Saad Al-Dahmash

Intravitreal Bevacizumab at 4-Month Intervals for Prevention of Macular Edema after Plaque Radiotherapy of Uveal Melanoma

PURPOSEnTo evaluate the efficacy of intravitreal bevacizumab for prevention of macular edema after plaque radiotherapy of uveal melanoma.nnnDESIGNnRetrospective, single-center, nonrandomized, interventional comparative study.nnnPARTICIPANTSnPatients with uveal melanoma treated with plaque radiotherapy were divided into 2 groups: a bevacizumab group and a control group.nnnINTERVENTIONnThe bevacizumab group received intravitreal bevacizumab injection at the time of plaque removal and every 4 months thereafter for 2 years (total, 7 injections). The control group had no intravitreal bevacizumab injection. Both groups had periodic follow-up with ophthalmoscopy and optical coherence tomography (OCT).nnnMAIN OUTCOME MEASURESnDevelopment of OCT-evident macular edema.nnnRESULTSnThere were 292 patients in the bevacizumab group and 126 in the control group. The median foveolar radiation dose was 4292 cGy (bevacizumab) and 4038 cGy (control; Pxa0= 0.327). The cumulative incidence of OCT-evident macular edema over 2 years (bevacizumab group vs. control group) was 26% versus 40% (Pxa0= 0.004), respectively; that for clinically evident radiation maculopathy was 16% versus 31% (Pxa0= 0.001), respectively; that for moderate vision loss was 33% versus 57% (Pu2009<u20090.001), respectively; and that for poor visual acuity was 15% versus 28% (Pxa0= 0.004), respectively. There was no statistically significant difference in clinically evident radiation papillopathy (Pxa0= 0.422). Kaplan-Meier estimates at 2 years showed statistically significantly reduced rates of OCT-evident macular edema (Pxa0= 0.045) and clinically evident radiation maculopathy (Pxa0= 0.040) in the bevacizumab group compared with controls.nnnCONCLUSIONSnPatients receiving intravitreal bevacizumab injection every 4 months after plaque radiotherapy for uveal melanoma demonstrated OCT-evident macular edema, clinically evident radiation maculopathy, moderate vision loss, and poor visual acuity less frequently over a period of 2 years than patients not receiving the injections.

Bilateral Lacrimal Gland Disease: Clinical Features of 97 Cases

OBJECTIVEnBilateral lacrimal gland (LG) disease is a unique presentation that can result from varied causes. We reviewed the diagnoses, clinical features, and outcomes of 97 patients with this entity.nnnDESIGNnCase series.nnnPARTICIPANTSnNinety-seven patients with bilateral LG disease.nnnMETHODSnRetrospective review and statistical analysis using analysis of variance and the Fisher exact test.nnnMAIN OUTCOME MEASURESnPatient demographics, clinical features, diagnostic testing, diagnosis, and treatment.nnnRESULTSnPatient age ranging from 8 to 84 years (mean, 46 years). The predominant gender was female (77%), and race included black (49%), white (38%), and Hispanic (12%) patients. Diagnoses fell into 4 categories: inflammatory (n = 51; 53%), structural (n = 20; 21%), lymphoproliferative (n = 19; 20%), and uncommon (n = 7; 7%) entities. The most common diagnoses included idiopathic orbital inflammation (IOI; n = 29; 30%), sarcoidosis (n = 19; 20%), prolapsed LG (n = 15; 15%), lymphoma (n = 11; 11%), lymphoid hyperplasia (n = 8; 8%), and dacryops (n = 5; 5%). Inflammatory conditions were more likely in younger patients (P<0.05) and in those with pain (P<0.001) and mechanical blepharoptosis (P<0.01) at presentation, whereas lymphoma was more common in older patients (P<0.001) without active signs of inflammation at presentation. Black patients were more likely to have sarcoidosis (P<0.01). Laboratory results showed high angiotensin converting enzyme level being significantly more likely in patients with sarcoidosis (P<0.05). However, sensitivity was limited to 45%, with 25% of patients diagnosed with IOI also demonstrating positive results. Corticosteroid therapy was the treatment of choice in 38 cases, corresponding to resolution of symptoms in 29% and improvement in an additional 32%. Overall, chronic underlying disease was found in 71% of patients, among whom 26% achieved a disease-free state, whereas 3% succumbed to their underlying disease.nnnCONCLUSIONSnThe cause of bilateral lacrimal gland disease most commonly was inflammatory, followed by structural and lymphoproliferative. Patient characteristics and clinical presentations were key features distinguishing between competing possibilities. Despite local control with corticosteroids or radiotherapy, underlying disease continued in 71% of patients and led to death in 3%.

External ophthalmomyiasis: A case report

Ophthalmomyiasis is an infestation of the eye with larvae of most common sheep nasal botfly (Oestrus ovis). We describe a case of ophthalmomyiasis in a 50-year-old man who presented with ocular foreign body sensation, redness and tearing. The causative larvae were removed in the emergency room and sent to laboratory for identification. The patient symptoms improved after topical treatment with antibiotics-steroid combination therapy.

Rare presentation of definitive ocular tuberculosis in an immunocompetent young patient

Ocular tuberculosis is not uncommon ocular presentation in our community nowadays. Rare presentations described mainly in the immunocompromised patients. The diagnosis of ocular TB is presumed in the vast majority of the cases of the intraocular TB. We are presenting a very rare presentation of definitive intraocular TB in a healthy 24-year-old male.

Atypical posterior scleritis mimicking choroidal melanoma

We report a case of atypical posterior scleritis mimicking amelanotic choroidal melanoma. A 30-year-old healthy Filipino man, with a history of painless subacute loss of vision in his left eye over 5 months, was referred to our institute for further workup and management. On examination, visual acuity of the left eye was 20/200. Anterior segment examination yielded unremarkable results, with injected conjunctiva and quiet episcleral blood vessels, while fundus examination revealed non-pigmented nasal choroidal mass, with significant subretinal fluid resembling amelanotic choroidal melanoma. Right eye examination yielded unremarkable results. The patient was diagnosed with atypical posterior scleritis, and treated with oral steroids for 2 weeks, with no improvement. A periocular steroid was then injected to the left eye, causing dramatic reduction in choroidal mass size, and complete resolution of subretinal fluid. The visual acuity improved to 20/28.5 one month after the injection. Timely treatment was crucial for minimizing vision-threatening complications.

Incidence, Risk Factors and Surgical Outcomes of Cataract among Patients with Uveitis in a University Referral Hospital in Riyadh, Saudi Arabia

ABSTRACT Purpose: To investigate incidence, risk factors, and surgical outcomes of cataract among uveitis patients. Methods: Retrospective review of 1000 patients (1582 eyes). Results: At initial presentation, cataract was diagnosed in 290 (18.3%) eyes and was most common in eyes with anterior uveitis. Fuchs’ uveitis, herpetic uveitis, and presumed tuberculous uveitis were leading clinical entities associated with cataract at presentation. During follow-up, cataract developed in additional 200 (12.6%) eyes and was most common in eyes with anterior uveitis. Significant risk factors at presentation included age >18 years, female gender, presence of keratic precipitates, hypopyon, and posterior synechiae. Among the 490 eyes with cataract, 204 underwent cataract extraction during follow-up period. Best corrected vision of ≥20/40 was achieved in 122 (60.1%) eyes. Conclusions: Incidence of cataract differed depending on anatomic and etiologic diagnoses of uveitis. There is a significant association between severity of inflammation at presentation and development of cataract.

Predictors of performance in an ophthalmology residency program

OBJECTIVEnTo assess the value of current selection criteria and additional factors as predictors of performance in an ophthalmology residency training program.nnnDESIGNnA retrospective study.nnnPARTICIPANTSnData were collected from the files of 166 residents who were collectively trained in an ophthalmology residency program from 2000 to 2013.nnnMETHODSnThe programs selection criteria included medical school grade point average (GPA), Saudi licensing examination (SLE) score, multiple-choice question ophthalmology selection (MCQ) examination score, and interview mark. Indicators of performance included average scores in the promotion examination for 4 years of training (average R), King Saud University fellowship examination (KSU) score, and Saudi Board in Ophthalmology examination (SBO) score. An average of KSU and SBO scores was also used as a performance indicator. Times of program completion and average performance score across all years in the residency program were used as second-level indicators of performance.nnnRESULTSnThere were strong correlations between the MCQ examination score and each training performance indicator (average R, KSU score, SBO score, and average of KSU and SBO scores; p = 0.002, 0.008, 0.05, and 0.002, respectively). The interview mark correlated well with average R (p = 0.001) but not with other indicators. The MCQ examination score and the interview mark were the only predictors of second-level indicators of performance (p = 0.009 and 0.029, respectively).nnnCONCLUSIONSnThe MCQ examination score and interview mark were the 2 best predictors of performance as an ophthalmology resident. GPA and SLE score were poor predictors of performance.