Saudi Journal of Ophthalmology RSS feed: Current Issue. Saudi Journal of Ophthalmology is an English language, peer-reviewed scholarly publication in the area of ophthalmology. Saudi Journal of Ophthalmology publishes original papers, clinical studies, reviews and case reports. Saudi Journal of Ophthalmology is the official publication of the Saudi Ophthalmological Society and is published by King Saud University in collaboration with Elsevier and is edited by an international group of eminent researchers. http://www.saudiophthaljournal.com/?rss=yesElsevier Inc.en © 2012 King Saud University. Published by Elsevier Inc. All rights reserved. Saudi Journal of Ophthalmology1319-4534262April 2012 © 2012 King Saud University. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.saudiophthaljournal.com/article/PIIS1319453412000525/abstract?rss=yesEditorial Board10.1016/S1319-4534(12)00052-5Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1vvihttp://www.saudiophthaljournal.com/article/PIIS1319453412000203/abstract?rss=yes10.1016/j.sjopt.2012.01.006Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Editorial115116http://www.saudiophthaljournal.com/article/PIIS1319453412000069/abstract?rss=yesAbstract: A majority of intraocular tumors can be diagnosed based on clinical examination and ocular imaging studies, which obviate the need for diagnostic ophthalmic fine needle aspiration biopsy (FNAB). Overall, diagnostic accuracy of ophthalmic FNAB is high but limited cellularity can compromise the diagnostic potential of ophthalmic aspirate samples. The role of ophthalmic FNAB is limited in retinal tumors. Orbital FNAB should be considered in the evaluation of lacrimal gland tumors, orbital metastasis, and lymphoproliferative lesions. Negative cytologic diagnosis of malignancy should not be considered unequivocal proof that an intraocular malignancy does not exist. With improved understanding of genetic prognostic factors of uveal melanoma, ophthalmic FNAB is gaining popularity for prognostic purposes in combination with eye conserving treatment of the primary tumor. In special clinical indications, ancillary studies such as immunohistochemistry and FISH can be performed on ophthalmic FNAB samples. Assistance of an experienced cytopathologist cannot be overemphasized.Fine needle aspiration biopsy of ophthalmic tumorsArun D. Singh, Charles V. Biscotti10.1016/j.sjopt.2012.01.005Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Ophthalmic Pathology Update117123http://www.saudiophthaljournal.com/article/PIIS1319453412000355/abstract?rss=yesAbstract: Transitional papilloma (inverted papilloma, Schneiderian papilloma) is a relatively common, benign epithelial neoplasm of the sinonasal tract that also occurs in the lacrimal drainage system. The name transitional papilloma is recommended because it reflects the key histological features required for pathological diagnosis, as well as the histogenesis of the tumour. The histogenesis of the tumour is reviewed, together with its natural history, which is characterized by bone remodelling and destruction, a tendency to recur and to undergo malignant transformation. Biomarkers associated with these features have been identified in the sinonasal tumours and may also be of relevance to the lacrimal sac tumours, although the necessary studies have not yet been undertaken.Transitional neoplasms of the naso-lacrimal system: A review of the histopathology and histogenesisJ. Godfrey Heathcote10.1016/j.sjopt.2012.02.008Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Ophthalmic Pathology Update125131http://www.saudiophthaljournal.com/article/PIIS1319453412000392/abstract?rss=yesAbstract: Lacrimal gland neoplasms are rare and much of our knowledge of the behavior and molecular pathogenesis of these tumors comes from study of the similar, but more numerous salivary gland neoplasms. After briefly discussing the classification of lacrimal gland neoplasms, I review three areas of emerging knowledge in the pathogenesis of these neoplasms: (1) the concept of adenoid cystic carcinoma with high-grade transformation and the associated cytogenetic changes; (2) recent analysis of the MYB-NFIB gene fusion in adenoid cystic carcinoma, and; (3) overexpression of HER2 in malignant salivary and lacrimal neoplasms.Update on lacrimal gland neoplasms: Molecular pathology of interestValerie A. White10.1016/j.sjopt.2012.02.012Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Ophthalmic Pathology Update133135http://www.saudiophthaljournal.com/article/PIIS1319453412000318/abstract?rss=yesAbstract: Ocular melanomas comprise uveal and conjunctival sub-types, which are very different from each other. A large majority of uveal melanomas involve the choroid, with less than 10% being confined to the ciliary body and iris. They tend to metastasize haematogenously, almost always involving the liver. Therapeutic methods include various forms of radiotherapy, surgical resection and phototherapy, which are often used in combination. Conjunctival melanomas show many similarities to their cutaneous counterparts, often metastasizing by lymphatic spread. Treatment consists of excision of invasive melanoma with adjunctive radiotherapy and/or cryotherapy and topical chemotherapy for intra-epithelial disease. The management of patients with ocular melanomas demands a good understanding of the pathology of these tumours. Pathological examination of the tumour indicates the prognosis and hence the need for further investigation and treatment. The scope of the pathologist is enhanced thanks to advances in molecular biology.Ocular melanomaBertil E. Damato, Sarah E. Coupland10.1016/j.sjopt.2012.02.004Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Ophthalmic Pathology Update137144http://www.saudiophthaljournal.com/article/PIIS1319453412000379/abstract?rss=yesAbstract: Although rare, uveal melanoma is the most common intraocular tumor in adults. Most cases arise from the choroidal layer of the uvea, displaying a discoid, collar-button, or mushroom shaped growth. Histopathologically, neoplasms are classified by the dominant cell type: spindle, epithelioid or mixed spindle cell type. The most important prognostic factors are cell type, nucleolar size, largest tumor dimension, and mitotic figures. Patient prognosis is poor when metastases occur in the liver, one of the main reasons that despite advances in the diagnosis and treatment of uveal melanoma, the mortality rate has not change significantly since 1973.Uveal melanoma: Ocular and systemic diseaseCristina Miyamoto, Matthew Balazsi, Silvin Bakalian, Bruno F. Fernandes, Miguel N. Burnier10.1016/j.sjopt.2012.02.010Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Ophthalmic Pathology Update145149http://www.saudiophthaljournal.com/article/PIIS1319453412000331/abstract?rss=yesAbstract: Malignant melanoma of the conjunctiva is a relatively infrequent neoplasm that can be associated with significant morbidity and cause diagnostic difficulty to both the ophthalmologist and pathologist. We herein describe the first reported case in North American and European databases of a rare variant-signet ring cell melanoma – arising in the background of primary acquired melanosis (PAM) and use this case as a review of important diagnostic and therapeutic considerations when faced with this condition.Conjunctival malignant melanoma: A rare variant and review of important diagnostic and therapeutic considerationsDanah H. Albreiki, Steven M. Gilberg, James P. Farmer10.1016/j.sjopt.2012.02.006Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Ophthalmic Pathology Update151156http://www.saudiophthaljournal.com/article/PIIS1319453412000306/abstract?rss=yesAbstract: The patients’ survival for the most common intraocular tumor in children, retinoblastoma, has a wide spectrum among the world countries. This study was conducted to provide an overview of the retinoblastoma survival disparity worldwide by discussing the trends of patients’ survival, as well as recent advances in the management of retinoblastoma.The design of this study was literature review and commentary. Selected articles from PubMed (except one) including both developing and developed countries regarding the patients’ survival in retinoblastoma were considered and reviewed critically. An analysis of 47 articles was performed. In conclusion, in spite of an obvious contrast of retinoblastoma survival disparity in the world, the expanding horizons in developing countries are promising and continuing on all fronts and results are hope-inspiring.“Retinoblastoma survival disparity”: The expanding horizon in developing countriesMasood Naseripour10.1016/j.sjopt.2012.02.003Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Ophthalmic Pathology Update157161http://www.saudiophthaljournal.com/article/PIIS1319453412000410/abstract?rss=yesAbstract: Many advances in the field of management of retinoblastoma emerged in the past few years. Patterns of presentation of retinoblastoma in the Middle East region differ from Western community. The use of enucleation as a radical method of eradicating advanced disease is not easily accepted by patient’s family. We still do see stage E, failed or resistant retinoblastoma and advanced extraocular disease ensues as a result of delayed enucleation decision. In this review, we discuss updates in management of retinoblastoma with its implication on patients in our part of the world. Identifying clinical and high risk characteristics is important prognostically and are discussed for further management of retinoblastoma cases.Retinoblastoma major review with updates on Middle East management protocolsIhab Saad Othman10.1016/j.sjopt.2012.03.002Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Ophthalmic Pathology Update163175http://www.saudiophthaljournal.com/article/PIIS1319453412000367/abstract?rss=yesAbstract: Orofacial granulomatosis (OFG) is an uncommon but increasingly recognized disease of unknown etiology. The typical presentation is chronic swelling of the perioral soft tissue, but eyelid edema can be the sole manifestation. Terminology of this disease can be confusing as it may also be referred to as granulomatous cheilitis and a monosymptomatic presentation of Melkersson–Rosenthal syndrome (MRS). Crohn’s disease and sarcoidosis should also be considered in the differential as the histopathology can be similar. Corticosteroids are the mainstay of treatment but can lack efficacy. Atypical presentations and the possibility of systemic disease involvement can further challenge the management. We describe an unusual case in which OFG manifests solely as chronic eyelid swelling. This 69-year old Asian female patient had a delayed diagnosis that responded well to intralesional corticosteroid injection with surgical skin reduction. In addition to describing this unusual presentation of OFG, we review the relevant literature and evaluate the current terminology used to describe this entity.Orofacial granulomatosis presenting as bilateral eyelid swellingCurtis W. Archibald, Karim G. Punja, Allan F. Oryschak10.1016/j.sjopt.2012.02.009Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Ophthalmic Pathology Update177179http://www.saudiophthaljournal.com/article/PIIS1319453412000380/abstract?rss=yesAbstract: Endophthalmitis is a feared complication of trauma, surgical procedures and septicemia. Although uncommon, its potential for significant visual loss is well recognized. Especially over the past decade, complicated surgeries and medical techniques have increased and seriously ill patients are being sustained in ever increasing numbers. New pathogens are being recognized and known ones reclassified thanks to advances in molecular analysis. Continuously evolving PCR methodologies also add a new dimension to the diagnosis of infectious endophthalmitis. As well, medical literature is now truly international, encompassing studies from around the world that expand our understanding of ocular infectious disease. This report reviews some of these changes as they relate to endophthalmitis and particularly to the spectrum of organisms involved.Endophthalmitis: A review of recent trendsJanice R. Safneck10.1016/j.sjopt.2012.02.011Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Ophthalmic Pathology Update181189http://www.saudiophthaljournal.com/article/PIIS1319453411001202/abstract?rss=yesAbstract: Microbial (non-viral) keratitis is a serious vision-threatening condition. The management of microbial keratitis in children is particularly complicated by the children’s inability to cooperate during examinations and the lack of information prior to presentation. Predisposing factors vary according to geographical location and age. Corneal trauma is the leading cause for microbial keratitis in children, followed by systemic and ocular disease. Etiologic agents are most frequently Gram-positive and Gram-negative bacteria commonly found in contact lens-related microbial keratitis. Mycotic keratitis is a major risk factor in tropical weather conditions, particularly when associated with agricultural trauma. Early diagnosis, intensive drug treatment, and timely planned surgical intervention may effectively improve the outcome of pediatric microbial keratitis.Non-viral microbial keratitis in childrenAbdullah G. Al-Otaibi10.1016/j.sjopt.2011.10.002Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Ophthalmic Pathology Update191197http://www.saudiophthaljournal.com/article/PIIS1319453412000343/abstract?rss=yesAbstract: Microsporidia are getting more recognized as causative organism of ocular, gastrointestinal, renal, pulmonary, and sinus diseases, in both immunocompetent and immunosuppressed patients. Ocular microsporidiosis can be isolated or may present as part of systemic infection. Recent reports showed increasing number of cases of ocular microsporidiosis in immunocompetent individuals. The ocular type occurs mainly in two forms: keratoconjunctivitis form which is mostly seen in immunocompromised individuals and stromal keratitis form seen in immunocompetent individuals. The ocular cases which present with superficial keratitis in acquired immune deficiency syndrome (AIDS) patients differ from the cases seen in immunocompetent individuals which present mainly as deep stromal keratitis.We are presenting the only two documented cases of microsporidial keratitis diagnosed over 25 years of practice in our institution. The cases are diagnosed by identification of the Acid-fast organisms. Ultrastructure and additional information on species identification in one of the cases. Both cases are eventually managed by therapeutic PKP. Diagnosis and treatment modalities are discussed based on a comprehensive literature review.Microsporidial keratitis: Literature review and report of 2 cases in a tertiary eye care centerHind M. Alkatan, Sultan Al-Zaaidi, Sreedharan Athmanathan10.1016/j.sjopt.2012.02.007Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Ophthalmic Pathology Update199203http://www.saudiophthaljournal.com/article/PIIS1319453412000057/abstract?rss=yesAbstract: Purpose: To elucidate the distinct histochemical and immunohistochemical profile of mucoepidermoid carcinoma of the conjunctiva (MECC) and to determine which combination of stains is most useful in diagnosing MECC and differentiating it from squamous cell carcinoma of the conjunctiva (SCC) in cases where the clinical or cytological findings are not definitive.Methods: Eight specimen of MECC from 4 patients and 4 specimens of SCC from 4 patients were examined using a variety of special stains and immunohistochemical markers. The results were then analyzed for usefulness in diagnosing MECC.Results: The most useful markers in diagnosing MECC and differentiating it from SCC are mucicarmine, colloidal iron, and alcian blue all with sensitivities of 88%, and a specificity of 100%; CEA with a sensitivity of 83% and a specificity of 75%; and, mucin-1 with a sensitivity of 100% and a specificity of 25%, but which showed a distinct pattern of staining of MECC when compared to SCC. In our series, the sensitivity of the CK7+/CK20− combination for MECC was only 38%.Conclusions: The most useful stains in ruling out SCC in a suspected case of MECC were shown to be mucicarmine and the glycosaminoglycan (GAG) stains. However, in cases where mucicarmine and the GAG stains are negative or difficult to interpret and there is suspicion of a diagnosis of MECC, CEA and mucin-1 may be helpful for this diagnosis. The findings of CK7+/CK20− also may be of assistance, but are not as sensitive when compared to analogous salivary gland lesions, when differentiating MECC from SCC.Histochemical analysis and immunohistochemical profile of mucoepidermoid carcinoma of the conjunctivaAndré Jastrzebski, Seymour Brownstein, David R. Jordan, Steven M. Gilberg10.1016/j.sjopt.2012.01.004Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Original Articles205210http://www.saudiophthaljournal.com/article/PIIS1319453411000646/abstract?rss=yesAbstract: Purpose: This study evaluates the relative frequency of benign eyelid lesions presented to a teaching hospital in Saudi population.Patients and methods: Charts of patients with benign eyelid lesions were retrospectively reviewed from January 2003 to December 2008. Clinical details included demographic data, symptoms and signs, surgical findings, primary diagnosis, and indication for biopsy were analyzed in a histopathologically confirmed benign eyelid lesions. Eyelid lesions were arranged according to their order of frequencies.Results: A total of 222 biopsies were evaluated from 181 patients (male 39.2% and female 60.8%). The age of the patient at the time of biopsy ranged from 2 to 87years old. The most common benign eyelid lesion encountered in our practice was sweat gland hidrocystoma followed by chalazion, skin tag, epidermal cyst, nevus, seborrheic keratosis, xanthelasma, and molluscum contagiosum respectively. Histopathological studies confirmed the clinical diagnosis in 95.9% (213/222) of specimens and was different from the clinical diagnosis in 4.1% (9/222) of the lesions which included seborrheic keratosis (n=3), pilomatrixoma, steatocystoma, hemangioendothelioma, juvenile xanthogranuloma, calcinosis cutis, and syringocystadenoma papilliferum. No malignant lesion was labeled as benign.Conclusion: Epidemiology of benign eyelid lesions in Saudi population is different from Far East or Western populations. Sweat gland hidrocystoma with classical clinical features and straightforward diagnosis is the most frequent lesion in our series which could be due to characteristic dry climate.Epidemiology of benign eyelid lesions in patients presenting to a teaching hospitalYasser H. Al-Faky10.1016/j.sjopt.2011.05.005Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Original Articles211216http://www.saudiophthaljournal.com/article/PIIS1319453411001330/abstract?rss=yesAbstract: Purpose: To determine the incidence and microbiological profile of mycotic keratitis seen at a tertiary care eye hospital.Materials and methods: A retrospective review of microbiology records of patients presenting with suspected microbial keratitis seen between January 2006 and December 2009 was performed. Patients with positive fungal cultures were further analyzed for the type of fungus isolated and associated bacterial pathogens.Results: Microbiology records of 2300 patients with suspected microbial keratitis were reviewed. A microbiological diagnosis of mycotic keratitis was established in 87 (3.8%) patients over a four year period based on positive fungal cultures. The yearly incidence of mycotic keratitis was 3.2% (2006), 4.9% (2007), 3.3% (2008) and 3.6% (2009). Filamentous fungi were isolated more often than yeasts. Aspergillus species followed by Fusarium species and Trichophyton species were the commonest filamentous fungi isolated while Candida albicans was the most frequently encountered yeast. Mixed infections due to fungal and bacterial pathogens were seen in 25/87 (28.7%) patients.Conclusion: Cumulative incidence of mycotic keratitis was 3.8% over a four year period. Aspergillus species and Candida albicans were the most frequent pathogenic organisms causing mycotic keratitis in this part of the world. Mixed infections were seen in 28.7% of the patients. Knowledge of the “local” etiology within a region may be valuable in the management of mycotic keratitis in instituting an empirical therapy, especially when facilities for microscopy, cultures and antifungal susceptibility are not readily available. The baseline information presented will also be helpful in the planning of a corneal ulcer management strategy and for future studies on mycotic keratitis.Incidence and microbiological profile of mycotic keratitis in a tertiary care eye hospital: A retrospective analysisHind Alkatan, Sreedharan Athmanathan, Conchita C. Canites10.1016/j.sjopt.2011.11.005Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Original Articles217221http://www.saudiophthaljournal.com/article/PIIS1319453412000409/abstract?rss=yesAbstract: Purpose: Evaluation of the effect of different microorganisms on congenital nasolacrimal duct obstruction (CNLDO) tightness and whether probing or silastic intubation is likely to fail in a particular microorganism infection.Methods: The culture and sensitivity results of lacrimal drainage system (LDS) discharge samples from patients with CNLDO were reviewed. Different microorganisms were correlated with the severity of nasolacrimal duct (NLD) obstruction observed during surgical intervention. The success rates of probing and silastic intubation as a primary procedure for each identifiable microorganism were documented. Statistical analysis was conducted to correlate the type of microorganism with the tightness of CNLDO and treatment failure.Results: Out of 181 specimens, 22 had no growth (12.1%). LDS with positive culture had 76.6% successful probing (n=49) and 82.1% successful silastic intubation (n=78). Gram-positive and Gram-negative species were almost equally detected. The most prevalent organisms were Streptococcus pneumoniae and Hemophilus influenzae (48.1% and 39.2%, respectively). Tight CNLDO was more prevalent in Serratia marcescens (n=2; 100%) and Staphylococcus aureus (n=4; 33.3%) infections with a 7.75 Odds ratio [95% confidence interval (CI), 1.67–34.63]. Staphylococcus aureus had 37.5% successful probing; however, success was achieved in all cases with silastic intubation. Serratia marcescens infections had 100% successful silastic intubation.Conclusion: Microbiology study can predict tight CNLDO and helps in choosing the most successful treatment option. CNLDO with Staphylococcus infection and Serratia marcescens were likely to have tight NLD obstruction and silastic intubation had better outcomes.Value of microbiology study in congenital nasolacrimal duct obstructionYasser H. Al-Faky, Tahir Naeem, Nora Al-Sobaie, Reem Al-Huthail, Hessa Al-Odan, Essam A. Osman, Ahmad Mousa10.1016/j.sjopt.2012.03.001Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Original Articles223228http://www.saudiophthaljournal.com/article/PIIS1319453412000446/abstract?rss=yesAbstract: We report a family of three siblings followed between 2005 and 2011 with bilateral combined hamartoma of the retina and retinal pigment epithelium, with the age of diagnosis ranging from 7 to 13years. The main reason for consultation was reduction of vision and squint. The diagnosis was determined based on the clinical findings on fundus examination: increased pigmentation at the macula with slightly elevated, gray–white macular lesion, tortuosity of perimacular blood vessels and glial epiretinal membrane. The elder brother was found to have left posterior subcapsular cataract. He was also confirmed to have neurofibromatosis type 1, the youngest sister fit in the diagnostic criteria for neurofibromatosis type 1, while the middle sister was presumed to have neurofibromatosis type 1. Follow-up showed stability of the retinal lesion in the three cases, with the progression to develop right posterior subcapsular cataract in the elder sister.This report is aimed to demonstrate that the occurrence of bilateral combined hamartoma of the retina and retinal pigment epithelium could raise the possibility of associated neurofibromatosis.Familial bilateral combined hamartoma of retina and retinal pigment epithelium associated with neurofibromatosis 1Sanaa A. Yassin, Elham R. Al-Tamimi10.1016/j.sjopt.2012.03.005Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Case Reports229234http://www.saudiophthaljournal.com/article/PIIS1319453411001378/abstract?rss=yesAbstract: Primary Diffuse Large B-cell Lymphoma (DLBCL) represents the 2nd most common lymphoma occurring in the orbit, after Mucosal Associated Lymphoid Tissue (MALT) lymphoma. A total of 5 cases of ocular adnexal DLBCL were diagnosed over 25years of experience at our tertiary eye care center. Two cases involved the lacrimal sac and one case involved the lacrimal gland. In this paper we are presenting the remaining 2 non-lacrimal cases of DLBCL. The first case is a 32year old male who was referred with a slowly growing, painless mass involving the left medial canthal area as a case of dacryocystitis. The mass was found to be extending into the orbit inferiorly with upward displacement of the left globe. The second case is a 65year-old lady who presented with unilateral proptosis as a result of a right orbital mass extending to the orbital apex. Histopathologic examination and immunohistochemical analysis of the incisional biopsy in both cases confirmed the diagnosis of Diffuse Large B-cell Lymphoma (DLBCL).Diffuse large B-cell lymphoma of the orbit: A tertiary eye care center experience in Saudi ArabiaHind M. Alkatan, Ahmad M. Alaraj, Ayman Al-Ayoubi10.1016/j.sjopt.2011.09.004Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Case Reports235239http://www.saudiophthaljournal.com/article/PIIS1319453412000434/abstract?rss=yesAbstract: Myeloid sarcoma is a tumor of immature myeloid cells occurring in many extramedullary sites, orbit being one of them where the tumor may occur prior to or after the diagnosis of underlying disease. We report a case of a 17-year-old male who presented with upper eyelid swelling, proptosis and diplopia after presumed blunt trauma without any other clinical signs and symptoms. Initial imaging suggested possibility of subperiosteal hematoma. Magnetic resonance imaging studies demonstrated a solid tumor. Complete excision of the tumor and histopathologic diagnosis revealed evidence of acute myeloid leukemia (AML). There were no other sites indicating any tumoral process; however, bone marrow aspirate revealed an evidence of systemic disease. After chemotherapy and allogenic bone marrow transplant, the patient had complete remission of his disease. An episode of graft vs host reaction resulting in severe dry eyes along with skin eruptions was treated successfully by immunosuppression and topical lubrication without any visual or systemic sequela. This case emphasizes on the need for an aggressive work-up for any unusual orbital lesion in the absence of any explainable etiology. Further, AML may be suspected in the cases of orbital tumors even in the absence of systemic manifestations of leukemia at any age.Unilateral eyelid swelling, proptosis and diplopia as initial manifestation of acute myeloid leukemiaImtiaz A. Chaudhry, Ahmad M. Alaraj, Hind M. Alkatan10.1016/j.sjopt.2012.03.004Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Case Reports241244http://www.saudiophthaljournal.com/article/PIIS1319453411001251/abstract?rss=yesAbstract: We are reporting a 34-year-old Arabic white female patient who presented with a white mass covering her left cornea following multiple ocular surgeries and healed corneal ulcer. The lesion obscured further view of the iris, pupil and lens. The patient underwent penetrating keratoplasty and the histopathologic study of the left corneal button showed epithelial hyperplasia, absent Bowman’s layer and subepithelial fibrovascular proliferation. The histopathologic appearance was suggestive of a corneal keloid which was supported by further ultrastructural study. The corneal graft remained clear 6months after surgery and the patient was satisfied with the visual outcome. Penetrating keratoplasty may be an effective surgical option for corneal keloids in young adult patients.Healed corneal ulcer with keloid formationHind M. Alkatan, Khalid M. Al-Arfaj, Mohammed Hantera, Soliman Al-Kharashi10.1016/j.sjopt.2011.10.005Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Case Reports245248http://www.saudiophthaljournal.com/article/PIIS1319453412000288/abstract?rss=yesAbstract: A twenty-six year old male with decreased vision in right eye was diagnosed with non-rhegmatogenous retinal detachment. Further evaluation revealed a yet undiagnosed left testicular mass found to be choriocarcinoma on histopathology. Chemotherapy resulted in complete remission; however, there was no improvement in vision. There is a substantial risk of visual loss in the presence of ocular metastatic lesions. Early detection and treatment is highly effective in terms of tumor control and a more favorable survival and visual outcome. The onus of the ocular diagnosis lies on the ophthalmologist. The presence of a testicular origin tumor must be considered in a young male with intraocular metastasis.Choroidal metastasis as the presenting feature in a case of testicular choriocarcinomaSukhdeep Bains, Anu Jain, Kumudini Sharma10.1016/j.sjopt.2012.02.001Saudi Journal of Ophthalmology 26, 2 (2012)2012-04-01Saudi Journal of Ophthalmology2012-04-01262S1319-4534(12)X0003-1Case Reports249251