The first retinoblastoma local experience in Kuwait: A retrospective case series.

Background: To report the first series of retinoblastoma (RB) cases that were managed locally in Kuwait by the retinoblastoma team that was established during the COVID-19 pandemic. Results: Six cases with RB were included in this study. The ages ranged from 3 months to 2 years with a male to female ratio of 2:1. All cases presented with an abnormal pupillary reflex with or without strabismus. Examination findings mostly showed leukocoria and an intra-retinal mass with calcification with or without vitreous seeding. Most cases were unilateral except for one case, which had bilateral RB. International classification of RB staging ranged from group B to E. Multidisciplinary approach was followed to manage these cases by applying a well-set protocol created by the RB team. Each case was treated according to grade at presentation. Conclusion: COVID-19 pandemic revolutionized the standard of care for RB in Kuwait and mandated the establishment of a multidisciplinary team to follow a standardized protocol to manage RB cases successfully.

Smartphone ophthalmoscopy versus slit-lamp biomicroscopy for optic nerve head evaluation: A digital apparatus into medical education.

OBJECTIVE: Th aim of this study is to explore the diagnostic accuracy of smartphone-based D-EYE ophthalmoscopy in the diagnosis of optic nerve head (ONH) abnormalities and screening for glaucoma. METHODS: This is a prospective clinical-based validation study performed on 90 patients recruited from a tertiary teaching hospital. Patients underwent dilated fundus examination by slit-lamp and smartphone-based D-EYE fundoscopy operated by two experienced ophthalmologists. RESULTS: The diagnostic accuracy of smartphone-based D-EYE ophthalmoscopy of normal vertical cup-to-disc ratio (VCDR) was acceptable (sensitivity 85.8%-96.4%; specificity 51.4%-96.4%). The D-EYE would often underestimate VCDR values as mean VCDR was significantly lower among overall and glaucoma cohorts (all p-value <0.001) for D-EYE in comparison with slit-lamp. In terms of ONH abnormalities, the D-EYE adequately demonstrated high sensitivity in the identification of only margins-related abnormalities (sensitivity 92.5%-96.6%). Overall, the diagnostic accuracy and agreement between expert ophthalmologists using the D-EYE and the reference slit-lamp examination were significantly poor. CONCLUSION: We demonstrated that the D-EYE is a highly specific tool for VCDR within the normal range but not in patients with glaucoma. Despite being an easy and portable tool to measure VCDR, it is limited in terms of diagnosing ONH and blood vessel abnormalities.

Risk factors associated with sickle cell retinopathy: findings from the Cooperative Study of Sickle Cell Disease.

BACKGROUND: Sickle cell retinopathy (SCR) is one of the most important ocular manifestations of sickle cell disease (SCD). This study aims to assess the prevalence of SCR in SCD, identify risk factors for its development and progression to proliferative sickle cell retinopathy (PSCR), and evaluate the potential implications of these results on clinical practice. METHODS: This research is a secondary analysis of patients diagnosed with SCD from the epidemiological, multicenter Cooperative Study of Sickle Cell Disease (CSSCD). We included all patients who completed a full ophthalmic evaluation. We identified clinical and laboratory SCD characteristics associated with SCR using multivariate logistic regression models. Proliferative sickle cell retinopathy (PSCR) was diagnosed according to the Goldberg classification system. RESULTS: Of the 1904 study participants with SCD who met the inclusion criteria, 953 (50.1%) had retinopathy; of which 642 (67.3%) had bilateral disease. SCR was associated with older age (p < 0.001), history of smoking (p = 0.001), hematuria (p = 0.050), and a lower hemoglobin F (HbF) level (p < 0.001). PSCR risk increased with smoking (p = 0.005), older age (p < 0.001) higher hemoglobin level (p < 0.001) and higher white blood cell count (p = 0.011). Previous blood transfusion (p = 0.050), higher reticulocyte count (p = 0.019) and higher HbF level (p < 0.001) were protective factors against the development of PSCR. Ocular symptoms were associated with progression to PSCR in patients with SCR (p = 0.021). CONCLUSION: In this cohort of individuals with SCD, half of the participants had signs of SCR. Smoking and blood hemoglobin level were the two modifiable risk factors associated with increased retinopathy progression. Screening to identify the different stages of retinopathy, actively promoting smoking cessation, and optimizing the hematological profile of patients with SCD should guide treatment protocols designed to prevent the vision-threatening complications of the disease.

Prevalence, characteristics and risk factors of diabetic retinopathy in type 2 diabetes mellitus patients in Jordan: a cross-sectional study.

OBJECTIVES: To measure the prevalence of diabetic retinopathy in patients with type 2 diabetes, to define their characteristics, and identify the associated risk factors. METHODS: We performed a cross sectional study of 1316 adult patients with type 2 diabetes mellitus who attended an ophthalmology clinic. Demographic, clinical, and laboratory data were analyzed. Diabetic retinopathy (DR) was diagnosed using a complete ophthalmic evaluation, including a fundic examination. Two regression models were constructed to identify the risk factors associated with DR and the parameters associated with the stage of retinopathy. RESULTS: Men accounted for 774 (58.8%) of the participants. The prevalence of DR was 28.2% (371 participants). DR was significantly more common in participants who were ≥60 years old, were women, had had diabetes for >10 years, were taking insulin, were not taking metformin, had a body mass index >30 kg/m2, were current smokers, or had a history of hypertension. Advanced stages of DR were more common in participants in the later stages of nephropathy and with albuminuria. CONCLUSIONS: Poor glycemic control, smoking, and advanced diabetic kidney disease are most closely associated with retinopathy. Further longitudinal studies are necessary to identify the mechanisms underlying these relationships and to guide community-based interventions.

Environmental Risk Factors Associated With the Need for Penetrating Keratoplasty in Patients With Keratoconus.

Purpose To identify environmental risk factors associated with the need for penetrating keratoplasty (PKP) (full-thickness corneal transplantation) in patients with keratoconus in a Middle Eastern country. Methods This is a retrospective case-control study. This study included patients with keratoconus who underwent PKPor were waitlisted for PKP. Controls were patients diagnosed with keratoconus who did not reach a stage that necessitates PKP. Groups were matched by age and gender. Chi-square test was used to figure out the association between different risk factors including eye rubbing, vernal keratoconjunctivitis (VKC), smoking, paternal consanguinity, eye dryness, family history, asthma, eczema, and diabetes with the need for PKP. Results A total of 111 patients were included in this study, there were 48 (43.26%) men and 63 (56.75%) women. The case group included 42 subjects and the control group included 69 subjects. We found statistically significant differences between the two groups in relation to eye rubbing (p=0.0005), VKC (p=0.005), paternal consanguinity (p=0.02), and smoking rate (p=0.04), all being significant in the group in need of PKP. On the other hand, we did not find out a statistically significant difference between the two groups in relation to family history (p=0.31), dryness (p=0.58), asthma (p=0.15), eczema (p=0.28), or diabetes (p=0.29). Conclusion This study has identified several risk factors associated with the need for PKP in patients with keratoconus, part of which are modifiable. These findings can benefit clinicians in community counseling and give recommendations that can help in preventing or - at least - delaying the need for PKP surgery in keratoconus, such as smoking cessation, aggressive treatment of VKC disease, eye rubbing avoidance, as well as raising awareness regarding the potential risks of paternal consanguinity in this disease entity.

Perinatal events predicting retinopathy of prematurity in extremely pre-term infants.

BACKGROUND: Extremely preterm infants are peculiar in regard to their risk of retinopathy of prematurity (ROP). In this study, we aim to study insults that may affect extremely preterm infants, including prenatal, at birth, and postnatal insults and their effect on the development of ROP. METHODS: This study used the data from Prematurity and Respiratory Outcomes Program (PROP). All included infants with a gestational age of 23 0/7 to 28 6/7 weeks using best obstetrical estimate. We included stressful events and/or modifiable variables that may affect the normal development. We used multiple regression analysis in our statistical analysis. RESULTS: We included a total of 751 infants in our study. The mean birth weight for the included sample was 915.1 (±232.94) grams. 391 (52.1%) Infants were diagnosed with ROP. We found a significant negative correlation between ROP development and birth weight (p < 0.001), with a correlation coefficient of - 0.374. We found that the need for prophylactic indomethacin (OR 1.67), the occurrence of air leaks (OR: 2.35), ventilator-associated pneumonia (OR: 2.01), isolated bowel perforations (OR: 3.7), blood culture-proven sepsis (OR: 1.5), other infections (OR: 1.44), and receiving ventricular shunt (OR: 2.9) are significantly associated with the development of ROP. CONCLUSIONS: We believe this study included the largest number of factors studied in the largest sample of extremely premature infants. We recommend a screening program for extremely preterm infants that takes into account a scoring system with higher scores for complicated condition.

Ocular Manifestations of Sickle Cell Disease: Signs, Symptoms and Complications.

BACKGROUND: Sickle cell disease is an inherited hematological disorder that can affect any organ in the body including the eyes (1-6). Previous studies on ocular manifestations of sickle cell disease generally included samples of less than 100 patients. In this study, we aim to assess the frequency of different ocular signs, symptoms and complications among sickle cell disease patients. METHODS: This study was conducted using data from the Cooperative Study of Sickle Cell Disease (CSSCD). Patients with major sickle cell hemoglobinopathies (SS, SC, S ß-thal) were eligible for enrollment. Patients from all age groups were included. Patients underwent detailed ophthalmological examination under standardized conditions. RESULTS: A total of 1904 patients were included in this study, with a mean age of 27.67 (±11.72) years. 1,802 (96.4%) patients had BCVA of more than 20/40 in the better-seeing eye. On slit lamp examination, the presence of vascular loops and segment, representing a positive conjunctival sign, was the most common reported abnormal finding (54.1%). The most common complication was peripheral retinal artery occlusion detected in225 patients (20.3%) bilaterally and 77 patients (6.9%) unilaterally. CONCLUSION: In this study that included one of the largest samples ever studied to assess ocular complications of sickle cell disease, we identified the frequency and percentages of different ocular signs, symptoms and complications in different age groups.

Bifid appendix: a case report and a review of literature.

Anomalies of the appendix are extremely rare, with a reported incidence of 0.004 to 0.009. Due to the wide range of variations, failing to recognize these anomalies may lead to failure of treatment and complications. We report a case of a 21-year-old female patient who presented to the Emergency Department with a clinical picture of acute appendicitis. After performing the proper laboratory and radiological tests, a decision was made to do a laparoscopic appendectomy which revealed a partially duplicated 'bifid' vermiform appendix with features of acute appendicitis.