Traditional Arabic technique of couching for cataract treatment in Yemen.

PURPOSE: In Yemen, a number of cataract patients still receive sight-restoring surgery using a traditional Arabic couching procedure. In order to evaluate the relative effectiveness and outcomes of the traditional couching procedure, patients attending a teaching center in Sana'a who had the procedure were studied. METHODS: Fifty-five eyes of 50 patients treated by traditional couching were evaluated. All individuals were checked for best-corrected visual acuity, intraocular pressure, slit-lamp biomicroscopy and fundal examination. All were questioned regarding their clinical history, cost of the surgery, and their satisfaction with the procedure immediately following the operation and presently. RESULTS: There were 55 eyes of 50 patients treated by a traditional couching procedure by a local healer. A total of 32 (64%) were men and 18 (36%) were women. The traditional healer was often paid partially in kind and the price paid varied according to patientís ability and was on average 62 USD plus accommodation and meals in the village the healer visited. After aphakic correction of eyes, 1.8% (1/55) had good vision (VA > or = 6/18), 21.8% (12/55) had low vision (> or =3/60), and 76.4% (42/55) were still blind (<3/60). Complications noted were glaucoma (21), corneal opacity (14), uveitis (6), posterior capsule opacity (8), retinal detachment (7), and severe pain (14). CONCLUSIONS: In Yemen, cataract-blind persons are still treated by traditional healers. This study suggests that the couching method used is relatively expensive, ineffective, and dangerous, and most patients are not satisfied with the results.

Pediatric Ocular Trauma during Eid Festivities in Yemen.

PURPOSE: We sought to elucidate causes of ocular trauma in children younger than 17 years of age during the Eid festivities in Sana'a, Yemen. METHODS: A prospective observational case series study was conducted in two tertiary emergency hospitals (Al-Thawra and Magrabi Hospital). The Eid Al-Fitr festive holidays in 2016 lasted 10 days from July 3 to 12. All children up to 17 years of age presenting with ocular trauma were included in the study. All patients underwent detailed history-taking and examination concerning ocular trauma. RESULTS: One hundred sixty children presented to the two hospitals with ocular injury. All were males (100%). The mean ± standard deviation age was 9.59 ± 4.92 years (range, 4-15 years). The injury involved the right eye in 84 children (52.5%) and the left eye in 76 (47.5%) children. The majority of injuries (n = 152, 95.0%) had occurred in the street, while eight (5.0%) had happened at home. The most frequent cause of injury was toy guns and fireworks, while the most frequent findings were hyphema, corneal laceration, and corneal abrasion. CONCLUSIONS: The causes of ocular injuries are diverse and tend to vary by geographical area. In particular, their incidence can increase during holidays, especially long ones. Usually, eye injuries with toy guns result in significant trauma that requires medical intervention and hospitalization with potential long-term eye complications. Public health workers need to conduct health education program to alert parents and health professionals to the danger of such toys.

Results of laser enhancement for residual myopia after primary laser in situ keratomileusis.

PURPOSE: The purpose of the study is to evaluate and analyze the results and outcomes after laser enhancement for residual myopia after primary laser in situ keratomileusis (LASIK). MATERIALS AND METHODS: This retrospective interventional consecutive case series clinical study was performed on 112 consecutive eyes (82 patients) that had undergone primary LASIK before the enhancement procedure. The study was done in the Refractive Surgery Unit in Yemen Magrabi Hospital between 2006 and 2014. The retreatment was for residual myopia with or without astigmatism. Either the original flap was lifted or surface ablation was performed. Parameters evaluated were uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (VA), spherical equivalent (SE) refraction, corneal topography, and pachymetry. Complications after laser enhancement were also evaluated. RESULTS: Mean age of the study group was 26.72 ± 6.89 years (range from 18 to 44 years). Males accounted for 37/82 (45.1%) and females for 45/82 (54.9%). The right eye was treated in 67/112 (59.8%) and the left eye in 45/112 (40.2%). Before primary LASIK, the mean SE (MSE) was -5.78 ± 1.89 D. Before enhancement, the MSE was -1.32 ± 0.61 D (range -3.25 D to -0.50 D), and none of the eyes had an UCVA of 20/40 or better. Twelve months after retreatment, the percentage of eyes having UCVA of 20/40 or better increased to 67.9% (76 of 112). There were no vision-threatening complications seen. CONCLUSION: Retreatment or enhancement after LASIK surgery by lifting the original flap or surface ablation is a safe and effective method for the treatment of regressed or undercorrected myopia. The risk of postoperative complications is very minimal.

Regular visits to a diabetes clinic were associated with lower magnitude of visual disability and diabetic retinopathy-a hospital-based historical cohort study in yemen.

BACKGROUND: We associated regularity in visits to a diabetes clinic with the presence of diabetic retinopathy (DR) and visual disabilities. METHODS: This historical cohort study was conducted in 2004. The physician reported details of diabetes mellitus (DM), hypertension, and other illness. The ophthalmologist examined eyes and noted visual acuity, DR, and other ocular morbidities. We calculated the relative risk (RR) of different complications of diabetes. RESULTS: Our cohort consisted of 228 patients (114 in each group, one that attended diabetes clinics regularly [group A] and one that had irregular attendance [group B]). DR was found in 47 (41.2%) and 68 (61.4%) patients, respectively. The risk of DR was significantly higher in group B (RR = 1.51, 95% confidence interval [CI] 1.23 to 2.18). The severity of DR was also positively associated with irregularity in clinic visits (x(2) = 33.56, degrees of freedom = 5, P = 0.000003). The risk of bilateral blindness (RR = 4.0, 95% CI 1.38 to 11.6) and low vision disability (RR = 2.53, 95% CI 1.84 to 3.47) were higher in group B. The duration of diabetes and the regularity in clinic visits were the predictors of DR. CONCLUSIONS: The presence of DR and visual disabilities among patients with diabetes is associated with irregular attendance at diabetes clinics. The regularity of medical visits seems to be a proxy indicator of better primary prevention of eye complications of DM.

Eye camps in Yemen--providing medical coverage to the underprivileged.

BACKGROUND: This study aimed to decrease the massive problem of cataract-related blindness and visual disability in rural areas of Yemen and reach more visually impaired and blind people to provide them with an improved standard of visual rehabilitation. MATERIAL/METHODS: From January 1999 to June 2006, 181,123 patients were examined, out of which 6112 underwent cataract extraction. After a media announcement, patients had a comprehensive preoperative evaluation; suitable patients were selected for cataract surgery. RESULTS: Since 2002, 65 "eye camps" were done (26 of them were large eye camps; while 39 others were smaller and called the "wagon trains of light"). We worked in eye camps in the rural provinces of Yemen (Abyan, Aden, Addaleh, Amran, Dhamar, Hadramout, Hagga, Hodeidah, Ibb, Lahg, Mahara, Mahweet, Sana'a city, Sana'a, Shabwa and Taiz). Postoperatively, patients were examined by a local ophthalmologist. Patients who received these services in these eye camps were poor and were provided with free surgery, medicine, and glasses. CONCLUSIONS: The "eye camps" involved a comprehensive cooperative relief effort on a large scale to combat the widespread prevalence of cataract and chronic shortages of ophthalmic facilities and medical personnel as it affects residents of rural areas in Yemen. Until primary and secondary care facilities are optimal for cataract screening and surgery in Yemen, such eye camps are recommended to reduce the backlog of curable blindness resulting from cataract. This project will continue until enough eye hospitals are built in Yemen.

Cataract surgical rate in Yemen: 2012.

OBJECTIVE: To determine cataract surgical rate (CSR) in 2012 (01 January to 31 December 2012) in 22 Governorates of Yemen in order to identify the needs to reduce cataract related blindness. METHODS: A standardized questionnaire was sent to the 184 eye units in governmental, university, military, private and charity clinics and hospitals in Yemen. RESULTS: The response rate to the questionnaire was 80.7%, and the collected data are summarized. During the 12-month period, a total of 62,577 cataract surgeries were performed by 268 ophthalmology specialists and residents. The cataract surgical rate was 2473 cataract operations per million inhabitants per year. Intraocular lens implantation was performed on 98% of the cases. CONCLUSION: CSR has increased in Yemen in the recent years but is still below the target suggested by WHO. There is need to increase the cataract surgical rate in Yemen mainly in rural areas. Inadequate number of eye surgeons, limited accessibility of cataract surgical services in rural areas and the affordability of surgery to large sections of society are major constraints that have to be addressed. The information from this study will help and enable Ministry of Health and other eye care providers to more equitably disperse trained ophthalmic personnel and eye units in Yemeni governorates.

Functional outcome and patient satisfaction after laser in situ keratomileusis for correction of myopia and myopic astigmatism.

PURPOSE: The purpose was to evaluate subjective quality of vision and patient satisfaction after laser in situ keratomileusis (LASIK) for myopia and myopic astigmatism. PATIENTS AND METHODS: A self-administered patient questionnaire consisting 29 items was prospectively administered to LASIK patients at the Yemen Magrabi Hospital. Seven scales covering specific aspects of the quality of vision were formulated including; global satisfaction; quality of uncorrected and corrected vision; quality of night vision; glare; daytime driving and; night driving. Main outcome measures were responses to individual questions and scale scores and correlations with clinical parameters. The scoring scale ranged from 1 (dissatisfied) to 3 (very satisfied) and was stratified in the following manner: 1-1.65 = dissatisfied; 1.66-2.33 = satisfied and; 2.33-3 = very satisfied. Data at 6 months postoperatively are reported. RESULTS: This study sample was comprised of 200 patients (122 females: 78 males) ranging in age from 18 to 46 years old. The preoperative myopic sphere was - 3.50 ± 1.70 D and myopic astigmatism was 0.90 ± 0.82 D. There were 96% of eyes within ± 1.00 D of the targeted correction. Postoperatively, the uncorrected visual acuity was 20/40 or better in 99% of eyes. The mean score for the overall satisfaction was 2.64 ± 0.8. A total of 98.5% of patients was satisfied or very satisfied with their surgery, 98.5% considered their main goal for surgery was achieved. Satisfaction with uncorrected vision was 2.5 ± 0.50. The main score for glare was 1.98 ± 0.7 at night. Night driving was rated more difficult preoperatively by 6.2%, whereas 79% had less difficulty driving at night. CONCLUSION: Patient satisfaction with uncorrected vision after LASIK for myopia and myopic astigmatism appears to be excellent and is related to the residual refractive error postoperatively.

Central corneal pachymetry in Yemeni patients undergoing refractive surgery.

OBJECTIVE: To assess the preoperative central corneal thickness (CCT) of myopic and/or astigmatism patients presenting for refractive surgery in a tertiary hospital in Yemen. METHODS: In this hospital-based cross-sectional study, 2,304 subjects aged 18-50 years with myopia and myopic astigmatism who presented to the refractive surgery unit were recruited. Data for the current study was collected from our electronic pool of patients presenting to the refractive surgery clinics in Yemen Magrabi Hospital, Sana`a, Yemen, between January 2006 and December 2008. The inclusion criteria were absence of corneal or anterior segment disease, glaucoma, and any ocular surgery. Central corneal thickness was assessed by ultrasound pachymetry. Data from the right eye only was analyzed. RESULTS: All patients were Yemeni citizens, where the majority (1248; 54.2%) were women with a mean (+/-SD) age of 26.74 (+/-6.1), range 18-50 years. The mean (+/-SD) CCT was 521.7 (+/-31.62), range 432-643 um. The measured CCT was independent of gender (p=0.567) and did not differ between both eyes (p=0.371). Corneal thickness increased with age, correlated to vision (p=0.027), keratometric readings (K1 , K2) (p<0.001 for both), and increased with the increase in severity of myopia (p=0.026). CONCLUSION: Yemeni patients have thinner CCT compared to other populations. Refractive surgeons should be careful in choosing the suitable procedures. The available cornea for ablation in Laser-Assisted in situ Keratomileusis (LASIK) is very limited. Possible alternative treatments; namely photorefractive keratectomy (PRK) and phakic intraocular lens implantation options should be discussed with patients prior to surgery.

Post-LASIK interface fluid syndrome caused by steroid drops.

Interface fluid syndrome after laser in situ keratomileusis (LASIK) is a rare but visually threatening postoperative complication. In this case series we present 8 post-LASIK eyes that developed interface fluid syndrome after prolonged steroid use. Patients presented with signs mimicking diffuse lamellar keratitis (DLK) that worsened with steroid treatment. Slit-lamp examination revealed corneal haze and an optically clear fluid-filled space between the flap and stroma. The IOP was high in all cases. Topical steroids were stopped and replaced with topical and systemic anti-glaucoma medications resulting in a dramatic improvement in visual acuity.

Visual outcomes and patient satisfaction after implantable collamer lens and Toric implantable collamer lens correction for moderate to high myopia and myopic astigmatism.

OBJECTIVE: To compare preoperative and postoperative visual outcomes, determine patient's satisfaction, and evaluate visual symptoms after implantable collamer lens (ICL) implantation. METHODS: One hundred and twelve patients with myopia between -2.75 and -19.50 diopter had ICL or Toric ICL (TICL) implantation. The implantations were carried out at the Cornea and Refractive Unit, Magrabi Eye Hospital, Sana'a, Republic of Yemen between September 2007 and October 2010. Preoperative and postoperative uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), and refraction was evaluated. Patient's satisfaction and visual symptoms were evaluated using a questionnaire. RESULTS: The mean age was 26.74 +/- 5.6 years. The mean preoperative UCVA improved from 0.01 +/- 0.04 to 0.75 +/- 0.22. The mean postoperative UCVA (0.75 +/- 0.23) versus preoperative BSCVA (0.61 +/- 0.23) had a significant statistical change (p<0.001), and Pearson correlation of 0.818. Preoperative BSCVA versus postoperative BSCVA gained 5 lines in 2.5%, 4 lines in 4.4%, 3 lines in 14.2%, 2 lines in 32.8%, and one line improvement in 24%, whereas it was maintained in 20.1%, and lost one or more lines in 2%. The mean score for the overall satisfaction was 2.67 +/- 0.45. A total of 15.2% reported complaint of halos, 13.4% reported perception of stars around lights, and 23.2% had glare. CONCLUSION: Implantation of ICL and TICL is safe and effective and provides predictable refractive results with good satisfaction in the treatment of moderate to high myopia, suggesting its viability as a surgical option for the treatment of myopia.

Posterior vitreous detachment and retinal detachment after implantation of the Visian phakic implantable collamer lens.

INTRODUCTION: To evaluate the vitreoretinal complications in myopes after Visian implantable collamer lenses (ICL) implantation. MATERIALS AND METHODS: This is a retrospective, observational, non-comparative clinical study that evaluated 617 consecutive myopes who underwent ICL implantation at the Department of Refractive Surgery, Yemen Magrabi Hospital, Sana'a, Yemen between July 2006 and May 2010. Follow up ranged from 6 months to 40 months. Preoperative and postoperative patient evaluation included manifest and cycloplegic refractions, uncorrected (UCVA) and best spectacle-corrected visual acuity (BSCVA), slit-lamp biomicroscopy, intraocular pressure and dilated retinal examination. Investigations included corneal topography, central corneal thickness, anterior chamber depth and white to white diameter. Retinal diseases and complications were recorded and analyzed preoperatively and postoperatively. RESULTS: Preoperatively, 61 (9.9%) eyes had posterior segment pathology requiring prophylactic laser photocoagulation. One eye developed spontaneous rhegmatogenous retinal detachment (RRD), one eye developed traumatic retinal detachment and two eyes required laser treatment postoperatively. The overall retinal detachment rate post-ICL was 0.32%. CONCLUSIONS: Posterior segment complications are rare after ICL implantation but dilated vitreoretinal assessment is important before and after the procedure. Patients with suspicious retinal lesions need a comprehensive vitreoretinal evaluation by a retinal specialist. If a patient develops floaters or blurry vision he/she requires further assessment by a vitreoretinal specialist.

A retrospective analysis of the first Yemeni experience on Artisan phakic intraocular lens for the treatment of moderate and high myopia.

OBJECTIVES: To evaluate the outcome and safety of the iris-fixated Artisan phakic intraocular lens (PIOL) for the correction of moderate and high myopia. MATERIALS AND METHODS: A retrospective non-controlled clinical study of the data of patients who underwent Artisan PIOLs between March 2006 and July 2008 was evaluated. Pre-operative examination included age, gender, refraction, uncorrected (UCVA) and best spectacle corrected (BSCVA) visual acuity, predictability and safety were analyzed. Post-operative time course ranged from 12 to 36 months. RESULTS: An Artisan myopia lens was implanted in 62 eyes of 39 patients. The mean pre-operative spherical equivalent (SE) was -13.17 ± 5.62 D. The pre-operative myopia ranged from -4.5 to -24 D. Mean patient age was 25.44 ± 5.22 years. At last follow-up visit, residual SE was within ±1.00 D in 36 eyes (58.1%) and ±2.00 D in 56 eyes (90.3%). In the last visit UCVA was equal to or better than pre-operative BSCVA in 57 (91.9%) of the eyes. One eye (1.6%) lost one Snellen line, three eyes (4.8%) lost two or more Snellen lines and one eye lost vision (1.6%). Post-operative complications included anterior chamber reaction in one eye, rise in intraocular pressure in two eyes and retinal detachment in one eye. CONCLUSION: When laser keratorefractive surgery is not an option, implantation of Artisan PIOL to correct moderate to high myopia results in a stable and good refractive result with few complications that must be kept in mind.

Ocular complications of severe vernal keratoconjunctivitis (VKC) in Yemen.

OBJECTIVES: The objective of this study was to assess the ocular complications and visual loss among patients with severe vernal keratoconjunctivitis (VKC). METHODS: Four hundred and thirty-one patients with VKC seen at Ibn Al-Haitham Eye Center were the study group. This is a retrospective non-comparative observational study between 01 January 2002 and 31 December 2002. Visual acuity was measured with the standard Snellen visual acuity chart and for children under 5 years of age Kay pictures were used. Visual impairment was assessed by means of the World Health Organization criteria for visual disabilities. Cases with severe VKC that developed ocular complications leading to blindness and severe visual impairment were analyzed. RESULTS: The majority of VKC patients were males (75.9%) with a male:female ratio of 3.1:1. A total of 68 (15.7%) patients (54 boys and 14 girls) had severe VKC. The ocular findings among 20 patients with severe VKC that led to blindness and severe visual impairment included keratoconus (7); steroid-induced cataract (5), central corneal scars (5) and steroid-induced glaucoma (3). Two of the keratoconus cases developed acute hydrops. CONCLUSION: Severe VKC in developing countries including Yemen is a potentially blinding disease. Visual loss may be due to keratoconus and corneal scars, as well as complications of the unsupervised use of topically administered corticosteroids.

Reasons for not performing keratorefractive surgery in patients seeking refractive surgery in a hospital-based cohort in "yemen".

BACKGROUND: To determine and analyze the reasons why keratorefractive surgery, laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) were not performed in patients who presented for refractive surgery consultation. MATERIALS AND METHODS: A retrospective observational study was performed between January 2006 and December 2007 in the Yemen Magrabi Hospital. The case records of 2,091 consecutive new patients who presented for refractive surgery were reviewed. Information from the pre-operative ophthalmic examination, such as refractive error, corneal topography and visual acuity, were analyzed. The reasons for not performing LASIK and PRK in the cases that were rejected were recorded and analyzed. RESULTS: In this cohort, 1,660 (79.4%) patients were advised to have LASIK or PRK from the 2,091 patients examined. LASIK and PRK were not advised in 431 (21%) patients. The most common reasons for not performing the surgery were high myopia >-11.00 Diopters (19%), keratoconus (18%), suboptimal central corneal thickness (15%), cataract (12%) and keratoconus suspect (forme fruste keratoconus) (10%). CONCLUSION: Patients who requested keratorefractive surgery have a variety of problems and warrant comprehensive attention to selection criteria on the part of the surgeon. Corneal topographies and pachymetry of refractive surgery candidates need to be read cautiously. High-refractive error, keratoconus and insufficient corneal thickness were found to be the leading reasons for not performing keratorefractive surgery in this study.

Prophylactic measures used for the prevention of postoperative endophthalmitis after cataract surgery. a survey of routine practice in Yemen.

OBJECTIVE: This study documents the current practice of perioperative prophylactic methods used for cataract surgery in Yemen. It investigates the routine practice in antibiotic and antiseptic use in preventing postoperative endophthalmitis. METHODS: This is a non-comparative survey. A telephone interview survey was conducted with 100 ophthalmologists' from different governorates in Yemen in September 2008. A questionnaire was used to ask the ophthalmic surgeons. RESULTS: The practices of 100 ophthalmologists were contacted. Five ophthalmologists did not perform cataract surgery routinely. Of the remaining 95 respondents, all performed extracapsular cataract extraction and 5 also performed phacoemulsification. Preoperative topical antibiotics were routinely prescribed by 12 (12.6%) cataract surgeons. Before the start of the procedure, 21 (22.1%) used 10% povidone-iodine to prepare the skin and 5 (5.3%) instilled 5% povidone-iodine in the conjunctival sac. Intracameral antibiotics or antibiotic in the irrigating fluid were not given by any of the surgeons. All gave subconjunctival antibiotics mostly gentamicin. Postoperatively, 25 (26.3%) used a combination steroid and antibiotic eyedrop and 70 (73.7%) gave a separate eyedrop and 39 (41.1%) gave systemic antibiotics. CONCLUSION: This study reveals a wide variation of prophylactic measures used by Yemeni ophthalmologists. All surgeons used intraoperative subconjunctival gentamicin and postoperative topical antibiotic. A significant majority (94.7%) are failing to use preoperative conjunctival povidone-iodine, despite its widespread acceptance as the only convincingly proven prophylactic method. The routine practices adopted reflect personal preferences, and were not necessarily evidence-based.

Intraoperative and early postoperative complications of laser in situ keratomileusis in Yemen.

OBJECTIVE: To determine the intraoperative and early postoperative complications and visual outcome of laser in situ keratomileusis (LASIK) surgery for the correction of myopia. METHODS: The first 2000 consecutive myopic LASIK eyes operated at the Department of Refractive Surgery, Yemen Magrabi Hospital, Sana'a, Yemen from June 2005 to October 2006 were the study group. This is a retrospective observational noncomparative clinical study. The preoperative and postoperative spherical equivalent, best-corrected visual acuity, and corneal status was recorded. The intraoperative and early postoperative complications were reviewed. RESULTS: There were 15 (0.8%) intraoperative microkeratome-related flap complications recorded namely, buttonhole (5), incomplete cut (3), thin flap (3), epithelial defect (3) and eccentric flap (1). There were 4 (0.2%) non-keratome related surgical events of inability to obtain sufficient suction. There were 46 (2.3%) first-day postoperative complications. Nine eyes required repositioning of the flap for macro-striae (5), or displaced flap (4). Four needed washing under the flap for severe deep lamellar keratitis (2), and gauze debris under the flap (2). Laser enhancement was carried out in 28 eyes (1.4%), and uncorrected visual acuity of 20/40 or better was attained in 96.9% of treated eyes. Twenty-four eyes (1.3%) lost more than 2 lines of best-corrected vision. CONCLUSION: The LASIK is a safe and effective procedure for the correction of myopia. A small number of patients may suffer complications, most of which are not serious, and rarely lead to visual loss of more than 2 Snellen lines.

Vitreoretinal complications in Yemeni patients with keratorefractive surgery.

OBJECTIVE: To evaluate vitreoretinal complications in patients undergoing laser keratorefractive surgery. METHODS: This retrospective observational non-comparative clinical study was carried out between June 2005 and March 2008, and included 4691 consecutive laser keratorefractive surgery procedures for 2480 patients performed in the Department of Refractive Surgery, Yemen Magrabi Hospital, Sana'a, Yemen. Patients were followed up for 12-36 months. The preoperative patient evaluation included manifest and cycloplegic refractions, uncorrected visual acuity, best spectacle-corrected visual acuity, slit-lamp biomicroscopy, and dilated vitreoretinal assessment. Retinal diseases were recorded and analyzed during the preoperative and postoperative care. RESULTS: Sixty-five (1.4%) of the 4691 eyes had posterior segment pathology requiring intervention. In the preoperative assessment, 57 eyes had prophylactic laser photocoagulation for retinal lesions. Seven eyes developed posterior vitreous detachment postoperatively, and 4 of these required prophylactic laser therapy for lattice degeneration and retinal breaks. Two eyes (0.04%) developed rhegmatogenous retinal detachment, which occurred spontaneously. One patient developed cystoid macular edema in both eyes. CONCLUSION: Most complications are related to the refractive outcome or to corneal and anterior segment injury. Posterior segment complications are rare, but dilated vitreoretinal assessment is important before and after laser keratorefractive procedures. Patients with suspicious retinal lesions need a comprehensive vitreoretinal evaluation by a retinal specialist.

Diabetic retinopathy, visual impairment and ocular status among patients with diabetes mellitus in Yemen: a hospital-based study.

BACKGROUND: We present a series of patients with diabetes mellitus (DM) who attended an eye hospital in Sana, Yemen during 2004. AIM: To determine the magnitude and risk factors of diabetic retinopathy (DR). DESIGN: Cross-sectional study. MATERIALS AND METHODS: Ophthalmologists assessed vision, ocular pressure, ocular media and posterior segment to note ocular manifestations among patients with DM. DR was graded by using bio-microscope and Volk lens. The prevalence and 95% confidence interval of ocular complications of DM were calculated. Risk factors of DR like age, sex, duration of diabetes and hypertension were evaluated. STATISTICAL ANALYSIS: Univariate and multivariate analysis. RESULTS: Our series comprised 350 patients suffering from DM. The duration of diabetes was > or =15 years in 101 (29%) patients. Physician was treating 108 DM patients with insulin. The prevalence of DR was 55% (95% CI 49.6-60.1). The proportions of background diabetic retinopathy (BDR), preproliferative diabetic retinopathy (PPDR), proliferative diabetic retinopathy (PDR) and diabetic macular edema were 20%, 13%, 17% and 22% respectively. The prevalence of blindness among DM patients was 16%. The prevalence of cataract and glaucoma was 34.3% and 8.6%. Duration of DM was the predictor of DR. One-fifth of the patients had sight-threatening DR and needed laser treatment. CONCLUSIONS: DR was of public health magnitude among our patients. An organized approach is recommended to address DR in the study area.