Middle East African Journal of Ophthalmology最新文献

Purpose: Survivors of Ebola virus disease (EVD) are at risk for ocular complications after infection. We sought to identify demographic factors associated with the likelihood to present for eye examination among Ebola survivors enrolled in a longitudinal natural history study of EVD.

Methods: The Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL) III Ebola natural history study is a 5-year study that seeks to identify long-term sequelae of EVD, including ocular sequelae. All survivors enrolled in the PREVAIL parent study from June 2015 to March 2016 were asked to return for comprehensive eye examination through June 2016. Logistic regression was conducted using self-reported survivor status, age, gender, and distance from the hospital as covariates.

Results: A total of 1448 subjects enrolled in the parent PREVAIL III longitudinal cohort during the defined window, of which 1375 (95.0%) followed up for baseline eye examination. Ebola survivors (635/661, 96.1%) and adult close contacts (727/767, 94.8%) demonstrated a comparable likelihood for presenting for eye examination (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.36-1.28). In an adjusted model, age over 50 (OR 10.2, 95% CI 1.35-77.3) and living outside Montserrado County (OR 0.18, 95% CI 0.10-0.33) were associated with the likelihood of presenting for a baseline comprehensive eye examination.

Conclusion: Most EVD survivors and their close contacts who enrolled during the study window presented for eye examinations. Older participants and those who lived closer to clinical facilities were most likely to present. Focused strategies accounting for these factors may assist with organizations planning survivor care in the setting of EVD.

Purpose: The purpose of this study was to identify biomarkers that predict the response of treatment-naive idiopathic choroidal neovascularization (iCNV) to anti-VEGF treatment.

Methods: Fourteen eyes diagnosed with iCNV underwent a dilated fundus examination, Swept Source Optical Coherence Tomography (SS-OCT) and Optical Coherence Tomography - Angiography (OCT-A), and were given an anti-VEGF injection. The same examinations were repeated at every follow-up visit. Analysis of the pre- and posttreatment images was done to identify possible biomarkers which were evaluated to check association with decreased need for multiple anti-VEGF injections.

Results: At presentation, 11 patients showed a compact pattern, while three patients showed an arborizing pattern on OCT angiography (P = 1). On follow-up imaging, seven patients showed a marked response, five patients showed a moderate response, and two patients showed a mild response to anti-VEGF injection. Among the seven patients showing a marked response, only one required a repeat injection (P = 0.03). On analysis of SS-OCT, a novel Retinal Pigment Epithelium (RPE) healing response was observed in posttreatment imaging of six patients (P = 0.59).

Conclusion: A "marked" response to the first anti-VEGF injection results in a more sustained response and is a positive prognostic factor. RPE healing response is an interesting observation that merits further evaluation. Morphology of neovascular membranes has no effect on long-term need for multiple anti-VEGF injections.

Chronic myeloid leukemia (CML) is a malignant proliferative disorder involving the bone marrow and lymphatic system. Retinal involvement is a rare form of presentation in patients with CML. We report a case of a 49-year-old woman who presented with an acute bilateral visual disturbance. Her initial visual acuity was 20/20 in both eyes. Fundus examination revealed multiple yellowish retinal infiltrates, vascular sheathing, and peripheral sclerosed blood vessels. Fundus fluorescein angiography revealed bilateral peripheral retinal ischemia. Optical coherence tomography of the macula showed varying sizes of hyperreflective lesions distributed within the inner and outer retinal layers and in the subretinal space. Systemic workup revealed marked leukocytosis, and bone marrow biopsy revealed CML. Patients with CML can rarely present with ocular symptoms. Early recognition and prompt referral are crucial in lifesaving.

Glaucoma is a leading cause of irreversible blindness worldwide which affects all age groups. It is often identified by high intraocular pressure, characteristic optic neuropathy, and vision loss. Due to multifactorial nature of glaucoma pathogenesis, the molecular events responsible for its precipitation are currently poorly understood. Mitochondrial DNA (mtDNA) variations which are inherited maternally are being closely studied in recent times to elucidate the effect on glaucoma. Mitochondrial genetic studies till date have found a possible link between Leber hereditary optic neuropathy loci and glaucoma but with conflicting views. Furthermore, whole mtDNA studies in glaucoma points at the involvement of oxidative phosphorylation complex I and specifically the NADH dehydrogenase 5 gene in glaucoma. This review focuses on identifying the potential genes and variations in the maternally inherited mtDNA which might be involved in glaucoma pathogenesis.

Purpose: To examine the relationship between the presence and severity of retinopathy in women with diabetes mellitus and sleep quality assessed using Pittsburgh Sleep Quality Index (PSQI).

Methods: Among 90 female patients with type 2 diabetes, 30 patients without retinopathy were classified into Group 1, 30 patients with nonproliferative diabetic retinopathy as Group 2, and 30 patients with proliferative diabetic retinopathy as Group 3. People who had a known sleep problem, had a history of using medication other than sleeping pills that would affect sleep, had lower or upper respiratory tract disease, had history of previous surgery, or were unable to answer the survey questions appropriately were excluded from the study.

Results: The mean age was 52.6 ± 6.18 years in Group 1, 55.15 ± 8.15 years in Group 2, and 60.35 ± 5.93 years in Group 3. While no statistical difference was observed between Groups 1 and 2 (P = 0.27), a statistical difference was observed between both Groups 1 and 3 (P = 0.01) and Groups 2 and 3 (P = 0.02). PSQI scores were found to be 5.10 ± 1.07 in Group 1, 7.30 ± 2.34 in Group 2, and 6.70 ± 1.21 in Group 3. In terms of these scores, there was a statistical difference between Group 1 and both Group 2 (P = 0.01) and Group 3 (P = 0.01), while no difference was observed between Groups 2 and 3 (P = 0.31).

Conclusion: Although the presence of retinopathy significantly impairs sleep quality in diabeticwomen, no relationship was found between the severity of retinopathy and impaired sleep quality.

Purpose: The purpose of the study was to study the relationship between the timing of pars plana vitrectomy (PPV) with corrected distance visual acuity (CDVA) in cases of nucleus drop during phacoemulsification.

Methods: This retrospective analysis included 83 patients, who underwent PPV for nucleus or nuclear fragment drop from July 2017 to November 2019. Timing of PPV (≤2 weeks and >2 weeks) after the primary cataract surgery was noted. The primary endpoint was CDVA at 1 month, which was compared with the time of PPV. Visual outcome was assessed as good if CDVA was better than or equal to 20/40 and poor if CDVA was worse than 20/40. Mode of management along with type of secondary intraocular lens (IOL) implanted was also evaluated.

Results: Out of the 83 cases (55 males and 28 females) in which vitrectomy for nucleus drop was performed, 36 cases were operated within 2 weeks and 47 were operated between 2 weeks and 1 month. In cases which were operated within 2 weeks, CDVA of 20/20-20/40 was achieved in 33 cases. For those who were operated on after 2 weeks, CDVA of 20/20-20/40 was achieved in 43 cases. The difference in visual outcome in both the groups was statistically nonsignificant (Fisher's exact t-test, P = 0.97). In 64 (77%) cases, adequate sulcus was present, in which foldable 3-piece IOL was placed in 29 (35%) cases.

Conclusion: Timing of intervention has no bearing on the final visual outcome after vitrectomy in cases of nucleus drop during phacoemulsification. The continuity of the capsulorrhexis and the availability of capsular support determines the type of placement of the lens. A foldable lens can be placed in the sulcus if continuous capsulorrhexis is present.

Purpose: The objective is to analyze the radiological diagnosis of orbital lesions and their correlation with the final histopathological findings. We compared the initial reports by extramural radiologists and an in-house radiologist specialized in orbital imaging to evaluate the diagnostic accuracy in the interpretation of orbital imaging.

Methods: This was a retrospective chart review of forty patients referred to a Tertiary Eye Care Center in South India over a period of 7 years. These patients already had their imaging done elsewhere. The imaging was re-evaluated by an in-house radiologist. The radiological findings were correlated with the histopathological diagnosis. The diagnostic accuracy between the two radiologists was compared. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value in differentiating malignant from benign lesions were calculated in both groups. The sensitivity and PPV of the radiological diagnosis for neoplastic and inflammatory lesions in both groups were analyzed.

Results: The accuracy in differentiating malignant from benign and inflammatory lesions by our in-house radiologist and extramural radiologists was 95% (κ = 0.9 [0.764, 0.997]) and 50% (κ = 0.036 [-0.160, 0.232]), respectively. The sensitivity and PPV of the radiological diagnosis by our in-house radiologist were 93.31% and 100% for benign lesions and 95.24% and 95.24% for malignant lesions. On the contrary, reports from the extramural radiologists showed a sensitivity and PPV of 76.92% and 66.67% for benign lesions and 14.28% and 60% for malignant lesions.

Conclusion: A high radiological diagnostic accuracy is possible when analyzed by radiologists experienced in orbital imaging.

Purpose: The high recurrence rate of idiopathic orbital inflammation (IOI) has been reported. This study aims to determine existing predictive factors for the recurrence of IOI.

Methods: This was an 11-year retrospective study with at least a 12-month follow-up. Fifty patients with biopsy-proven IOI admitted between 2006 and 2017 at our tertiary hospital were observed. We compared the clinical characteristics, histopathological profile, and biomarker expressions (mast cell, immunoglobulin G4, tumor necrosis factor-alpha, and transforming growth factor-beta) of 16 patients with recurrence (Group I) and 34 patients with no recurrence (Group II). Statistical comparison and multivariate analysis were performed to establish the predictive factors.

Results: We discovered five recurrence predictive factors: presentation of proptosis (odds ratio [OR] 4.96, 95% confidence interval [CI] 1.36-18.03), visual impairment (OR 15, 95% CI 1.58-142.72), extraocular muscle (EOM) restriction (OR 3.86, 95% CI 1.07-13.94), nonanterior involvement (OR 7.94, 95% CI 1.88-33.5), and corticosteroid (CS) alone treatment (OR 7.20, 95% CI 1.87-27.8). On multivariate analysis, nonanterior involvement and CS alone treatment were validated as predictive factors (area under the curve = 0.807 [95% CI 0.69-0.92]). Histopathological profile and biomarker expressions were not associated with recurrence. However, there was a 22-fold higher recurrence risk for granulomatous-type patients given CS alone treatment.

Conclusion: Unlike the five clinical characteristics mentioned, both histopathology and biomarker variables were not associated with recurrence. CS alone treatment for patients with nonanterior involvement or granulomatous type is proven to increase the risk of recurrence. Therefore, we suggest not giving CS without any combination treatment with other modalities for this group of patients.

We report two glaucoma patients who experienced unusual instances of spontaneous globe rupture. The patients arrived at the Bowen University Teaching Hospital's emergency ophthalmology unit with a history of bleeding from one eye without any history of ocular trauma. They were known glaucoma patients with poor control of their intraocular pressures (IOP). They eventually underwent evisceration shortly after presentation. Spontaneous eyeball rupture in glaucomatous eyes is extremely unusual and has a very poor prognosis for vision. Proper management and appropriate follow-up of glaucoma patients are very important to avert this dreaded complication of uncontrolled IOP.

Purpose: The purpose of the study was to audit the primary and final success rate for primary rhegmatogenous retinal detachment (RRD) surgery performed between 2017 and 2022 at the Department of Ophthalmology in Salmanyia Medical Complex, the Kingdom of Bahrain. In addition, secondary outcomes for our study include assessments of risk factors for recurrence, final visual outcomes and complication rates.

Methods: Prospective observational study showed data analysis of case series for 75 RRD patients operated during the study period. All patients who met the inclusion criteria were included in the study and evaluated by a specialized vitreoretinal surgeon before and after their operation. All patients were operated by the same surgeon (M.A) in the study period. Data collected from the hospital's electronic medical recording system (I-Seha) include macular state, pre- and postoperative best-corrected visual acuity, duration of symptoms, the presence of proliferative vitreoretinopathy (PVR), retinal breaks and their locations, any ocular comorbidities associated in the perioperative period such as increase in intraocular pressure or development of cataract, and operative notes related to the type of primary, secondary, and tertiary surgery if needed.

Results: A total number of 70 eyes from 70 patients with the majority of male patients (74.28%, n = 52) were included in the study. The mean age of the participants was 54.75 years (range: 11-91 years). Most of the patients 48.57% presented within 6 days of symptoms. Nearly 77.1% of the operated cases were macula off, whereas 22.85% were macula on. Thirty-six of the eyes (51.4%) had complex RRD with a combination of PVR (34.2%). Sixty-three of the eyes (51.4%) underwent standard 23G pars plana vitrectomy, while the combined surgery with a scleral buckle was performed on 9 eyes (12.8%). Five patients underwent pneumatic retinopexy and two patients had primary scleral buckles. Combined phacoemulsification with vitrectomy in selected cases was performed on 13 eyes (18.5%). Different tamponading agents were used 35 eyes (50%) silicon oil, 17 eyes (24%) C3F8, and 18 eyes (25%) SF6. The primary reattachment rate after one operation was 77.1% (54 eyes). The final reattachment rate following a second or third procedure was 95.7%. The mean postoperative visual acuity was 6/18 (range: 6/6 to hand motions). Thirty percent of the cohort of patients had a visual acuity of 6/12 or better. Sixteen out of the 70 eyes redetached (22.8%) and 10 of those eyes (62.5%) were classified as "complex" preoperatively which is thought to be a significant risk factor for failure.

Conclusion: Our audit overall met international success rates despite the presence of some complex scenarios which required multiple surgical interventions. The primary use of gas or silicon oil did not influence reattachment rates but had a statistical significance wh