Abdullah Al-Mujaini

Cerebro-rhino orbital mucormycosis: An update

Mucormycosis is an uncommon fungal infection which can lead to fulminant necrotizing infection under optimal host condition. Fungi have the ability to invade blood vessels and can affect different parts of the body. The most common, though the most aggressive, form is cerebro-rhino-orbital mucormycosis that occurs in debilitated patients, in conjunction with sinus or para-sinus involvement. Due to increased number of newly diagnosed cases of mucormycosis world-wide resulting from uncontrolled metabolic conditions, this paper intends to widen the readers scope and knowledge about the nature of the disease and its multicomplexity that require a collaborative effort for careful management. Patients who are at risks both at the onset of the disease and during its management have been identified in the paper.

Orbital Infarction in Sickle Cell Disease

PURPOSE To determine the role of hematological and genetic factors in the development of orbital infarction in sickle cell disease. DESIGN Retrospective, noncomparative case series. METHODS Fourteen sickle cell disease patients were diagnosed with orbital infarction during a vaso-occlusive crisis. Clinical and radiological findings were reviewed retrospectively. Sickle cell disease patients without orbital infarction were recruited as controls after matching for disease severity. Sickle haplotypes were determined for all patients. Differences between groups were evaluated statistically. RESULTS Patients with orbital infarction in sickle cell disease presented with acute periorbital pain and swelling with or without proptosis, ophthalmoplegia, and visual impairment during a vaso-occlusive crisis. Radiological findings included orbital soft tissue swelling (100%), hematoma (orbital, 36%; intracranial, 21%), and abnormal bone marrow intensities. Severity of orbital involvement was unrelated to that of the systemic disease (Pearson correlation coefficient, -0.1567). Affected patients predominantly had the Benin haplotype (P < .00782). CONCLUSIONS Orbital infarction is a potential threat to vision in sickle cell disease patients. Magnetic resonance imaging is more specific than computed tomography or nuclear scintigraphy in the evaluation of orbital changes. The degree of severity of the orbital manifestations appears unrelated to the severity of sickle cell disease. Patients with the Benin haplotype are more likely to develop orbital infarction during vaso-occlusive crises.

Sebaceous gland carcinoma of the eyelid

Sebaceous gland carcinoma, commonly arises in the periocular area, is an uncommon condition. It represents 1–5.5% of eyelid malignancies and is considered to be the third most common eyelid malignancy after basal cell and squamous cell carcinomas, although few reports placed this tumor as second most common after basal cell carcinoma. It usually affects elderly women and characterized by high rate of local recurrence, regional, and distant metastases. A delay in diagnosis, which can be attributed primarily to ability of this tumor to masquerade as more benign conditions, often leads to inappropriate management with increased morbidity and mortality rates. In this study, the authors discuss key elements of the primary disease and therapeutic options available to treat such devastating problem.

Optical Coherence Tomography: Clinical Applications in Medical Practice

Optical Coherence Tomography (OCT) is a success story of scientific and technological co-operation between a physicist and a clinician. The concept of cross-sectional imaging revolutionalized the applicability of OCT in the medical profession. OCT is a non-contact, topographic, biomicroscopic device that provides high resolution, cross-sectional digital images of live biological tissues in vivo and in real time. OCT is based on the property of tissues to reflect and backscatter light involving low-coherence interferometry. The spatial resolution of as little as 3 microns or even less has allowed us to study tissues almost at a cellular level. Overall, OCT is an invaluable adjunct in the diagnosis and follow up of many diseases of both anterior and posterior segments of the eye, primarily or secondary to systemic diseases. The digitalization and advanced software has made it possible to store and retrieve huge patient data for patient services, clinical applications and academic research. OCT has revolutionized the sensitivity and specificity of diagnosis, follow up and response to treatment in almost all fields of clinical practice involving primary ocular pathologies and secondary ocular manifestations in systemic diseases like diabetes mellitus, hypertension, vascular and neurological diseases, thus benefitting non-ophthalmologists as well. Systemically, OCT is proving to be a helpful tool in substantiating early diagnosis in diseases like multiple sclerosis and drug induced retinopathies by detecting early changes in morphology of the retinal nerve fiber layer.

Functional Endoscopic Sinus Surgery: Indications and Complications in the Ophthalmic Field

Functional Endoscopic Sinus Surgery (FESS) is a highly sophisticated type of surgery, which has revolutionized the surgical management of chronic sinus diseases. In the ophthalmic field, FESS plays a crucial role in the management of a few conditions, but not without risks. Ophthalmic complications associated with FESS are well documented. They mainly occur due to the shared common anatomic areas between ophthalmology and otolaryngology. Ophthalmic complications can vary in severity from very trivial cases such as localized hematoma collection, which is not very problematic to very devastating cases, such as optic nerve damage, which can lead to complete blindness. In order to minimize such complications, safety measures need to be considered prio to the surgery, these include; precise knowledge of detailed anatomy, the operating surgeons ability to interpret precisely the para nasal sinus CT scan and experienced procedural surgical skills.

Lymphocytic infundibulo-neurohypophysitis: An unusual cause of recurrent optic neuropathy in a child

Lymphocytic infundibulo-neurohypophysitis (LINH), a rare autoimmune disease, is distinct from lymphocytic hypophysitis and is characterized by lymphocytic and plasma cell infiltration of the posterior lobe of the pituitary and the pituitary stalk.(1) We report the case of a young boy who presented with recurrent, steroid-responsive optic nerve dysfunction and diabetes insipidus. T1-weighted magnetic resonance imaging scans of the brain showed an isointense soft tissue mass within the sella turcica and a thickened pituitary stalk. Tissue specimen resected at transsphenoidal surgery revealed chronic inflammation with infiltration of lymphocytes and no granulomatosis or necrosis, establishing the diagnosis of LINH.(2) This is the first report of optic neuropathy in association with LINH in a child.

Valsalva retinopathy in pregnancy: a case report

IntroductionValsalva retinopathy is a unilateral or bilateral condition that occurs when increased intra-thoracic or intra-abdominal pressure transmitted to the eye causes a sharp rise in the intra-ocular venous pressure, and rupture of superficial retinal capillaries. The patient often gives a history of a recent strenuous physical act, which could have increased the intra-thoracic pressure. Pregnancy is known to be a risk factor for Valsalva retinopathy.Case presentationA 23-year-old woman in her seventh month of pregnancy presented with a history of decreased vision in her left eye of one-week duration. Examination of the affected eye showed best corrected visual acuity of 20/50, and fundus examination revealed a pre-retinal hemorrhage located in the macula. Based on clinical findings, the diagnosis of Valsalva retinopathy was made.ConclusionRetinal hemorrhages can be generated by Valsalva maneuvers. Pregnancy is a known risk factor for Valsalva retinopathy; however, the diagnosis should be made only after excluding other causes of retinal hemorrhages. It is a self-limited event. We report a case of Valsalva retinopathy complicating normal pregnancy and confirm that, to date, there is no evidence to indicate that there is a risk of recurrence following spontaneous vaginal delivery.

Natural course of central serous chorioretinopathy without subretinal exudates in normal pregnancy

BACKGROUND Pregnancy is a well-known risk factor for central serous chorioretinopathy (CSCR). METHODS Patients were examined using slit-lamp biomicroscopy, fundus examination, fundus photography, and optical coherence tomography, making note of best-corrected visual acuity. RESULTS All patients had resolution of CSCR. INTERPRETATION We present CSCR in 3 consecutive pregnant women without subretinal exudates.

Frosted branch angiitis, neuroretinitis as initial ocular manifestation in Behçet disease

Behçet disease is an idiopathic, multisystem disorder characterized by recurrent episodes of orogenital ulceration and vasculitis of the veins and arteries of all calibers. Ocular involvement may affect the conjunctiva, sclera, uveal tract, vitreous, blood vessels, and retina. Many theories have pointed toward an autoimmune response behind its pathogenesis, which may be triggered by exposure to an infectious agent. Frosted branch angiitis is characterized by vascular inflammation, sheathing, retinal edema, and retinal hemorrhages. The disease may be idiopathic in a majority of the cases or may be associated with ocular and systemic pathology. Association between Behηet disease, Frosted branch angiitis, and neuroretinitis is not reported in literature. This uncommon combination reflects the varied systemic and ocular manifestations in Behçet disease, especially in patients who are not diagnosed and treated in time. We hereby report a case of bilateral frosted branch angiitis and neuroretinitis in a young male from Middle-east, suffering from Behçet disease.

Electronic Medical Record System: Have we Bitten off More Than we Can Chew?

First used for management and administrative purposes, Electronic Medical Record (EMR) systems are now being increasingly employed to collect and synthesize medical information. The EMR system offers support in medical decision-making, promotes use of guidelines, increases coordination between different health care providers and is believed to improve overall quality of care. The Sultan Qaboos University Hospital (SQUH) had a functioning Healthcare Information System (HIS) since its inception in 1991, which mainly functioned in the Departments of Radiology, Laboratory Medicine and Pharmacy. The hospital adopted a fully integrated EMR system for patient care and administrative purposes in June 2006. As the hospital acclimatizes to new technology, the need for assessment of quality and improvement of patient care and health delivery has been perceived.