Purpose To determine the risk factors and visual outcome of endophthalmitis associated with traumatic intraocular foreign body (IOFB) removal and its allied management. Methods A retrospective review was conducted of patients with penetrating eye trauma and retained IOFB with associated endophthalmitis managed at King Khaled Eye Specialist Hospital over a 22 year period (1983 to 2004). Results There were 589 eyes of 565 patients (90.3% male; 9.7% female) which sustained ocular trauma and had retained IOFB that required management. Forty-four eyes (7.5%) developed clinical evidence of endophthalmitis at some point after trauma. From these 44 eyes, initial presenting visual acuity (VA) of 20/200 or better was recorded in 8 eyes (18.1%) and the remaining 36 eyes (81.9%) had VA ranging from 20/400 to light perception.Eleven eyes (25%) underwent IOFB removal and repair within 24 hours after trauma while 33 eyes (75%) had similar procedures done 24 hours or more after trauma. Thirty-one eyes (70%) underwent primary pars plana vitrectomy (PPV) at the time of removal of posteriorly located IOFBs. Definite positive cultures were obtained from 17 eyes (38.6%). Over a mean follow-up of 24.8 months, 21 eyes (47.7%) had improved VA, 6 eyes (13.6%) maintained presenting VA while 17 eyes (38.7%) had deterioration of their VA, including 10 eyes (22.7%) that were left with no light perception (NLP) vision. After the treatment of endophthalmitis, 20 eyes (45.4%) had VA of 20/200 or better at their last follow-up. Four eyes (12.9%) from the vitrectomy group (31 eyes) and 5 eyes (45.4%) from non-vitrectomy (11 eyes) group had final VA of NLP. Predictive factors for the good visual outcome included good initial presenting VA, early surgical intervention to remove IOFB (within 24 hours), and PPV. Predictors of poor visual outcome included IOFB removal 48 hours or later, posterior location and no PPV for the posteriorly located IOFB. Conclusions Delayed removal of IOFB following trauma may result in a significant increase in the development of clinical endophthalmitis. Other risk factors for poor visual outcome may include poor initial presenting VA, posterior location of IOFB and no vitrectomy at the time of IOFB removal.

PurposeTo study the anatomical and visual outcomes and prognostic factors that may predict the outcomes of rhegmatogenous retinal detachment (RRD) in children.MethodsA retrospective chart review was performed for patients 16 years of age or younger who underwent retinal reattachment surgery for RRD at the King Abdulaziz University Hospital from 1996 to 2005 and the King Khalid Eye Specialist Hospital from 2002 to 2006, Riyadh, Saudi Arabia. Good visual outcome was defined as ≥20/200. The association between two categorical variables was evaluated with the Chi-squared test or the exact test, as appropriate. Predictors for RRD and good final visual acuity were identified by conducting stepwise logistic regression analysis. P < 0.05 was statistically significant.ResultsThe study population comprised 148 patients (166 eyes). There were 104 (70%) males and 44 (30%) females. Mean age at presentation was 8.33 ± 3.26 years (range 1.5–16 years). The retina was reattached after one surgical procedure in 106 (63.8%) eyes and reattached in 130 (78.3%) eyes after multiple surgeries. Factors predicting recurrence after the first surgery were myopia (P = 0.028), proliferative vitreoretinopathy (PVR) at presentation (P = 0.024), and total retinal detachment (P = 0.032). Good final visual outcome was achieved in 60 (44.4%) eyes. Predictors of good visual acuity were: good visual acuity at presentation (P < 0.001); absence of PVR at presentation (P < 0.001); one quadrant of retinal detachment (P = 0.0024); macula on (P = 0.0107); absence of primary repair of a ruptured globe (P = 0.0059); no pars plana vitrectomy (PPV) (P = 0.0123); clear phakic lens at follow-up (P < 0.001); absence of postoperative complications (P < 0.001); absence of recurrence of RRD (P < 0.001); and absence of epiretinal membrane (P = 0.0088). Logistic regression analysis indicated that recurrence of RRD was associated with myopia and previous congenital cataract surgery; good final visual outcome was associated with macula on detachment and poor visual outcome was associated with recurrence of RRD and occurrence of postoperative complications and previous repair of a ruptured globe.ConclusionRRD in children is usually associated with a predisposing factor, a high rate of PVR, and total retinal detachment. Despite late diagnosis and the presence of PVR, favorable anatomical and visual outcomes can be achieved.

Objective:To investigate the clinical features, prevalence, role of surgical intervention and the visual prognosis of macular holes (MH) in patients with Behcet's disease (BD).Materials and Methods:Retrospective study of patients with BD and MH from January 1998 to November 2008.Results:Out of 159 patients, 21 eyes of 17 patients were identified with MH. The mean age was 38.59 (range 23-61) years and the mean follow-up period was 5.1 years (range 13-164 months). The prevalence of MH was 7%. Visual acuity (VA) at the time of presentation ranged from 20/70 to hand-motion. Optical coherence tomography (OCT) findings revealed intraretinal cysts at the edge of the MH. The mean size of MH was 983.6 um; 52% had elevated edges, 43% had flat edges and only one eye (5%) was closed postoperatively. Fluorescein angiography (FA) was consistent with macular ischemia in 76% of the cases. Human leukocyte antigen (HLA) B51 association was found in 14 of the 15 patients investigated. Six patients (out of 17) underwent pars plana vitrectomy. The final VA on their last follow-up ranged from 20/70 to 2/200. Surgical intervention for MH did not result in any visual improvement as compared to non-operated eyes. One patient lost vision completely due to elevated intraocular pressure post vitrectomy and silicon oil tamponade.Conclusions:MH in patients with BD may lead to significant visual disability. Surgical intervention does not seem to have any potential beneficial effect on the VA, probably due to significant macular ischemia and sequelae from the ocular inflammation.

ABSTRACT.Purpose: To evaluate the feasibility of two novel 'heavy' dye solutions for staining the internal limiting membrane (ILM) and epiretinal membranes (ERMs), without the need for a prior fluid-air exchange, during macular surgery. Methods: In this prospective nonrandomized multicenter cohort study, the high molecular weight dyes ILM-BlueÔ [0.025% brilliant blue G, 4% polyethylene glycol (PEG)] and MembraneBlue-DualÔ (0.15% trypan blue, 0.025% brilliant blue G, 4% PEG) were randomly used in vitrectomy surgeries for macular disease in 127 eyes of 127 patients. Dye enhanced membrane visualization of the ILM and ERMs, 'ease of membrane peeling', visually detectable perioperative retinal damage, postoperative best-corrected visual acuity (BCVA), dye remnants and other unexpected clinical events were documented by 21 surgeons. Results: All surgeries were uneventful, and a clear bluish staining, facilitating the identification, delineation and removal of the ILM and ERMs, was reported in all but five cases. None of the surgeries required a fluid-air exchange to assist the dye application. BCVA at 1 month after surgery improved in 83% of the eyes in the MembraneBlue-DualÔ group and in 88% in the ILM-BlueÔ group. No dye remnants were detected by ophthalmoscopy, and no retinal adverse effects related to the surgery or use of the dyes were observed. Conclusion: The 'heavy' dye solutions ILM-BlueÔ and MembraneBlue-DualÔ can be injected into a fluid-filled vitreous cavity and may facilitate staining and removal of the ILM and ⁄ or ERMs in macular surgery without an additional fluid-air exchange.