Marwan Abdulaal

Intravitreal Adalimumab in Active Noninfectious Uveitis: A Pilot Study.

Abstract Purpose: To evaluate the short-term efficacy of intravitreal adalimumab (IVA) for the treatment of eyes with active noninfectious uveitis. Methods: Consecutive eyes with active noninfectious uveitis were injected with IVA at 0, 2, then every 4 weeks for total of 26 weeks. Results: Six out of 7 patients (12 of 13 eyes) completed 26 weeks of treatment. One patient (1 eye) failed treatment. Seven out of 12 eyes had improvement of ≥2 ETDRS lines. Three out of three eyes had resolution of anterior chamber cells. And 9 of 10 eyes with vitreous haze had zero haze at 26 weeks. Five out of 8 eyes with macular edema had complete resolution. Median fluorescein angiography score improved from 14 to 4 on last follow-up. Conclusions: IVA was effective in controlling the inflammation, decreasing the macular edema, and improving the best corrected visual acuity in the majority of eyes in this series.

Chronic Postoperative Endophthalmitis: A Review of Clinical Characteristics, Microbiology, Treatment Strategies, and Outcomes

Chronic postoperative endophthalmitis (CPE) is a delayed infectious intraocular inflammation process that occurs more than six weeks after ocular surgery and frequently masquerades as autoimmune uveitis. These cases are at risk of delayed diagnosis and erroneous long-term treatment with corticosteroids. This paper aims to review the epidemiology, microbiology, clinical characteristics, diagnosis, management strategies, and outcome of chronic postoperative endophthalmitis. The incidence of CPE is still uncommon, and multiple pathogens have been reported with varying frequencies. Review of the literature reveals that CPE cases have a high incidence of visual impairment and recurrence rate might be decreased with aggressive surgical approach.

Etiology and Clinical Features of Ocular Inflammatory Diseases in a Tertiary Center in Lebanon

Abstract Purpose: To identify the pattern of uveitis in patients presenting to the American University of Beirut Medical Center (AUBMC) uveitis service in Lebanon. Methods: The charts of patients seen between January 2009 and September 2011 were retrospectively reviewed. Data pertaining to patient demographics, eye examination on presentation, workup, and final diagnoses were collected. Results: The total number of charts reviewed was 209. The most common noninfectious etiologies were Behçet disease, sarcoidosis, and HLA-B27-associated uveitis, while toxoplasmosis, herpes, and tuberculosis were the most common infectious etiologies. The mean duration of the disease before presentation to our center was 38 ± 56 months (range 0–284 months), with cataract formation in 90/234 (38%) and visual impairment in 134/291 (46%) eyes on presentation. Conclusions: This case series reveals a significant delay in referring uveitis cases to a specialized center, which may contribute to the high percentage of patients presenting with ocular complications.

Uveitis in the Aging Eye: Incidence, Patterns, and Differential Diagnosis

Uveitis is a vision threatening inflammation of the eye that carries considerable morbidity. It is responsible for 10% of legal blindness in the United States and up to 25% in the developing world. Uveitis in patients more than 60 years of age is less common. The aging body has a changing response of the immune system, which might reflect a different pattern of uveitis in the elderly population. In this paper we review the incidence and patterns of uveitis in the elderly as reported in the literature and discuss changes with time. We also delineate a thorough differential diagnosis of de novo uveitis in the elderly.

Induction With Intravitreal Bevacizumab Every Two Weeks in the Management of Neovascular Age-Related Macular Degeneration

PURPOSE To explore the benefit of rapid induction with intravitreal bevacizumab for neovascular age-related macular degeneration (AMD). DESIGN Single-institution prospective randomized pilot study. METHODS Patients with treatment-naïve neovascular AMD were randomized 1:1:1 into 1 of 3 groups based on the induction sequence: (1) every 2 weeks for 3 consecutive injections; (2) every 4 weeks for 3 consecutive injections; and (3) immediate pro re nata (prn) after the first injection. Retinal angiomatous proliferation and polypoidal choroidal vasculopathy were excluded. Best-corrected visual acuity (BCVA) and central retinal thickness using optical coherence tomography (OCT) were measured at baseline and at each follow-up. After induction, bevacizumab was administered as needed based mainly on OCT. Main outcome measure was mean initial fluid-free interval after induction. Secondary outcomes were mean improvement in BCVA and central retinal thickness. RESULTS Each group included 30 patients (30 eyes). Mean initial fluid-free interval was 2.4, 3.4, and 3.5 months for biweekly induction, monthly induction, and immediate prn groups, respectively (P = .03). Significance was lost when corrected for age and sex (P = .073). Mean improvement in BCVA, central retinal thickness, and total number of injections were similar among the groups at 12 months. Six eyes in the biweekly induction group developed subretinal fibrosis vs no eyes in the other 2 groups (P = .003). CONCLUSION Biweekly induction with intravitreal bevacizumab for treatment-naïve neovascular AMD does not increase initial fluid-free interval or cause significant anatomic and functional benefit compared to monthly induction or immediate prn. There is also the potential development of subretinal fibrosis with biweekly induction.

Genotype/Phenotype Correlation in Primary Congenital Glaucoma Patients in the Lebanese Population: A Pilot Study

Abstract Background: The incidence of primary congenital glaucoma (PCG) varies among geographic regions and ethnic groups. The frequency of PCG in Lebanon and identification of disease-causing mutations have not been studied previously. Purpose: To investigate the role of Cytochrome P1B1 (CYP1B1) gene and Myocillin (MYOC) gene mutations in PCG in the Lebanese population and study possible genotype/phenotype correlations. Methods: Patients with unilateral or bilateral PCG diagnosed at the American University of Beirut Medical Center and their first-degree relatives (parents and siblings) were screened for CYP1B1 and MYOC mutations. Demographic and phenotypic characteristics were recorded. Phenotypic characteristics pertaining to disease severity and outcomes were compared. Results: Eighteen Lebanese families (66 subjects) with at least one member affected with PCG were included in this study. Mutations in the CYP1B1 gene were detected in 6 families (33%). Five previously described mutations (p.R444Q; p.E229K; p.R469W; p.G61E; p.M1T) and one new single nucleotide deletion were identified (1793delC). Patients in whom CYP1B1 mutations were detected tended to have a more severe phenotype as evidenced by earlier age at diagnosis, higher rate of bilateral disease, and higher number of glaucoma surgeries than those in whom no CYP1B1 mutations were present. MYOC gene mutations were not detected in any patients. Conclusion: The rate of CYP1B1 mutations in Lebanese patients with PCG is lower than that reported in other Arab and Middle Eastern populations and suggests other genes are responsible for PCG in the remainder.

Indocyanine Green-Enhanced Thermotherapy for Retinoblastoma

Purpose: To report the outcome of pediatric patients with retinoblastoma refractory to traditional local therapy who were treated with indocyanine green (ICG)-enhanced thermotherapy. Materials and Methods: This is a retrospective review of a case series of 3 patients with bilateral retinoblastoma who were treated with ICG-enhanced thermotherapy after showing no response to conventional chemothermotherapy or transpupillary thermotherapy (TTT) alone noted on two consecutive examinations under anesthesia. Results: The 3 patients had had one eye enucleated previously due to advanced disease, and the remaining eye was diagnosed with a large tumor, which showed either a marginal or no response to systemic chemotherapy and TTT. Addition of ICG enhancement during the subsequent TTT session shrunk the tumor to a measurable size that could then be followed by TTT alone as a means of treatment. One patient had tumor recurrence, at which time additional TTT without ICG was successfully applied after the tumor size had decreased; ICG enhancement was then added whenever TTT alone provided no response. Conclusions: ICG enhancement with TTT led to a measurable tumor regression in lesions that had previously not been responsive to traditional chemothermotherapy or isolated TTT. Message: These tumors had shown a minimal to no response to previous TTT treatment. However, adding ICG resulted in a measurable regression even though the same TTT treatment parameters were applied.

Transposition Surgery for Inferior Rectus Fibrosis

Congenital fibrosis of the extraocular muscles is a rare hereditary strabismus disorder. A case of congenital fibrosis of the inferior rectus muscles with severe chin-up posture and bilateral limitation of up gaze is reported. Bilateral large recessions of the tight inferior rectus muscles provided only partial improvement. Residual head posture and hypotropia were successfully corrected with bilateral horizontal rectus muscle transpositions toward the superior rectus muscles, despite persistently tight inferior rectus muscles at the time of surgery.