Middle East African Journal of Ophthalmology最新文献

Purpose: This is a retrospective multicenter study to report the incidental discovery of keratoconus (clinical and subclinical) in a screening of laser vision correction (LVC) surgery candidates.

Methods: This retrospective multicenter study was conducted on patients presenting for LVC in four Egyptian governorates (Cairo-Giza-6^th of October-Beni Suef) during the year 2018. The patients were examined using the Pentacam HR (OCULUS Optikgeräte GmbH, Wetzlar, Germany) or Sirius (Costruzione Strumenti Oftalmici, Italy). The following parameters were evaluated: the axial curvature map, keratometry (Kmax and K2 on the posterior surface), minimum corneal thickness, anterior elevation, posterior elevation, Baiocchi-Calossi -Versaci index (Sirius), index of height decentration, and BAD-D (Pentacam). The prevalence of keratoconus cases was reported and data were analyzed.

Results: A total of 46 out of 782 candidates presenting for LVC in 2018 were incidentally discovered as clinical or subclinical keratoconus cases and were excluded from performing the LVC procedure.

Conclusion: Screening of LVC candidates for keratoconus is a crucial tool to detect the incidence of the disease in the Egyptian population.

Purpose: The purpose of this study was to estimate the rate and review determinants of successful therapy for unilateral amblyopia in children.

Methods: This prospective cohort consisted of Saudi children aged 6-12 who received amblyopia therapy between 2020 and 2022. Best-corrected visual acuity (BCVA) in the amblyopic eye improved to reach the BCVA of the fellow eye at follow-up visits, or BCVA in the amblyopic eye improved and remained stable over three follow-up visits. Demographic and ocular characteristics were associated with the outcome.

Results: In 30 children, the median BCVA at presentation and the last follow-up was 0.8 logMAR (interquartile range [IQR]: 0.6; 1.0) and 0.45 logMAR (IQR: 0.3; 0.6), respectively. The success rate of amblyopia therapy was 80% (95% confidence interval: 65.7; 94.3). It was 100%, 76.5%, and 77.8% in eyes with anisometropic, strabismic, and mixed types of amblyopia, respectively. Amblyopia grade (P = 0.177), type of amblyopia (P = 0.96), and spectacles as therapy in the past (P = 0.09) were not significantly associated with the successful out. The duration of follow-up was significantly longer in those with unsuccessful outcomes (P = 0.05). Excellent compliance for occlusion was observed in 62.5% of children with successful outcomes. In 14 (46.7%) children, BCVA was ≤0.3 logMAR BCVA at the last follow-up. Two-line improvement in amblyopic eyes was in 26 (86.7%) children at the last follow-up compared to BCVA at presentation.

Conclusion: Occlusion therapy complemented using glasses in older children also significantly improved visual recovery in amblyopic eyes.

Purpose: The purpose of this study was to compare glaucoma therapy escalation (GTE), graft survival, vision, and glaucoma following penetrating keratoplasty (PK group) and Descemet stripping automated endothelial keratoplasty (DSAEK group) to treat pseudophakic bullous keratopathy (PBK).

Methods: This cohort included cases of PBK managed with PK from 2009 to 2014. We compared the incidences and determinants of GTE, graft survival, and visual disability. P < 0.05 was statistically significant.

Results: There were 58 eyes in the PK group and 117 eyes in the DSAEK group. The incidence of GTE in the PK and DSAEK groups at the last follow-up was 34.2% (95% confidence interval [CI]: 19.5-48.9) and 46.6% (95% CI: 27.7-65.4), respectively. The risk of GTE was similar between the groups (relative risk [RR] = 1.36 [95% CI: 0.94-1.98], P = 0.12). GTE was significantly associated with graft survival in the PK group (RR = 3.25 [95% CI: 1.5-7.0], P < 0.001) and the DSAEK group (RR = 3.77 [95% CI: 2.6-5.6], P < 0.001). Glaucoma (P = 0.001) and previous keratoplasty (P < 0.001) were significant predictors for GTE. At the final follow-up visit, severe visual disability was not significantly different between the groups (RR = 0.9 [95% CI: 0.3-2.9], P = 0.88). There was a statistically significant improvement in vision after DSAEK (P < 0.001) but not after PK (P = 0.67).

Conclusion: GTE was similar in eyes with PBK managed by PK or DSAEK. Glaucoma and previous keratoplasty were predictors of GTE post-keratoplasty. DSAEK gave better visual outcomes than PK for managing PBK.

To report a case of toxic keratopathy secondary to the self-application of seawater eye drops. A 60-year-old male who presented with unexplained unilateral decrease in vision and corneal thinning. Best-corrected visual acuity was 20/400 OD, slit-lamp examination indicated diffuse corneal edema with central thinning, intact sensation, and no vascularization. Laboratory analysis of the eye drops in conjunction with clinical symptoms and findings was consistent with toxic keratopathy. Toxic keratopathy can masquerade as the other forms of keratopathy, and a thorough history taking and laboratory analysis may help elucidate the diagnosis and avoid significant visual morbidity.

Purpose: Studies have shown that there are significant differences in the concepts of medical professionalism among residents. Very few studies have specifically evaluated the perception of medical professionalism in a specific specialty. The aim of the study is to evaluate the perception of medical professionalism among ophthalmology residents and to assess the differences in the concept of professionalism between junior and senior residents.

Methods: This cross-sectional study used a questionnaire to survey ophthalmology residents enrolled in different regions of Saudi Arabia in 2020. The ophthalmology residents included both junior and senior residents. In this study, "professionalism" concurred with the definition in the American Board of Internal Medicine's "Project Professionalism" and the Accreditation Council for Graduate Medical Education.

Results: A total of 167 participants were recruited in the study. Out of the 127 participants who completed the survey, 60 (47.24%) were junior residents and 67 (52.76%) were senior residents. The scores for the attributes varied markedly. The lowest score obtained was 6.54 ± 3.349 for the attribute "In an emergency putting the welfare of others over my own safety" in the "Altrusim" domain and the highest score obtained was 9.62 ± 0.854 for the attribute "respect for co-workers" in the "Respect for others" domain. Out of the total residents who completed the survey (n = 127), 84 (66.14%) agreed that professionalism is teachable through a residency curriculum and 85 (66.93%) thought that it is testable.

Conclusion: The characteristics of different attributes of professionalism varied significantly among the residents. The findings of the present study highlights that the conceptualization and perception of professionalism is changing and there is a need to focus on the resident curriculum to instill the values of professionalism. Targeted training is needed on the concepts of professionalism to develop behaviors consistent with medical professionalism and to evaluate the levels of professionalism among residents.

Purpose: The aim of the study was to determine the publication rates of abstracts presented at the annual Saudi Ophthalmology Society (SOS) Conferences from 2015 to 2018.

Methods: This is a cross-sectional study on abstracts collected from the scientific programs for the SOS meetings from 2015 to 2018. Titles and first authors' names were used in the search process on PubMed. A Chi-square test was conducted to compare between the categorical variables. Kruskal-Wallis test was used for nonnormally distributed variables.

Results: A total of 365 abstracts were presented in the SOS Conferences from 2015 to 2018. In the SOS meetings (2015-2018), the publication rate was 45.7%. Seventy-two (43.1%) of the published abstracts were published in journals with an impact factor. The mean impact factor was 1.4 ± 1.9. The median time to publication was 12.0 months (range: 0-60 months). On univariate analysis, basic science (P < 0.001), abstracts on rare diseases (P = 0.003), affiliation with eye hospitals (P < 0.001), and public hospitals (0.007) were associated with a higher publication rate. On multivariate analysis, basic science studies (odds ratio [OR]: 4.23, confidence interval [CI]: 1.77-10.12, P = 0.001), rare topic-related abstracts (OR: 2.03, CI: 1.22-3.38, P = 0.007), and eye center affiliation (OR: 1.67, CI: 1.03-2.68, P = 0.036) were associated with a better publication rate. The factors associated with publication in high impact factor journals were oral abstracts (P = 0.007) and noncase report abstracts (P = 0.023).

Conclusion: Basic science studies, rare topic-related abstracts, and first author affiliation with an eye center were all associated with a higher publication rate. Orally presented and noncase report abstracts increased the chance of publication in higher impact factor journals.

The manifestation of intermediate uveitis (IU) in patients with retinitis pigmentosa (RP) is uncommon and poses diagnostic and management challenges. In this case, we describe the clinical features and management outcomes in an RP patient with a novel homozygous splice site mutation in PRPF8. A 21-year-old male presented with unilateral decrease of vision in the right eye for 1 week. Retinal dystrophy features were present in the left eye. After 2 weeks of topical steroid therapy, near-total resolution of IU was achieved and vision improved to 20/30. Signs of (RP) were present bilaterally, with the right eye more affected than the left. Genetic testing indicated a novel homozygous c. 3061-6_3061-3del mutation in the PRPF8 gene. IU in young patients with RP can be effectively treated with a short course of topical steroids, sparing the need for systemic immunosuppressives. After the improvement in IU, the right eye showed more advanced RP changes.

Retinopathy of prematurity (ROP) is a disease that affects retinal vasculature in premature infants and remains one of the leading causes of blindness in childhood worldwide. ROP screening can encounter some difficulties such as the lack of specialists and services in rural areas. The evolution of technology has helped address these issues and led to the emergence of state-of-the-art multimodal digital imaging devices such fundus cameras with its variable properties, optical coherence tomography (OCT), OCT angiography, and fluorescein angiography which has helped immensely in the process of improving ROP care and understanding the disease pathophysiology. Computer-based imaging analysis and deep learning have recently been demonstrating promising outcomes in regard to ROP diagnosis. Telemedicine is considered an acceptable alternative to clinical examination when optimal circumstances for ROP screening in certain areas are lacking, and the expansion of these programs has been reported. Tele-education programs in ROP have the potential to improve the quality of training to physicians to optimize ROP care.

Purpose: Meibomian carcinoma is a rare and aggressive malignant neoplasm of the eyelids. The clinical presentation often mimics benign conditions thereby making the diagnosis challenging. The aim of the study was to analyze cases of meibomian carcinoma, the specimens of which were received, in the past 2 years in the pathology department.

Methods: This retrospective observational study was undertaken for 2 years and included 9 patients of meibomian carcinoma. For each case, detailed history and clinical findings were retrieved from the hospital records. Histopathological examination was undertaken in all cases after preparing hematoxylin and eosin-stained slides from tissue blocks preserved in the department.

Results: The mean age of the patients was 55 ± 15 years. Six (66.7%) patients were females, and the other three (33.3%) were male. Following surgery, gross examination of the specimens revealed that the mean size of the excised tumors was 2.45 ± 1.45 cm. The tumors were classified based on histopathological features according to growth pattern, cell type, and cytoarchitecture. Most cases had lobular growth pattern (5, 55.6% cases), consisted of epidermoid cells (5, 55.6% cases), and exhibited infiltrative cytoarchitecture (8, 88.9% cases).

Conclusion: Early diagnosis of meibomian carcinoma is important to reduce mortality from the aggressive tumor. The knowledge of clinicopathological aspects of the tumors that were biopsied in the department of pathology in the past 2 years will help in diagnosis and management of such tumors in future.