Oman Journal of Ophthalmology最新文献

Symptomatic retinal detachment threatening the macula is considered an emergency requiring surgical intervention. However, the management of subclinical rhegmatogenous retinal detachment remains controversial, with differing opinions among clinicians. Almost half of these cases are known to progress into symptomatic detachments; hence, management at the asymptomatic stage is advised rather than mere observation. In such cases, demarcation laser photocoagulation (DLP) can help to contain the detachment. It involves creating a laser barrage around the detachment by applying 3-5 rows of confluent laser burns with a laser indirect ophthalmoscopy delivery system. DLP, being an outpatient-based, inexpensive, and minimally invasive procedure, can prove beneficial in such patients, especially those who are not motivated enough to undergo an invasive procedure in an asymptomatic eye. Through this case series, the authors have described the clinical profile of the patients with subclinical retinal detachment, where DLP was helpful in the containment of the subretinal fluid.

Nonpenetrating deep sclerectomy (NPDS) was initially developed back in 1989. The procedure stands out in the field of glaucoma for its significant safety profile and good efficacy. Unlike other surgical alternatives, evidence has noted that NPDS results in a controlled and gradual reduction of intraocular pressure. The purpose of this literature review is to summarize the technique, challenges posed, current innovations, and overall outcomes mentioned in the literature on NPDS for various types of glaucomas and its various disease stages.

Context: Vascular endothelial growth factor (VEGF) is a potent and specific angiogenic growth factor that may participate in the formation of the vascular tumor stroma. Pretreatment VEGF levels can be a biomarker to predict tumor progression and prognosis in patients with primary ocular malignancies.

Aims: The aim of this study was to estimate the serum vascular endothelial growth factor (VEGF) in various ocular malignancies, correlate with clinicpathological parameters, and assess its prognostic and therapeutic implications.

Settings and design: This hospital-based observational study includes a total of 32 newly diagnosed histopathologically confirmed, patients with ocular malignancy.

Subjects and methods: Circulating VEGF levels were measured using as and which enzyme-linked immunosorbent assay technique in 32 patients and 16 healthy controls. Serum VEGF levels were expressed as means ± standard deviation and compared using a one-way analysis of variance test, Chi-squared test, and Student's t-test were used.

Results: Mean serum VEGF levels were significantly raised in patients as compared to healthy controls (79.85 ± 22.16 vs 67.15 ± 6.84 pg/ml). Moreover, VEGF levels were maximum in retinoblastoma (111.86 ± 33.54 pg/ml), followed by sebaceous gland carcinoma (77.83 ± 11.37 pg/ml), ocular surface squamous neoplasia (70.57 ± 5.84 pg/ml), and basal cell carcinoma (67.96 ± 4.55 pg/ml). No significant change in serum VEGF level depending on histopathological differentiation (P = 0.151). Overall, VEGF levels were markedly elevated in the advanced stage as compared to those with the early stage (94.43 ± 26.71 vs. 68.51 ± 6.20 pg/ml). Significant increase in VEGF levels was also found in patients with lymph node metastasis (108.90 ± 27.31 pg/ml, P < 0.001) and distant metastasis (124.71 ± 28.27 pg/ml, P < 0.001). In addition, recurrence was observed in 18.75% of patients with high-level VEGF (104.69 ± 35.78 pg/ml).

Conclusions: Serum VEGF may be a useful biomarker to assess disease severity, predict prognosis, and assess the likelihood of recurrence in various ocular cancers.

Background and purpose: Juvenile idiopathic arthritis (JIA) is the most common type of arthritis in children. JIA patients are at risk of developing uveitis and undergo ophthalmic screening at specific regular intervals based on international JIA screening guidelines. This study aimed to assess the adherence of ophthalmology and rheumatology services, and patients followed at Sultan Qaboos University Hospital (SQUH), Oman, to the screening guidelines and identify factors influencing adherence.

Subjects and methods: In this retrospective cohort study, we reviewed the charts of all patients diagnosed with JIA from 2015 to 2020 who were followed up by the pediatric rheumatology service at SQUH. Data collected included the patient's demographics, age at diagnosis of JIA and age at diagnosis of uveitis, disease duration, JIA subtype, disease markers, treatment, and frequency of rheumatology and ophthalmology appointments. The patients' actual appointments were compared with their planned appointments to assess adherence to the screening schedule.

Results: Thirty-nine JIA patients (13 males, 26 females) were recruited in the study. The median age of the patients at diagnosis of JIA was 3 years (interquartile range 2-7 years). The distribution of JIA subtypes was 13 (33.3%) oligoarticular JIA patients, 14 (35.9%) systemic-onset JIA patients, and 12 (30.8%) polyarticular JIA patients. A total of 23 (59%) patients were on biologics. Rheumatology service adherence for referring for the first screening visit was 94.9%, while ophthalmology adherence for scheduling first-visit appointments was 76.9%, and patient adherence for the first visit was 96.7%. Over the 5 years, the average adherence to screening guidelines was 81.3% for the ophthalmology service and 88.4% for patients. One patient developed uveitis during the study period. A significant association was found between higher age at diagnosis of JIA patients and patient adherence (P = 0.037). A significant association was also found between shorter JIA disease duration and patient adherence (P = 0.000275).

Conclusion: Assessment of adherence to the JIA screening recommendations for uveitis at SQUH revealed some shortcomings. While the rheumatology service's adherence is good, the ophthalmology service's adherence needs improvement. Patients' adherence to the first visit appointment is optimal but needs improvement throughout the 5 years. Although all patients had risk factors for uveitis, only one developed uveitis. In this cohort study of Omani JIA patients, the occurrence of uveitis seems to be low.

Background: Uncorrected refractive errors are a major global public health concern, responsible for approximately 50% of visual impairments. Surgical options such as photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) are effective but can result in myopic regression, necessitating retreatment. To evaluate the efficacy, safety, and predictability of transepithelial PRK (Trans-PRK) for correction of myopic regression after previous refractive surgery.

Methodology: Trans-PRK was performed in eyes with myopic regression after previous PRK or LASIK with a mean refractive spherical equivalent (SE) of - 1.92 diopter (D) ±0.96 (standard deviation). The mean preoperative logMAR uncorrected distance visual acuity (UDVA) was 0.59 ± 0.38. Postoperative evaluation included UDVA, SE, epithelial healing, and haze formation at 1 week, 2 months, and 6 months.

Results: The study evaluated 26 eyes of 15 patients. At 6 months postoperatively, the proportion of eyes within ± 0.50 D and ± 1.00 D of the target refraction was 37.5% and 100%, respectively. After the enhancement, the percentage of eyes with Snellen UDVA of 20/20 or better was 80% at 6 months, while all of the eyes had a Snellen UDVA of 20/25 or better. The mean postoperative SE was - 1.01 ± 0.74, at 1 week, -0.61 ± 0.98 at 3 months, and - 0.38 ± 0.57 at 6 months. No significant complications were noted.

Conclusions: The results of this study indicate that Trans-PRK appears to be safe, effective, stable, and predictable procedure for the treatment of myopic regression after previous PRK or LASIK.

Introduction: Preoperative anxiety is an unpleasant state in patients undergoing Phacoemulsification cataract surgery. Benzodiazepines are used to alleviate anxiety. The anxiolytic and analgesic effects of melatonin are compared with diazepam in this study. We have assessed the effect of melatonin on verbal anxiety score (VAS), verbal pain score (VPS), sedation score, intraocular pressure, and the adverse effects.

Materials and methods: Patients were randomized to receive a tablet of melatonin 3 mg or diazepam 5 mg orally 90 min before surgery. At the preoperative visit, VAS and VPS, 0-10 were explained to patients. A sedation score 4-point scale was assessed. VAS was recorded before premedication (T1), 60 min after premedication (T2), during the operation period (T3), and also postoperatively in the recovery room (T4). Pain and sedation score (T2, T3, T4). Intraocular pressure (IOP) before premedication and after 24 h. The ophthalmologist scored the intraoperative conditions as excellent, good, and poor.

Results: A total of 199 patients were recruited. 99 received melatonin, 100 diazepam. Females 54 and males 45 with a mean age of 62 ± 8 and 65 ± 7 years in melatonin, 62 F and 38 M with a mean age of 61.9 ± 8, 63 ± 10, respectively. Blood pressure and pulse rate were comparable between groups at T1 and T4. VAS and sedation score with melatonin reduced significantly compared to diazepam at T2, T3, and T4 (P = 0.0001). VPS between melatonin and diazepam was similar at all-time points. Intraoperative condition was scored as excellent at 71% and 28% in melatonin and diazepam, respectively. IOP between groups was similar.

Conclusion: Melatonin significantly reduced anxiety compared to diazepam with less sedation. Patient cooperation during the intraoperative period was better with melatonin.