Purpose: This hospital-based retrospective study was aimed to assess the causes of blindness among adults aged 17 years and over who attended a teaching eye hospital in Yemen. Methods: The case notes of 3845 consecutive new patients over 12 months attending Ibn Al-Haitham Eye Center which is affiliated to the University of Science and Technology in Sana'a (the capital of Yemen) were retrieved and analysed. Data collected included age, gender, chief complaint and complete eye examination. Results: 7.7 percent (296) were uniocularly blind and 11.2 percent (432) were binocularly blind (best corrected visual acuity <3/60 in the better eye). The leading causes of uniocular blindness were cataract, trauma related ocular complications, corneal opacity, amblyopia and glaucoma. Binocular blindness was mainly due to cataract, glaucoma, diabetic retinopathy, age related macular degeneration and corneal opacity. Conclusions: These data imply that the preliminary results give us some insight about the magnitude of the problem of blindness in Yemen while awaiting a national survey on the prevalence and causes of blindness. Cataract was found to be the main cause of unilateral and bilateral blindness and this will require surgical relief, either in public hospitals, private hospitals and clinics, or in eye camps. Trauma related ocular complications were found to be the second most common cause of uniocular blindness. Health education, implementing work safety measures and bringing ophthalmological care to the doorstep of underprivileged rural community will improve their level of awareness.

Purpose: The aim of this study was to investigate whether Saudi patients undergoing retinal surgery are more prone to perioperative anxiety and/or depression, to determine the relation between pre and postoperative emotional upset and also, to find the relation between severity of visual impairment and psychological dysfunction. Methods: Forty patients with retinal detachment (RD) undergoing Pars Plana Vitrecctomy were enrolled in this descriptive study. Regional block was performed using peribulbar technique in order to avoid confounding psychological effects of general anesthesia. The patients were tested for anxiety and depression using Hamilton Anxiety Rating Scale (HARS) and Beck Depression Inventory (BDI) one day before surgery and before discharge. Results: Psychological disturbance reported only by 17.5 percent of the studied patients. Preoperatively 71 percent of them showed mild to moderate anxiety. After the procedure, 80 percent of anxious patients maintained or experienced decrease level of anxiety. In addition to anxiety, 20 percent of anxious patient developed postoperative mild depression. 14 percent of the psychologically disturbed patients had moderate depression before surgery which became milder after it. Another 14 percent showed severe anxiety and moderate depression only postoperatively. Severe visual impairment was reported by 86 percent of psychological disturbed patients. Conclusion: Saudi patients with RD undergoing retinal procedures infrequently suffered anxiety and/or depression. Preoperative psychological disturbances were a good predictor of postoperative emotional upset. Perioperative psychological disturbances were related positively to the severity of visual impairment.

Objective: To determine the relationship between tear function and ocular surface abnormalities with subjective symptoms of dry eye. Methods: Patients with various ocular irritation symptoms suggestive of dry eye were examined for tear break up time (TBUT), Schirmer's test 1, and Rose Bengal staining pattern. They were compared with a group of asymptomatic healthy subjects. Results: There were 63 subjects, mean age 43.8 years (+/-14.7 years) with various complaints of dryness presenting as having irritation or foreign body sensation. A group of 17 asymptomatic subjects, mean age 42.1 years (+/-12.7 years) were studied as controls. There were 22 (34. 9 %) males and 41(65.1%) females in the symptomatic group while the control group had 4 (23.5%) males and 13(76.5%) females. Ocular irritations included itching 38(60.3%), pricking and itching 10 (15.9%). Mean Shirmer's test values were lower for symptomatic subjects (mean 14.5mm +/-12.3 right eye; 14.9mm +/-12.4 left eye), compared to the controls (23.0mm +/-13.4 right eye; 17. 9mm +/-13.4 left eye) P=0.02, for right eye and 0.4 for left. The mean TBUT were also lower amongst the symptomatic subjects (10.5 seconds, right eye and 10.1 seconds left eye), while for controls mean TBUT was 12.7 seconds right eye and 12.1 seconds left eye (P=0.2). Fifty -six out of 126 (46.8%) eyes of all symptomatic subjects compared to 7 out of 34 (20.6%) eyes of asymptomatic subjects had positive staining of conjunctiva with rose Bengal (p=0.06). For subjects with itching as the primary symptom 44.7% of them as opposed to 23.5% of the controls were likely to stain positive with rose Bengal, (sensitivity of itching as screening tool for dry eye was 81% , specificity 38.2%). Itching and pricking sensation together (sensitivity 46.2% and specificity improved to 65%). Rose Bengal grades were also inversely correlated with mean Schirmers values (Pearson correlation -0.429; P = 0.001) and TBUT (Pearson correlation -0.316, P=0.005). Conclusion: Itching and other ocular irritation symptoms may be indicative of underlying abnormal tear function and ocular surface damage, their presence calls for further examination for tear deficiency and prompt institution of treatment for dry eye.

Purpose: To provide an overview of the spectrum of diseases known as 'idiopathic orbital inflammatory syndrome' also known as orbital pseudotumor, with emphasis on specific diagnostic challenges in the evaluation and management of patients with this disorder. Methods: Review of the relevant literature and summarize recent findings regarding the epidemiology, diagnosis, pathophysiology and treatment of orbital pseudotumor. Results : Orbital pseudotumor is a benign intraorbital process confined to the orbit but extra orbital involvement can occur. It is among the 3 ^rd most common orbital diseases along with thyroid orbitopathy and lymphoproliferative disorder and accounts for 5-10% of orbital processes. Clinically, orbital pseudotumor has been categorized as myositis, dacryoadenitis, anterior, apical and diffuse process. Patients may present with diplopia, conjunctival chemosis, proptosis or abnormal computed tomography scan (CT-scan) findings. Patients may also have associated optic neuropathy. Diagnosis is based on careful history, ultrasonography (U/S), CT-scan and magnetic resonance imaging (MRI) studies which may also provide prognostic information. Treatment consists of systemic corticosteroids in the form of oral or intravenous administration. Confirmation is made by orbital biopsy. In addition to radiation, cytotoxic agents, immunosuppressant, IV immunoglobulin, biological therapy, TNF-alpha inhibitor monoclonal antibody and Mycophenolate Moftil have been found to be useful in the management of refractory orbital pseudotumor. Conclusion: Understanding of the clinical features of patients with orbital pseudotumor, differentiating it from other orbital processes by use of imaging techniques and timely implementation of available treatment strategies may help prevent visual loss and associated morbidity from this condition.

Purpose: To present a case of scleral buckle infection with Aspergillus flavus in a tertiary eye center in Saudi Arabia. Methods: A retrospective case report of a 28-year-old Saudi male who presented with a six-month history of conjunctival injection and discharge from the left eye which had undergone uncomplicated conventional retinal detachment surgery, at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, in the form of cryopexy, subretinal fluid drainage and scleral buckle (grooved segmental sponge and circumferential band with sleeve) for a macula on retinal detachment four years earlier. A diagnosis of infected extruded scleral buckle was made and the buckle was removed. Results: The infected scleral buckle was removed under local anesthesia with administration of sub-conjunctival irrigation of 50 mg solution of Vancomycin, and sub-conjunctival injection of 25mg of Vancomycin. Post operative microbiological studies revealed infection with silver staining of moderate Aspergillus flavus hyphae. Visual acuity of the left eye improved from 20/200 before surgery to 20/60 in the two years follow-up visit. Conclusion: This case report indicates the importance of considering infection with multiple organisms - including fungal ones - in cases of scleral buckle infections in our population.

A 35-year-old Kuwaiti lady, who is a known myope, developed severe anterior segment ischemia following extra-ocular muscle transposition surgery. The patient was treated with topical and systemic steroids. Her best corrected visual acuity after complete resolution of the inflammation was 20/40. She also developed pupillary mydriasis and anterior lens changes.

To report a case of cataract extraction and intraocular lens (IOL) implantation after phototherapeutic keratectomy (PTK). The IOL power was calculated using the single-K and the double-K SRK/T formula, as well as the Haigis formula after modifying the post PTK corneal power using methods described for corneal power measurements after myopic excimer laser treatment (photorefractive keratectomy (PRK) and LASIK). A new method for IOL power calculation after PTK is introduced.

Cataract extraction and intraocular lens implantation is considered to be a safe procedure in most cases. However, the new advances in the surgical technique namely phacoemulsification and hence the increased use of foldable intraocular lenses have given rise to new complications including late opacification of intraocular lenses. In this case we report late opacification of a foldable hydrophilic acrylic intraocular lens and the surgical technique for its exchange.

This report presents a case of marble intraocular foreign body that developed toxic complications during surgery. The patient is a 25 years old male who presented to the University of Benin Teaching Hospital with a history of trauma to the right eye while cutting marble. He was examined, had an ocular ultrasound scan and subsequently had an extracapsular cataract extraction. His visual acuity in the right eye was light perception. There was an entry point on the cornea, the lens was opaque, there was vitreous haemorrhage and the intraocular foreign body was localized in the posterior part of the posterior segment by ultrasound scan. He had extracapsular cataract extraction. During anterior capsulotomy, the cornea suddenly and rapidly became cloudy with a brownish tinge and the corneal epithelium started desquamating.Marble on its own may not be toxic but the other chemicals including cement, used in the processing of the marble were responsible for this delayed toxicity. Ultrasound scan is valuable in localisation of intraocular foreign bodies.