A 29 year-old healthy Saudi female presented with a 1 week history of headache followed by decreased vision in both eyes. Biomicroscopy revealed anterior uveitis without hypopyon, posterior synechia or keratic precipitate. Fundus examinations were remarkable for serous retinal detachment and hyperemic discs. Fundus fluorescein angiogram showed a hot disc with multiple pinpoint leakage in both eyes. CT scan and MRI were normal, all uveitis workups were negative. Five months later, the patient presented with complete criteria of Vogt-Koyanagi-Harada disease including a 2 weeks history of tinnitus, alopecia, poliosis and vitiligo. Headache alone followed by decreased vision before the onset of neurological and auditory symptoms can be an initial presentation of VKH disease. VKH should be considered in the differential diagnosis of atypical presentation of symptoms.

Objectives:To report the outcomes of penetrating keratoplasty (PKP) surgeries in eyes with failed PKP.Methods:This was a retrospective, non-comparative, descriptive case series. Thirty eyes of 30 patients with failed PKP comprised our study group, they were reviewed from January 2007 to December 2012 at the King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia. Data were collected on best corrected visual acuity before and after one week, one month, 3 months, 6 months, one year, and 2 years following PKP. Intraoperative and postoperative complications, changes in intraocular pressure (IOP), additional surgical procedure and other ocular comorbidities were also documented. The visual outcomes at 6 months and one year were associated with risk factors.Results:Before intervention, 18 (60%) eyes had vision <20/400. Vision was 20/20 to 20/60 in 10 (30%) eyes at 6 months, 17 (57%) eyes at 12 months, and 22 (73%) eyes at 24 months. The variation in IOP at different follow up periods was not significant (p=0.2). The presence of other ocular comorbidity was not significantly associated with functional visual outcome (p=0.4). Additional surgical procedure after repeat PKP enabled a regain of excellent vision in 9 (47%) eyes at one year. The numbers for past corneal surgeries were significantly associated with the visual outcome at 6 months.Conclusion:Penetrating keratoplasty to manage failed PKP resulted in reducing visual disabilities.

Analyzing medical images has always been a challenging task because these images are used to observe complex internal structures of the human body. This research work is based on the study of the retinal fundus and magnetic resonance images (MRI) for the analysis of ocular and cerebral abnormalities. Typically, clinical quality images of the eyes and brain have low-varying contrast, making it challenge to diagnose a specific disease. These issues can be overcome, and preprocessing or an image enhancement technique is required to properly enhance images to facilitate postprocessing. In this paper, we propose an iterative algorithm based on the McCann Retinex algorithm for retinal and brain MRI. The foveal avascular zone (FAZ) region of retinal images and the coronal, axial, and sagittal brain images are enhanced during the preprocessing step. The High-Resolution Fundus (HRF) and MR brain Oasis images databases are used, and image contrast and peak signal-to-noise ratio (PSNR) are used to assess the enhancement step parameters. The average PSNR enhancement on images from the Oasis brain MRI database was about 3 dB with an average contrast of 57.4. The average PSNR enhancement of the HRF database images was approximately 2.5 dB with a contrast average of 40 over the database. The proposed method was also validated in the postprocessing steps to observe its impact. A well-segmented image was obtained with an accuracy of 0.953 and 0.0949 on the DRIVE and STARE databases. Brain tumors were detected from the Oasis brain MRI database with an accuracy of 0.97. This method can play an important role in helping medical experts diagnose eye diseases and brain tumors from retinal images and Oasis brain images.

BACKGROUNDFailed corneal graft management is a challenge. Descemet stripping automated endothelial keratoplasty (DSAEK) and repeat penetrating keratoplasty (PKP) are two options. Only two studies have compared outcomes of DSAEK and PKP in the management of a failed graft.OBJECTIVETo compare the visual outcomes, changes in intraocular pressure (IOP) and complications in eyes with failed corneal grafts that were subsequently managed with DSAEK and PKP.DESIGNRetrospective cohort study.SETTINGSTertiary eye hospital of central Saudi Arabia.PATIENTS AND METHODSA retrospective chart review was performed for cases managed between 2007 and 2012. Data were collected on the best-corrected visual acuity (BCVA) before and at day 1, 1 week, 4 weeks, 12 weeks, and 24 weeks after intervention. BCVA was compared in patients managed with DSAEK or PKP. Intra- and postoperative complications were compared in both groups.MAIN OUTCOME MEASURESClear graft, vision at last follow up, complications.RESULTSThere were 15 eyes in the DSAEK group and 30 in the PKP group. The causes of previously failed PKP differed between groups. BCVA at 6 months after repeat surgeries was 20/20 to 20/40 in 4 (27%) eyes in the DSAEK group and in 8 (27%) eyes in the PKP group. The IOP at 6 months was statistically significantly higher in the DSAEK group than the PKP group (P=.006). In DSAEK group, one graft rejection occurred in one eye and graft dislocation in another eye. Seven eyes in PKP group had signs of graft rejection that regressed in 5 eyes following medical management.CONCLUSIONSDSAEK and PKP for previously failed corneal graft resulted in similar BCVA 6 months after repeat surgery. However, the visual outcomes were less promising with both types of surgeries. The lower complication rate and surgical ease may favor DSAEK over PKP in managing failed grafts.LIMITATIONSSmall sample, retrospective study.

A 49 year old man presented with one day history of mild right eye pain and proptosis. There was no definite history of trauma. On examination there was limitation of movement in all directions of gaze and 6 mm proptosis of his right eye. CT scan showed extraconal lesion compressing the optic nerve and inferior rectus muscle. Right inferior conjunctival fornix based approach was performed with lateral canthotomy and inferior cantholysis and exploration revealed a cyst containing blood which was removed.