Middle East African Journal of Ophthalmology最新文献

Purpose: Cataract surgical rate (CSR) (cataract surgeries performed per million population) is an eye health indicator that helps assess the state of eye care services. A survey in 2002 revealed a CSR of 2254. The current survey aimed to establish a new and sustainable development goal compliant baseline for the volume of cataract surgery performed by different service providers in Pakistan at district, provincial, and national levels.

Methods: The survey was commissioned by the National Committee for Eye Health under the Ministry of National Health Services, Regulations and Coordination. The methodology used for the survey included identification and mapping of all service providers by district and category and data collection from all districts in the country.

Results: There were more cataract surgeries performed in women than men with a male-to-female ratio of 0.95. About 98.9% of all cataract surgeries were performed with intraocular lenses, while 63.9% were performed by phacoemulsification. About 17.7% of cataract surgical services were provided in the government sector (including Forces), while nongovernmental organizations and the private sector contributed to 82.3%. Pakistan achieved a national CSR of 5307 which is almost double the CSR determined in 2002.

Conclusion: In order to achieve a CSR of 7500+ by 2030, there is a need for at least 1,840,000 cataract surgeries to be performed annually. If there is no change in the current annual cataract surgical output, the CSR will drop to 4628 by 2030.

We present an interesting case of failed Descemet's stripping endothelial keratoplasty (DSEK) graft, due to accidental implantation of a full-thickness precut tissue. A repeat DSEK was planned, and during the surgery along with the DSEK graft, an extra thick corneal tissue was also retrieved. Careful evaluation of both the explanted tissues revealed that the primary surgeon failed to separate a precut DSEK graft and implanted the entire full-thickness tissue. After the repeat DSEK, there was improvement in corneal edema and visual acuity.

Lateral rectus palsy presenting as abduction deficit resulting in diplopia is attributed to neurogenic causes. Metastasis as a cause of sixth cranial palsy is an extremely rare entity but cannot be overlooked. Cases of metastasis to lateral rectus secondary to lung and breast carcinoma have been reported. Primary adrenocortical carcinoma (ACC) metastasizing to lateral rectus muscle is extremely rare. Here, we report a case of ACC arising from the left adrenal gland that presented with left-sided abduction deficit in a 58-year-old male with vasculopathic risk factors. The case highlights the importance of neuroimaging in cases of isolated nontraumatic sixth nerve palsy or in cases with isolated ocular symptoms with associated systemic findings. The fact that all cases of muscle palsies may not be neurogenic and rare causes such as metastatic muscle involvement must be included as a differential diagnosis in suspected cases has been emphasized.

Purpose: Injuries caused by explosive materials are associated with severe ocular morbidity and visual impairment. This study aims to document the ophthalmic morbidity of terrorist-related severe injuries at a tertiary eye care center in the Middle East and report specific injury patterns.

Methods: In a noncomparative, interventional, retrospective case series, the visual outcomes were evaluated of 36 patients treated at a tertiary eye center in the Middle East for terrorist-related injuries from January 2003 to December 2019. Data were collected on age, gender, involved eye, initial examination of ocular injuries, associated systemic injuries, presenting visual acuity, anterior and posterior segment examinations, and the type of injury (open vs. closed globe).

Results: Among the 36 patients (32 males; average age, 28.1 years), 28 (77.8%) sustained trauma to one eye and 8 (22.2%) to both eyes. Despite multiple surgical procedures (average 3.1 surgeries), all patients suffered a severe visual loss. Final visual acuity of no light perception was recorded in 28 (77.8%) eyes and both eyes of 5 patients (13.9%).

Conclusion: Ophthalmic morbidity from terrorist-related injuries may be devastating, and the vast majority of patients experience a permanent loss of vision.

We present two cases of a novel missense variant mutation in the DHX38 gene, which is associated with autosomal recessive retinitis pigmentosa (RP) in two Saudi sisters who presented with poor visual acuity since childhood. On initial examination, the best-corrected visual acuity was 20/300 in both eyes for the two sisters. Fundus examination revealed widespread retinal pigmentary changes, linear peripheral hyperpigmentation clumps, bone spicules, and bilateral optic nerve drusen with bilateral macular hyperpigmentation. Spectral-domain optical coherence tomography scans reveal losses of the outer retinal layer and the presence of subretinal fibrosis and thinning of the choroid. Molecular sequencing analysis of the DHX38 exome identified a novel missense mutation of the homozygous variant c. 2571 (p. Ala857=), which co-segregates with the autosomal recessive RP gene that encodes the premRNA splicing factor, PRP16. The aim of this report is to describe the clinical feature associated with this variant and to provide additional evidence that DHX38 is involved in RP. To the best of our knowledge, this variant has not been described in the literature.

Purpose: To investigate the impact of coronavirus infection disease-19 (COVID-19) pandemic on ophthalmic referrals within an academic tertiary center in Oman.

Methods: Retrospective chart review of internal referrals received and evaluated by the ophthalmology department between March 1and August 31, 2020 (COVID-19 period) compared to a corresponding period in 2019 (pre COVID-19). Data included patient demographics, referral details, ocular diagnosis, intervention, and discharge plan.

Results: Referral volume significantly decreased by 58.2%; from 2019 prepandemic to 510 (P = 0.001), with the lowest in April and May 2020. Patient demographics did not differ significantly, but "urgent" referrals reduced by 96.2% (P < 0.001). Main reasons for referrals were reduced vision and screening in both periods. During pandemic, referrals for screening purposes increased from 30.3% to 37.9% (P = 0.013) and for reduced vision decreased from 30% to 23.3% (P = 0.021). Dry eye syndrome increased in frequency during 2020 (from 2.9% to 7.3%, P = 0.002) but cataracts and conjunctivitis both decreased (from 4.7% to 2.1%, P = 0.046 and from 2.3% to 0.3%, P = 0.013, respectively). Ocular trauma remained stable (from 0.8% to 0.3%, P = 0.456), but the proportion of chemical injuries increased by 13.7% (P = 0.025). There was a drastic decrease in interventions from 37% to 26.1% (P < 0.001) and an increase in discharge rate from 61.2% to 75.8% (P < 0.001).

Conclusion: The impact of COVID-19 pandemic on ophthalmic referrals within a tertiary academic centre in oman referral reductions and changes in pattern and characteristics as an epiphenomenon of COVID-19 reflect the extent of impact specifically in an Omani context. This information is vital for planning proper resource utilization, the adoption of innovative care delivery, and improving referral system pathways.

We report a 39-year-old with Alport's syndrome. The patient presented with anterior lenticonus, cataract, and a corrected distance visual acuity of 20/25 and 20/60 in the right and left eyes, respectively. Fundus examination revealed generalized retinal flecks sparing the fovea in both eyes. Optical coherence topography showed temporal macular thinning. Normal fundus autofluorescence was observed in both eyes. Full-field electroretinography (ERG) demonstrated normal photopic and scotopic responses, while multifocal ERG showed no reduction of amplitudes generated from the temporal thinned macula, compared to the nasal macula, indicating preserved functional integrity of the retina.

Purpose: To review students' perceived symptom-based computer vision syndrome (CVS) and its determinants and to suggest preventive measures.

Methods: This cross-sectional survey was conducted in 2021 at a university in Central Saudi Arabia. The presence and severity of symptoms related to CVS were investigated. The total CVS symptom score was the outcome variable. The CVS score was correlated to participants' demographics, visual habits when using digital devices, and knowledge about CVS. Due to skewed distribution, a nonparametric method was used for analysis.

Results: Overall, 521 students were surveyed. The prevalence of CVS based on at least one symptom was 96% (95% confidence interval 94.3-97.7). The median score was 8.0 (interquartile range 4.0-12.0). Of the 24 possible CVS scores, 42 students (8%) had scores of 18 or more (severe CVS). Being female (Mann-Whitney [MW] P < 0.001), being older (Spearman P < 0.001), refractive error (MW P < 0.001), the presence of dry eye (MW P < 0.001), using devices other than a desktop computer (KruskalWallis) P = 0.03), and more than 6 h constantly working with a device (MW P = 0.001) were correlated with a higher CVS score. Older age, female, refractive error, and using digital devices for more than 6 h were the independent and significant predictors of CVS in college students.

Conclusion: Most of the students suffered from mild-to-moderate CVS symptoms. Health promotion for prevention and periodic ophthalmic consultations are recommended. Identified predictors should be the focus when implementing strategies to combat CVS in the adolescent Saudi population.

Purpose: To present the outcomes of levator plication (levatorpexy) surgery by posterior approach for correction of ptosis of different aetiologies in Indian eyes.

Methods: Retrospective review of clinical notes and clinical photos of consecutive ptosis patients who underwent levatorpexy from January 2017 to September 2018. Surgery was considered successful if the following four criteria were simultaneously met: a postoperative MRD1 of ≥2 mm and ≤4.5 mm, inter eyelid height asymmetry of ≤1 mm, no overcorrection compared to the opposite eye, and a satisfactory eyelid contour determined by patient.

Results: Thirty six eyelids of 36 patients (mean age, 23.6 years; 25 females) underwent unilateral levatorpexy with the left eyelid affected in 66.6 %. Twenty one congenital (58.3%) (C), 12 (33.3%) aponeurotic (A) and 3 (8.3%) complex ptosis (CX) had a mean levator function of 9.8 mm (range, 6 to 15). Mean pre and post operative margin reflex distance (MRD 1) was 0.611mm (range, -1 to 3 mm) and 3 .00 mm (range, 2 to 4 mm) respectively. At the final follow up of 12 months, four patients remained under corrected (11.1%). At the final follow up of twelve months, the success rate was 78 percent.

Conclusion: Posterior approach for ptosis repair offers a scar less, minimally invasive, easy to revise, and successful lid height correction in congenital and acquired ptosis.

Purpose: The aim of the present study was to assess platelet activation by analyzing three platelet activation parameters in ocular Behçet's disease (BD): mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT).

Methods: Twenty-nine patients with active ocular BD (Group 1), 40 patients with inactive ocular BD (Group 2), and 40 healthy adult individuals serving as controls (Group 3) were evaluated. All of the individuals had been performed the complete ophthalmologic evaluation. The levels of MPV, PDW, and PCT were measured in each group.

Results: The mean MPV level was 8.40 ± 0.97 in Group 1, 8.32 ± 1.04 in Group 2, and 7.77 ± 0.72 in Group 3. The mean PDW level was 15.12 ± 1.09 in Group 1, 14.97 ± 1.02 in Group 2, and 14.52 ± 0.82 in Group 3. The mean PCT level was 0.23 ± 0.07 in Group 1, 0.21 ± 0.04 in Group 2, and 0.18 ± 0.03 in Group 3. MPV, PDW, and PCT levels were significantly higher in ocular BD patients than controls (P < 0.05).

Conclusion: Platelet activation may affect vascular occlusion in ocular Behçet's patients with posterior segment involvement. This result may be important in evaluating ocular BD patients.