Middle East African Journal of Ophthalmology最新文献

An 8-year-old male child who underwent an anterior approach left upper lid levator resection to correct congenital ptosis. After 6 months, he developed mechanical ptosis secondary to a painless cystic mass on his upper lid. Magnetic resonance proved a postseptal circumscribed cystic mass. The lesion was excised and a histopathology examination confirmed a conjunctival inclusion cyst (CIC). CIC is common benign lesions of conjunctiva but rarely detected as a complication of levator muscle surgery.

We report the two cases in which femtosecond laser (FSL) technology used to manage visually significant retained host's Descemet's membrane (RHDM) after penetrating keratoplasty (PKP). FSL-assisted descemetorhexis was done first, then membrane removal with intraocular forceps. Both patients had advanced keratoconus and were managed with PKP. In the first patient, FSL descemetorhexis of RHDM was incomplete. It was augmented manually, and then, the removal of the retained membrane was done with an intraocular forceps, whereas, a complete and central 5.5 mm FSL descemetorhexis was created in the second case. Then, it was pulled out with intraocular forceps. Postoperatively, the best-corrected visual acuity was 20/40, with an intraocular pressure (IOP) of 18 mmHg. In the second case, best-corrected visual acuity and IOP were 20/70 and 16 mmHg, respectively. In conclusion, FSL technology can be an alternative to manual or neodymiumdoped yttrium - aluminum garnet membranotomy for the management of RHDM after PKP.

Purpose: To determine the effect of smoking on the response to anti-vascular endothelial growth factor (anti-VEGF) therapy treatment in patients with diabetic macular edema (DME).

Methods: This is a retrospective case - control study that included 60 eyes with DME. Smoking habits were obtained from hospital records and patient recall. Patients were divided into two groups: the ever-smoker group and the never-smoker group. All patients received Intravitreal ranibizumab with three loading doses followed by PRN protocol and all were followed up for at least 1 year. Outcome measures were best-corrected visual acuity (BCVA), central retinal thickness (CRT) at the fovea, and number of visits.

Results: Smoking was not associated with worse posttreatment visual acuity and was not found to influence the change in ocular coherence tomography measurement of central macular thickness and the change in BCVA (posttreatment minus pretreatment). There were no statistically significant differences in the duration of treatment or number of visits between two groups of patients the ever-smoker group and the never-smoker group (P > 0.05).

Conclusion: In this study, smoking status did not influence the treatment outcome of anti-VEGFs; however, smoking should be encouraged due to its well-known other systemic unwanted effects.

Purpose: The influence of central corneal thickness (CCT) on intraocular pressure (IOP) measurement by Diaton is debatable. We present a correlation of CCT to transpalpebral IOP (tpIOP) and its determinants in patients undergoing transepithelial photorefractive keratectomy (TPRK) in Saudi Arabia.

Methods: In this cross-sectional study held in 2022, the IOP of patients undergoing TPRK was measured by Diaton tonometer. The CCT was measured before and 1 week after refractive surgery. The correlation coefficient of CCT and IOP and its Pearson P value were estimated. The effects of gender, type of refractive error (RE), and corneal epithelial thickness (CET) on the correlation of IOP to CCT were reviewed.

Results: We studied 202 eyes in 101 patients (Male: Female, 47:53; age 25.7 ± 5.8 years). The tpIOP was 15.1 ± 2.8 mmHg before, 15.9 ± 2.8 mmHg 1 week after, and 15.7 ± 4.1 mmHg 1 month after TPRK. The CCT was significantly correlated with tpIOP before surgery (Pearson correlation 0.168, P = 0.017) and after tPRK (Pearson correlation 0.246, P < 0.001). Gender (P = 0.96), CET (P = 0.43), and type of RE (P = 0.99) were not significant determinants of correlation between CCT and tpIOP before TPRK. The correlation of tpIOP and CCT was not affected by gender (P = 0.07), CET (P = 0.39), and type of RE (P = 0.13).

Conclusion: CCT should be considered before interpreting tpIOP measured by with Diaton. Diaton could be a useful tool to monitor IOP changes in young patients undergoing refractive surgery.

Purpose: The purpose is to determine the prevalence of primary open-angle glaucoma (POAG) and study the relationship of smoking and other potential risk factors with POAG.

Methods: This is a cross-sectional study based on the Azar cohort databases (including the eye cohort study) in Iran, including 11,208 participants aged 35-70 years. According to the questionnaire, participants were divided into five groups in terms of smoking. Ophthalmologic examinations were performed in two steps. The first step was performed by an optometrist, and all referred participants underwent a complete ophthalmological examination in the second step, then after POAG cases were diagnosed using Criteria of the International Society of Geographic and Epidemiological Ophthalmology.

Results: Of the participants, 4992 (44.5%) were male and 6216 (55.5%) were female, with a mean age of 50.1 ± 9.27 years. The prevalence of POAG in our study population was 1%, which included 58 (1.2%) males and 58 (0.9%) females. There was no significant difference between the two groups in terms of the prevalence of different smoking categories in both genders. There was a statistically significant difference between the two groups in both genders in terms of diabetes mellitus (DM) after adjusting for age and there was a statistically significant difference between the two groups in the male population in terms of triglycerides ≥150 mg/dl.

Conclusion: Findings of this study indicated that there is no association between cigarette smoking in different doses and a history of smoking with POAG. Other factors, such as aging and underlying diseases, including DM and hypertriglyceridemia, have a statistically significant association with POAG.

Purpose: Evaluating the quality, dependability, and popularity of YouTube videos about trabeculectomy.

Methods: A simulated user search for trabeculectomy videos on YouTube was conducted using the keywords "trabeculectomy, trabeculectomy surgery for glaucoma, and trabeculectomy surgery." Hundred out of the one hundred and fifty videos met the criteria and were analyzed. To assess quality and reliability, each video was evaluated by two independent reviewers using the DISCERN (scale, 1-5), Journal of the American Medical Association (JAMA; scale, 0-4), and Global Quality (GQ; scale, 1-5) criteria. The popularity of the videos was evaluated by Video Power Index (VPI). Videos were further classified into three groups based on the source of their upload.

Results: Of the 100 analyzed videos, 50 were uploaded to the system by doctors, 40 by health institutions and 10 by patients. Fifty-seven percent are videos with surgical content. The mean DISCERN score was 44.84 ± 8.14 the mean JAMA score was 2.08 ± 0.67, and the mean Global Quality score was 2.02 ± 0.72. Although some videos provided adequate information, the majority of the videos were rated as fair. While the DISCERN, JAMA, GQS scores were statistically higher in videos uploaded by doctors than in videos uploaded by patients (P < 0.01), VPI was higher in videos uploaded by patients (P = 0.003). Nonsurgical videos had the highest rate of likes and comments (P < 0.05). No substantial difference in scoring was observed between the 2 independent reviewers (P < 0.05).

Conclusion: Videos with high popularity had low information quality and reliability. This situation presupposes video sharing in a more understandable language for patients.

Purpose: We aimed to investigate the effect of botulinum toxin (BT) injection on the treatment of infantile and partially accommodative esotropia (PAET).

Methods: This retrospective cohort study included patients who received BT injections for infantile and PAET between January 2015 and December 2018. Treatment was considered successful if orthotropia, consecutive exotropia, or esotropia within 10 prism diopters (PD) was achieved.

Results: The overall success rate was 47.4%, with a mean follow-up period of 27.8 months in 403 children. BT treatment was considered successful in 37.1% of cases of infantile esotropia and 53.1% of cases of partially accommodative esotropia. The average deviation angle before starting treatment was 35.5 ± 13.9 PD. Side effects 1 week after BT injections included transient overcorrection (63.8%) and transient ptosis (41.7%). There were no significant differences in the success rates between the different doses of BT (P = 0.69). The angle of deviation at presentation was significantly associated with the success rate of BT injection (failed group, mean: 38.1 ± 15.3 PD vs. success group, mean: 32.6 ± 11.6 PD; P < 0.001). Other factors associated with higher success rates were overcorrection at 1 week and PAET, while multivariate logistic regression analysis showed that a smaller angle of deviation and overcorrection (1 week after injection) were associated with a higher success rate.

Conclusion: A smaller angle of deviation and transient overcorrection were associated with a higher success rate, and no significant difference was observed in the success rates of different BT doses.

Corneal epithelial thickness (CET) and the regional variations in response to changes in corneal architecture and biomechanics have recently drawn the interest of corneal surgeons. Corneal epithelium possesses the tremendous capability of remodeling and changing its thickness. This remodeling of corneal epithelium takes place in response to underlying stromal irregularities which can result from a variety of corneal disorders including corneal ectasia. Measurement of CET can reveal the underlying stromal abnormalities and supplement in early diagnosis of corneal disorders especially corneal ectasia which has been one of the leading challenges in planning corneal refractive surgery. A significant number of patients ends up in ectasia after refractive surgery and the most common cause of this complication is the presence of preoperative subclinical keratoconus. Furthermore, postoperative complications of corneal refractive surgery are partly masked by epithelial remodeling and make the diagnosis and management difficult and extremely challenging. This leads not only to unpredictable visual and refractive outcome but also the need of multiple interventions to treat these complications. Although corneal tomography is considered as gold standard in the detection and diagnosis of corneal ectasia, a small number of subclinical cases may still go undetected. In this review, we have highlighted the underlying mechanism of epithelial remodeling, the devices and imaging modalities used to measure CET, and application of epithelial mapping in the diagnosis and management of various corneal disorders.

Anterior scleritis is rarely diagnosed with a peripheral amelanotic subretinal mass. We reported a rare case of a 31-year-old woman who was referred for suspected left eye choroidal melanoma. The patient had granulomatosis with polyangiitis with a history of treated left eye necrotizing anterior scleritis. Her left eye examination revealed 20/60 vision, superotemporal diffuse scleral injection, and thinning. Dilated fundus examination of the left eye showed a large peripheral amelanotic subretinal mass below the area of anterior scleritis, optic disc hyperemia, and subretinal fluid. The patient was successfully treated with intravenous methylprednisolone, rituximab infusions, and oral methotrexate. Two months after treatment, her vision improved to 20/20, with inactive anterior scleritis and a significant reduction in the subretinal mass with complete resolution of optic disc hyperemia and subretinal fluid. High index of suspicion of this atypical presentation of anterior scleritis is important to avoid aggressive modalities of treatment.

Purpose: Glaucoma is a leading cause of visual impairment worldwide, and plateau iris syndrome (PIS) is the most common nonpupillary block mechanism of angle closure. This study aims to assess the prevalence of PIS among Saudi population.

Methods: It is a prospective observational study that examined patients previously diagnosed with chronic angle closure. Those patients already underwent peripheral laser iridotomy (PLI) and were assessed clinically and by ultrasound biomicroscopy (UBM).

Results: A total of 147 eyes in 77 patients were included in this study. The mean age among subjects was 61.2 years, and almost 69% were females. Chronic angle closure was noted to be bilateral in 91% of patients, whereas 5% had their left eye involved and 4% had right eye involved. The mean intraocular pressure (IOP) before PLI and after laser treatment was 19.3 and 16.2, respectively. The mean visual acuity before and after PLI was 0.3 logMAR. After UBM examination, plateau iris was found in 41.5% of subjects. The anterior chamber (AC) depth was noted to be deeper in PIS patients (P = 0.046). Other risk factors were observed in our study including place of residency (P = 0.048) and preintervention IOP (P = 0.032).

Conclusion: PIS is the most common mechanism of nonpupillary block angle closure. In addition to clinical findings, UBM is important to reach the appropriate diagnosis. This study reviewed the prevalence of PIS with the aid of UBM; it was found consistent with previous reports. In addition, PIS risk factors included AC depth, place of residency, and preintervention IOP.