Rola N. Hamam

Conjunctival/corneal intraepithelial neoplasia.

Tumors of the squamous epithelium of the conjunctiva and cornea are the most common type of primary ocular neoplasms encountered in clinical practice around the world. Pizzarello and Jakobiec coined the term conjunctival intraepithelial neoplasia (CIN) in 1978. In CIN, the abnormal epithelium can be limited to the conjunctiva, the cornea, or involve both. When this disordered epithelial maturation involves the cornea, it is called corneal intraepithelial neoplasia. Corneal intraepithelial neoplasia was first described in 1984 by Waring et al. Conjunctival and corneal invasive neoplasia was described by Erie et al in 1986. However, the term epithelioma was used by von Graefe as early as the 1860s to describe squamous cell carcinoma of the conjunctiva and cornea.

Nontuberculous Mycobacterial Ocular Infections: A Systematic Review of the Literature

Nontuberculous or atypical mycobacterial ocular infections have been increasing in prevalence over the past few decades. They are known to cause periocular, adnexal, ocular surface and intraocular infections and are often recalcitrant to medical therapy. These infections can potentially cause detrimental outcomes, in part due to a delay in diagnosis. We review 174 case reports and series on nontuberculous mycobacterial (NTM) ocular infections and discuss etiology, microbiology, risk factors, diagnosis, clinical presentation, and treatment of these infections. History of interventions, trauma, foreign bodies, implants, contact lenses, and steroids are linked to NTM ocular infections. Steroid use may prolong the duration of the infection and cause poorer visual outcomes. Early diagnosis and initiation of treatment with multiple antibiotics are necessary to achieve the best visual outcome.

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.

Seasonal Variation of Retinal Detachment in Lebanon

Background: The literature remains controversial regarding seasonal variation of rhegmatogenous retinal detachment (RRD). Methods: In this retrospective chart review, seasonal variation of RRD was examined based on the records of 211 consecutive patients operated for idiopathic RRD in one referral medical center over a 13-year period. Results: The number of eyes with RRD recorded per season was 46 in autumn, 46 in winter, 62 in spring and 57 in summer. There was a significant seasonal variation (p < 0.05) with an increase in RRD in the warm seasons (spring and summer) compared to the cold seasons (winter and autumn; 56 vs. 44%). Right eyes were more likely to be affected than left eyes (54 vs. 46%), and cases presented with a significantly younger age at onset in the warm than in the cold seasons (47 vs. 54 years, p = 0.007). A literature review of 8,533 cases including the present case series established further the seasonal variation of RRD (p < 0.001). Conclusion: There is convincing evidence for a seasonal variation of RRD in Lebanon and in the literature. This is likely to be related to sun exposure and outdoor activities in the warm seasons.

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.

Cytomegalovirus retinitis in children and young adults with acute lymphoblastic leukemia in Lebanon

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Positive Epstein-Barr virus polymerase chain reaction in a case of acute retinal necrosis

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Chronic granulomatous disease presenting as retinal mass.

Abstract1-year-old girl was admitted for fever of unknown origin. Funduscopy revealed juxtapapillary retinal inflammatory mass in one eye with a differential diagnosis of sarcoidosis, tuberculosis, retinoblastoma or metastatic disease. Retinal biopsy showed necrotizing granulomatous retinitis. Extensive workup and therapeutic trials failed to confirm the diagnosis of tuberculosis or sarcoidosis. Her 7-month brother and 4-year-old male cousin presented with nystagmus, poor vision, paravascular pigmentary changes and were initially diagnosed as recessive retinal dystrophy. The girl died at age 2 from tuberculous meningitis and the boys had recurrent tuberculous and Aspergillus infections. Awareness of the typical fundus findings in chronic granulomatous disease allows early diagnosis of the disorder.