed in thioglycolate broth and incubated at 37°C for 7 days. One pair of donor buttons not used in transplantation stored in each solution was examined for endothelial changes by using electron microscopy (EM). A second pair of cornea buttons was examined for toxicity by endothelial staining with 0.3% trypan blue and 0.2% alizarin red. All endothelial cells that stained (nonviable cells) and nonstained cells (viable cells) were counted, and the ratio of nonviable cells was calculated. Results: The rate of culture-positive donor rims in the Optisol-GS® group was 11.9% (61/509) and in the moxifloxacin-fortified Optisol-GS® media was 2.5% (13/509). The difference was statistically significant (P < 0.01; χ2 test). There was no difference in the cellular morphology of the button stored in moxifloxacin-fortified Optisol-GS® compared with Optisol-GS® using EM. In the bioassay, the rate of nonviable cells in the moxifloxacin-fortified media compared with the control media was nonsignificant (P > 0.05). Conclusion: Moxifloxacin (250 μg/mL) seems to be safe as an additive agent for cornea storage media. It significantly reduces the rate of positive rim cultures and shows no signs of endothelial cytotoxicity as viewed by EM and by a bioassay of trypan blue and alizarin red.

Acute-onset nosocomial endophthalmitis after cataract surgery: incidence, clinical features, causative organisms, and visual outcomes.

PURPOSE: To estimate the incidence of acute‐onset endophthalmitis after cataract surgery and to report its clinical features, microbiology, and final visual outcomes. SETTING: King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. METHODS: This was a retrospective observational case series. RESULTS: The 10‐year incidence of acute‐onset endophthalmitis after cataract surgery was 0.068%: 0.049% for extracapsular cataract extraction (ECCE) and 0.085% for clear corneal phacoemulsification (P = .268). The incidence of endophthalmitis was 0.053% during the first 5 years of the study and 0.08% during the next 5 years. The most common presenting features were pain and poor red reflex. Of the 20 cases, 18 were culture positive. The culture isolates showed Staphylococcus species in 7 eyes (35%), Streptococcus species in 7 eyes (35%), polymicrobial or mixed infections in 3 eyes (15%), and Propionibacterium acnes in 1 eye (5%). Two patients (10%) achieved a final visual acuity of 20/40 or better, 5 (25%) had worse than 20/40 to better than 20/200, and 8 (40%) had worse than 20/200; 5 eyes (25%) were eviscerated. Visual outcomes were good in endophthalmitis cases after phacoemulsification and in cases caused by Staphylococcus epidermidis and worse in cases that had Streptococcus species endophthalmitis. CONCLUSIONS: Clear corneal phacoemulsification had a 1.73‐fold higher risk for acute endophthalmitis than ECCE. Although the incidence of endophthalmitis after ECCE was lower than after phacoemulsification, the outcome was much worse in post‐ECCE endophthalmitis cases. Poor visual outcomes were associated with more virulent organisms and delayed presentation.

Late-onset donor-to-host transmission of Candida glabrata following corneal transplantation.

Objective: To demonstrate the potential value of obtaining routine fungal cultures of donor rims at the time of corneal transplantation and instituting prophylactic therapy in culture-positive cases, even in the absence of clinical evidence of established microbial keratitis or endophthalmitis. Methods: Interventional case report and literature review. Results: A 69-year-old Saudi man underwent penetrating keratoplasty with donor tissue that was culture-positive for Candida glabrata. The postoperative course was complicated by slight override of the graft associated with an associated epithelial defect, but there was no evidence of microbial keratitis or significant anterior chamber inflammation. Following repair of the graft override on postoperative day 42, the epithelial defect healed. The subsequent clinical course was unremarkable until postoperative day 146, when a deep stromal infiltrate was present at the graft-host junction, associated with a dense endothelial plaque. Cultures of the anterior chamber were positive for Candida glabrata. Treatment with topical and intracameral amphotericin B and systemic fluconazole, along with topical corticosteroids and intracameral t-PA, was successful in eradicating the corneal infiltrate and resolving intraocular inflammation. Four months after treatment was initiated, there was no evidence of recurrent fungal keratitis or endophthalmitis. Conclusion: This case provides support for the practice of obtaining routine fungal cultures of donor rims at the time of corneal transplantation and for the implementation of prophylactic antifungal therapy in culture-positive cases.

Incidence, clinical features, causative organisms, and visual outcomes of delayed-onset pseudophakic endophthalmitis.

Purpose To report the incidence, clinical features, causative organisms, and visual outcomes associated with delayed-onset pseudophakic endophthalmitis. Methods We retrospectively reviewed the clinical records and microbiology files of all patients with culture-proven endophthalmitis that was present 6 weeks or more after cataract extraction and posterior chamber intraocular lens (IOL) implantation who were treated at King Khaled Eye Specialist Hospital (KKESH) during a 10-year period. Results From January 1997 through December 2006, 17 patients with culture-proven, delayed-onset pseudophakic endophthalmitis were treated at KKESH. Of the 17 cases, only 5 cases developed delayed-onset endophthalmitis, among 29,509 cataract surgeries performed at KKESH, indicating an incidence rate of 0.017% (5/29,509). The mean time between cataract surgery and diagnosis of endophthalmitis was 5±2.48 months. The culture isolates revealed Propionibacterium acnes in 7 (41.2%) eyes, polymicrobial (mixed) infections in 3 (17.6%) eyes, Staphylococcus species in 3 (17.6 %) eyes, fungal infections in 3 (17.6%) eyes, and Alcaligenes xylosoxidans in 1 (5.9%) eye. The mean follow-up period was 29.8 months. The final visual outcomes were as follows: 7 eyes (41.2%) achieved a final best-corrected visual acuity of ≥ 20/60; 6 eyes (35.3%) achieved a best-corrected visual acuity of <20/60 to ≥ count fingers; 2 eyes (11.8%) had hand motion to light perception vision; and 2 eyes (11.8%) were enucleated. Conclusions In this study, infection by P acnes was the most common cause of delayed-onset pseudophakic endophthalmitis and had the most favorable visual outcome, whereas fungal endophthalmitis had the worst visual prognosis. (Eur J Ophthalmol 2009; 19: 804–11)

Mutations in ASPH Cause Facial Dysmorphism, Lens Dislocation, Anterior-Segment Abnormalities, and Spontaneous Filtering Blebs, or Traboulsi Syndrome

We have previously described a syndrome characterized by facial dysmorphism, lens dislocation, anterior-segment abnormalities, and spontaneous filtering blebs (FDLAB, or Traboulsi syndrome). In view of the consanguineous nature of the affected families and the likely autosomal-recessive inheritance pattern of this syndrome, we undertook autozygosity mapping and whole-exome sequencing to identify ASPH as the disease locus, in which we identified two homozygous mutations. ASPH encodes aspartyl/asparaginyl β-hydroxylase (ASPH), which has been found to hydroxylate aspartic acid and asparagine residues on epidermal growth factor (EGF)-domain-containing proteins. The truncating and missense mutations we identified are predicted to severely impair the enzymatic function of ASPH, which suggests a possible link to other forms of ectopia lentis given that many of the genes implicated in this phenotype encode proteins that harbor EGF domains. Developmental analysis of Asph revealed an expression pattern consistent with the proposed link to the human syndrome. Indeed, Asph-knockout mice had a foreshortened snout, which corresponds to the facial abnormalities in individuals with Traboulsi syndrome. These data support a genetic basis for a syndromic form of ectopia lentis and the role of aspartyl hydroxylation in human development.

Efficacy of punctal occlusion in management of dry eyes after laser in situ keratomileusis for myopia.

Abstract Purpose: To evaluate the effect of punctal plug use in preventing dry eye after laser in situ keratomileusis (LASIK). Materials and Methods: A randomized clinical trial at a tertiary eye care center, Riyadh, Saudi Arabia. Participants underwent LASIK for myopia in both eyes and a lower punctal occlusion in one eye only while the other eye served as control. Both eyes received the same postoperative medications except for lubricant duration (subject eye: four times per day for one week; control eye: four times per day for 6 months). Participants were evaluated at 1 week, 2, and 6 months after surgery for signs and symptoms of dry eye. The main outcome measures were visual acuity; ocular surface parameters; and Ocular Surface Disease Index questionnaire. Results: Seventy-eight eyes of 39 patients were included in this study. The Ocular Surface Disease Index scores of eyes with punctal plugs were better at all follow-up visits, and the differences between both eyes were statistically significant (1 week, p < 0.0001; 2 months, p < 0.0001; 6 months, p = 0.008). At the final follow-up visit, the percentage of normal eyes was higher in eyes with punctal plugs for all ocular surface parameters (Schirmer 1 test, 94.9%; tear breakup time, 77.8%; punctate epithelial keratitis score, 71.8%) compared to eyes without occlusion (Schirmer 1 test, 92.3%; tear breakup time, 58.3%; punctate epithelial keratitis score, 53.8%); however, such differences were not statistically significant. Conclusion: Punctal plug insertion after LASIK surgeries may minimize the need for frequent lubricant application and hence improve patient satisfaction.

Ring Corneal Infiltrate and Progressive Ring Thinning Following Primary Varicella Infection

Unilateral stromal keratitis is a known rare sequela of primary varicella infection. The authors describe a unique case of immunological (Wessely) ring formation and progressive ring thinning following primary varicella infection in a 6-year-old girl.

Lens Coloboma Associated with a Ciliary Body Cyst

Isolated congenital lens coloboma is a sectoral indentation of the crystalline lens due to zonular weakness or absence. The purpose of this report is to describe the association of lens coloboma with an adjacent cyst in the ciliary body and to suggest that ciliary body cysts may be an under-recognized cause of congenital lens coloboma.

Identification and localization of multiple intrastromal foreign bodies with anterior segment optical coherence tomography and ocular Pentacam

To report the clinical aspects and the imaging of a patient with intrastromal glass foreign bodies after a road traffic accident using both anterior segment optical coherence tomography (OCT) and ocular Pentacam. A detailed case report was made of the use of anterior segment OCT (AS-OCT) and ocular Pentacam to evaluate intrastromal foreign bodies. AS-OCT and Pentacam were valuable non-invasive tools in identification, localization and monitoring patients with intrastromal foreign bodies. This report demonstrates that AS-OCT and ocular Pentacam are effective and necessary procedures for both the diagnosis and follow-up of intracorneal foreign bodies.

Corneal endothelial cytotoxicity of the Calotropis procera (ushaar) plant.

Purpose: To report 6 eyes of 5 patients with transient corneal edema after exposure to the milky latex of Calotropis procera (ushaar). Methods: Interventional case series. Results: Intracorneal penetration of ushaar latex can lead to permanent endothelial cell loss with morphologic alteration. Corneal edema resolved completely in ∼2 weeks in all cases, despite reduced endothelial cell count and abnormal morphology. Conclusions: Corneal endothelial toxicity of ushaar latex is caused by its ability to penetrate the corneal stroma and induce permanent loss of endothelial cells. Corneal edema resolves if sufficient endothelial cell viability is still present after resolution of ushaar keratitis.