Population perceived eye strain due to digital devices usage during COVID-19 pandemic.

PURPOSE: To assess the magnitude severity and determinants of eyestrain and the use of digital devices in a Saudi population during the COVID-19 pandemic lockdown. METHODS: This web-based survey was conducted in September 2020 and enrolled only Saudi nationals 15 years or older. Data were collected on demographics, eye strain related symptoms, severity, and the use of optical aids during the COVID-19 lockdown. The frequency and severity of eye strain were calculated. A Computer Vision Syndrome (CVS) score was graded as none/mild moderate and severe, based on the sum of 15-eye strain related signs and symptoms. Correlation analysis was performed for determinants of CVS. RESULTS: The study sample was comprised of 2009 individuals with median age of 20 years. Among those who used digital devices for more than 6 h daily, the main reasons for use were work and social purposes among 68.4%, and 61% of respondents, respectively. The prevalence of knowledge on CVS and the '20-20 rule for using digital devices' was 9.4% and 6.9, respectively. The most common symptoms of eye strain from digital device usage were headache, burning, itching, tearing, and redness of eyes. Six hours of daily usage of digital devices was positively associated to the grade of eye strain severity during the COVID-19 lockdown (P < 0.05)). CONCLUSION: The Saudi population experienced eye strain during COVID-19 lockdown due to excessive digital devices usage. Longer duration of digital device usage was associated to eye strain. Health care providers should educate the general population on measures to mitigate eye strain due to digital devices. Trial registration ID None applicable.

Clinical Profile, Etiology, and Management Outcomes of Pediatric Ocular Trauma in Saudi Arabia.

OBJECTIVE: To evaluate cases of pediatric ocular trauma at a tertiary eye hospital in central Saudi Arabia and determine the demographics, causes, ocular injuries, and visual status before and after management. METHODS: A retrospective review was performed of health records of children younger than 16 years with ocular trauma managed from January 1998 to December 2019. Data were collected on patient demographics, eye involved, cause of trauma, the presenting and final vision, and the duration of follow-up. Best-corrected visual acuity at the last follow-up was compared between open and closed eye injury groups. The Birmingham Eye Trauma Terminology was used to classify the ocular injuries. RESULTS: Among 1003 patients, 728 (72.6%) had open globe and 275 (27.4%) had closed globe injuries. The main causes of trauma were unsafe playing-related activities (n = 394; 39.3%), unsafe home environment (n = 158;15.8%) and injury by metallic objects (n = 166; 16.6%). Gunshot-related ocular trauma was noted in 62 (6.2%) children. Presenting vision less than 20/400 was noted in 292 (40.1%) eyes with open globe injuries and 110 (40%) eyes with closed globe injuries (P = 0.4). After a median follow-up of 13.3 months, best-corrected visual acuity was 20/20 to 20/200 in 393 (53%) eyes with open globe injuries and 137 (49.8%) eyes with closed globe injuries (P = 0.03). CONCLUSIONS: Despite proper management, children in this study sustained significant permanent visual loss secondary to ocular trauma. Public health efforts in Saudi Arabia are needed to reduce preventable injury-related childhood blindness.

Magnitude and Determinants of Diabetic Retinopathy Among Indian Diabetic Patients Undergoing Telescreening in India.

Purpose: To determine the magnitude, determinants, and public health issues related to diabetic retinopathy (DR) in India using 2019 data from a for-profit telescreening program. Methods: Digital retinal images were captured using a nonmydriatic fundus camera and transferred via the telescreening program to a reading center. Ophthalmologists trained in DR image reading created the DR status reports. Age/sex-adjusted rates of DR, sight-threatening DR (STDR), and diabetic macular edema (DME) were calculated and correlated with known risk factors. Results: Images of 51,760 Indian diabetic patients (103,520 eyes) were reviewed. The prevalence of DR, STDR, and DME was 19.1% (95% confidence interval [CI]: 18.9-19.5), 5.1% (95% CI: 4.9-5.3), and 3.9% (95% CI: 3.7-4.1), respectively. Based on these data, we projected 14.7 million cases of DR, 3.9 million with STDR, and 3.0 million DME cases in India. Statistically significant risk factors for DR were male gender (odds ratio [OR] = 1.19, p < 0.001), older age (χ2 = 270, df = 3, p < 0.001), history of cataract surgery (OR = 2.0, p < 0.001), longer duration of diabetes (χ2 = 1084, p < 0.001), and type 1 diabetes (OR = 3.9, p = 0.01). There was a statistically significant variation of DR by geographic zones (χ2 = 310, p < 0.001). Laser treatment coverage for STDR was 22%. Duration of diabetes (p < 0.001), cataract surgery in the past (p = 0.02), and females (p = 0.001) were predictors of STDR. Conclusion: This model of telescreening for DR provides an additional pathway for screening and preventing diabetes-related visual morbidity in India. The data from this study can be used for epidemiologic and ophthalmic health policies related to diabetes.

Outcomes of the use of orbital hydrogel expanders in the management of congenital anophthalmia: CT-based orbital parameter analysis.

PURPOSE: To evaluate the outcomes of orbital hydrogel expanders in the management of congenital anophthalmia. METHODS: In this retrospective one-armed cohort study, a chart review was performed of eight children with congenital anophthalmia who underwent orbital expansion using orbital hydrogel tissue expander from January 2006 to July 2018. Computed tomography (CT) of orbital parameters was evaluated before and after surgery. Changes in the orbital parameters were correlated with clinical factors. RESULTS: The study sample comprised 11 anophthalmic orbits of eight children (seven males, one female; median age = 12 months), with a median postoperative follow-up of 3.8 years. The anophthalmic orbital parameters after hydrogel expander implantation improved significantly compared to preoperative assessment as follows: mean orbital height improved from 21.7 mm to 25.4 mm (P < .001); width from 19.2 mm to 23.8 mm (P < .001); depth from 27.5 mm to 32.6 mm (P = .008); and volume from 3.7 cm3 to 5.3 cm3 (P = .001). Despite enlargement in all dimensions, the anophthalmic orbits with hydrogel expander had a significantly lower development than the normal orbits, mainly in height and volume. At the last postoperative visit, four (36.4%) cases had fornices deep enough to maintain the conformer. Migration and extrusion occurred in two (18.2%) cases. CONCLUSIONS: Orbital hydrogel expander can improve the orbital development in congenital anophthalmia. However, the enlargement is not as extensive as that observed in the normal orbit. Orbital expanders associated with external conformers were not sufficient to induce normal growth of lids and fornix.

Ocular emergencies visits after corneal transplantation at a tertiary eye care hospital in Saudi Arabia.

PURPOSE: To evaluate the characteristics of patients with post-keratoplasty complications and their presentation at an emergency center. DESIGN: Retrospective one-armed cohort study. METHODS: Data were evaluated on patients who underwent corneal grafts in 2019 and presented to an emergency unit. Data were collected on patient demographics, presenting symptoms, clinical details, diagnosis at emergency visit, final diagnosis, best-corrected visual acuity (BCVA) at presentation and at the last follow-up after management. Severe visual impairment (SVI) and graft rejection were tested for correlations to other factors. RESULTS: The study sample was comprised of 149 eyes of 124 patients with a mean age of 27.5 years. Keratoconus was the indication for keratoplasty in 94 (75.8%) patients. The main presenting symptoms were pain 57 (38.3%) and red eye in 52 (34.9%) patients. The median interval between emergency visit and keratoplasty was 1.6 years. There were 63 (42.3%) patients who had emergency visits due to suture-related problems. The rates of SVI and graft rejection at the time of discharge after managing emergencies in eyes with previous keratoplasty were 14.1% (95% CI 8.5; 19.7) and 13.4 (95% CI 7.9; 18.9), respectively. Keratoconus (OR = 22.8) and young age (P < 0.001) were negatively associated with SVI after management. CONCLUSION: Patients with keratoplasty are at high risk for severe vision loss and should be counseled to seek urgent eye care for early detection and management of sight-threatening complications to improve graft survival and vision.

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.

Effect of Bandage Contact Lens Exchange on Pain and Healing After Photorefractive Keratectomy-A Randomized Control Trial.

OBJECTIVE: To evaluate the corneal re-epithelialization and patient-perceived pain after bandage contact lens (BCL) exchange on day one, after photorefractive keratectomy (PRK). METHODS: A randomized controlled trial, of all patients who underwent bilateral transepithelial-PRK (trans-PRK) or bilateral alcohol debridement and PRK (A-PRK), between March and October 2019. One eye of each patient was randomly assigned to BCL exchange on the first postoperative day (exchange group) and the BCL was not exchanged in the fellow eye (control group). Patients were evaluated daily until healing was complete. At each visit, the corneal epithelial defect was measured, and a questionnaire was used to assess pain, photophobia, and excessive tearing. P<0.05 was statistically significant. RESULTS: The study sample was comprised of 56 patients (mean age 27.2±5.7 years). Trans-PRK was performed in 20 (34.5%) and A-PRK in 36 (64.3%) patients. At day 3, 40 (71.4%) eyes of the exchange group healed completely compared with 38 (67.9%) eyes of the control group (P=0.5). At day-1 follow-up, the pain score was 1.87±1.4 in the exchange group and 2.29±1.3 in the control group (P=0.009). The mean pain score was 1.58±1.4 among patients who underwent A-PRK and 2.35±1.2 among patients operated by trans-PRK (P=0.04). CONCLUSION: The epithelial healing did not vary when BCL was exchanged one day after refractive surgery. However, postoperative pain score after PRK was lower at day 1, when the BCL was exchanged. Compared with A-PRK, trans-PRK group demonstrated a higher pain score in the early postoperative phase.

Electronic Health Record-Related Stress Among Nurses: Determinants and Solutions.

Background: Documentation and navigation through electronic health records (EHRs) is an essential, but stressful, task. We present the magnitude, determinants of such events, and solutions proposed by nurses to address EHR-related stress (EHR-S) at a tertiary eye hospital in Saudi Arabia. Methods: Nurses of an eye hospital were surveyed in 2019 about EHR-S. A Likert scale was used to assess the responses of 10 components of EHR-related work. The total score was graded as follows: minimum (<-10), mild (<0 to -10), moderate (1-10), and severe (>11). The score was correlated with determinants. Solutions suggested by nurses to reduce stress were reviewed. Results: This survey covered 212 nurses. Of them, 106 (50%; 95% confidence interval: 43.3-56.7) reported EHR-S. The median EHR-S score was -3.0 (interquartile range: -9.0; +8.0). Thirty-five (16%) nurses reported severe EHR-S. Senior nurses (M-W, p < 0.02) and those working in emergency and recovery units (M-W, p < 0.01) had statistically higher EHR-S. The main stressors were incomplete EHR work by other departments affecting nursing care (70.8%), difficulty in correction after entering the data (60.4%), and difficulty in data retrieval (60.4%). The main solutions to reduce EHR-S were to reduce the frequency of changes to configuration of the EHR (58%), more training (54.2%), and appreciation of good work (52.8%). Conclusions: EHR-S is experienced by half of the nurses working at an eye care hospital. Implementation of solutions such as better training and fewer changes to the EHR system could reduce stress levels of nurses.

Analysis of retinal structure and function in cone dystrophy with supernormal rod response.

PURPOSE: To report the clinical and electrophysiological features of cone dystrophy with supernormal rod response (CDSRR). METHODS: Retrospective cohort study of 15 unrelated patients (nine males and six females, median age 16, range 5-47 years) diagnosed with CDSRR by clinical examination, full-field electroretinography (ERG) and genetic testing. OBSERVATIONS: History, ophthalmic examination including near vision, color vision and contrast sensitivity assessment, multimodal retinal imaging and ERG. Genetic testing was done for all patients using next-generation sequencing. RESULTS: The rate of consanguinity was 86.7%. Color vision was defective in 56.3%. Near vision was defective in all patients (mean 20/160). Contrast sensitivity was affected in all patients at low contrast of 2.5%. A parafoveal ring of increased autofluorescence imaging was seen in most patients (75%). Supernormal mixed maximal response b-wave was seen bilaterally in 63% of patients (and high normal in 37%). Rod dysfunction with prolonged rod b-wave latency was detected in all. The 30-Hz flicker response was more reduced and delayed compared to the single-flash cone response. A novel homozygous missense variant c.530G>C (p.Cys177Ser) in KCNV2 was detected in one patient, the nonsense homozygous mutation c.427G>T (p.Glu143*) was found in 13 patients, and the nonsense c.159C>G (p.Tyr53*) was found in one patient. CONCLUSION: This is the largest cohort of CDSRR from a single ethnic background. Rod dysfunction and reduced 30-Hz flicker response were demonstrated in all patients. In contrast to previous descriptions in the literature, a supernormal combined dark-adapted rod-cone ERG was present in the majority of the patients at standard stimulus intensity. Considering the consistent genotype and the demonstration of likely pathogenic genetic variants in all the patients, we argue that the combination of delayed rod b-wave and subnormal flicker response strongly suggests the diagnosis of CDSRR.

Medical professionalism in ophthalmology: design and testing of a scenario based survey.

BACKGROUND: Professionalism is hard to quantify but essential in medical practice. We present a survey tool for ophthalmologists that assessed professionalism using case-based scenarios in central Saudi Arabia. METHODS: Ophthalmologists (resident, fellows and consultants) participated in a web-based survey in 2015. Out of 44 attributes related to professionalism, experts selected 32 attributes with validity indices of ≥0.80. To evaluate these attributes, 51 scenario-based questions were developed and included in the survey. For each attribute, participants were given choices of close ended responses: unacceptable (1), probably unacceptable (2), acceptable (3), probably acceptable (4). The attribute score was compared to the gold standard (responses of an expert group). An attribute score was generated and compared among subgroups. RESULTS: Of the 155 ophthalmologists, responses of 147 ophthalmologists who completed more than 50% of questions were reviewed. Their mean attribute score was 84.1 ± 10.1 (Median 87.1; 25% quartile 78.1; minimum 50; and maximum 100). The variation in attribute score among consultants, fellows and resident ophthalmologists was significant (P = 0.008). The variation of attribute score by groups of attributes was also significant (P < 0.05). The score for 'Personal characteristics' was on a lower scale compared to that of other attribute groups. The variation in the scores for attribute groups; 'Personal characteristics attribute' group (p < 0.01) and 'Workplace practices & relationship' group (P = 0.03) for consultants, fellows and residents were significant. CONCLUSIONS: Professionalism among ophthalmologists and those in training was high and influenced by years of experience. The survey tool appeared to show differences in responses to specific professional attribute groups between trainees and consultants. Additional studies with a larger sample size might be helpful in validating the survey as a tool to be used to assess professionalism in graduate medical education in ophthalmology.

Perception Among Diabetic Patients of Telescreening for Diabetic Retinopathy.

Purpose: To evaluate the satisfaction of diabetic patients and its determinants of telescreening for diabetic retinopathy (DR) in Saudi Arabia. Methods: This cross-sectional survey was conducted in December 2018 in a diabetes center of Riyadh, Saudi Arabia. Ten questions were asked by the interviewer. A 5-point Likert scale was used to grade patient responses for each question. Rasch analysis was conducted to evaluate the response of the participants. The main outcome variable was the sum of the Logit values of the responses. The Rasch score was also compared among subgroups. Results: Two hundred (n = 200) diabetic patients were interviewed. The median Rasch score of client-perceived benefit of DR telescreening was +14.6 (25% quartile +3.09, minimum; -23.2, maximum; +35.7). A positive attitude of patients regarding DR telescreening was recorded in 159 (79.5%) participants. The perception of telescreening was better in younger diabetic patients than in older diabetic patients (Friedman p < 0.001). The perception was similar in both genders (Mann-Whitney p = 0.3). Diabetic patients from Riyadh and the southern region of Saudi Arabia had significantly more positive perception than those from north and eastern regions (Freedman p < 0.001). Conclusion: Diabetic patients have positive attitude toward tele-DR screening. Their cooperation is likely to be high if large scale tele-DR screening is implemented in the Kingdom.

Comparison of Digital Retinal Images and Information Tele-Transferred Through the Hala System to Manual Image Transfer of Diabetic Patients from Primary Health Care Centers in Riyadh.

Background: Diabetes is a significant problem in Saudi Arabia, and telemedicine in the form of tele-screening for diabetic retinopathy (DR) is recommended. Introduction: A comparison of the quality of images and information transferred through the Hala system of the Ministry of Health, Saudi Arabia, with images transferred in a survey at Primary Healthcare Centers in Riyadh, Saudi Arabia, was conducted. Methods: A review of health records was undertaken in 2017-2018. Digital retinal images of diabetics were tele-transferred from a diabetes center to the King Khaled Eye Specialist Hospital (KKESH) for review by medical retina specialists (Group I). Similarly, images of diabetic patients that were transferred from seven primary health clinics to KKESH during a survey were used as images for research (Group II). Additional information reviewed for completeness included patient demographics, risk factors of DR, and previous eye surgery. Results: There were 40 images of 40 patients transferred through the Hala system. There were 120 randomly selected images from survey files. There were significantly more poor images from the Hala system (12.5%) than the research survey system (2.4%). There was no significant difference in the severity of DR between groups. The median Rasch score for the images was -0.58 (interquartile range [IQR] -5.6, 2.6) in Group I and 19.7 (IQR 18.3, 19.7) in Group II. The image reader perceived that the quality of digital retinal images was significantly better in images transferred from the research survey compared with those transferred through the Hala DR tele-transfer system. (Mann-Whitney p < 0.001). Conclusions: Digital image capture and supplementary risk factor information require improvement to enhance DR screening using the Hala system.

Clinical and histological features and outcomes of upper eyelid colobomas in the Saudi population.

PURPOSE: To study the clinical features, histopathology, and management of congenital upper eyelid coloboma (CEC) in the Saudi population. METHODS: A retrospective review of health records evaluated the demographics, histopathology, and surgical outcomes of patients with CEC. RESULTS: Thirty-nine eyelids of 27 patients were included in this study. CEC was bilateral in 12 (44.4%) patients, isolated in 17 (62.9%), and as part of a syndrome in 10 (37.1%) patients. CEC was commonly located in the medial upper lid (22 lids, 56.4%) and mostly involved the full thickness of the lid (27 lids, 69.2%). Corneal adhesion (18 eyes, 46.1%) and poorly formed eyebrows (21 eyebrows, 53.8%) were the most common ocular/adnexa associations. Histopathology was similar in all cases and the main features were scarred dermis, atrophic orbicularis oculi, and atrophic or absent tarsus. Visual acuity at the final follow-up was 20/50 or better in 13 (33.3%) eyes. Complete lid closure without lagophthalmos after one or more surgical procedures was achieved in 11 (40.7%) cases. CONCLUSIONS: CEC features in Saudi patients are similar to those described in the literature. Dermal scarring and defective orbicularis muscles are common. Achieving cosmetic and functional success after management remains challenging.

Knowledge, attitude and practice among non-ophthalmic health care providers regarding eye management of diabetics in private sector of Riyadh, Saudi Arabia.

BACKGROUND: The levels of knowledge, attitude and practice among primary physicians concerning both diabetic retinopathy screening and treatment of sight threatening diabetic retinopathy have been studied by different groups, such as medical students, pharmacists, Primary Health Care staff and opticians. In some studies, the levels were very high, while in others it was noted to be less than desired. AIM: This study's intent is to estimate and improve level of Knowledge (K), Attitude (A) and Practice (P) among non-ophthalmic health care providers regarding eye management of diabetes and barriers that people with diabetes face in Saudi Arabia. METHODS: This cross-sectional survey targeted medical doctors (except ophthalmologists) working at private sector institutions in Riyadh. They were interviewed using closed-ended questions for knowledge (8), attitude (5), practice (5), and reasons for their current KAP status comprised of 8 questions. The level of Knowledge was assessed as good if its score was (> 50%); positive attitude (> 50%) and excellent practice (> 75%) were estimated and associated to the risk factors. RESULTS: Out of the 355 participants that were interviewed, the percentages of good knowledge, positive attitude and excellent practice concerning diabetic retinopathy (DR)were 193 [54.3% (95% CI 49.2-59.5)], 111 [31.3% (95% CI 26.4-36.1)], and 145 [40.8% (95% CI 35.7-46.0) participants, respectively. Gender, place of work and type of doctor were not significantly associated with the level of KAP. Salient reasons for low KAP status included a busy schedule (54.6%), less resources (75.2%), inadequate periodic training in eye care (69%), and absence of retinal evaluation training (49.6%). CONCLUSIONS: Improving KAP level is urgently needed. Addressing underlying causes of low KAP could enhance eye care of people with diabetes. Additionally, training for primary health care providers for early detection of DR and timely management of sight threatening diabetic retinopathy (STDR) is necessary.

Characteristics and Success Rates of Same Day or Asynchronous Bilateral External Dacryocystorhinostomy.

PURPOSE: To evaluate the characteristics of bilateral nasolacrimal duct obstruction (NLDO) carriers and success rates of same day (simultaneous) or asynchronous (different day) bilateral dacryocystorhinostomy (DCR). METHODS: This retrospective study included patients with bilateral NLDO who underwent bilateral external DCR between January 2010 to August 2015 at the King Khaled Eye Specialist Hospital, Saudi Arabia. Postoperative success rate was considered as subjective perception of no tearing bilaterally or failure if unilateral or bilateral tearing persists after surgery. Data were statistically analyzed with P <0.05 indicating significance. RESULTS: Of 57 patients undergoing bilateral DCR, 32 (56%) had same-day surgeries and 25 underwent asynchronous surgery. The median duration of follow up was 7 months. The success rates were similar for the same day group [61.3%-95% CI 49.4-73.2)] and for the asynchronous group [54.2% (95% CI 40.4-68.0)]. Success rate was not correlated to the age, gender, or use of stents. CONCLUSIONS: The authors strongly recommend bilateral same-day external DCR to treat bilateral NLDO since the success rate of the procedure is similar to the asynchronous surgery, allowing a full treatment in just 1 operative visit.

Deepening Fornix Technique Using Central Split-Medium Thickness Skin Graft to Treat Contracted Anophthalmic Sockets.

PURPOSE: The aim of thhis study was to present the outcomes of postauricular split-medium thickness skin graft (SMTSG) to treat anophthalmic sockets with contracted fornices. METHODS: This case series enrolled patients with grade 2 or 3 anophthalmic sockets between 2015 and 2016. Data were collected on patient demographics, objective and subjective parameters preoperatively and 180 days postoperatively. Success of the surgery was graded on the height of the graft, the depth of the superior and inferior fornices, and presence/abscence of lagophthalmos, entropion, and ability to retain an external prosthesis. RESULTS: Eighteen patients were enrolled with a mean age of 35.9 ±â€Š18 years. The median height of the graft was 22 mm (25% quartile = 18.75) when removed and 20 mm (25% quartile = 16) postoperatively. The median depth of the superior fornix was 6.5 mm (25% quartile = 4.5 mm) preoperatively and 10 mm (25% quartile = 8 mm) postoperatively (P = 0.5). The median inferior fornix depth was 7 mm (25% quartile = 3.5 mm) preoperatively and 8 mm (25% quartile = 5 mm) (P = 0.27) postoperatively. Preoperatively, there were 13 (72.2%) patients with lagophthalmos, 10 (44.4%) with entropion, 3 (37.5%) with poor prosthesis retention, and 5 (62.5%) who were unable to retain the prosthesis. Postoperatively, 7 (38.9%) patients had lagophthamos, 1 (5.6%) had entropion, and all the patients could retain the prosthesis. None of the sockets had a foul odor postoperatively. CONCLUSIONS: Postauricular SMTSG achieves successful outcomes for the treatment of contracted anophthalmic sockets, reshaping the anterior socket surface and deepening the fornices.

OUTCOMES OF PARS PLANA VITRECTOMY IN THE MANAGEMENT OF REFRACTORY AQUEOUS MISDIRECTION SYNDROME.

PURPOSE: To determine the efficacy and complications of pars plana vitrectomy (PPV) and adjunct surgeries for aqueous misdirection refractory to medical therapy. METHODS: A retrospective review of consecutive eyes with refractory aqueous misdirection at the King Khaled Eye Specialist Hospital between 2002 and 2010. Patients underwent two-port and three-port pars plana vitrectomy (PPV) with adjunct procedures including pars plana lensectomy combined with posterior capsulectomy, hyaloido-zonulo-iridectomy, and synechiolysis. Main outcome measures included anatomical success, functional success, and factors associated with the outcomes. RESULTS: Sixty-nine eyes were evaluated over a mean follow-up period of 17.6 ± 3.8 months (3-156 months). Anatomical success was achieved in 62 eyes (90%) and functional success in 54 eyes (78%) that underwent PPV as a primary surgery. The factors associated with the altering misdirected aqueous flow and reducing intraocular pressure significantly associated with a two-line improvement of best-corrected visual acuity included surgical treatment within 4 weeks of presentation (P = 0.004) and preoperative intraocular pressure (P = 0.001). The success of two-port PPV and standard three-port PPV was similar (P = 0.7). The intraoperative and postoperative complications included retinal detachment in two eyes and endophthalmitis in one eye. CONCLUSION: The PPV was effective for managing aqueous misdirection refractory to medical therapy. Two-port or three-port PPV did not change the success rate but early surgery improved both anatomical and functional outcomes.

Outcomes of and barriers to cataract surgery in Sao Paulo State, Brazil.

BACKGROUND: Cataract is the leading cause of blindness in developing countries and identification of the barriers to accessing treatment is essential for developing appropriate public healthcare interventions. To evaluate the barriers to cataract surgery after diagnosis and assess the postoperative outcomes in Sao Paolo State, Brazil. METHODS: This prospective study evaluated cataract patients from 13 counties in São Paulo State in 2014. Cataract was diagnosed in the community by a mobile ophthalmic unit and patients were referred to a hospital for management. Gender, age, distance to the hospital and local municipal health structure were evaluated as possible barriers. Data were analyzed for postoperative outcomes and the impact on blindness and visual impairment. RESULTS: Six hundred patients were diagnosed with cataract with a mean age of 68.8±10.3 years and 374 (62.3%) were females. Two hundred and fifty-four (42.3%) patients presented to the referral hospital. One hundred forty-four (56.7%) underwent surgery, 56 (22.0%) decided not to undergo surgery, 40 (15.7%) required only YAG-Laser and 14 (5.5%) required a spectacle prescription only. Visual acuity increased statistically significantly from 1.07±0.73 logMAR at presentation to 0.25±0.41 logMAR at the final visit after intraocular lens implantation (p=0.000). There was a statistically significantly decrease from 17 (11.8%) blind patients and 55 (38.2%) visually impaired patients at presentation to 2 (1.4%) and 5 (3.5%) patients respectively after treatment (p=0.000). CONCLUSION: Less than half of the individuals with cataract presented to the hospital for surgery. Among the patients who underwent treatment, there was an overall decrease in the number of blind individuals and visually impaired individuals. The barriers to cataract surgery were older age, greater distance to the hospital, municipalities with fewer inhabitants and less ophthalmic services.

Assessment of the prevalence and risk factors of ophthalmoplegia among diabetic patients in a large national diabetes registry cohort.

BACKGROUND: There are limited data on the epidemiology and risk factors of ophthalmoplegia among diabetic patients. This study aims to determine the prevalence and important risk factors related to ophthalmoplegia among diabetic patients. METHODS: This is an observational registry-based study using the Saudi National Diabetes Registry (SNDR) database to select diabetic patients regardless of their diabetes type. A total of 64,351 Saudi diabetic patients aged more than 18 years and registered in SNDR between January 2000 and December 2010 were analyzed to identify ophthalmoplegic cases. Demographic, clinical, and biochemical parameters were studied and STROBE guidelines were used to design and report the results of this study. RESULTS: The overall prevalence of ophthalmoplegia cases was 0.32 %, further distributed into: 53.11 %, 36.36 %, and 2.8 % for cranial nerves VI, III, IV palsies respectively. Ophthalmoplegic cases were predominantly type 2 diabetic males with older age and longer diabetes duration. The most important and significant risk factors were age ≥ 45 years, diabetes duration ≥ 10 years, male gender and presence of retinopathy and nephropathy. CONCLUSIONS: Ophthalmoplegia is a rare entity associated mainly with type 2 diabetes. Clinicians have to consider its risk factors when screening or planning for prevention of this condition.

Endophthalmitis Caused by Rhizobium radiobacter After Posterior Chamber Phakic Intraocular Lens Implantation to Correct Myopia.

PURPOSE: To describe a 29-year-old man presenting with acute-onset endophthalmitis caused by Rhizobium (formerly Agrobacterium) radiobacter after uneventful implantable collamer lens implantation for myopia. METHODS: Case report. RESULTS: The patient was treated with intravitreal injections of vancomycin and ceftazidime, as well as topical and systemic antibiotics. The patient had a good response with a final visual acuity of 20/50 at the last follow-up visit 25 months postoperatively. CONCLUSIONS: This case represents the first case report of endophthalmitis caused by Rhizobium radiobacter following implantable collamer lens implantation.