Vitreous levels of pigment epithelium-derived factor and vascular endothelial growth factor in diabetic and non-diabetic retinopathy: associated factors and anatomical correlation.

BACKGROUND: This study aims to investigate the factors affecting the vitreous levels of pigment epithelium-derived factor (PEDF) and vascular endothelial growth factor (VGEF) among patients with pars plana vitrectomy (PPV). Also, this study correlates the levels of PEDF with RRD characteristics. METHODS: All patients who were scheduled for PPV for any indication were included in the study. They were divided into a case group which included patients with advanced PDR and a control group which included the remaining diagnoses. During the PPV, an undiluted vitreous sample was taken and the enzyme-linked immunosorbent assay method was utilized to measure the levels of VEGF and PEDF. RESULTS: Eighty eyes were involved. Patients diagnosed with advanced PDR and endophthalmitis exhibited higher levels of VEGF. PEDF was affected inversely by the age of the patients and PEDF levels were higher in RRD and endophthalmitis cases. In patients with RRD, the level of PEDF was higher if the tear was found inferiorly, if the macula was detached, and with a longer duration of RRD. CONCLUSIONS: This study highlights the clinical importance of those biomarkers. Anti-VEGF-based treatment is the mainstay against PDR. PEDF may show a promising predictive values regarding patients with RRD.

Successful Management of Bilateral Uncontrolled Advanced Primary Open Angle Glaucoma in a Pregnant Woman during the Restrictive COVID-19 Lockdown.

COVID-19 is a viral illness that can cause severe respiratory symptoms. COVID-19 has caused a worldwide pandemic that necessitated many countries to perform a national lockdown. In Jordan, a lockdown was imposed by the government. During the lockdown, the hospitals were only dealing with outpatient emergency cases, urgent referrals from primary or secondary health institutions, and inpatients whose medical conditions required keeping them admitted. Elective clinics and surgeries were canceled. At the King Abdullah University Hospital (KAUH), which is the only tertiary center in northern Jordan, we dealt with an unusual case of uncontrolled and advanced primary open angle glaucoma in a 38-year-old pregnant female patient. The patient was presented with an intraocular pressure (IOP) of 53 mmHg in the right eye and 40 mmHg in the left eye despite using dorzolamide and timolol eye drops twice daily. The angle was opened in gonioscopy. The decision was made to implant Ahmed glaucoma valves (AGV) in each eye in one session under general anesthesia which was performed successfully. At the last follow-up visit 4 years later, the IOP was maintained at 15 mmHg.

Bilateral total iris atrophy, corneal decompensation and glaucoma following bilateral cosmetic artificial iris implantation: A case report of severe sequela and successful management.

PURPOSE: Cosmetic iris implants have a record of high ocular complications and are no longer in use. These complications include glaucoma, corneal decompensation, iris atrophy, uveitis, cataract and retinal detachment. CASE PRESENTATION: We report a case of a 44-year-old lady presented with bilateral total iris atrophy, glaucoma and corneal decompensation after cosmetic artificial iris implantation. The patient underwent bilateral artificial iris removal, glaucoma drainage device for the right eye, and micropulse laser for the left eye. In addition, she underwent phacoemulsification with iris-diaphragm intraocular lens implant for the right. The cornea of the right eye ended up with successful Boston keratoprosthesis after rejection of previous 2 grafts. CONCLUSIONS: To the best of our knowledge, we describe the first report of bilateral total iris atrophy following a cosmetic iris implant accompanied by bilateral glaucoma and corneal decompensation.

The Economic Burden of Diabetic Retinopathy in Jordan: Cost Analysis and Associated Factors.

Objective: Diabetic retinopathy (DR) is the leading cause of visual loss worldwide in patients with diabetes mellitus (DM). The aims of our study are to describe the costs associated with (DR) and to evaluate its economic impact in Jordan. Methods: Retrospectively, we included all patients with DM and classified them according to the severity of DR. Data regarding medical history, ophthalmic history, stage of DR, presence of DME, and the ophthalmic procedures and operations were collected. The total DR-related cost was measured as a direct medical cost for the outpatient and inpatient services. Results: Two hundred and twenty-nine patients were included in the study. Only 49.7% of the patients presented without DR, and 21% presented with diabetic macular edema (DME) unilaterally or bilaterally. The DR-related cost was significantly associated with insulin-based regimens, longer duration of DM, higher HbA1c levels, worse stage of DR at presentation, the presence of DME at presentation, the presence of glaucoma, and increased mean number of intravitreal injections, laser sessions, and surgical operations. Multivariate analysis should the presenting stage of DR, presence of DME, and the presence of DME be the independent factors affecting the DR-related cost. Conclusion: This study is the first study to be conducted in Jordan and encourages us to establish a screening program for DR for earlier detection and treatment. DM control and treatment compliance will reduce the heavy costs of the already exhausted healthcare and financial system.

Silicone Oil Utilized in Pars Plana Vitrectomy for Patients with Advanced Proliferative Diabetic Retinopathy: Physico-Chemical and Optical Properties.

Objective: Silicone oils have the role in maintaining the attachment of the retina in conditions where the risk of retinal re-detachment is high. However, silicone oils have the tendency to emulsify with subsequent complications. In this work, analyses have been performed to understand changes that occurred to the optical, and physical characteristics of the oil after removal from the vitreous cavity of patients underwent pars plana vitrectomy (PPV) for fibrovascular membranes/tractional retinal detachment (FVM/TRD). Methods: Four samples of silicone oil were allocated from patients who underwent PPV for FVM/TRD. The Fourier-transform infrared (FTIR) spectroscopy, micro-viscometry, and ultraviolet-visible spectrometer analyses were utilized to determine the changes in its chemical bondings, viscosity, absorbance, transmittance, buoyance, and specific gravity. Results: The mean age of the patients was 49.0 years. The mean duration of silicone oil implantation was 18.9 months. FTIR analysis showed significant breaking in the chemical bonding that was related to the lens status during the primary PPV, the presence of significant retinal hemorrhages, the duration of silicone oil implantation, and the degree of silicone oil filling. Similarly, viscosity and contact angle analyses revealed a reduction in the viscosity with similar factors to the FTIR analysis. Moreover, absorbance and transmittance were largely affected by the aggressiveness of FVM/TRD. Conclusion: This study revealed that certain factors such as the age of the patient, duration of silicone oil implantation, lens status, and the presence of retinal hemorrhages, the degree of silicone oil filling and aggressiveness of FVM/TRD may contribute to the emulsification process.

Vitreous Levels of Vascular Endothelial Growth Factor and Platelet-Derived Growth Factor in Patients with Proliferative Diabetic Retinopathy: A Clinical Correlation.

Background: The global epidemic status of diabetic retinopathy (DR) and its burden presents an ongoing challenge to health-care systems. It is of great interest to investigate potential prognostic biomarkers of DR. Such markers could aid in detecting early stages of DR, predicting DR progression and its response to therapeutics. Herein, we investigate the prognostic value of intravitreal concentrations of vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) in a DR cohort. Materials and methods: Vitreous sample acquisition was conducted at King Abdullah University Hospital (KAUH) between December 2020 and June 2022. Samples were obtained from any patient scheduled to undergo a pars plana vitrectomy (PPV) for any indication. Included patients were categorized into a DR group or a corresponding non-diabetic (ND) control group. Demographics, clinicopathological variables, standardized laboratory tests results, and optical coherence tomography (OCT) data were obtained for each included individual. Intravitreal concentrations of VEGF and PDGF were assessed using commercial enzyme-linked immunosorbent assay (ELISA). Results: A total of 80 eyes from 80 patients (DR group: n = 42 and ND control group: n = 38) were included in the analysis. The vitreous VEGF levels were significantly higher in the DR group compared to the ND control group (DR group 5744.06 ± 761.5 pg/mL versus ND control group 817.94 ± 403.1 pg/mL, p = 0.0001). In addition, the vitreous PDGF levels were also significantly higher in the DR group than those in the ND control group (DR group 4031.51 ± 410.2 pg/mL versus ND control group 2691.46 ± 821.0 pg/mL, p = 0.001). Bassline differences between test groups and clinical factors impacting VEGF and PDGF concentrations were investigated as well. Multiple regression analysis indicated PDGF as the sole independent risk factor affecting best-corrected visual acuity (BCVA) at the last follow-up visit: the higher the PDGF vitreous levels, the worst the BCVA. Conclusions: Vitreous concentrations of VEGF and PDGF are correlated with DR severity and may exhibit a possible prognostic potential value in DR. Further clinical and experimental data are warranted to confirm the observed findings and to help incorporate them into daily practice.

Postoperative exogenous endophthalmitis caused by Escherichia coli: a rare case report and literature review.

Aim: We report a rare case of postoperative endophthalmitis caused by Escherichia coli. Case description: The diagnosis of postoperative endophthalmitis in our patient was established based on the clinical signs of hypopyon along with vitritis. The patient underwent pars plana vitrectomy, anterior chamber washout, intraocular lens removal, and intravitreal antibiotics (amikacin and vancomycin) injection. The culture of both the vitreous sample and the intraocular lens, revealed a heavy growth of Escherichia coli. Conclusion: Escherichia coli is an unusual microorganism to cause postoperative endophthalmitis. A major breach in the sterilization may explain this infection. Proper sterilization and prophylactic measures are crucial to avoid this disastrous complication.

Endophthalmitis is a rare catastrophic sight threatening complication after cataract surgery. It is commonly caused by Gram­positive bacteria. In this rare case report, we present a case of postoperative cataract surgery caused by Escherichia coli; a Gram-negative bacteria. Proper prophylactic measures in the operation rooms along with proper prophylactic antibiotics may aid in avoiding such complications by such rare microorganism.

Refractive errors among medical students in Jordan: prevalence, types and possible risk factors.

Aim: This study aims to determine the prevalence of refractive errors among medical students in Jordan. Materials & methods: Cross-sectional model through an online questionnaire was conducted. The questionnaire was distributed randomly to 700 medical students. Results: Females participated more than males. It was revealed that 525 (75%) of the total students were found to have a refractive error. Myopia was the most common type. About 79.0% of students have a positive family history of refractive errors which was more significant in students with refractive errors. Spectacles were the most common used method of treatment. Conclusion: The prevalence of refractive errors was high among medical students in Jordan. A positive family history was associated with students having refractive errors.

Many reports have studied refractive errors and their risk factors in different groups and ethnicities. Also, types of refractive errors were found to have a different prevalence in different age groups. Whilst refractive errors in medical students have been studied in many countries, the prevalence of refractive errors has never been studied in Jordanian medical students before. In this study, we found that myopia (with or without astigmatism) was the most common type of refractive error in medical students.

Recurrent delayed-onset cerebral vasospasm following ruptured ICA aneurysm: case report.

We report a unique case of late-onsetcerebral vasospasm at 21 and again at 30 days following aneurismal subarachnoid hemorrhage.

The largest malignant peripheral nerve sheath arising from the gluteal region: case report.

We report a unique case of a huge malignant peripheral nerve sheath tumor with probable smooth muscle differentiation.

Unique case of successful surgical treatment of recurrent spinal epidural hematoma after lumbar disc surgery in a Glanzmann thrombasthenia patient.

We report a case of recurrent postoperative spinal hemorrhage after lumbar disc surgery in a Glanzmann thrombasthenia patient.

Outcomes of Iris-Claw IOL Implantation in Patients with Marfan's Syndrome in Jordan.

Objective: The management of ocular complications of Marfan's syndrome, especially ectopia lentis, is challenging. In this study, we present the effectiveness and the safety of iris-claw intraocular lens (IOL) implantation along with lensectomy for those patients. Also, we compare the practice of implanting these IOLs either in the anterior chamber of retropupillary. Methods: Retrospectively, we included all patients with Marfan's syndrome who underwent lensectomy with iris-claw IOL implantation as a result of ectopia lentis. The patients were categorized into two groups: anterior chamber iris claw IOL and retropupillary iris-claw IOL. The clinical and demographic data, the visual outcome and postoperative complications were compared. Results: Eighteen eyes of 10 patients were included in the study. The mean age of the patients was 19.1 years. Six patients were males. The iris-claw IOL was implanted anteriorly in 13 eyes. The visual outcome was comparable between both groups and most patients achieved improvement in the visual acuity. In addition, the postoperative complications developed similarly in both groups. However, all cases of IOL disenclavation (6 cases) developed in the anterior group. It is revealed that the age of the patient was the most significant factor affecting the occurrence of IOL disenclavation. Conclusion: Iris-claw IOL (either anteriorly or retropupillary) is an effective and relatively safe method in treating ectopia lentis in patients with Marfan's syndrome. In younger patients, anterior iris-claw IOL is safer than retropupillary iris-claw IOL as the risk of disenclavation is higher in younger patients.

Optical and Physical Properties of Silicone Oil Extracted from the Vitreous of Patients Who Underwent Vitrectomy for Retinal Detachment.

Purpose: Silicone oil (SO) is a crucial tool in vitreoretinal surgery. SO has the tendency to emulsify depending on certain factors. In this work, detailed analyses have been conducted to understand changes that occurred to the physical, optical, and chemical characteristics of the oil after removal from the vitreous cavity. Methods: Five samples of SO were collected from patients who underwent vitrectomy for rhegmatogenous retinal detachment. The fourier-transform infrared (FTIR) spectroscopy, ultraviolet-visible spectrometer, and contact angle analysis were utilized to determine the changes in its chemical bondings, transmittance, absorbance, viscosity, buoyance, and specific gravity. Results: FTIR analysis showed significant changes in the chemical bonding that might be related to the age of the patient, lens status, the presence of retinal hemorrhages, and the exposure to laser after implantation of SO. In addition, contact angle analysis revealed that the viscosity might be affected by duration of implantation and the age of the patient. Moreover, transmittance and absorbance were largely affected by the exposure to laser retinopexy after implantation. Conclusion: This study showed that certain factors such as the age of the patient, the exposure to laser, lens status, and the presence of retinal hemorrhages may contribute to the emulsification process.

Reactivation of Herpes Simplex Keratitis on a Corneal Graft Following SARS-CoV-2 mRNA Vaccination.

Background: Ocular herpes simplex is usually caused by herpes simplex virus type 1 (HSV-1) and less commonly by the type 2 virus (HSV-2). Ocular manifestations of HSV include blepharitis, conjunctivitis, lacrimal system obstruction, corneal involvement, and uveitis. Corneal involvement is one of the causes of loss of vision and can be epithelial herpetic keratitis or stromal herpetic keratitis. Objective: A significant population has a colonization of herpes viruses. Under certain circumstances, these viruses can reactivate with a significant ocular morbidity. Globally, COVID-19 vaccines are recommended; however, the vaccine safety data are limited. Case report: Herein, we reported a case of herpetic keratitis reactivation that occurred 2 days after receiving SARS-CoV-2 mRNA vaccine. The patient is a 50-year-old man who underwent penetrating keratoplasty (PKP) in 2020 for corneal opacity caused by a previous herpes simplex keratitis in 2013. Herpetic keratitis was treated successfully with topical antiviral acyclovir along with topical moxifloxacin and artificial tears. After treatment, prophylactic oral acyclovir was started. Conclusion: Both ophthalmologist and patients should be aware of this phenomenon. Long-term prophylactic antiviral treatment may be recommended for those patients.

Anterior Versus Retropupillary Iris-Claw Intraocular Lens: Indications, Visual Outcome and Postoperative Complications.

INTRODUCTION: In cases of inadequate capsular support for intraocular lens (IOL) implantation, iris-claw IOL is a practical option. Iris-claw IOL can be implanted anteriorly or retropupillary. In this study, we compare the outcome of implantation of iris-claw IOL between anterior and retropupillary locations. METHODS: We retrospectively examined the characteristics and outcomes of patients who underwent iris-claw "Artisan®" intraocular lens implantation (IOL) during the period of January 2014 to July 2020. The study population included all patients who underwent iris-claw IOL implantation, whether as a primary or secondary implantation, regardless of the causative indication. The study population was categorized by location of implantation and indication. The outcome was compared by visual acuity and postoperative complications. RESULTS: In this study, 171 eyes of 151 patients were included. Iris-claw IOL was implanted anteriorly in 110 (64.3%) eyes. The most common indication for iris-claw IOL was complicated cataract surgery, followed by ectopia lentis and by trauma. Patients with retropupillary position achieved better visual outcome whatever the causative indication. Anterior iris-claw IOL patients had more high intraocular pressure readings and macular edema. CONCLUSIONS: This study revealed that retropupillary iris-claw IOL may achieve better visual outcome without significant postoperative complications. Further prospective studies and trials on larger sample sizes are needed.

Evaluating the Prognostic Role of Monocytopenia in Chemotherapy-Induced Febrile Neutropenia Patients Treated with Granulocyte Colony-Stimulating Factor.

OBJECTIVE: Chemotherapy-induced febrile neutropenia is a common and serious oncological emergency which carries a substantial mortality and morbidity. The main objective of this study is to evaluate the usage of absolute monocyte count (AMC) at presentation as a prognostic factor for patients with chemotherapy-induced febrile neutropenia who were subsequently treated with granulocyte colony-stimulating factor (G-CSF). STUDY DESIGN: The electronic medical records of our center were used retrospectively to identify patients diagnosed with unprecedented chemotherapy-induced febrile neutropenia treated with G-CSF between January 2010 to December 2020 and diagnosed with solid and hematological malignancies. Patient's demographics, disease characteristics and laboratory investigations were extracted. Disease progression measures were statistically compared between the study groups in the short-term period of follow-up (six days) including absolute neutrophil count (ANC), ANC difference compared to the baseline readings, hospitalization period, and mortality. RESULTS: A total of 80 patients were identified and categorized into two groups namely monocytopenia (n = 34) and non-monocytopenia (n = 46) with an AMC cutoff point of 0.1×109 cells/L. The monocytopenia group exhibited a worse prognosis with lower ANC values and slower improvement illustrated by the low ANC difference values at all follow up points (P-value ≤ 0.05) apart from day 5. A statistically significant lower hospitalization period was also observed in the non-monocytopenia group (P-value = 0.006). Linear regression analysis evaluated the association between AMC values at admission and ANC values at admission along with subsequent days of follow up which were found to be statistically significant (P-value ≤ 0.05). Receiver operating characteristic curves suggest a satisfactory predictability of ANC changes by AMC values at admission, days1, 2, 3, 4 and 6. CONCLUSION: Monocytopenia holds a worse prognosis in chemotherapy-induced febrile neutropenia patients treated with G-CSF. In addition, AMC values at presentation represents a potential risk factor that can predict short-term changes regarding ANC measures.

Predictive Factors for Failure of Limb Salvage in Blunt Leg Trauma Associated with Vascular Injuries.

INTRODUCTION: Blunt leg trauma is common; however, it is rarely associated with significant vascular injury. This study was undertaken to determine the risk factors attributed to failure of limb salvage in acute postoperative period in blunt leg trauma with vascular injuries after revascularization. METHODS: A retrospective analysis was conducted of all patients with blunt leg trauma involving bone and soft tissue associated with vascular injuries. They were studied in terms of demographic data, associated comorbidities, mechanism of trauma, associated extra leg injuries, type and nature of bone fractures, soft-tissue injuries, nerve injuries, time of ischemia, Injury Severity Score (ISS), Mangled Extremity Severity Score (MESS), injured vascular segments, modality of vascular repair, modality of bone fixation, thrombosis at the site of vascular repair, complications, limb salvage failure, and mortality. RESULTS: Vascular injuries were identified in 45 arterial segments and 9 popliteal veins among 31 patients. The patients were 93% male, with a mean age of 31 years. The MESS ranged from 6 to 11, and the ISS ranged from 9 to 41. The main pathology of the injured vessels was contusion/thrombosis in 28 legs, which were repaired by interposition-reversed long saphenous vein graft. Seven patients developed postoperative thrombosis and underwent thrombectomy/embolectomy. Failure of limb salvage occurred in seven limbs with no mortality. CONCLUSIONS: Severe multi-segmental bone fractures, prolong ischemic time of >10 h, and MESS of ≥9 are significant predictors of limb loss in patients with blunt leg trauma in association with vascular injuries.

Complete remission of advanced low-grade endometrial stromal sarcoma after aromatase inhibitor therapy: a case report.

BACKGROUND: Low-grade endometrial stromal sarcoma is a rare neoplastic growth in the uterine cavity, representing less than 1% of uterine tumors. Such tumors usually affect premenopausal and perimenopausal women, with a mean age of 46 years. Treatment generally starts with surgical resection of the tumor, followed by chemotherapy, radiotherapy, or hormonal therapy. CASE PRESENTATION: In the current report, we again present a case of low-grade endometrial stromal sarcoma in a 51-year-old Mediterranean woman presenting with abdominopelvic pain. Computed tomography scan revealed a primary uterine tumor measuring 17 × 9 × 9 cm metastasizing to the lungs, bladder, and ureteral orifice, along with lymphovascular involvement. The patient underwent total abdominal hysterectomy, omentectomy, and lymph node dissection. Estrogen deprivation was accomplished by bilateral salpingo-oophorectomy. Lifelong hormonal therapy consisting of letrozole 2.5 mg per day was prescribed, which demonstrated remarkable efficacy, resulting in a partial remission of lung metastasis within 8 months after surgery. Full remission was observed after 18 months of hormonal therapy, with no recurrence. Another scan was performed after 2.5 years, revealing complete remission with no recurrence. CONCLUSION: We again report a case of complete remission of low-grade endometrial stromal sarcoma after surgical removal of the tumor along with first-line hormonal therapy without the use of chemotherapy or radiotherapy, emphasizing the role of hormonal therapy in the treatment of such tumors.

Intractable Biliary Candidiasis in Patients with Obstructive Jaundice and Regional Malignancy: A Retrospective Case Series.

BACKGROUND: Candida species are infrequently grown in bile cultures. An association between biliary candidiasis and regional malignancy may exist. The role of fungus membranes in frequent biliary stent occlusion is also presented in this case series. METHODS: We retrospectively identified patients who underwent percutaneous trans-hepatic cholangiogram (PTC) for obstructive jaundice between January 2014 and January 2019. The results of bile cultures - obtained by PTC - for all patients were analyzed, and patients with fungus growth were determined; their medical records were reviewed. RESULTS: A total of 71 patients with obstructive jaundice underwent PTC between January 2015 and January 2019. Five patients (all male; mean age 55.8 years) had candida species growth in bile cultures. Two patients were diagnosed with cholangiocarcinoma, one with adenocarcinoma of the head of the pancreas, one with gallbladder cancer, and one with locally advanced gastric adenocarcinoma. Formation of fungal balls predisposed to frequent PTC drain clogging. Eradication of Candida was achieved in 4 patients after 10 days to 3 weeks of antifungal therapy. CONCLUSION: We present a case series of biliary candidiasis in patients with obstructive jaundice and regional malignancy. We suggest that patients with obstructive jaundice and regional malignancy should be screened for biliary candidiasis. Persistent cholestasis may be caused by the recurrent formation of fungal membranes (balls).