Saudi Journal of Ophthalmology最新文献

{"title":"A 5-year review of fungal keratitis in Oklahoma.","authors":"Rishika Garg, Amanda Pan, Emmaline Prinz, Karanpreet Multani, Ethan Adre, Mostafa Khattab, Kai Ding, Kamran M Riaz","doi":"10.4103/sjopt.sjopt_485_25","DOIUrl":"10.4103/sjopt.sjopt_485_25","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate demographics, risk factors, clinical characteristics, and visual outcomes of fungal keratitis (FK) in Oklahoma over 5 years and identify factors linked to poor outcomes.</p><p><strong>Methods: </strong>A retrospective chart review was conducted at the Dean McGee Eye Institute (University of Oklahoma) from January 2019 to February 2024, identifying 103 cases of FK among 1213 corneal ulcer patients. Poor outcomes were defined as final best corrected visual acuity (BCVA) ≤20/70 or need for surgery. Statistical comparisons were performed using the Chi-square test, Wilcoxon rank-sum test, and multivariate logistic and linear regression analyses.</p><p><strong>Results: </strong>Overall, 42/103 (40.8%) of patients had poor outcomes. Mold was the most common etiology (74.8%). Topical steroid use (odds ratio 3.57, <i>P</i> = 0.0025) and poor contact lens (CL) hygiene (<i>P</i> = 0.027) were both independently associated with worse outcomes. However, CL users had a better final BCVA than non-users (<i>P</i> = 0.0138), possibly due to earlier presentation or less severe disease. Intrastromal antifungal injections and scleral lenses resulted in clinically significant mean VA improvements of 7.4 and 4 lines (logMAR-converted), respectively.</p><p><strong>Conclusion: </strong>The epidemiologic patterns observed in this geographic region of the United States, a mold-predominant environment with frequent steroid misuse and CL-associated disease, highlight the importance of early diagnosis, risk-factor modification, and ready access to adjunctive therapies. As FK incidence continues to rise in similar climates, these lessons from our regional cohort may help refine triage pathways and inform treatment approaches to reduce preventable vision loss.</p>","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 2","pages":"159-164"},"PeriodicalIF":1.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354160","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":"Evaluation of corneal infections using a smartphone macro lens for synchronous telemedicine.","authors":"Joseph A Anaya, Julia Yu, Marisa A Schoen, Dilru C Amarasekera, Cherie A Fathy, Sophia Lam, Christopher J Rapuano, Zeba A Syed","doi":"10.4103/sjopt.sjopt_392_25","DOIUrl":"10.4103/sjopt.sjopt_392_25","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the efficacy of synchronous telemedicine consultation with a corneal specialist using a macro lens attachment to a smartphone to evaluate corneal infections.</p><p><strong>Methods: </strong>Patients aged 18 years or older who presented to the Cornea Clinic at Wills Eye Hospital between June 2020 and March 2021 with a corneal infection were examined by two fellowship-trained cornea specialists. One examiner (CJR) performed face-to-face (FTF) slit-lamp evaluations, whereas another examiner (ZAS) performed synchronous telemedicine visit (STV) evaluations via a smartphone with a macro lens of 7× magnification (Olloclip; Foothill Ranch, CA, USA) held by trained study coordinators. Agreement between examinations was measured.</p><p><strong>Results: </strong>Twenty patients were enrolled with an average age of 53.1 ± 13.5 years. When comparing FTF and STV approaches, perfect or excellent concordance or agreement was detected when documenting lagophthalmos (100% agreement), quadrants of conjunctival injection (100% agreement), epithelial defect size (intraclass correlation coefficient [ICC] = 0.964 and 0.946 for maximum and minimum dimensions, respectively), infiltrate size (ICC = 0.920 and 0.831 for maximum and minimum dimensions, respectively), Seidel positivity (100% agreement), presence of hypopyon (κ = 1.000), size of hypopyon (ICC = 0.979), and posterior synechiae (100% agreement). Good concordance was observed for the presence of conjunctival injection (κ = 0.643). Fair concordance was noted for percentage corneal thinning (ICC = 0.504) and presence of Descemet folds (κ = 0.400). Poor concordance was observed for the presence and number of keratic precipitates (κ = -0.184 and - 0.042, respectively) and for anterior chamber cells (κ = 0.286).</p><p><strong>Conclusion: </strong>Synchronous telemedicine enabled by a macro lens-supplemented smartphone camera may be a valuable method for evaluating various key features of infectious keratitis.</p>","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 2","pages":"168-172"},"PeriodicalIF":1.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354202","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 treatments in fungal keratitis.","authors":"Aafreen Bari, Tushar Agarwal, Rajesh Sinha","doi":"10.4103/sjopt.sjopt_492_25","DOIUrl":"10.4103/sjopt.sjopt_492_25","url":null,"abstract":"<p><p>Fungal keratitis is a major cause of corneal blindness, particularly in tropical and low-resource settings, and remains challenging to manage due to delayed diagnosis, limited drug penetration, emerging resistance, and host-mediated tissue damage. Conventional antifungal therapies, including natamycin and voriconazole, are often inadequate in deep, severe, or refractory infections, underscoring the need for alternative strategies. This narrative review summarizes and critically appraises emerging treatments in fungal keratitis, with a focus on recent pharmacological advances, innovative drug delivery systems, adjunctive therapies, and immunomodulatory approaches. Newer-generation azoles, echinocandins, and repurposed agents are discussed alongside advanced formulations such as liposomal amphotericin B, solubilized natamycin, nanoparticle-based delivery, and intrastromal drug administration. Adjunctive modalities, including photo-activated corneal cross-linking, photodynamic therapy, therapeutic contact lenses, and low-temperature plasma, are reviewed for their antimicrobial and corneal-stabilizing effects. The role of immunomodulators in mitigating excessive inflammation while preserving antifungal defense is also highlighted. In addition, evolving strategies for managing infections caused by emerging and fungus-like pathogens, including Pythium <i>sp</i>., are addressed. While many of these therapies show promising experimental and early clinical outcomes, robust randomized controlled trials and standardized treatment protocols remain limited. This review emphasizes the need for translational research, ocular-specific antifungal development, and integrated therapeutic approaches to improve visual outcomes and reduce the burden of fungal keratitis.</p>","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 2","pages":"145-153"},"PeriodicalIF":1.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354156","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":"Non-antibiotic management of bacterial keratitis.","authors":"Mizna Akbar, Christopher Phung, Alexis Monical, Mikhayla L Armstrong, John C Alverdy, Asim V Farooq","doi":"10.4103/sjopt.sjopt_389_25","DOIUrl":"10.4103/sjopt.sjopt_389_25","url":null,"abstract":"<p><p>Bacterial keratitis (BK) is a common subtype of infectious keratitis, the most common cause of corneal blindness globally. While antibiotics are the mainstay of treatment for BK, numerous nonantibiotic treatments and adjuncts have emerged in recent years. These include, but are not limited to, collagen cross-linking, phototherapy, immunomodulators, and various forms of transplantation. The purpose of this work is to provide a comprehensive summary of the current literature, highlight promising areas of progress, and identify gaps and areas for further work in the management of BK. With rising resistance to antibiotics, this review echoes and emphasizes the call to study and establish alternative and adjunctive strategies for BK treatment.</p>","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 2","pages":"120-129"},"PeriodicalIF":1.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354224","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":"Intrastromal antimicrobial injections in microbial keratitis: Current evidence and clinical perspectives.","authors":"Naazli M Shaikh, Aaliyah S Shaikh, Raad S Shaikh","doi":"10.4103/sjopt.sjopt_387_25","DOIUrl":"10.4103/sjopt.sjopt_387_25","url":null,"abstract":"<p><p>Intrastromal antimicrobial injections are an emerging adjunctive treatment for severe, deep, or recalcitrant microbial keratitis when conventional topical or systemic therapies are insufficient. By delivering high local concentrations of antimicrobial agents directly into the corneal stroma, this approach may overcome limitations in tissue penetration and, in selected cases, delay or avoid the need for keratoplasty. Current evidence supporting intrastromal therapy is strongest in fungal keratitis, where it is increasingly used in deep stromal disease. In contrast, evidence for bacterial keratitis remains limited and is derived largely from case reports and small case series, typically in refractory or biofilm-associated infections. This review synthesizes the available literature on intrastromal antimicrobial injections, including indications, technique, efficacy, safety, and dosing considerations. A targeted literature review was performed using PubMed, Scopus, and Google Scholar. While intrastromal therapy shows promise, outcomes vary according to organism, antimicrobial selection, and study design. Further high-quality studies are needed to define optimal protocols, comparative efficacy, and long-term safety.</p>","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 2","pages":"130-132"},"PeriodicalIF":1.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354175","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":"Outcomes of corneal perforations secondary to microbial keratitis at a tertiary care center: A case series.","authors":"Jonathan Carcione, Abhinav Bheemidi, Ahmed Omar","doi":"10.4103/sjopt.sjopt_388_25","DOIUrl":"10.4103/sjopt.sjopt_388_25","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose is to characterize clinical outcomes and management strategies for corneal perforations secondary to microbial keratitis, and to identify potential risk factors for poor visual prognosis and trends in management.</p><p><strong>Methods: </strong>This retrospective case series analyzed patients treated for corneal perforation secondary to documented microbial keratitis at a tertiary care center between July 2023 and July 2025. Patients with traumatic or autoimmune etiologies were excluded. Clinical data, including demographics, visual acuity, microbial culture results, time to perforation, and treatment modalities, were reviewed.</p><p><strong>Results: </strong>Of 23 identified corneal perforation cases, 5 were attributed to microbial keratitis. Pathogens included <i>Pseudomonas aeruginosa</i>, herpes simplex virus 1, and suspected fungal organisms; cultures were not obtained in all cases. Time to perforation ranged from immediate presentation to 8 weeks after symptom onset. Most patients (80%) underwent penetrating keratoplasty, while others were managed with corneal gluing, bandage contact lenses, or medical therapy alone. Final visual acuity varied significantly, with outcomes ranging from hand motion to 20/30. Worse visual outcomes were associated with central or large perforations and preexisting ocular comorbidities.</p><p><strong>Conclusion: </strong>Corneal perforation due to microbial keratitis remains a severe, vision-threatening complication requiring timely and often surgical intervention. Delayed presentation and central ulceration were associated with poorer outcomes. Although limited by a small sample size and a retrospective design, this series highlights the variability in clinical course and visual recovery. Further prospective, multicenter studies are warranted to better define prognostic indicators and to guide standardized treatment algorithms for infectious corneal perforations.</p>","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 2","pages":"178-182"},"PeriodicalIF":1.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354246","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":"Interface keratitis following endothelial keratoplasty.","authors":"Ellen H Koo","doi":"10.4103/sjopt.sjopt_5_26","DOIUrl":"10.4103/sjopt.sjopt_5_26","url":null,"abstract":"<p><p>Infectious interface keratitis (IIK) is an uncommon but potentially vision-threatening complication following posterior lamellar keratoplasty, including Descemet stripping automated endothelial keratoplasty (EK) and Descemet membrane EK. The interface space allows microbial sequestration, limits antimicrobial penetration, and complicates microbiologic diagnosis. This review summarizes epidemiology, microbiology, clinical presentation, management strategies, and outcomes of IIK after EK, with an emphasis on surgical decision-making. Across reviews and case series, Candida remains the predominant organism causing IIK after EK. In certain cases, selected localized infections may be considered as graft-sparing candidates for interface drainage and/or directed intrastromal antimicrobial therapy. While others - particularly fungal and atypical infections - require escalation to repeat keratoplasty or therapeutic penetrating keratoplasty (TPK). IIK following EK should be approached as a deep-seated infection in an anatomically secluded space. When clinical progression is observed or diagnosis remains uncertain, early intervention and timely \"source control\" are central to management. Targeted intrastromal and/or interface therapy may preserve the original EK graft in carefully selected cases, whereas TPK remains the most definitive approach, especially for progressive or medically refractory infection.</p>","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 2","pages":"109-112"},"PeriodicalIF":1.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354255","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":"Characteristics and causes of ocular trauma - A retrospective, multi-center study.","authors":"Nasser A Alsabaani, Ibrahim A Al Zehefa, Ahmed S Al Zomia, Mohammed A Al-Amri, Abdullah J Korkoman, Ziyad S Aldawh, Osama H Alalmaie, Ahmed A Alamoud, Saeed S Alqahtani, Ashwaq Y Asiri","doi":"10.4103/sjopt.sjopt_239_24","DOIUrl":"10.4103/sjopt.sjopt_239_24","url":null,"abstract":"<p><strong>Purpose: </strong>Ocular trauma remains a significant public health concern worldwide, with regional variations in its incidence and characteristics. This study aimed to examine the trends and features of ocular trauma in the Asser region of Saudi Arabia, where limited data currently exist.</p><p><strong>Methods: </strong>A retrospective study was conducted using medical records from patients treated in the Ophthalmology Departments of three hospitals in the Asser region between January 1, 2010, and December 30, 2022. The collected data included demographics, injury details, symptoms, treatment timing, hospitalization, interventions, and visual outcomes. Descriptive statistics were used for analysis.</p><p><strong>Results: </strong>A total of 148 patients were included in the study. Open globe injuries were the most common (66.3%), with penetrating injuries being the most frequent subtype (55.4%). Closed globe injuries (contusions) accounted for 33.8% of cases. Most injuries occurred at home (40.5%) or during transportation (34.5%), with driving being the most frequently reported circumstance (36.5%). Common symptoms were pain (64.9%), reduced visual acuity (54.1%), and redness (18.2%). Notably, 98.0% of patients did not wear protective eyewear. Regarding treatment timing, 43.2% received care within 12 h, while 31.8% waited over 24 h. Hospitalization was required in 75.7% of cases, with 7.4% involving orbital fractures. The most frequent interventions included primary corneal closure and globe repair. Visual outcomes showed temporary impairment in 46.6% of patients, no impairment in 45.3%, and permanent impairment in 8.1%.</p><p><strong>Conclusion: </strong>This study highlights the distinct patterns of ocular trauma in the Asser region, providing essential data for improving preventive strategies and healthcare responses. Further research is necessary to reduce ocular trauma incidence in similar settings.</p>","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 3","pages":"229-233"},"PeriodicalIF":1.1,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991793","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":"Effect of ultraviolet-A-induced corneal collagen cross-linking in the management of <i>Staphylococcus epidermidis</i> keratitis: <i>In vitro</i> study.","authors":"Muhanna M Alanazi, Saleh A Alkhaldi","doi":"10.4103/sjopt.sjopt_237_25","DOIUrl":"10.4103/sjopt.sjopt_237_25","url":null,"abstract":"<p><strong>Purpose: </strong>Bacterial keratitis remains a significant cause of corneal morbidity and visual impairment. Increasing resistance to antimicrobial therapy has prompted interest in alternative or adjunctive treatments, including corneal collagen cross-linking (CXL) with ultraviolet-A (UV-A) and riboflavin. The aim of the study is to develop an <i>in vitro</i> human corneal infection model and to evaluate the efficacy of UV-A-induced corneal collagen CXL as an adjuvant treatment for <i>Staphylococcus epidermidis</i> keratitis.</p><p><strong>Methods: </strong>Three human donor corneas were dissected into quadrants and assigned to four experimental groups: (1) control (noninoculated and nontreated), (2) inoculated only, (3) inoculated and postinfection cross-linked, and (4) precross-linked and subsequently inoculated. All infected samples were exposed to <i>S. epidermidis</i> and the CXL procedure was applied either 24 h prior to or 24 h following bacterial inoculation. Corneal tissues were processed and analyzed using hematoxylin and eosin staining and immunohistochemistry.</p><p><strong>Results: </strong>The postinfection CXL group demonstrated a significant reduction in bacterial load compared to the inoculated-only and precross-linked groups. Moreover, there was limited bacterial spread, and posterior stromal architecture was better preserved in the treated corneas.</p><p><strong>Conclusion: </strong>The study successfully established a human <i>in vitro</i> model of bacterial keratitis. UV-A-induced corneal collagen CXL shows promise as an effective adjunctive therapy for <i>S. epidermidis</i> keratitis by mitigating bacterial invasion and preserving tissue integrity.</p>","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 2","pages":"189-194"},"PeriodicalIF":1.1,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354163","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":"Re: Research productivity of ophthalmology residents in Saudi Arabia: A comprehensive analysis.","authors":"Fayiqa A Bahkir","doi":"10.4103/sjopt.sjopt_323_25","DOIUrl":"10.4103/sjopt.sjopt_323_25","url":null,"abstract":"","PeriodicalId":46810,"journal":{"name":"Saudi Journal of Ophthalmology","volume":"40 1","pages":"103-104"},"PeriodicalIF":1.1,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13082551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700023","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}