We describe the case of 2-year-old boy with neurofibromatosis type I who developed an extensive diffuse plexiform neurofibroma of the right orbit. A paraspinal mass that involved the right parotid and parapharyngeal space with extension through the foramen ovale into the right cavernous sinus was also detected.

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Endogenous bacterial endophthalmitis is a rare but visually devastating disease. We report the case of a 43-year-old man with septic arthritis and bacterial endocarditis who presented with sudden, complete, and permanent loss of vision caused by endogenous Staphylococcus aureus endophthalmitis.

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Purpose. Proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) may be a response to abnormal angiogenic growth factors, such as vascular endothelial growth factor (VEGF) and angiopoietin (Ang)-2. The purpose of this study is to compare vitreous, aqueous, and serum levels of VEGF and Ang-2 in diabetic patients who have PDR and DME with those of nondiabetic patients, and to identify correlations between the vitreous, aqueous, and serum levels of these angiogenic cytokines. Patients and Methods. Aqueous humor, vitreous fluid, and serum samples were obtained during cataract and vitreous surgery from 16 eyes of 16 patients with PDR (10 eyes) and DME (6 eyes), as well as from 8 eyes of 8 nondiabetic patients with macular holes, and analyzed for levels of VEGF and Ang-2. Results. The mean vitreous level of VEGF was significantly higher in the samples from patients with PDR (182.1 ± 19.0 ng/mL) and from patients with DME (152.2 ± 46.3 ng/mL) when compared to that of the samples from the control group (63.0 ± 37.2 ng/mL) (P<.001; P<.01, respectively). The mean vitreous level of Ang-2 was significantly higher in patients with PDR (369.3 ± 352.2 pg/mL) and in patients with DME (495.3 ± 434.7 pg/mL) than in the control group (28.6 ± 20.9 pg/mL) (P < .001; P<.05, respectively). There was a significant correlation between vitreous and aqueous levels of VEGF (r) = 0.985; P<.001), but not between vitreous and aqueous levels of Ang-2 (r) = 0.087; P = not significant [NS]). There was no correlation between glycosylated hemoglobin (HbA _1c ) and intraocular levels of VEGF (vitreous and aqueous) or Ang-2. Conclusion. VEGF and Ang-2 are significantly elevated in vitreous and aqueous humor in the eyes of patients with PDR and DME when compared to control eyes of patients without diabetes. Among diabetics, there is no correlation between HbA _1C and intraocular levels of VEGF or Ang-2. Correlations do exist between the vitreous, aqueous, and serum levels of VEGF, but not of Ang-2, in patients with PDR and DME. Measuring the aqueous humor level of VEGF may be useful in analyzing the pathogenesis of PDR and in predicting disease activity.

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There is compelling evidence that trachoma-inclusion conjunctivitis (TRIC) agents can and do persist in clinically "healed" subjects, raising the possibility that such persistent cases may constitute reservoirs of infection. The percentage of persistent cases, with antigen detection utilizing polymerase chain reaction, ligase chain reaction, or Giemsa stain techniques, varies from 24% to 53%. The hypothesis put forth in this review is that persistent antigens can cause the endogenous reactivation of clinical disease after being triggered by factors that cannot be clearly elucidated at the present time. Based on the findings of existing studies, it is not evident at this time if single-dose azithromycin will eradicate persistent infection and prevent reactivation through this pathway. Repeat cycles of infection are probably, in large part, caused by this endogenous reactivation, which leads to conjunctival scarring/shrinkage and entropion/trichiasis. The evolution of trachoma from incipient to healed stages, coupled with the infection, reinfection and reactivation cycles, and the interaction of these cycles and stages with environmental factors, compels the postulation of a trachoma ecosystem in which all these factors are integrated.

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Purpose. To determine plasma levels of nitrate and malondialdehyde (MDA) in patients with age-related cataract. Patients and Methods. Serum nitrate and MDA levels were measured in 17 patients with posterior subcapsular cataract and systemic hypertension, 12 patients with cortical cataract, 19 patients with nuclear cataract and a history of cigarette smoking (> 15 years), and 12 age-matched controls without cataract. Results. The mean plasma levels of nitrate and MDA were significantly higher in all 3 groups of cataract when compared to controls. The highest levels of nitrate and MDA were in patients with posterior subcapsular cataract and hypertension. The lowest levels were recorded in patients with cortical cataract. There was a statistically significant correlation between elevated plasma levels of nitrate and MDA in patients with all 3 types of cataract. Conclusion. There is a possible role for elevated levels of nitrate and MDA in the pathogenesis of cataract in the human eye.

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Purpose. To compare serum homocysteine levels in cataract patients with and without pseudoexfoliation (PXF). Patients and Methods. This study included 29 patients with cataract and PXF syndrome, as well as 29 age- and sex-matched controls with cataract but without PXF syndrome. Patients with systemic and ocular conditions known to be associated with hyperhomocysteinemia were excluded from the study. Results. The mean serum homocysteine level was significantly elevated among patients with cataract and PXF syndrome when compared to those without PXF syndrome (16.61 vs. 11.67 ΅mol/L; P = .01). The percentage of patients with PXF syndrome and elevated serum homocysteine was significantly higher than in patients without PXF syndrome (56% vs. 14%; P<.0001). Logistic regression analysis identified elevation in plasma homocysteine levels as a significant risk factor for the development of PXF syndrome (odds ratio = 8.85; 95% confidence interval, 2.40-32.12). Conclusion. Hyperhomocysteinemia is significantly associated with PXF syndrome in patients with cataract.

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Purpose. To compare the use of enzyme-linked immunosorbent assay (ELISA) with Toxocara canis embryonated egg (TEE) antigen and the use of antigen capture ELISA with toxocara excretory/secretory or exoantigen (TEX) in the diagnosis of toxocariasis in asymptomatic pregnant women and infants. Patients and Methods. Serum specimens were collected from 28 asymptomatic pregnant women, as well as from their 28 infants, at El-Salam Center of Family Planning between August 2005 and April 2006. During the same time interval, serum specimens were also collected from 79 apparently healthy infants at Abu El-Reash Teaching Hospital. Toxocara antibody titers were measured using ELISA-TEE and antigen capture ELISA-TEX by previously described methods. Results. Using the ELISA-TEE method, Toxocara antibodies were detected in 7 (25.0%) of 28 pregnant women; in comparison, 12 (42.9%) positive titers were determined using the ELISA-TEX method. Of the 28 infants of the pregnant women, 3 (10.7%) were determined to have Toxocara antibodies using the ELISA-TEE method, whereas 7 (25.0%) positive titers were found using the ELISA-TEX method. Among asymptomatic infants, Toxocara antibodies were detected in 13 (16.5%) of 79 infants using the ELISA-TEE method as compared to 20 (25.3%) positive titers detected using the ELISA-TEX method. On examination, 1 case of active ocular toxocariasis and 4 cases of inactive ocular toxocariasis were detected. Conclusion. The ELISA-TEX method detected a higher prevalence of positive Toxocara antibody titers in asymptomatic women and their infants, as well as in apparently healthy infants, than did the ELISA-TEE method. The ELISA-TEX method was more effective in discriminating between positive and negative titers than the ELISA-TEE method. Ophthalmologists should be aware that active and inactive ocular toxocariasis may be present in these asymptomatic patients.

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Purpose . To evaluate the potential adverse retinal effects of indocyanine green (ICG) when used in staining the anterior lens capsule. Materials and Methods . This study included 12 rabbits, which were placed into 2 different groups. The first group (3 rabbits) was used as a control. The second group was divided into three subgroups, based upon time of sacrifice: at 2 days (3 rabbits), 10 days (3 rabbits), and 20 days (3 rabbits). Eyes were enucleated and examined using light and electron microscopy. Results. Histopathologic retinal abnormalities were present as early as 2 days in eyes in which ICG staining of the anterior lens capsule had been performed. These changes increased in severity 10 days and 20 days after ICG staining. Conclusion. ICG staining of the anterior capsule may be associated with retinal toxicity.

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A 38-year-old man was treated at King Khaled Eye Specialist Hospital for bilateral cicatricial conjunctivitis and keratitis associated with human cowpox infection. To the best of our knowledge, this is the first such case reported in the Kingdom of Saudi Arabia.

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The majority of lymphomas of the ocular adnexa are non-Hodgkin's B-cell lymphomas; many of which occur as primary tumors without systemic involvement. A 16-year-old Saudi male was treated at King Khaled Eye Specialist Hospital for primary non-Hodgkin's B-cell lymphoma without evidence of systemic involvement. Over a 4-year period of follow-up, there was no evidence of recurrent conjunctival tumor or systemic lymphoma development.

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