Background : To describe the initial experience, effectiveness, and safety profile of 23-gauge instrumentation for a variety of vitreoretinal conditions. Methods : A retrospective review of 30 consecutive 23-gauge vitrectomy cases done by a single vitreoretinal surgeon for various posterior segment conditions was done. All surgeries were performed using the two-step 23-gauge system developed by Dutch Ophthalmic Research Center (DORC). All patients had at least 3-month follow-up. Main outcome measures included surgical success, visual acuity, intraocular pressure, and operative complications. Results : Mean follow-up was 7.7 months (range 3-12 months). Indications for surgery included rhegmatogenous retinal detachment (n=8), nonclearing vitreous hemorrhage (n=6), tractional retinal detachment (n=5), macular hole (n=5), epiretinal membrane (n=3), retained lens fragments (n=2) and endophthalmitis (n=1). Gas tamponade was used in 18 eyes (60%) and silicone oil in six eyes (20%). Mean overall preoperative visual acuity was 20/1053 and final acuity was 20/78 ( P = 0.001). Mean intraocular pressure after 6 hours was 15.1mmHg (range 4-25 mmHg) and on postoperative day one was 14.5 mmHg (range 2-21 mmHg). Four eyes (13.3%) required suturing of sclerotomy intraoperatively. Conversion to 20-gauge was done in one eye (3.3%). Hypotony was reported in one eye (3.3%) postoperatively. Subconjunctival silicone oil reported in one eye (3.3%). There were no postoperative complications of endophthalmitis, retinal or choroidal detachment. Conclusion : 23-gauge transconjunctival sutureless vitrectomy was effective in the management of wide variety of vitreoretinal surgical indications. The safety profile compared favorably with published rates for 25-gauge systems.

Purpose: To evaluate the visual outcome of patients who underwent pars plana vitrectomy (PPV) for posteriorly dislocated lens fragments after phacoemulsification. Methods : A retrospective chart review was conducted of all patients who had PPV for posteriorly dislocated lens fragments after phacoemulsification between January 2000 and September 2004 in the Vitreoretinal Service at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. Demographics, preexisting eye diseases, details of the previous cataract surgery, findings at presentation, details of the vitreoretinal procedures, final visual acuity, and complications observed during the follow-up were evaluated. Results: Of the 60 patients identified, 37 patients (37 eyes) had a full set of data and were included in the study. In 21 eyes (56.8%), PPV was performed within 1 week of cataract extraction; in 15 eyes (40.5%), PPV was performed more than 1 week postcataract extraction. An initial visual acuity of 20/200 or worse was found in 34 eyes (91.9%). The final visual acuity was 20/40 or better in 10 eyes (27%), and 20/200 or worse in 13 eyes (35.1%). Retinal detachments were found in 3 eyes (8.1%): 1 before and 2 after vitrectomy. Conclusion: There was no statistically significant difference in outcome between those having vitrectomy the first week after cataract surgery and those having it later; however, there was a trend of better visual outcome in early vitrectomy patients (within 1 week).

Background: Idiopathic intracranial is common in adults, particularly obese young women, but also occurs in children and adolescents. Aim: C linical presentation of idiopathic intracranial hypertension in the pediatric population and how the presenting signs and symptoms may be different from those seen among adult patients. Results: This study is a prospective study conducted in the Alexandria Medical School, Egypt, between the periods starting from January 2003 till December 2007. Ten patients were included in this study, 9 patients were treated with repeated spinal taps while only one patient necessitated insertion of a theco-peritoneal shunt. Conclusion: Idiopathic intracranial hypertension may occur in children as among adults. If diagnosed early, visual acuity can be saved with proper management .

Purpose: The aiming was to study the long-term clinical outcome and the merit of the author's modification of the fox's procedure. Methods: Mersilene mesh brow suspension (MMBS) procedure was performed in 50 upper lids with severe blepharoptosis and poor levator function. Results: The improvement in lid height was evaluated by preoperative and postoperative vertical palpebral aperture measurements and ranged from 2 to 6 mm (average 4 mm). The functional and cosmetically accepted results were maintained in 94% of the lids during mean follow-up of 39.4 months. Conclusion: In the present non-comparative study we believe that late Mersilene knot extrusion and forehead granuloma formation can be prevented by the modification adopted by the authors.

Purpose: To compare two phaco techniques, namely Phaco Prechop and Divide and conquer, basically during their early learning curves. Patients and Methods: The study included 50 patients divided into 2 groups, each including 25 patients; group (A) where phaco Prechop was performed, and group (B) in which divide and conquer was performed. The mean effective ultrasound time, mean endothelial cell count, mean endothelial cell loss, corneal thickness, intraoperative complications, and the best corrected visual acuity were reported in the two groups both preoperative and postoperative. Results: The mean effective ultrasound time in group A was 19.36 ± 8.51 seconds, and in group B, it was 24.44 ± 7.86 seconds with a statistically significant difference between the two groups (P = 0.033). The mean endothelial cell count 3 months postoperative in group A was 2139.88 cells/mm ² . In group B, the mean endothelial cell count 3 months postoperative was 2087.08 cells/mm ² . The difference between the two groups was statistically insignificant (P = 0.558), however The difference in endothelial cell loss 3 months postoperatively between the two groups was statistically significant. (P = 0.001). Four cases in groups A (16%) had posterior capsular rents compared to three cases (12 %) in group B. Postoperative best corrected visual acuity in group B was 6/12 or better in 88% of cases as compared to 92% in group A with no statistical difference. Conclusion: Early cataract surgical cases performed with the Phaco Prechop and divide and conquer techniques showed comparable results and complications. However the former technique utilized less phaco time and energy without significant effect on the final surgical outcome.

We should address visual disabilities in children instead of only the childhood blindness. Diseases related to nutritional, communicable diseases should be addressed through strategies for achieving 'Millennium Development Goals'. Facilities in African countries and countries with populations like India and China must be strengthened to address curable/preventable visual disabilities in children. Even though all efforts are done to strengthen, we will have 0.93 million blind children by 2020. Role of family physicians and paediatricians in trans-disciplinary approach to address visual disabilities in children is very crucial. If rational distribution of skilled human resource is not planned visual disabilities will not reduce effectively. Rehabilitation of visually disabled children should be integral part of addressing childhood blindness. All stakeholders including parents of children with visual disabilities should work together to achieve the goals.

To describe uncommon association between central retinal artery obstruction and dominant macular drusen in two young female patients. First patient, a 22-year-old female was presented with right central artery obstruction associated with bilateral dominant macular drusen. Systemic evaluation disclosed the presence of mitral valve regurge. Second patient, a 34-year-old female with a previous history of right central retinal artery obstruction diagnosed elsewhere. Fundus exam showed bilateral dominant macular drusen and her systemic evaluation revealed severe rheumatic valve stenosis, moderate aortic regurge with moderate to severe tricuspid regurge and she underwent mitral valve replacement. To the best of our knowledge, the association between central retinal artery obstruction and dominant macular drusen was not previously reported.

Bilateral optic nerve sheath meningioma is rare. A meningioma is a benign neoplastic lesion from meningothelial cells of the meninges. They usually involve the intracanalicular portion of the optic nerve but may extend into the optic canal and through it to occupy the intracranial space. We present a case of 25-year-old Saudi female with bilateral optic nerve sheath meningioma. The diagnosis was delayed more than six years from initial symptoms.