Visual outcomes and recurrence rate of macular corneal dystrophy following phototherapeutic keratectomy in Saudi Arabia.

PURPOSE: The purpose of the study was to evaluate the visual outcomes and recurrence rate of patients with macular corneal dystrophy (MCD) who have undergone phototherapeutic keratectomy (PTK). METHODS: This retrospective, single-centered study enrolled patients from King Khaled Eye Specialist Hospital who had undergone PTK for MCD between 2000 and 2020. Pre-, intra-, and post-operative data were collected, and the primary outcome measures included uncorrected visual acuity, best-corrected visual acuity (BCVA), spherical equivalent, central keratometry, keratometric astigmatism, recurrence rate, and necessity of subsequent surgery. RESULTS: This study evaluated 42 eyes of 29 patients. BCVA improved from 0.41 (±0.17) preoperatively to 0.30 (±0.16) postoperatively. Sixteen out of 42 eyes (38%) had the recurrence of macular dystrophy deposits within the stroma; the average time from PTK to recurrence was 37 months (range: 5.5-115.4 months). The overall success rate of PTK at 2 years was 44.8%. Eleven eyes (26%) required subsequent surgery following PTK at an average of 43 months postoperatively. Deeper ablation and longer application of mitomycin C (MMC) were both found to be statistically significant factors associated with visual improvement and lower recurrence rate following PTK. CONCLUSION: PTK can be considered a treatment modality for younger patients to defer keratoplasty to a later stage. Deeper ablation is associated with improved postoperative visual acuity, and longer application of MMC is associated with lower recurrence rates of MCD.

Challenges of Glaucoma Management in Patients with Type I Boston Keratoprosthesis.

Type I Boston keratoprosthesis is implanted in patients with severely diseased eyes who are considered poor candidates for traditional keratoplasty. Glaucoma is considered a major visual comorbidity following the implantation of type I Boston keratoprosthesis (KPro). Eyes that receive a Boston KPro are at high risk of progression of pre-existing glaucoma and the development of de novo glaucoma. Both complications can limit best-corrected visual acuity postoperatively. Diagnosis and surveillance for glaucoma in KPro eyes are fundamental to mitigate the risk of visual morbidity. However, managing these patients presents several challenges. The diagnosis of glaucoma after KPro implantation is usually hindered by inaccurate intraocular pressure (IOP) measurements and unreliable ophthalmic investigations such as visual field testing and optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL). In these eyes, medical management of glaucoma with topical medications is usually insufficient, and glaucoma surgery is usually warranted either prior to or during KPro implantation. Options for glaucoma surgery include glaucoma drainage device (GDD) and cyclodestructive procedures. The aim of this article is to highlight the incidence, pathophysiology, diagnosis, and management options of glaucoma in eyes that have undergone type I Boston keratoprosthesis.

Preferred Method of Education Among Patients in Ophthalmic Care in Saudi Arabia.

PURPOSE: Educating patients about their diagnosis and proposed management is integral part of healthcare. Often patient noncompliance is due to a lack of knowledge that could result in irreversible ocular damage. In an era where access to information is virtually unlimited, an understanding of the preferred method of eye care education among patients is required for greater effectiveness in lowering morbidity and mortality of diseases. SUBJECTS AND METHODS: Patients visiting the ophthalmology clinics of a tertiary hospital in Riyadh, Saudi Arabia, were interviewed. This cross-sectional study was conducted between December 2014 and March 2015. A representative sample of 200 patients was enrolled. Close-ended questionnaire covering current and client preferred health promotion methods were used to collect clients' response. Data were analyzed with descriptive statistics. RESULTS: Out of the 200 participants, 110 (55%) were males. The majority (n = 154; 77%) listed an ophthalmologist as their current primary source of information regarding their eye condition. Approximately half of the participants (n = 95; 48%) were keen to be educated regarding the causes of the eye disease. The top four educational methods preferred by patients were one-on-one session with an eye care provider (n = 116; 58%), a group session with an eye care provider (n = 30; 15%), an application on a smartphone (n = 53; 27%), video lectures on eye health and diseases (n = 8; 4%). CONCLUSION: Majority of patients in ophthalmic care prefer a one-on-one session with an eye care provider for their eye care education.

Behavior, knowledge, and attitude of surgeons and patients toward preoperative smoking cessation.

INTRODUCTION: Tobacco smoking is a well-known risk factor for postoperative complications. Quitting smoking prior to surgery helps overcome those complications. PROBLEM: Surgeons' attention for educating their patients about the importance of smoking cessation prior to surgery is one of the most effective ways to reduce smoking-related surgical complications. The extent of advised patients by their surgeons has not been identified. METHODS: A descriptive, comparative cross-sectional study using a survey was conducted in 2013 including eligible patients in King Khalid University Hospital. Simultaneously, 69 surgeons were included. All participant data were randomly collected and analyzed using Chi-square analysis. RESULTS: The frequency of smokers is more in surgical patients (37.5%) when compared to ex-smokers (12.5%) and passive smokers (8.3%), which were ex- and passive smokers, and it demonstrated an increased risk (P = 0.001) for surgery group compared to the nonsurgery group (P = 0.001). When comparing with nonsurgery group, most surgical patients agreed to quit smoking before surgery (95.3%). More than half (58.8%) of the patients said that they have been advised by their treating surgeons to quit smoking before surgery. Concerning the surgeons, 66 nonvascular and nonpediatric surgeons responded to the questionnaire (response rate: 22.83%). The majority of the surgeons (60.9%) were interacting with smoker patients. With regard to smoking cessation, 69.6% surgeons have advised smoker patients to stop smoking for more than 2 weeks before surgery. More than half of the surgeons (53.6%) believed that patients quit smoking after preoperative smoking cessation advice. CONCLUSION: The surgeons and patients who participated in this study were aware that smoking cessation improves outcomes, but most of the surgeons did not provide brief advice about time duration to stop smoking.