Saudi Journal of Ophthalmology最新文献

{"title":"Indocyanine green angiography in uveitis.","authors":"Luca De Simone, Anna Byszewska, Abdulrahman F Albloushi, Riccardo Genovese, Ioannis Papasavvas, Carl P Jr Herbort","doi":"10.4103/sjopt.sjopt_225_26","DOIUrl":"10.4103/sjopt.sjopt_225_26","url":null,"abstract":"<p><p>Indocyanine green angiography (ICGA) represents an indispensable imaging modality for the precise evaluation and management of posterior uveitis by allowing to explore the choroidal compartment. ICGA leverages near-infrared fluorescence and extensive protein binding to provide an unhindered, dynamic assessment of the choriocapillaris and choroidal stroma. This review explores the principles, standard protocols, and clinical applications of ICGA in posterior uveitis. It details ICGA's critical role in classifying and diagnosing primary inflammatory choriocapillaropathies, like multiple evanescent white dot syndrome or serpiginous-like choroiditis, and stromal choroiditis, including Vogt-Koyanagi-Harada disease, birdshot chorioretinitis, and sarcoidosis. Furthermore, its utility in infectious uveitis, such as presumed intraocular tuberculosis and syphilitic chorioretinitis, is discussed. ICGA uniquely reveals subclinical choroidal lesions, such as hypofluorescent dark dots and geographic nonperfusion, which frequently exceed clinical or fluorescein angiography findings. By mapping the true extent of choroidal inflammatory activity, ICGA decisively guides the initiation and escalation or safe tapering of systemic corticosteroid and immunosuppressive therapies. Despite emerging noninvasive alternatives, ICGA cannot be fully replaced; it must be integrated into a multimodal imaging approach to optimize long-term visual outcomes and prevent irreversible structural damage in patients with complex chorioretinal inflammation.</p>","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 3","pages":"199-228"},"PeriodicalIF":1.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world outcomes of faricimab in treatment-naïve diabetic macular edema: The Middle East perspective.","authors":"Abdulrahman F AlBloushi, Ahmed M Bedda, Ahmed Habib, Anant Pai, Ahmed Souka, Faisal Alkathery, Yasmine Bedda, Eman Samir, Heba Abdelaziz, Hashem A Abu Serhan","doi":"10.4103/sjopt.sjopt_99_26","DOIUrl":"10.4103/sjopt.sjopt_99_26","url":null,"abstract":"<p><strong>Purpose: </strong>Diabetic macular edema (DME) is a major cause of visual impairment in patients with diabetic retinopathy. While intravitreal anti-vascular endothelial growth factor (anti-VEGF) monotherapy has been considered standard of care, many patients have suboptimal treatment responses. Faricimab, which targets angiopoietin-2 and VEGF-A, has shown efficacy and tolerability in randomized controlled trials (RCTs). As RCT results are often challenging to replicate in real-world practice, this study assessed the impact of faricimab on DME outcomes in Middle Eastern real-world settings.</p><p><strong>Methods: </strong>Treatment-naïve patients with DME receiving faricimab between 2023 and 2025 with ≥6 months follow-up were examined at five sites in Egypt, Saudi Arabia, and Qatar. Following loading doses, patients were treated with either pro re nata or treat-and-extend regimens. Outcomes included visual acuity (VA), retinal thickness, number of injections, and adverse events (AEs). Data were analyzed separately by site.</p><p><strong>Results: </strong>Eighty-eight eyes were treated across sites, with mean follow-up ranging from 7.6 to 12.5 months. Mean number of faricimab injections ranged from 3.0 to 4.2. Improvements from baseline in VA (mean logarithm of the Minimal Angle of Resolution reductions between -0.16 and -0.49) and retinal thickness (mean reductions between -50.6 μm and -194.0 μm) were observed with faricimab treatment at all sites, regardless of differences in treatment protocol or observation time points. No AEs of intra-ocular inflammation or endophthalmitis were observed.</p><p><strong>Conclusion: </strong>The findings suggest faricimab conferred visual and anatomical improvements in a heterogeneous group of patients with DME in real-world Middle East settings. Further real-world studies are essential to confirm long-term safety and effectiveness in clinical practice.</p>","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 3","pages":"234-241"},"PeriodicalIF":1.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging diagnostic modalities in microbial keratitis: Beyond culture and smear.","authors":"Victoria Vought, Rita Vought, Hassaam S Choudhry, Mohammad H Dastjerdi","doi":"10.4103/sjopt.sjopt_345_25","DOIUrl":"10.4103/sjopt.sjopt_345_25","url":null,"abstract":"<p><p>Microbial keratitis (MK) is a significant cause of corneal blindness worldwide, necessitating accurate and timely diagnosis for effective treatment. Traditional diagnostic techniques, such as corneal scraping for staining and culture, have limitations in sensitivity, specificity, and result time. This review analyzed peer-reviewed PubMed articles to explore emerging diagnostic modalities that address these challenges, focusing on molecular diagnostics, imaging techniques, and artificial intelligence (AI). Polymerase chain reaction and next-generation sequencing offer rapid and sensitive detection of the causative pathogen, although limitations include cost and false positives. Imaging technologies, such as <i>in vivo</i> confocal microscopy and anterior segment optical coherence tomography, allow for visualization of corneal pathology and may be useful for some etiologies. The emergence of AI with these imaging techniques has demonstrated significant success in classifying pathogens, which can be used to tailor antimicrobial treatment. The integration of these advanced diagnostic tools into clinical practice has the potential to significantly improve the management and outcomes of MK by enabling precise and rapid pathogen identification, guiding more effective treatment strategies, and ultimately reducing the morbidity associated with this condition. As these technologies continue to evolve and become more accessible, they are poised to transform the diagnostic approach to MK.</p>","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 2","pages":"133-138"},"PeriodicalIF":1.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ceftazidime for Gram-negative bacterial keratitis.","authors":"Tadhg Schempf, Kanwal Matharu, Regis P Kowalski, Vishal Jhanji","doi":"10.4103/sjopt.sjopt_413_25","DOIUrl":"10.4103/sjopt.sjopt_413_25","url":null,"abstract":"<p><strong>Purpose: </strong>Empiric keratitis to treat Gram-negative infections is often fortified with tobramycin or monotherapy with fluoroquinolones. Ceftazidime is not generally administered, although it has found success in the past. In this <i>in vitro</i> study, we sought to understand the possible role of ceftazidime in the treatment of Gram-negative keratitis in comparison to other anti-infectives.</p><p><strong>Methods: </strong>This was a retrospective study at an academic tertiary care ophthalmology department. The laboratory records of patients with culture-positive Gram-negative keratitis were evaluated for anti-infective susceptibility of Gram-negative bacteria to ceftazidime, tobramycin, ciprofloxacin, and polymyxin B. The median minimum inhibitory concentration (MICs μg/ml) of each Gram-negative bacterial group was compared to the established serum standards.</p><p><strong>Results: </strong>Analysis of <i>Pseudomonas aeruginosa</i> isolates from 38 patients between January 1, 2020, and December 31, 2021, demonstrated median MICs for four antibiotics: ceftazidime (1.5 μg/ml), tobramycin (1.5 μg/ml), ciprofloxacin (0.094 μg/ml), and polymyxin B (1.75 μg/ml). Among 15 isolates from other Gram-negative isolates during the same period, the median MICs were: ceftazidime (0.19 μg/ml), tobramycin (1.0 μg/ml), ciprofloxacin (0.032 μg/ml), and polymyxin B (1.0 μg/ml). All median MIC values for <i>P. aeruginosa</i> and other Gram-negative bacteria were denoted as susceptible, as interpreted by the serum standards.</p><p><strong>Conclusion: </strong>Based on <i>in vitro</i> testing, our data suggest that ceftazidime may still be useful in the treatment of Gram-negative keratitis. Patient comfort, costs, and availability will dictate the role of ceftazidime in the treatment of Gram-negative keratitis.</p>","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 2","pages":"165-167"},"PeriodicalIF":1.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corneal biopsy as a primary diagnostic tool in microbial keratitis patients on poly-antimicrobials.","authors":"Lavanya Gandepalli, Aafreen Bari, Prafulla K Maharana, Seema Kashyap, Nishat Ahmed, Pranita Sahay, Dewang Angmo, Tanuj Dada, Namrata Sharma, Jeewan Titiyal","doi":"10.4103/sjopt.sjopt_504_25","DOIUrl":"10.4103/sjopt.sjopt_504_25","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the role of corneal biopsy in nonhealing keratitis patients on multiple antimicrobials.</p><p><strong>Methods: </strong>In a randomized, prospective, interventional study conducted at a tertiary eye center in India, 44 patients with infectious keratitis were recruited from February 2022 to October 2023. The cases that were on ≥2 topical antimicrobial drugs belonging to 2 different classes for ≥1 week with no signs of healing and corneal ulcer size of ≥4 mm were included. They were randomized into two groups: the corneal scraping group and the corneal biopsy group. The primary outcome measure was culture positivity rate, while the secondary outcome measures were smear positivity rate and complication rates in both groups.</p><p><strong>Results: </strong>The culture positivity rate of the corneal scraping group was 59.09% and the corneal biopsy group was 77.27% in cases of bacterial keratitis (<i>P</i> = 0.32). However, in cases of fungal keratitis, the culture positivity rate of the biopsy group was better than the scraping group (<i>P</i> = 0.012). The sensitivity and specificity of the Gram stain of the corneal scraping sample were found to be 55.56% and 92.31%, respectively. The sensitivity and specificity of the potassium hydroxide stain of the corneal scraping sample were found to be 50% and 94.4%, respectively. The sensitivity and specificity of histopathological samples obtained from biopsy to detect fungal elements were 66.6% and 90%, respectively. No complications were noted in both the groups during the procedure.</p><p><strong>Conclusion: </strong>In nonhealing keratitis with suspected fungal cause, corneal biopsy may be used as a primary diagnostic modality in a referral center.</p>","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 2","pages":"154-158"},"PeriodicalIF":1.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbial keratitis in transition: From traditional paradigms to emerging solutions.","authors":"Kamran M Riaz","doi":"10.4103/sjopt.sjopt_223_26","DOIUrl":"https://doi.org/10.4103/sjopt.sjopt_223_26","url":null,"abstract":"","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 2","pages":"107-108"},"PeriodicalIF":1.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Keratitis patterns in patients with human immunodeficiency virus: A 10-year retrospective study.","authors":"Omar Nusair, Ikesinachi Osuorah, Jaron Sanchez, Mohammad Soleimani","doi":"10.4103/sjopt.sjopt_320_25","DOIUrl":"10.4103/sjopt.sjopt_320_25","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the relationship between human immunodeficiency virus (HIV) disease markers, types of keratitis, and sociodemographic factors.</p><p><strong>Methods: </strong>This retrospective epidemiologic study examines HIV-positive patients diagnosed with keratitis over the past 10 years. A chart review was conducted to confirm diagnosis and extract key demographic data (sex, age at keratitis diagnosis, race, and zip codes) and disease metrics (type of keratitis, infectious organism, antimicrobials used, CD4 count, and antiretroviral therapy [ART] adherence). The distribution of keratitis types and infectious organisms was analyzed for associations with demographic and clinical data.</p><p><strong>Results: </strong>Among HIV-positive patients with infectious keratitis, herpes simplex virus (HSV) and varicella zoster virus (VZV) accounted for 71.4% of infections. The distribution of organisms differed significantly from a uniform distribution (<i>P</i> = 0.0036), indicating a predominance of HSV and VZV. For noninfectious cases of keratitis, CD4 count and ART adherence were both significantly associated with the presence of keratoconjunctivitis sicca (dry eye disease; <i>P</i> = 0.0067 and 0.0126, respectively). The Black race was also more likely to be observed in the dataset (<i>P</i> < 0.001). Despite no significant relationship being observed between median household income based on zip code case clustering and keratitis incidence, this relationship approached statistical significance (<i>P</i> = 0.1358).</p><p><strong>Conclusion: </strong>HIV-positive patients with keratitis are most likely to be colonized by HSV or VZV in infectious cases. HIV infection and ART usage are associated with chronic inflammation that may be related to dry eye disease. Racial and socioeconomic disparities continue to influence access to care in patients with HIV.</p>","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 2","pages":"173-177"},"PeriodicalIF":1.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A report of herpetic necrotizing keratitis following coronavirus disease 2019 infection.","authors":"Joshua M Huang, Jordan J Huang, Anna M de Ribot, Francesc M de Ribot","doi":"10.4103/sjopt.sjopt_34_26","DOIUrl":"10.4103/sjopt.sjopt_34_26","url":null,"abstract":"<p><p>Herpetic necrotizing keratitis is a severe ocular manifestation of herpes simplex virus (HSV) infection, often leading to significant visual impairment. We report a case of a 65-year-old female who presented with ocular pain and reduced acuity in the left eye, 2 weeks after a coronavirus disease 2019 (COVID-19) infection, with a relevant history of a herpetic keratitis three decades prior. Examination revealed necrotizing keratitis with stromal necrosis, dendritic epithelial defect, corneal neovascularization, and diffuse conjunctival injection. This was managed concurrently with topical and systemic aciclovir, and topical prednisolone was introduced at the 2-week mark. Recovery to good visual function and resolution of symptoms was achieved. This is a rare case of herpetic necrotizing keratitis following COVID-19 infection and likely represents a reactivation of the latent HSV type 1 by Severe acute respiratory syndrome coronavirus 2. This case emphasizes the importance of recognizing and managing inflammatory ocular complications in individuals with a history of herpetic infections and highlights another potential repercussion of COVID-19.</p>","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 2","pages":"195-197"},"PeriodicalIF":1.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Updates in mycobacterial keratitis diagnosis and treatment.","authors":"Uma L Balakrishnan, Ryan T Wallace, Patricia Chévez-Barrios, Alejandro Arboleda, Masih U Ahmed","doi":"10.4103/sjopt.sjopt_414_25","DOIUrl":"10.4103/sjopt.sjopt_414_25","url":null,"abstract":"<p><p>Mycobacterial keratitis is an uncommon but challenging form of infectious keratitis, often associated with postsurgical eyes. Clinical presentation is variable and may be difficult to recognize, resulting in delays in diagnosis and challenges in management. Traditional diagnostic techniques from corneal scrapings are limited by slow organism growth and may yield negative results. Treatment is challenging due to antimicrobial resistance and typically requires prolonged multidrug therapy. Advances in diagnostic modalities, antimicrobial therapies, surgical approaches, and adjunctive treatments such as corneal crosslinking have improved clinicians' ability to mitigate or avoid severe visual consequences. Despite these developments, optimal management strategies remain incompletely defined, and outcomes continue to vary widely. This review highlights clinical presentations and diagnostic techniques, including slit-lamp images and microbiologic findings from patients at our institution, and discusses emerging technologies such as polymerase chain reaction. We also review the existing literature on NTM keratitis to inform clinical practice, with a focus on medical therapies, surgical management, and newer photodynamic treatment approaches. This review aims to provide a comprehensive framework to support earlier diagnosis and guide more effective management of NTM keratitis.</p>","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 2","pages":"113-119"},"PeriodicalIF":1.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-inflammatory treatments in microbial keratitis.","authors":"Esteban Peralta, Kourtney Houser","doi":"10.4103/sjopt.sjopt_28_26","DOIUrl":"10.4103/sjopt.sjopt_28_26","url":null,"abstract":"<p><p>Infectious keratitis remains a leading cause of corneal blindness worldwide. The role of topical anti-inflammatory agents such as corticosteroids, calcineurin inhibitors, and other steroid-sparing therapies in the management of infectious keratitis has not been clearly defined and remains controversial. The benefit of corticosteroids in the treatment of infectious keratitis varies depending on the causal organism. While one large randomized-controlled trial supports their use in some cases of bacterial keratitis, high-quality evidence for their use in fungal or amoebic keratitis is not well-established. There are few case reports and no randomized control trials evaluating the safety and efficacy of steroids in the treatment of fungal or amoebic keratitis, although generally steroids are avoided in fungal keratitis and used judiciously in amoebic keratitis. Topical steroid-sparing anti-inflammatory treatments such as calcineurin inhibitors may especially have a role in the treatment of fungal keratitis, where topical corticosteroid use is generally avoided. Emerging adjunctive therapies, including amniotic membrane transplantation, photoactivated chromophore cross-linking, and experimental immunomodulators, show preclinical or early clinical promise but lack robust human data. Large, multicenter trials are needed to establish evidence-based protocols for infectious keratitis treatment that balance infection eradication with control of host inflammation. While judicious anti-inflammatory use appears beneficial in many cases, optimal timing, dosing, and combination strategies remain uncertain. This review summarizes current evidence on topical anti-inflammatory therapy for infectious keratitis, focusing on bacterial, fungal and amoebic infections, and highlights key gaps in knowledge.</p>","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 2","pages":"139-144"},"PeriodicalIF":1.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}