Oman Journal of Ophthalmology最新文献

Carotid-cavernous fistula (CCF) is a rare condition involving an abnormal communication between the carotid artery and the cavernous sinus. We present a unique case of posttraumatic unilateral CCF initially misdiagnosed as a corneal melt with iris prolapse and orbital cellulitis. The patient, a 25-year-old male, experienced swelling, bleeding, and sudden vision loss in the affected eye following a fall. Imaging confirmed a direct CCF, and the patient underwent endovascular coiling, evisceration, and prosthetic replacement. Partial loss of levator palpebrae superioris muscle function was observed postprocedure. This case underscores the diagnostic challenge of CCF and highlights the significance of early and accurate diagnosis for appropriate management.

Purpose: To estimate the level and determinants of knowledge, attitude, and practices (KAPs) of kindergarten teachers regarding vision and eye screening of preschool children of Qassim region of Saudi Arabia.

Methods: As a part of a study to evaluate the KAP of stakeholders in the Qassim region, we surveyed kindergarten teachers from July to September 2023. The responses to ten knowledge-related and five attitudes and practices of teachers about eye and vision screening were collected using a graded Likert scale. The KAP score was associated with teacher-related variables. Teachers' current and desired sources of knowledge were also reviewed.

Results: We surveyed 60 KG teachers. All were female. The good level of knowledge was in 85% of teachers. The positive attitude and good practices were in 90% of teachers. Teachers' education levels were not associated with teachers' knowledge (Kolmogorov-Smirnov [KS] P = 0.456), attitudes (KS P = 0.71), and practice (KS P = 0.06). Social media and computer-based sources provided knowledge on eye and vision screening of children in nearly half of the teachers. More interaction between ophthalmologists and optometrists was desired to learn about the topic.

Conclusions: The high awareness, positive attitude, and practices noted among KG teachers in this study are promising and favor their involvement in universal vision and eye screening initiatives in the Qassim region of Saudi Arabia.

Central retinal vein occlusion (CRVO) is a significant cause of vision impairment in adults, often associated with various systemic and ocular risk factors. The current literature presents a limited understanding of the efficacy of antithrombotic agents in CRVO management, with sparse comparative studies evaluating the effectiveness of different antiplatelet therapies. Here, we report the case of nonischemic CRVO in a 54-year-old male with multiple systemic comorbidities, including diabetes mellitus, hypertension, and dyslipidemia. Initial treatment with aspirin 100 mg daily resulted in worsening visual acuity (VA) and retinal pathology, prompting a transition to clopidogrel 75 mg daily due to patient refusal of intravitreal injection. Remarkably, clopidogrel therapy led to rapid and sustained improvement in VA, macular edema resolution, and complete resolution of retinal vascular pathology within weeks. This case underscores the therapeutic potential of clopidogrel in nonischemic CRVO management, suggesting its superiority over aspirin in select patients. We discuss the mechanisms underlying the differential efficacy of antiplatelet agents and highlight the need for further comparative studies to guide optimal treatment strategies in CRVO.

Background: The purpose of this study was to evaluate and compare the values of hexagonality of endothelial cells among type-2 diabetics and nondiabetics. It also aimed at finding the correlation of the hexagonality of endothelial cells with the duration of diabetes, random blood sugar level, and severity of diabetic retinopathy in type-2 diabetics.

Materials and methods: A comparative cross-sectional study was conducted for 8 months from January to August 2022. The data was collected from tertiary care eye hospital named Al-Shifa Trust Eye hospital jhelum road, Rawalpindi, Pakistan. After taking the informed consent, a complete history of each subject was taken. Visual acuity and refraction were performed using Early Treatment Diabetic Retinopathy Study visual acuity chart and then, complete slit-lamp anterior and posterior segment examination was performed followed by specular microscopy (TOMEY Specular Microscope EM-4000) to evaluate endothelial cell hexagonality. The diabetic subjects were checked for their random blood sugar levels immediately after specular microscopy using a digital glucometer and the readings were recorded.

Results: Results showed that the hexagonality of endothelial cells was statistically significantly lower (P = 0.000) in type-2 diabetics than in nondiabetics. Correlation analysis of the hexagonality of endothelial cells showed a negative correlation (P < 0.05) with random blood sugar levels while no correlation (P > 0.05) with the duration of diabetes and severity of diabetic retinopathy.

Conclusion: The study concluded that the hexagonality of endothelial cells was significantly different among the two groups under study, i.e., type-2 diabetics and nondiabetics.

Purpose: To describe a bimanual method for management of posteriorly dislocated large nucleus fragment using standard chopper.

Methods: A 23G assistant handheld endoilluminator was used as light source through inferonasal self-sealing port, while the large nuclear fragment was broken into smaller fragments using phacofragmatome and standard phaco chopper.

Results: A case of posteriorly dislocated large nuclear fragment was operated using this technique. The time taken for phacofragmentation was significantly reduced, as well as the ultrasound energy required for the same. There was no port site complication.

Conclusion: This technique allows greater maneuverability and reduces amount of ultrasound energy used by dividing nucleus into small fragments in vitreous cavity.

In this case series, we will describe sterile keratitis in the early postoperative period after hypotonic collagen cross-linking (CXL) in two pediatric cases. This is a retrospective case series of two eyes of two children who developed inflammatory keratitis with central corneal haze after uneventful epithelial-off hypotonic CXL. After ensuring microbiological sterility, appropriate treatment with topical steroids and lubricants was started. There was complete resolution of corneal infiltrates with minimal scarring. Both patients regained almost the preoperative best-corrected visual acuity of 20/80 and 20/60, respectively.

An 18-year-old female presented with sudden onset bilateral vision loss. Extensive retinal hemorrhages were seen in both eyes. Systemic examination lead to a diagnosis of acute promyelocytic leukemia. The patient was treated with all trans retinoic acid (ATRA) and other medications in the induction phase. Bilateral disc edema was noted during the second consolidation cycle with ATRA. Complete resolution of bilateral disc edema was attained in three weeks' time after discontinuing ATRA.

Purpose: This study aims to describe the demographic profile, prevalence, pattern, and risk factors for retinal vein occlusion (RVO) in patients over 40 years of age presenting to the Liberia Eye Centre, John F Kennedy Memorial Medical Centre, Monrovia, Liberia.

Subjects and methods: A retrospective study was conducted on patients presenting to Liberia Eye Centre from July 2017 to February 2021. A total of 17506 new patients were examined during this period out of which 10813 patients were over 40 years of age. Data were collected from the electronic medical record system database. The variables in the collected data included age, gender, location, laterality of eye affected, uncorrected visual acuity, best-corrected visual acuity, intraocular pressure, ocular diagnosis, systemic risk factors, and associated complications.

Results: Of the 10813 patients, RVO was found in 111 patients with an overall prevalence rate of 1.03% (95% confidence interval 0.80-1.2). Central RVO (CRVO) was more common than branch RVO (BRVO) in the defined population with similar proportions of both genders. The mean age for any RVO was 64.45 ± 12.27 standard deviation (SD) years (P = 0.734). Majority of the cases of RVO were from Lofa (n = 20; 18%). Fifty-five (61.1%) patients had hypertension, 5 (5.6%) had diabetes mellitus, and 6 (6.7%) had dyslipidemia. More than one systemic risk factor was present in 24 (26.7%) patients. However, none of the systemic risk factors were statistically significant. Visual acuity was most affected in patients with CRVO, with a visual acuity of <3/60 in 45 (63.4%) patients compared to 12 (30.0%) in BRVO patients. Glaucoma was present in 34 (30.6%) patients. The most common ocular complication was macular edema (n = 62, 55.8%) followed by vitreous hemorrhage (n = 8, 7.2%).

Conclusions: RVO was detected in 1.03% of the study population over the age of 40 years in Liberia, CRVO being more common than BRVO. The clinical presentation of RVO in the Liberian population for the first time provides insight into the burden of the disease and opportunity for further research.