Sami H. Uwaydat

Ethmoid sinus osteoma presenting as epiphora and orbital cellulitis: case report and literature review.

Paranasal sinus osteoma is a slow-growing, benign, encapsulated bony tumor that may be commonly asymptomatic, being detected incidentally in 1% of plain sinus radiographs or in 3% of sinus computerized tomographic scans. In a patient presenting with orbital cellulitis and epiphora, computed tomography disclosed a large osteoma of the ethmoid sinus. Excision of the osteoma allowed recovery of vision, return of extraocular muscle function, and resolution of choroidal folds. Proptosis, diplopia, and visual loss are other frequent presenting signs of paranasal osteomas. Epidemiology, diagnosis, treatment, and pathologic findings in paranasal sinus osteoma are reviewed.

Long-term follow-up in Bietti crystalline dystrophy

Purpose To present a long-term follow-up of Bietti crystalline dystrophy. Methods Two brothers are presented including the clinical findings, fluorescein angiography, electrophysiology (electroretinography [ERG], electrooculography [EOG], adaptometry), optical coherence tomography (OCT), and transmission electron microscopy of bulbar conjunctiva and peripheral blood lymphocytes. The clinical findings were documented over a period of 25 years in one brother and 5 years in the other. Results The most striking features were deposits in the retina that were formed de novo with old ones replaced by choroidal atrophy in advanced stage of the disease. The light rise (EOG), rod- and cone-driven responses (ERG), and visual fields were affected progressively during the course. These changes of the retinal pigment epithelium and choriocapillaris were observed in the second decade and worsened gradually. OCT demonstrated preferential crystal accumulation in the inner retina. Cytoplasmic lipid crystalline inclusions were found in lymphocytes and conjunctival fibroblasts by transmission electron microscopy. Conclusions Bietti crystalline retinopathy is a progressive retinal disease characterized by retinal crystals gradually replaced by atrophy of the retinal pigment epithelium and gradual constriction of visual fields.

The use of topical honey in the treatment of corneal abrasions and endotoxin-induced keratitis in an animal model.

Purpose: To investigate the effect of topically applied honey on intact corneas, surgically induced corneal abrasions and endotoxin induced keratitis. Materials and Methods: The effect of honey on the cornea was investigated by application of honey on intact corneas, wounded corneas and endotoxin-induced keratitis in Lewis rats. The corneas were wounded by creating an epithelial defect using a surgical blade, and the keratitis was induced by topically applying Pseudomonas aeruginosa endotoxin to scarified corneas. After treatment rats were sacrificed and cornea harvested in each case. Corneas were processed for paraffin embedding for histological and immuno-fluorescence staining. Corneas were also harvested and processed for total ribonucleic acid (RNA) isolation for reverse transcriptase-polymerase chain reaction (RT-PCR) analysis for various growth factors and inflammatory chemokines/cytokines). Results: Histological analysis revealed that no inflammation or morphological changes occurred after honey treatment in naive intact corneas. Vascular endothelial growth factor (VEGF) levels were also not altered after honey treatment. Topical application of honey to injured corneas resulted in faster epithelial healing and decreased expression of VEGF, transforming growth factor beta (TGF-β), interferon gamma (IFN-γ), interleukin 12 (IL-12) and tumor necrosis factor alpha (TNF-α) in injured corneas. Our results also established that honey treatment reduced the inflammation in endotoxin-induced keratitis by reducing the levels of angiogenic factors (VEGF and TGF-β), inflammatory cytokines (IL-12) and chemokines (CC chemokine receptor 5(CCR-5)). Conclusion: Short term use of honey on intact corneas can be safe. Honey has anti-angiogenic and anti-inflammatory properties that can be explored in several corneal inflammatory and infectious conditions.

Confirmation of the autosomal recessive syndrome of ectopia lentis and distinctive craniofacial appearance

We report four members of a Lebanese Druze family with the syndrome of lens dislocation, spontaneous filtering blebs, anterior segment abnormalities, and a distinctive facial appearance. The constellation of clinical abnormalities in these patients is not suggestive of the Marfan syndrome or other connective tissue disorders associated with ectopia lentis. We previously described this syndrome in another presumably unrelated and highly inbred Druze family from the mountains of Lebanon. We postulated autosomal recessive inheritance in a pseudo-dominant pedigree. A few isolated reports of similar cases are scattered in the world literature. We now confirm that this is a distinct autosomal recessive syndrome whose gene mutation is enriched in the Lebanese Druze community.

Primary care physicians’ knowledge of the ophthalmic effects of diabetes

OBJECTIVE Previous studies suggest that many patients with diabetes do not receive an annual dilated eye examination because of a lack of referrals from primary care physicians (PCPs). This study aims to determine the depth of knowledge of PCPs regarding diabetic eye disease. DESIGN Cross-sectional assessment. PARTICIPANTS Ninety-seven PCPs. METHODS An 8-question, multiple-choice assessment was administered over a 3-month period to 208 PCPs in attendance at continuing medical education conferences. RESULTS Ninety-seven PCPs completed the assessment. Participants had a mean total score of 5.9 of 8 possible (73.8%). Questions regarding screening, clinical findings, and prevention were answered correctly by ≥81% of the respondents. However, questions regarding risk factors and complications were answered correctly by less than 35% of the respondents. No difference in scores was found based on the type of residency training received or the number of years in practice. CONCLUSIONS Although PCPs may require greater education in the complications and risk factors of diabetic eye disease, study participants demonstrated a good overall depth of knowledge regarding diabetic eye disease. Thus, previous reports of only 35% to 55% of patients with diabetes receiving an annual dilated fundus examination are likely not due to a lack of physician education.

Radiologic findings in infected and noninfected scleral buckles.

Purpose To present the radiologic findings in scleral buckle infections and in the early postoperative period after scleral buckling. Methods Retrospective multicenter orbital computed tomography (CT) study of 14 patients and brain magnetic resonance (MR) in one patient with scleral buckle infections, some with the referring diagnosis of endophthalmitis, proliferative vitreoretinopathy, orbital cellulitis, or unilateral headache. The control population consisted of early postoperative prospective CT study of 38 consecutive patients with scleral buckle without clinical infection. Results Diffuse scleral thickening and preseptal soft tissue swelling were noted in acute scleral buckle infections. Scleral thickening decreased radiologically following prompt antibiotic therapy in five patients with acute infections. Silicone sponge had low attenuation without infection and high attenuation with infection. In chronically infected scleral buckle, the sclera was thickened around the buckle, with scleral melt under the buckle. MR showed increased signal intensity in the preseptal region in one patient with chronic fungal infection. In the controls, two had thickening of the sclera without soft tissue swelling. Conclusions CT or MR can assist in the early diagnosis and management of scleral buckle infections.

Treatment of severe ocular hypotony by monthly injections of a viscoelastic agent.

patients, particularly those with narrow angles or a family history thereof, may significantly increase the risk of development of angle-closure glaucoma. The authors of this article recommend that each patient receiving botulinum toxin for cosmetic purposes should undergo ophthalmic assessment including gonioscopy prior to receiving botulinum toxin injections in order to determine their angleclosure glaucoma risk profile and those at risk should undergo prophylactic laser iridotomy prior to botulinum toxin treatment.

Bilateral familial nevus of Ota.

Nevus of Ota is a benign congenital melanocytic lesion found most commonly in people of Asian ancestry. It is associated with an increased risk of glaucoma and uveal melanomas. Most cases are sporadic and unilateral. We present the first reported case of a brother and sister with familial, bilateral nevus of Ota.

Nutritional Optic Neuropathy Status Post Bariatric Surgery

A 31-year-old woman who had lost 240 lbs following bariatric surgery 3 years ago presented with decreased vision. The patient was found to have deficiencies of folate and vitamin B1, and to a lesser degree vitamins B6 and B12. The patient was treated with vitamin supplementation but without improvement. Bariatric surgery is known to cause B vitamin and folate deficiencies, which can lead to both serious ocular and neurological complications. This is important as the incidence of obesity increases and thus the number of bariatric procedures. It is paramount that patients undergoing these procedures and their physicians be made aware of the need for vitamin supplementation to prevent nutritional optic neuropathy.

Review and update of cataract surgery in the diabetic eye

ABSTRACT Introduction: Diabetes, a systemic disease of increasing world prevalence, is a major risk factor for cataract development. It influences cataract formation through osmotic and free radical damage, leading to different subtypes of lenticular opacity. Cataract surgery in diabetics is predicted to increase substantially over the next 30 years. Diabetic cataract surgery is often more challenging due to pre-existing diabetic eye disease and is associated with higher rates of intra- and postoperative complications. Areas covered: In this review, the pathogenesis of diabetic cataract, pre-operative assessment, surgical planning, intraoperative management of specific complications, management of postoperative complications, as well as advances in pharmacotherapy have been discussed. Expert commentary: A comment on best current practices based on clinical experience and emerging treatment modalities has been profiled. Diabetic patients considered for cataract surgery should have a thorough preoperative evaluation in close collaboration with cataract and retina surgeon. In addition, diagnosing and treating diabetic retinopathy and maculopathy both pre and post-operatively with laser therapy and or pharmacological agents like anti-VEGF and newer steroid implants helps in achieving better patient outcomes.