Long-term outcomes of cyclophotocoagulation in refractory pediatric glaucoma: treatment response and success in 262 eyes.

PURPOSE: To report the surgical success and response to treatment for children undergoing cyclophotocoagulation (CPC) for refractory pediatric glaucoma. METHODS: The medical records of children with a diagnosis of glaucoma who underwent a first CPC between May 2000 and May 2020 were reviewed retrospectively. The cumulative probability of success was assessed. For definition 1, treatment success was defined as IOP ≤21 mm Hg at all the visits after the first 3 months without the need for additional glaucoma surgery or repeat CPC. For definition 2, repeat CPC did not constitute failure. RESULTS: Of 300 eyes that underwent CPC, we identified 262 eyes eligible for inclusion. The mean age at time of first treatment was 5.33 ± 5.03 years, with a mean follow-up of 4.3 ± 4.2 years (31 eyes having at least 10 years of follow-up). The success rates for definitions 1 and 2 were 26.7% (95% CI, 21.7%-32.4%) and 46.2% (95% CI, 40.2%-52.3%), respectively. Older age was associated with a lower risk of failure after both single CPC (HR, 0.92; 95% CI, 0.88-0.96; P < 0.001) and multiple CPCs (HR, 0.95; 95% CI, 0.90-1.00, P = 0.073). Of the 262 eyes, 107 (41%) had sustained IOP-lowering with a single treatment and 56 (21%) with multiple treatments; 35 (13%) had a transient response, and 64 (24%) had no response. CONCLUSIONS: Glaucoma control through CPC often requires multiple treatments, with around a quarter of children responding suboptimally. Older children are more likely to exhibit successful IOP lowering.

Outcomes of Medical and Surgical Management in Aqueous Misdirection Syndrome.

Purpose: To report the outcomes of medical and surgical management in patients diagnosed with aqueous misdirection syndrome (AMS). Patients and Methods: A retrospective chart review of all cases diagnosed with AMS at a single tertiary care eye center during the period from 2014 to 2021. Outcome measures were anatomical success (deepening of the anterior chamber (AC)), functional success (improvement in visual acuity), and treatment success (control of intraocular pressure (IOP)). Results: A total of 26 eyes with AMS from 24 patients were included. The patients were followed for a mean duration of 24 ± 18 months. Although some patients initially responded to medical and laser therapy, all but one (3.8%) eventually required surgery during the first 3 months after presentation. The mean duration from presentation until surgery was 45.9 ± 45.8 days (range: 2-119 days). The majority of cases (69.2%) were managed by pars plana vitrectomy. At the last follow-up visit, anatomical success was achieved in 20 (76%) eyes, 15 (57%) eyes had a final visual acuity that was either similar to or better than baseline, and successful control of IOP was achieved in 17 (65%) eyes. Univariate analysis revealed that a history of trabeculectomy as a cause of AMS was a risk factor for treatment failure (OR, 7.8; 95% CI, 1.16-52.35; P, 0.02). Conclusion: Our findings indicate that medical and laser management of AMS provide temporary control, and almost all patients eventually require surgery within the first 3 months. A history of trabeculectomy was found to be a risk factor for treatment failure.

Comparison of the Ahmed and Baerveldt Glaucoma Drainage Implants in the Treatment of Primary Congenital Glaucoma.

PURPOSE: To compare the outcomes of the Ahmed glaucoma valve (AGV) (New World Medical, Inc) with the Baerveldt glaucoma implant (BGI) (Johnson & Johnson Vision) in primary congenital glaucoma (PCG). METHODS: This was a retrospective review of children with PCG who underwent AGV or BGI implantation with a minimum follow-up of 6 months. Main outcome measures were intraocular pressure (IOP), the number of glaucoma medications, success rate, complications, and surgical revisions. RESULTS: The study included 153 eyes of 86 patients (120 eyes in the AGV group and 33 eyes in the BGI group), and the mean follow-up period was 58.7 ± 6.9 months in the AGV group and 58.5 ± 5.0 months in the BGI group. At baseline, IOP was lower in the AGV group (33 ± 6.3 vs 36.4 ± 6.1 months; P = .004) and the number of glaucoma medications was comparable between groups (3.4 ± 0.9 vs 3.6 ± 0.5 medication; P = .183). At 5 years, the mean IOP (18.4 ± 5.0 vs 16.3 ± 2.5 mm Hg; P = .004) and number of glaucoma medications (2.1 ± 1.3 vs 1.0 ± 1.0 medication; P = .001) were significantly less in the BGI group. Furthermore, the surgical success was 53.4% in the AGV group and 78.8% in the BGI group (P = .013). CONCLUSIONS: Both the AGV and BGI were successful in providing adequate IOP control in patients with PCG. Long-term follow-up showed that the BGI was associated with a lower IOP, fewer glaucoma medications, and a higher success rate. [J Pediatr Ophthalmol Strabismus. 2023;60(6):448-454.].

Efficacy and Safety of Temporary in situ Stenting of Ahmed Glaucoma Valve in Eyes with High Risk of Hypotony.

Introduction and Objective: To describe a novel technique for providing external ligation of the Ahmed glaucoma valve (AGV) to prevent hypotony in eyes at high risk with a 4/0 nylon stent suture and report outcomes compared to ligation with an absorbable vicryl suture and no ligation in terms of efficacy and safety. Methods: This was a retrospective cohort study investigating the efficacy and safety of in situ stenting compared to an absorbable ligature and the standard care, in high risk eyes, of hypotony. It included 116 patients; 34 in Group A (ligation + stent), 27 in Group B (ligation - stent), and 55 in Group C (no ligation). Results: The mean age (in years) of the participants was 53.94±19.01 in Group A, 44.85±29.92 in Group B and 52.62±24.47 in Group C, 59% (n = 20), 63% (n = 17) and 60% (n = 33) were males, respectively. The follow-up period was at least 6 months (Group A: 9.1±4.2 months, Group B: 9.6±3.4 months and Group C: 10.2±6.4 months). The mean baseline Snellen VA (LogMAR) was 1.82±1.34, 1.30±0.98 and 1.34±1.07 and the mean baseline IOP was 32.50±9.48, 28.22±7.12 and 28.33±10.63 mmHg, in Groups A, B and C, respectively. The failure rates, by the Kaplan Meier Survival curve, were higher 27.3% in Group C (no ligation) compared to 20.6% in Group A (ligation + stent) and 18.5% in Group B (ligation - stent) yet not found to be statistically significant (p = 0.4; log rank test). There was lower hypotony 2.9% in Group A and lower complications 25.9% in Group B but no statistical significance was found amongst the groups. Conclusion: In conclusion, temporary nylon in situ stenting of AGV had lower rates of hypotony. Furthermore, lower failure and complication rates were observed in vicryl only ligated AGV, then nylon in situ stented AGV and lastly in standard AGV controls.

Assessment of Diabetic Patients' Adherence to Diabetic Retinopathy Screening and the Influencing Factors in Al-Ahsa, Saudi Arabia.

Background Diabetic retinopathy (DR) is one of the diabetic complications that leads to the loss of vision. Most diabetic patients will have DR that is varying in its severity under the effect of many factors such as type of diabetes, duration of diabetes, and poor glycemic control. This study aimed to assess the level of adherence of diabetic patients to diabetic retinopathy screening (DRS) and to identify the influencing factors of adherence among diabetic patients in Al Ahsa, Saudi Arabia. Methods A cross-sectional study was conducted via a self-administered questionnaire among diabetic patients who were attending the primary health-care centers in Al Ahsa, Saudi Arabia, from July to August 2021. This questionnaire included five sections: sociodemographic data, diabetic profile, assessment of the knowledge, attitude toward DRS, and barriers to DRS. Results A total of 397 diabetic patients were involved in the study. Diabetic ocular complications were reported among 35.3% of the patients. The most commonly reported diabetic eye complication was cataract (37.1%; 52) followed by retinopathy (36.4%). Among the participants, 32.2% had a good awareness level regarding DR. In addition, 46.9% of diabetic patients have DRS. The most reported barriers were having no visual or eye problems, difficulty getting an appointment, and the cost and lack of information about the screening procedure (50.9%, 50.1%, 42.1%, and 39.8%, respectively).  Conclusion Improvement of patients' knowledge is a significant step to enhancing adherence to DRS. The availability of screening programs and well-established ophthalmology clinics in primary healthcare centers in addition to trained physicians will help to overcome the barriers of DRS.

p53/NF-kB Balance in SARS-CoV-2 Infection: From OMICs, Genomics and Pharmacogenomics Insights to Tailored Therapeutic Perspectives (COVIDomics).

SARS-CoV-2 infection affects different organs and tissues, including the upper and lower airways, the lung, the gut, the olfactory system and the eye, which may represent one of the gates to the central nervous system. Key transcriptional factors, such as p53 and NF-kB and their reciprocal balance, are altered upon SARS-CoV-2 infection, as well as other key molecules such as the virus host cell entry mediator ACE2, member of the RAS-pathway. These changes are thought to play a central role in the impaired immune response, as well as in the massive cytokine release, the so-called cytokine storm that represents a hallmark of the most severe form of SARS-CoV-2 infection. Host genetics susceptibility is an additional key side to consider in a complex disease as COVID-19 characterized by such a wide range of clinical phenotypes. In this review, we underline some molecular mechanisms by which SARS-CoV-2 modulates p53 and NF-kB expression and activity in order to maximize viral replication into the host cells. We also face the RAS-pathway unbalance triggered by virus-ACE2 interaction to discuss potential pharmacological and pharmacogenomics approaches aimed at restoring p53/NF-kB and ACE1/ACE2 balance to counteract the most severe forms of SARS-CoV-2 infection.

Topiramate-induced acute angle closure: A systematic review of case reports and case series.

Topiramate-induced acute angle closure (TiAAC) is a potentially vision-threatening side effect of topiramate (TPM) use. The purpose of this article is to review demographic characteristics, clinical features, and management options of TiAAC. A systematic literature search of all reported cases and case series of TiAAC was conducted in the following search engines: PubMed, Web of Science, Google Scholar, Elsevier, and EBSCO. Seventy-three publications describing 77 cases were included. 58 (75.3%) patients were female, and the mean age was 34.88 ± 11.21 years (range, 7-57). The most commonly reported indication of TPM use was migraine headache (59.7%), and the mean duration from starting treatment until the onset of angle closure was 14.1 ± 31.5 days. All cases were managed by immediate cessation of TPM and topical therapy. In addition, systemic medications (carbonic anhydrase inhibitors, hyperosmotic agents, and steroids) were used in 51 patients (66.2%). A laser and/or surgical intervention was performed in 10 patients (13%). After commencement of treatment, the mean duration until the resolution of TiAAC was 3.9 ± 3.6 days (range, 1-18). The findings of our study present a summary of the current body of evidence provided by case reports and case series on TiAAC. In conclusion, the onset of angle closure following TPM use peaks at 2 weeks after initiating treatment, and in most cases, successful management can be achieved by discontinuing TPM and initiating appropriate medical therapy.

The outcomes of trans-scleral cyclophotocoagulation in pediatric glaucoma secondary to Sturge-Weber syndrome.

PURPOSE: To report the outcomes of trans-scleral cyclophotocoagulation (TSCPC) in pediatric glaucoma secondary to Sturge-Weber syndrome (SWS). METHODS: The medical records of all SWS glaucoma cases in the pediatric age group (<18 years of age) that underwent TSCPC at our institute from January 2000 to September 2017. RESULTS: A total of 22 eyes of 22 patients were included. Mean age at the time of TSCPC was 5.9 ± 5 years (range, 0-16 years). Mean postoperative follow-up was 32.2 ± 16.6 months (range, 6-54 months). Intraocular pressure (IOP) was reduced from a preoperative mean of 28 ± 4.5 mm Hg to 20.3 ± 3.7 mm Hg at 36 months (P = 0.02). The mean number of glaucoma medications used was 3.5 ± 0.7 preoperatively and 3.1 ± 1.4 at 36 months (P = 0.70). The overall success rate (complete and qualified) was 72.7% at 12 months, 62.3% at 24 months, and 54.5% at 36 months. One eye developed hypotony and choroidal effusion, which resolved with medical therapy. Of the patients for whom visual acuity was recorded preoperatively, no one experienced a loss of more than 2 lines of Snellen visual acuity. CONCLUSIONS: In our study cohort, TSCPC resulted in mild reduction in IOP, with minimal complications.

Experience, Attitude, and Perceived Barriers Toward Research Among Ophthalmology Residents in Saudi Arabia: A National Cross-Sectional Study.

INTRODUCTION: Research sets the foundation for evidence-based practice in medicine. Globally resident doctors in various specialties are facing major obstacles to accomplish high quality research projects. Understanding these obstacles may help residents achieve their maximum research potential. This current study was undertaken to document the experience, attitude, and perceived barriers toward research among Saudi ophthalmology residents. METHODOLOGY: A specific questionnaire was developed and validated for the purpose of this study. The questionnaire was distributed online via email to actively enrolled residents in all five ophthalmology training programs in Saudi Arabia. RESULTS: Out of a total number of 193 ophthalmology residents in all five training programs, 147 responded to the questionnaire yielding a 76.1% response rate the mean age of participants was 27.6 ±1.8 and the number of males and females was almost equal. The vast majority [96.4%] have worked on at least one research project before starting residency training. Involvement was mainly in the phases of concept and design [72.5%], proposal preparation [85.9%], the three most frequent obstacles to conducting research projects for trainees were burden of other activities [4.27], lack of protected time for research [4.11] and too many regulations in obtaining ethical approval [3.67]. DISCUSSION: Our current study shows that ophthalmology residents understand the importance of clinical research, but they are facing a considerable number of barriers toward accomplishing high-quality research projects. Findings of our study may help program directors to address these barriers and improve the incorporation of research along with clinical training in residency curricula.

Outcomes of selective laser trabeculoplasty in corticosteroid-induced ocular hypertension and glaucoma.

PURPOSE: To report the outcomes of selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in patients with steroid-induced ocular hypertension and glaucoma. METHODS: A retrospective chart review of patients who underwent SLT for steroid-induced ocular hypertension or glaucoma between January 2014 and October 2018. Success of SLT was defined as ⩾20% IOP reduction from baseline without further medical or surgical intervention and/or a reduction in the number of glaucoma medications by ⩾1 from baseline while maintaining the target IOP. Main outcome measures were change in IOP from baseline and reduction in the number of medications post-laser. RESULTS: A total of 25 eyes of 17 patients were included in the study. The mean duration of follow-up was 18.8 ± 4.5 months. IOP decreased from 23.7 ± 6.7 mmHg pre-laser to 14.4 ± 3.2 mmHg post-laser, at the last follow-up visit (p < 0.001). The mean number of medications was 1.8 ± 1.6 medications pre-laser and 1.4 ± 1.3 medications post-laser (p = 0.262). The overall success rate at 12 months was 72%. No visually significant complications were encountered during the whole duration of follow-up. CONCLUSION: SLT is a safe and effective procedure that can result in well-controlled IOP in patients with steroid-induced ocular hypertension and glaucoma.

Long-term Outcomes of Uveitis Associated with Vogt-Koyanagi-Harada Disease in the Pediatric Age Group.

PURPOSE: To investigate the outcomes of uveitis associated with Vogt-Koyanagi-Harada (VKH) disease in pediatric age group (aged 16 years and under). METHODS: A retrospective review of patients with VKH disease. RESULTS: Among the 244 patients identified, 38 (76 eyes) were children. Among them, five had insulin-dependent diabetes mellitus. 21 presented with initial-onset acute disease and 17 with chronic recurrent disease. The mean follow-up period was 59.1 months. At presentation, chronic recurrent disease was associated with more severe inflammation as indicated by the presence of mutton-fat keratic precipitates (p < .001), iris nodules (p = .005) and posterior synechiae (p < .001). During follow-up, the rate of complications was higher in children with chronic recurrent disease compared with initial-onset acute disease (p < .001). 92.4% of the eyes with initial-onset acute disease achieved a final visual acuity of ≥20/40 compared with 70.6% of the eyes with chronic recurrent disease (p = .013). CONCLUSIONS: Chronic recurrent VKH disease in children is associated with worse outcomes.

Frequency and risk factors of narrow angles in patients with pseudoexfoliation: a case-control study.

PURPOSE: To determine the frequency and risk factors of narrow angles in pseudoexfoliation (PXF) patients. METHODS: A prospective case-control study was conducted during the period from March 2017 to December 2020. Adult patients (above 40 years) presenting with PXF were consecutively enrolled (study group). Cases were matched with individuals above 40 years presenting to a comprehensive ophthalmology clinic without evidence of PXF (control group). RESULTS: We enrolled 196 PXF patients and 98 controls. The occurrence of narrow angles was 25% in the PXF group and 5.1% in the control group (P = 0.0001). Compared to controls, PXF patients were older (72.6 ± 9.6 vs. 64.4 ± 8.5, P < 0.0001) and had a lower mean ACD (2.79 ± 0.4 vs. 3.05 ± 0.4, P < 0.0001). There was no difference in AL measurements between both groups (23.3 ± 1.4 vs. 23.7 ± 1.0, P = 0.0714). After stratification by age group and gender, the risk of narrow angles was higher in PXF patients above 70 years (OR, 4.15; 95% CI, 0.91-23.87; P, 0.044). There was no gender difference in the risk of developing narrow angles. CONCLUSION: Narrow angles are more frequently encountered in PXF patients compared to controls. Advanced age (> 70 years) is significantly associated with an increased likelihood of developing narrow angles.

Bullous choroidal detachment requiring drainage following endoscopic cyclophotocoagulation.

Endoscopic cyclophotocoagulation is a relatively safe cyclodestructive procedure with a lower complication rate compared to trans-scleral cyclophotocoagulation. Serous choroidal detachment is a complication that has been reported following endoscopic cyclophotocoagulation; however, it is usually mild and transient. A case of bullous choroidal detachment with a flat anterior chamber requiring drainage after endoscopic cyclophotocoagulation is presented, along with a discussion on the risk factors precipitating such complication.

Incidence and Risk Factors of Ocular Hypertension and Glaucoma in Patients With Acanthamoeba Keratitis.

OBJECTIVES: To determine the incidence of ocular hypertension (OHT) and glaucoma in patients with acanthamoeba keratitis (AK) and to outline the risk factors for the development of glaucoma. METHODS: A retrospective review of patients diagnosed with AK at our institute during the period from 2000 to 2018. The main outcome measures were the incidence of OHT and glaucoma, and risk factors for the development of glaucoma. RESULTS: Fifty-two eyes diagnosed with AK were included. The incidence of OHT and glaucoma was 51.9% and 32.7%, respectively. The mean duration from disease onset to the first attack of elevated intraocular pressure was 8.4±16.6 months. The use of corticosteroids in the treatment regimen was significantly associated with the development of glaucoma (odds ratio, 3.93; 95% confidence interval, 0.96-16.15; P=0.049). At the last follow-up visit, both patients with glaucoma and nonglaucoma patients had improved visual acuity without a difference in the mean amount of logarithm of the minimum angle of resolution acuity improvement among them (0.56±0.91 vs. 0.67±0.87, P=0.686). CONCLUSION: Our findings confirm that OHT and glaucoma are frequent complications in AK. Patients treated with a regimen containing corticosteroids are at a higher risk; thus, they should receive close intraocular pressure monitoring.

The Use of Social Media among Saudi Ophthalmologists: A Descriptive Cross-Sectional Study.

PURPOSE: The purpose of this study is to evaluate the use of and beliefs toward social media (SM) among Saudi ophthalmologists. METHODS: This was a cross-sectional descriptive study. A web-based, self-administered questionnaire was e-mailed to ophthalmologists within Saudi Arabia. RESULTS: Out of 392 recipients, 293 completed the survey (74.7% response rate). The vast majority (90.1%) used at least one platform for personal and professional purposes or either. The three most commonly used applications were Twitter (72.3%), Snapchat (65.9%), and Instagram (51.9%). The opinions of respondents with regard to the different aspects of SM varied widely. Around half (56.7%) believed that it was permissible for ophthalmologists to promote themselves on SM and 70.6% agreed that SM usage by health-care professionals should be regulated. Participants believe that SM had both a positive and a negative impact on their daily life and clinical practice. For example, 94 (32.1%) respondents stated that it improved their ability to educate patients, on the other hand, 80 (27.3%) reported that SM wastes quality time that can be spent on something more productive. CONCLUSION: Our results demonstrate an increased utilization of SM among Saudi ophthalmologists. The ethical aspects of SM usage were a matter of controversy among our respondents. This necessitates the establishment of guidelines by regulatory bodies and/or individual health-care organizations.

Ophthalmology Research Trends in Saudi Arabia: A Four-Decade Bibliometric Analysis.

Background Clinical research output by a country could reflect its advancement in medical education and quality of patient care. This study aims to assess the contribution of Saudi research in the field of ophthalmology. Methods This retrospective cross-sectional bibliometric analysis was performed in March 2020 to assess the contribution of Saudi research in the field of ophthalmology. Web of science (WoS) advanced search engine was used. All Saudi-affiliated publications from 1980 till 2019 were included. A qualitative assessment included the total number of publications, citations, citing articles, journal titles, and affiliated institutions. Quality of publications was evaluated by H-index. A comparative quantitative analysis of Arabian and some selected countries worldwide was performed. Publication productivity was adjusted to each country by population size. Results In the period of 1980-2019, Saudi Arabia published 2178 articles in ophthalmology. The number of publications (Spearman's correlation Coefficient = 0.94; P < .001) and sum of citations (Spearman's correlation Coefficient = 0.99; P < .001) increased significantly over the past 40 years. The highest notable increase was detected in the period for 2010-2019. H-index was 58 with an average citation of 10.79 per article. The sum of citations was 23,507 while 18,460 articles were cited by Saudi publications. When compared to other countries, Saudi Arabia ranks the highest among Arab countries and the second most productive in Asia following Japan. Conclusion Despite the continuous improvement in the trends of ophthalmology research in Saudi Arabia, further effort is needed to strengthen the publications output and achieve a considerable international status.

Ownership and Usage of Mobile Devices Among Ophthalmology Residents and Attending Physicians: Identifying the Generation Gap.

BACKGROUND: Ophthalmology residents strongly rely on digital technology in training. This characteristic may not be shared by their teachers, attending physicians. Therefore, the aim of this study was to describe the ownership and usage of mobile devices among Saudi ophthalmology residents and their attending physicians and to compare ownership and usage patterns between both groups. METHODS: A survey was conducted to determine the rates of ownership of mobile devices and the patterns of usage among Saudi ophthalmology residents and their attending physicians. The survey was sent to 305 eligible participants. RESULTS: The overall response rate was 81%. The mean age of residents and attendings was 27.4 and 48.6 years, respectively. The ownership of mobile phones was higher among attendings (1.21 ± 0.4 vs 1.36 ± 0.5, p = 0.02), whereas the ownership of tablets was higher among residents (1 ± 0.6 vs 0.7 ± 0.6, p = 0.01). Residents utilized mobile devices to access online educational resources more frequently compared to attendings. A statistically significant difference between residents and attendings was reported in the utilization of wikis (91% vs 46%), e-books (90% vs 54%), file sharing sites (84% vs 52%), and vodcasts (78% vs 58%). Both groups also differed with regards to reasons of utilization. While residents most commonly used mobile devices to answer clinical questions on demand (87%) and to acquire basic knowledge (84%), the main reasons of utilization cited by attendings were to look up controversial issues (77%) and to connect with peers (72%). CONCLUSION: The two studied groups differ from each other in the type of devices owned, reasons for usage, and frequency of utilization. The difference in behavior between educators and their students can lead to a generation gap that halts the progress of residents' training.

The relationship between axial length, age and intraocular pressure in children with primary congenital glaucoma.

Whilst axial length (AxL) from ultrasound examination is a useful clinical parameter for monitoring progression in younger children with glaucoma, distinguishing AxL changes due to raised intraocular pressure (IOP) from age is often challenging. Existing normograms have included a limited number of children with glaucoma. The aim of this study was to evaluate the relationship between AxL with age and IOP in children with primary congenital glaucoma (PCG) and develop a model for expected AxL increase with age. All children (n = 208; 397 eyes) with PCG who attended our tertiary eye care facility from June 2014 and July 2018 and had AxL and IOP measurements were included. The relationship of AxL with age and IOP was studied by applying a LOWESS fit and then mixed effects models. In the final model, age was the most significant factor influencing the growth of AxL (coefficient age 3.14[95% CI 2.91-3.35, p < 0.001], coefficient age2 - 0.53[95% CI, - 0.59 to - 0.47, p < 0.001]), and this association was influenced by the interaction of IOP with sex (p = 0.098 for girls relative to boys), the number of antiglaucoma medications (AGM [p < 0.001 for ≥ 3 AGM]) and glaucoma surgery (p = 0.015). This model enabled us to derive predicted values for clinical use in children with PCG to predict those with progressive glaucoma.

Assessment of Ophthalmology Residency Programs in Saudi Arabia: A Trainee-Based Survey.

PURPOSE: To assess the satisfaction and competency of Saudi ophthalmology residents and compare their performance against International Council of Ophthalmology (ICO) standards. METHODS: A cross-sectional web-based survey of senior ophthalmology residents (postgraduate years [PGY] 3-4) and recent graduates (from 2010 to 2015) assessed various aspects of training. The questionnaire was sent to the participants and was divided into 3 main domains: demographics, training program evaluation, and preparedness for board exams and clinical practice. RESULTS: Out of the 145 invitees, 120 (82.8%) responded. Fifty percent of respondents reported an overall satisfaction with the program. Adequate clinical exposure was reported in most subspecialties except refraction and low vision rehabilitation with inadequate exposure reported by 55.8% and 95.8%, respectively. Surgical exposure was reported as adequate for phacoemulsification (58.3%) and strabismus surgery (68.3%) only. Eighty-nine percent of respondents reported performing less than 80 cases of phacoemulsification. Of the respondents who had graduated, most (89.7%) passed the final board exam at the first attempt. There were 73.5% of respondents who reported that residency training prepared them well for the board exam. Ongoing clinical and call duties were reported as having a negative impact on exam performance. CONCLUSIONS: Saudi ophthalmology residents demonstrate a high level of clinical competency. However, additional efforts should aim at improving surgical training to increase the level of satisfaction among residents and improve the quality of training to meet international standards.

Primary congenital glaucoma: An updated review.

Primary congenital glaucoma (PCG) is a rare disease affecting children early in life. PCG was considered untreatable with inevitable blindness. However, recent advances in biochemical and genetic studies, the introduction of new diagnostic tools, intraocular pressure (IOP) lowering medications and improvement of surgical techniques have led to a better understanding of this devastating disease and preserving the vision of affected children. This paper presents an updated and broad overview of PCG in terms of the epidemiology and genetic aspects, particularly in Saudi Arabia, the clinical presentation and diagnostic approach to PCG with major emphasis on the treatment options.