Assessment of refractive outcomes in eyes that underwent intraocular lens implantation in the posterior chamber but not "in-the-capsular bag:" A comparative retrospective study.

PURPOSE: The purpose of this study was to report visual and refractive outcomes in eyes that underwent intraocular lens (IOL) fixation in the absence of capsular support. METHODS: This was a retrospective chart review of cases undergoing posterior chamber iris-fixated IOL (IFIOL) and scleral-fixated IOL (SFIOL) implants from June 2014 to March 2020 with more than 3 months of follow-up and having a preoperative best-corrected visual acuity of 20/80 and more. RESULTS: Records of 120 eyes of 112 patients were reviewed. The mean age of the patients was 46.9 ± 22.3 (14.4-98.0) years, and 62% (n = 70) of participants were male. Most of the eyes (102: 85%) were aphakic at the time of surgery. The mean follow-up was 22.95 ± 17.1 months. The efficacy index of sutured IFIOL and glued SFIOL outperformed sutured SFIOL at 3 months and final visits postoperatively (P < 0.001). All techniques studied here resulted in a similar safety index at 3 months (P = 0.4). The mean predictive error (postoperative spherical equivalent refraction minus intended target refraction) was +0.07 ± 1.5 D and -0.12 ± 1.4 D at 3 months and the final postoperative visit, respectively. CONCLUSION: The studied techniques have relatively good visual and refractive outcomes in this series. In addition, techniques involving a small corneal incision with foldable IOL fixation to the iris or scleral tissue have superior efficacy and safety indices compared to creating large corneoscleral wounds for rigid IOL fixation techniques.

Micropulse transscleral cyclophotocoagulation (MP-CPC): efficacy endpoints for the treatment of refractory paediatric glaucoma - a retrospective case-series.

BACKGROUND: This study evaluates the efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-CPC) in paediatric patients. METHODS: This retrospective case-series recruited 44 eyes for glaucoma patients who were younger than 17 years and were treated with MP-CPC and followed for at least one year. Pre- and post-intervention intraocular pressure (IOP) was compared out to at least one year postoperatively. Success rates at 6 months and 1 year postoperatively were assessed. P < 0.05 was considered statistically significant. RESULTS: There were 35 (79.5%) eyes with a history of glaucoma surgery. IOP decreased statistically significantly from a baseline of 32.7 (standard deviation:8.7 mmHg) to 23.2 (8.6) and 21.7 (7.9) mmHg at the 6 months and 1-year follow-up, respectively (P < 0.0001, all comparisons). Overall success was noted in 19 (47.5%) eyes at the 6 months follow-up, and 23 (53.5%) eyes at 1 year. CONCLUSIONS: MP-CPC reduces IOP and the burden of medications in paediatric patients with glaucoma. Additionally, its safety profile favours the use of MP-CPC as an adjunctive modality for refractory glaucoma.

Ocular manifestations of children with atopic dermatitis in Saudi Arabia.

AIM: To examine the incidence of ocular abnormalities in children with atopic dermatitis (AD) in Saudi Arabia and its association with the severity of AD. METHODS: This is a cross-sectional study on 50 children with AD who were between 5 and 16 years of age. The severity of AD was evaluated using the SCORing Atopic Dermatitis (SCORAD) index. All the children underwent slit lamp exams, visual acuity assessment, intraocular pressure measurement, and corneal topography. The children were considered to have an ophthalmic abnormality if one or more of the following signs were present: glaucoma, keratoconus suspicion, in addition to lid, conjunctival, corneal, lenticular, or retinal abnormalities. RESULTS: Based on the SCORAD severity index, 14% of children had mild AD (7/50), 38% had moderate AD (19/50), and nearly half had severe AD. More than half the children exhibited facial involvement, and half had peri-orbital signs. The mean SCORAD index was 35.75. The mean age was 10.48±3.6y, and the cohort showed a slight male predominance (54% males). Both eyes of the 50 children in the cohort were studied. Based on the ocular examinations, 92% of the patients showed ocular abnormalities: lid abnormalities (27/50) followed by keratitis (22/50). Four patients had moderate risk for keratoconus in one eye and eight patients were suspected to have keratoconus. However, SCORAD severity index was not associated with age, sex, or the number or presence of ophthalmic abnormalities. CONCLUSION: This is the first study in Saudi Arabia to evaluate the prevalence of ocular manifestations in children with AD. The results indicate that the majority of children with AD have ocular abnormalities that mainly include lid abnormalities. Based on these findings, larger scale studies are needed to affirm whether regular screening for ophthalmic abnormalities would be beneficial for children with AD in terms of early intervention and prevention of sight-threatening complications.

Performance of dialysis patients on the standard and basic Arabic versions of the Montreal Cognitive Assessments.

OBJECTIVES: To assess cognitive performance in Saudi patients on dialysis using Arabic versions of the Montreal Cognitive Assessment (MoCA) and assess the reliability of the scales. METHODS: We performed a cross-sectional study at the dialysis unit of King Saud University Medical City, Riyadh from April 2019 to March 2020. Patients ≥ 18 years of age with no history of dementia underwent cognitive assessment with the standard (MoCA-A) and basic (MoCA-B) Arabic versions, with repeat testing in a subset of participants. RESULTS: Recruitment included 83 participants, 56 on hemodialysis (HD) and 27 on peritoneal dialysis (PD). The mean±SD for age was 49.99 (15.48), and for years of education was 10.29 (5.5). The mean score for MoCA-A was 21.03±5.35, and for MoCA-B was 23.45±5.14. Younger age, longer years of education and peritoneal dialysis were significantly associated with higher MoCA scores on both versions (p<0.05). The ICC was 0.81 (95% CI 0.65, 0.91) and 0.77 (95% CI 0.58, 0.89) for MoCA-A and MoCA-B, respectively. The performance on the executive and calculation tasks were higher in the PD group on the MoCA-B. The recall mean score was higher in the PD group on the MoCA-A. CONCLUSION: The HD patients are at higher risk for cognitive impairment compared to PD patients. Age and education are important variables influencing performance. Both Arabic versions of the MoCA are reliable screening tools.

"Smart Optometry" phone-based application as a visual acuity testing tool among pediatric population.

OBJECTIVES: To evaluate the validity of a smartphone-based application for visual acuity (VA) testing in children and to compare parent and clinician-performed VA to standard VA assessment. METHODS: A cohort of 100 children aged <18 years old was recruited. Subjects were randomly assigned to either start with conventional distance VA chart screening or the smartphone VA assessment twice by both the clinician and the caregiver if applicable. Near VA scores were assessed using the near vision E chart. Accuracy and reliability values were analyzed. RESULTS: One hundred patients with an average age of 9.92 ± 3.0 years old were enrolled. The difference between conventional distance and application logMAR values was -0.023, and the difference between near vision and application logMAR values was -0.004. "Smart Optometry" had a sensitivity of 89.3% in detecting subnormal VA compared with conventional vision testing methods. Sensitivity in detecting subnormal VA was found to be higher in younger age groups up to 91.7% in comparison with the older age groups. The interclass correlation of application-measured VA scores by the caregivers and the clinician were 0.77 (95% CI; 0.67-0.83) using single measures and 0.87 (95%CI; 0.8-0.9) using average measures. CONCLUSION: "Smart Optometry" phone application was found to be an acceptable home-based VA testing tool with good inter-rater reliability for young children showing good sensitivity in detecting subnormal VA, but lower sensitivity in detecting amblyopia.

Comparison of Performance on the Clock Drawing Test Using Three Different Scales in Dialysis Patients.

BACKGROUND: The clock drawing test (CDT) is frequently used to detect changes in cognition. Multiple scales of varying length have been published to assess performance. The aim of this study is to compare the CDT performance measured by three scales among a sample of nondemented patients on renal dialysis and identify the variables that affect performance. Methodology. This is a cross-sectional study performed at the dialysis unit at King Saud University Medical City. Eighty-nine dialysis patients performed the CDT. The CDT was scored by the methods of Rouleau et al. (RCS 10-point), Babins et al. (BCS 18-point), and the MoCA (MCS 3-point). Regression models were used to determine influencing demographic and dialysis variables. Scores were then correlated, and a combined factor analysis of scale components was done. RESULTS: Females represented 44.6%, the mean (SD) age was 49.99 (15.49) years, and education duration was 10.29 (5.5) years. Dialysis vintage was 55.81 (62.91) months. The scores for the MCS, RCS, and BCS were 2.18 (1.08), 6.67 (3.07), and 11.8 (5.5), respectively, with significant correlation (P < 0.0001). In all scales, increasing age was associated with a lower score (each P < 0.0001). The scores increased with increasing education (each P < 0.0001). Diabetics had a lower score on both the BCS and MCS by 2.56 (SE 1.2) (P = 0.035) and 0.71 (P = 0.003) points, respectively. However, only age and years of education were significant in the multivariable analysis. In factor analysis, two shared factors appeared between the three scales: hand and number placement and the clock face. CONCLUSION: Age and education influence the performance on the CDT, and factors diverged into executive and visuospatial components. The MCS is likely to yield useful information but should be interpreted as part of the MoCA.

The Relationship between Cognitive Impairment and Coronary Artery Disease in Middle-aged Adults.

Background Cognitive impairment is a phenomenon that appears late in many diseases. Many clinicians do not seriously consider cognitive impairment until there has been significant deterioration over time. Cognitive function can be assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB). Methods Using an observational case-control study design, we examined the relationship between coronary artery disease (CAD) and cognitive impairment. Participants (57 patients with CAD and 60 healthy controls; age: 30-60 years) were recruited and sampled using a non-probability quota sampling technique. Self-administered questionnaires were used to collect data about participants' demographic information. Blood chemistry samples were obtained to evaluate patients for CAD. Mini-Mental State Examination (MMSE) and CANTAB using three subsets including intra-extra dimensional set shift, spatial span (SSP), and pattern recognition memory (PRM) were used to assess participants' cognitive function. Results The SSP and PRM were significantly lower in patients with CAD as compared with healthy controls. There were significant relationships of PRM with creatine kinase- muscle/brain, aspartate aminotransferase, and total cholesterol. On the other hand, SSP was found to have a significant relationship with triglycerides. Conclusion There is cognitive impairment in CAD patients that needs to be assessed for early interventions to maintain cognitive functions.