Surgical outcomes of phakic, pseudophakic and combined phaco-trabeculectomy in a tertiary care centre in Saudi Arabia.

PURPOSE: To compare the outcomes of phakic, pseudophakic and combined phaco-trabeculectomy in eyes of Saudi patients. METHODS: This was a retrospective cohort study. Eyes of patients with primary open angle glaucoma, primary angle closure glaucoma or secondary exfoliation glaucoma (XFG) that underwent phakic (n = 152), pseudophakic (n = 40) or combined phaco-trabeculectomy (n = 45) at the King Khaled Eye Specialist Hospital, Riyadh from January 2012 to December 2017 were included. The primary outcome measure was the success at 3 years after surgery. Complete success was defined as achieving an intraocular pressure (IOP) of ≥ 6 and ≤ 21 mmHg without topical antiglaucoma medications; qualified success as achieving the same IOP criteria with or without the use of glaucoma medications. Cumulative probabilities of failure were computed using Kaplan-Meier survival analysis. We used Cox regression analysis to identify factors associated with treatment failure. Reduction in mean IOP and AGM over time was estimated using mixed-effects linear models. RESULTS: The mean decrease in IOP at 3 years from baseline in the phakic, pseudophakic and combined groups was 12.0 (95% CI, 9.9, 14.1) mmHg, 10.1 (95% 6.3, 13.9) mmHg, and 6.4 (95% CI, 1.9, 11.0) mmHg, respectively, and was not significantly different from each other. The values for qualified success were also comparable: 95.2% (95% CI: 86.7-99.0), 95.3% (95% CI: 76.2-99.9), 92.3% (95% CI: 64.0-99.8). Failure was significantly associated with postoperative suturelysis (p = 0.004), XFG (p = 0.018) and AGM (p = 0.038). CONCLUSIONS: This is the first study to provide relative surgical outcomes of trabeculectomy, phaco-trabeculectomy and pseudophakic trabeculectomy in Saudi Arabia and did not show any significant difference in terms of overall success.

Perception of Medical Professionalism Among Ophthalmology Residents in Saudi Arabia: A National Survey Study.

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.

A preliminary comparison of the Aravind aurolab drainage implant with the Baerveldt glaucoma implant: A matched case-control study.

PURPOSE: The Aurolab® aqueous drainage implant is a low-cost alternative to the Baerveldt glaucoma implant. The aim of this study was to test the hypothesis that the two implants are comparable in terms of surgical success and safety. METHODS: We conducted a retrospective case-control study of Aurolab aqueous drainage implant done at our institution from May 2015 and May 2017. Twenty-five consecutive patients who received an Aurolab aqueous drainage implant were matched by age and diagnosis to patients who received a Baerveldt glaucoma implant. Data were collected pre-operative and post-operative visits, including visual acuity and intraocular pressure, number of medications, and complications. Surgical success was defined as intraocular pressure between 5 and 21 mmHg with a minimum 20% reduction from baseline, without loss of light perception or the need for further glaucoma surgery. Cox regression analysis was used to predict factors associated with surgical success. RESULTS: The median (interquartile range, IQR) intraocular pressure at 1 year was 16.0 (8.0) mmHg for the Baerveldt glaucoma implant and 13.0 (8.0) mmHg for the Aurolab aqueous drainage implant, p = 0.38. Success (mean ± SE) at 1 year for the intraocular pressure >21-mmHg failure criterion was 65% ± 15% for the Baerveldt glaucoma implant and 79% ± 11% for the Aurolab aqueous drainage implant (p = 0.80). The frequency of complications listed was similar for the two groups (Fisher's exact p = 0.71). In the Cox regression, the type of implant was not found to be associated with surgical success. CONCLUSIONS: Our preliminary results suggest that the Aurolab aqueous drainage implant is comparable to the Baerveldt glaucoma implant. Further long-term data in a larger population are needed to confirm these findings.

Marcus Gunn Jaw-Winking Syndrome Associated with Morning Glory Disc Anomaly.

Marcus Gunn jaw-winking syndrome (MGJWS) is a rare form of congenital blepharoptosis and one of the congenital cranial dysinnervation disorders (CCDD). In addition, morning glory disc anomaly (MGDA) is a congenital optic disc anomaly of unknown etiology. The present report is the first to describe an association between MGJWS and MGDA in an otherwise healthy 7-year-old boy. He also had counting finger vision, anisometropia, esotropia, and monocular elevation deficiency in the same eye. In the literature, both MGJWS and MGDA have been reported to be associated with Duane retraction syndrome, a form of CCDD.

Sun exposure behaviours, attitudes and protection practices among Prince Sattam bin Abdulaziz University Students- A survey study.

OBJECTIVE: To evaluate sun exposure behaviours, sun protection practices, general knowledge, attitudes and awareness of University students about the benefits of sun exposure and harmful effects of too much or avoidance of sun exposure. METHODS: This cross-sectional survey study was conducted in December 2014 and January2015 at Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia. A questionnaire consisting of multiple-choice closed questions was used. Sample was collected using cluster sampling method. SPSS 16 was used for data analysis. RESULTS: Of the 399 participants, 200(50.1%) were men and 199(49.9%) were women. The overall mean age was 21±1.82years (range: 18-30 years). Moreover, 217(54.4%) participants intentionally exposed themselves to sun. Spending summer holidays in coastal areas was reported by 150(37.6%). Sunglasses were used by 161(40.4%) participants. Besides, 274(68.7%) participants agreed that sun exposure of 5 to 10 minutes for two or three times per week was very important; 189(47.4%) were aware of the importance of sun exposure for child health. 165(66%), knew that too much sun exposure was harmful and might cause skin cancer. CONCLUSIONS: Most of the participants were aware of both beneficial effects of the appropriate sun exposure and harmful effects of too much exposure or its avoidance. However, proper sun exposure practices and sun protection practices need further guidance and encouragements from health-promoting programmes.