Middle East African Journal of Ophthalmology最新文献

Bilateral acute iris transillumination (BAIT) syndrome is an uncommon disorder marked by sudden dispersion of pigment in the anterior chamber, iris sphincter muscle paralysis, and elevated intraocular pressure. This syndrome has been linked to viral infections and the administration of fluoroquinolones such as moxifloxacin. This study presents a case of a 54-year-old male, otherwise in good health, who developed BAIT syndrome 1 week after experiencing an upper respiratory tract infection that followed a coronavirus disease 2019 (COVID-19) diagnosis. The patient was effectively treated with topical prednisolone acetate and antiglaucoma medications. Further studies are required to investigate the relationship between COVID-19 and BAIT to enhance understanding of its pathophysiology.

Purpose: To identify risk factors and perioperative complications and assess postoperative visual outcome in patients of white mature cataracts undergoing phacoemulsification surgery.

Methods: This cross-sectional study was conducted on 46 patients of white mature cataract undergoing phacoemulsification. Preoperatively, a detailed ocular examination was done, and anterior chamber depth (ACD) and lens thickness (LT) were measured on ultrasound biomicroscopy. Intraoperative and postoperative complications (on days 1, 7, and 30) and best-corrected visual acuity on postoperative day 30 were noted.

Results: The mean age of patients was 60.78 ± 9.001 years. The study group consisted of 41.3% of males and 58.7% of females. 8 (19.56%) cases encountered complications during phacoemulsification surgery. The intraoperative complications were capsulorhexis-related in 5 (10.86%) patients, posterior capsular rent in 2 (4.3%) patients, and 1 (2.17%) case had zonular dialysis. There was no difference in mean ACD and LT in cases who developed complications and those who underwent uneventful surgery (P > 0.05). The commonly observed postoperative complications on day 1 were corneal edema (41.3%), anterior chamber flare (45.65%), and cells (39.13%) which resolved with routine topical medications. All patients showed a significant reduction in postoperative intraocular pressure (P < 0.001). A total of 37 (80.43%) eyes regained vision between 6/6 and 6/9 postoperatively (P < 0.001).

Conclusion: Phacoemulsification surgery is safe in white mature cataract that results in significant visual improvement. Common intraoperative complications are capsule related, while frequently encountered postoperative complications are corneal edema and anterior chamber reaction. Preoperative ACD and LT have no role in predicting intraoperative complications.

Purpose: The purpose of this study was to analyze the incidence of retinopathy of prematurity (ROP), treatment requiring ROP (TROP), course, and systemic risk factors in extreme preterm or extreme low-birth-weight babies.

Methods: A retrospective analysis of neonatal intensive care unit-based ROP screening from January to December 2021 in a tier-2 city in Kerala, India, was done. Inclusion criteria were gestational age (GA) ≤28 weeks or birth weight ≤1000 g. ROP screening and treatment were done according to the International Classification of ROP guidelines. Treatment was indicated in babies with type 1 ROP or aggressive ROP. Details of ROP screening, treatment, and neonatal risk factors were collected from the records. The results were statistically analyzed, and P < 0.05 was considered statistically significant.

Results: The study included 54 babies with a mean GA of 27.47 ± 1.76 weeks and a mean BW of 847.43 ± 189.22 g. ROP was detected at an average postmenstrual age of 33.8 ± 1.7 weeks. The incidence of any ROP and TROP was 87% and 19.14%, respectively. All babies with TROP were managed with laser or intravitreal antivascular endothelial growth factor injection or both. ROP resolved spontaneously in 60%, but those with Zone 2 disease had delayed regression. Inotropic support and anemia were found to increase the risk for ROP.

Conclusion: The incidence and outcome of any ROP and TROP in this study are comparable to the rates reported globally, and this reflects the improvement in neonatal care. The use of inotropes and anemia may increase the risk for ROP and needs to be managed judiciously.

This case reports the development of foveoschisis in a child with high myopia due to a homozygous LRPAP1 pathogenic variant. A 9-year-old girl with high myopia due to a homozygous mutation in the LRPAP1 gene and a history of retinal detachment repair in her right eye, presented on follow-up with progressive myopic foveoschisis in the left eye noted on optical coherence tomography. The schitic changes evolved into a lamellar macular hole and required vitrectomy. Postoperatively, stabilization of the condition was achieved. Myopic foveoschisis could develop in childhood in the setting of recessive LRPAP1 pathogenic variants. Long_term follow-up is needed to determine the natural history of early-onset myopic foveoschisis.

Purpose: The purpose of the study was to evaluate the status of health services for diabetes mellitus (DM) and diabetic retinopathy (DR) in Jordan in terms of availability and accessibility by interviewing people engaged with health-care process including decision makers, professional providers, and community representatives.

Methods: This is a qualitative study where participants were invited to respond by direct interview to a standard questionnaire that is validated by the World Health Organization (WHO), "Tool for Assessment of Diabetic Retinopathy and DM Management Systems". The questionnaire casts out of the WHO Health Systems Framework concept, assessing the presence of programs, guidelines, health technology and workforce, health promotion, and financing of DM and DR care in Jordan.

Results: Forty-two participants were included. DM is considered as priority in Jordan, but no programs are implemented. National guidelines are present for DM but not for DR. Networking should be improved between different disciplines caring for DM and DR. Human resources for DM and DR care were found insufficient and inadequately distributed. Health technology is only present in major cities and central hospitals. There is no nationwide data on disease burden nor a screening program for DR. More collaborated efforts should be spent on health education and raising awareness among people living with diabetes about the risk of DR.

Conclusion: Advanced DM and DR care is not accessible to most people. Programmatic efforts from the government and NGOs must formulate a national action plan to reduce the human and financial impact of the disease in Jordan.

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.