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.

Traumatic wound dehiscence after penetrating keratoplasty: Clinical features and outcome in 53 cases in Yemen.

AIMS: Penetrating keratoplasty (PKP) carries the risk of developing wound dehiscence, which can lead to vision loss. The main aim of this study is to analyze the management and outcome of surgery for traumatic wound dehiscence occurring in patients who had PKP. SUBJECTS AND METHODS: This retrospective study included post-PKP patients who sustained traumatic wound dehiscence at the Cornea Unit in Yemen Magrabi Eye Hospital between 2008 and 2016. Fifty-three eyes with a history of wound dehiscence were treated with primary wound closure. Patient files were reviewed for type and time of injury, distance visual acuity (VA), and outcome. RESULTS: Ruptured globe with dehiscence of wound occurred on average 2.4 years (3 months to 13 years) after PKP. The mean age at wound dehiscence was 22.27 years and males accounted for 77.4% (41). All patients were managed with primary closure of the wound. Lensectomy of traumatic or dislocated lens was the most frequent additional surgical procedure (14, 26.4%), followed by anterior vitrectomy (6, 11.3%). In the end, 43 (81.1%) grafts remained clear. In the last follow-up, 34 eyes (64.1%) had best-corrected VA of 20/200 or better and two eyes had no perception of light. CONCLUSION: Rupture globe and wound dehiscence occurs after PKP at the graft-host junction. Wound dehiscence is a lifelong risk after PKP and wound weakness persisted for a long period after PKP. Visual outcome and graft survival are generally poor after the injury, and the restoration of a satisfactory visual result is possible if treated early.

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.

Ophthalmic services during ongoing conflict: the eye health system in Yemen.

There is little information on the provision of ophthalmic services and the eye health system in Yemen. Using the WHO framework for analysing health systems, we aim to assess what is known about the current eye health system in Yemen with ongoing conflict. Financial constraints, transportation difficulties and security instability are barriers for many of Yemen's people in need of healthcare. The most recent cataract surgical rate reported in 2012 is 2473 operations per million population, with an increase in operations performed in charity eye camps and the private sector. We identify many governorates of Yemen have inadequate ophthalmic resources. We describe the need for short-term solutions to reduce the backlog prevalence of blindness while local infrastructure is rebuilt, and the importance of long-term reconstruction and transition to local ownership with a sustainable workforce and health service as peace is restored.

Clinical phenotyping of newly diagnosed type 2 diabetes in Yemen.

OBJECTIVE: To identify clinical phenotypes of type 2 diabetes (T2D) among adults presenting with a first diagnosis of diabetes. RESEARCH DESIGN AND METHODS: A total of 500 consecutive patients were subject to clinical assessment and laboratory investigations. We used data-driven cluster analysis to identify phenotypes of T2D based on clinical variables and Homeostasis Model Assessment (HOMA2) of insulin sensitivity and beta-cell function estimated from paired fasting blood glucose and specific insulin levels. RESULTS: The cluster analysis identified three statistically different clusters: cluster 1 (high insulin resistance and high beta-cell function group), which included patients with low insulin sensitivity and high beta-cell function; cluster 2 (low insulin resistance and low beta-cell function group), which included patients with high insulin sensitivity but very low beta-cell function; and cluster 3 (high insulin resistance and low beta-cell function group), which included patients with low insulin sensitivity and low beta-cell function. Insulin sensitivity, defined as median HOMA2-S, was progressively increasing from cluster 1 (35.4) to cluster 3 (40.9), to cluster 2 (76) (p<0.001). On the contrary, beta-cell function, defined as median HOMA2-ß, was progressively declining from cluster 1 (78.3) to cluster 3 (30), to cluster 2 (22.3) (p<0.001). Clinical and biomarker variables associated with insulin resistance like obesity, abdominal adiposity, fatty liver, and high serum triglycerides were mainly seen in clusters 1 and 3. The highest median hemoglobin A1c value was noted in cluster 2 (88 mmol/mol) and the lowest in cluster 1. CONCLUSION: Cluster analysis of newly diagnosed T2D in adults has identified three phenotypes based on clinical variables central to the development of diabetes and on specific clinical variables of each phenotype.

Emergency visits after corneal transplantation in Yemen.

PURPOSE: Awareness of symptoms and signs of possible complications after corneal transplantation is very important. Early presentation can enhance long-term survival of the cornea. This study evaluates the reasons for emergency presentation and management of postcorneal transplantation complications. PATIENTS AND METHODS: This retrospective study included a total of 134 postkeratoplasty patients at the cornea unit in Yemen Magrabi Eye Hospital in Sana'a between 2008 and 2010. RESULTS: The most common indication for keratoplasty was keratoconus in 103 patients (76.9%) followed by bullous keratopathy (4.5%) and corneal dystrophy (4.5%). 80 (59.7%) patients presented for emergency visits. Pain and foreign body sensation were the main presenting symptoms. Loose irritating sutures (29.9%) and graft rejection (10.4%) were the most common diagnoses. Twelve patients (8.9%) were admitted to the hospital for re-suturing. CONCLUSION: Proper postoperative care is critical for a successful keratoplasty; early intervention of sight-threatening complications increases the chance of graft survival and best-obtained vision. In our corneal transplantation service, all patients are routinely instructed to arrange a same day emergency visit if they experience any symptom in eyes that have undergone keratoplasty.

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.

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.

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.

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.

Effect of Khat (Qat) consumption on pain during and after local anesthesia for patients undergoing cataract surgery.

BACKGROUND: The leaves of the Khat (Qat) plant (Catha edulis), which contain amphetamine-like compounds, are widely chewed in Yemen and East Africa for their pleasurable stimulant properties and for their psychostimulative effects. Khat consumption has a number of unwanted side-effects. This study investigates effects of Khat consumption on the quality of local anesthesia with peribulbar injection and patient perception of pain after administration of local anesthesia for routine cataract extraction. MATERIAL/METHODS: This single-center, prospective trial included 323 consecutive patients undergoing routine cataract extraction for senile cataract. Cataract surgery was performed within 10 minutes of the administration of local anesthesia. The patients were divided into 2 groups: Group A for those who are consuming Khat on a regular basis and Group B for those who had not consumed Khat within the last 3 months. To assess pain experience during injection, intraoperatively, and postoperatively, each patient was asked to use a 10-point pain score chart. RESULTS: The study included 164 males and 159 females. There were 121 patients (37.5%) in Group A and 202 patients (62.5%) in group B. All patients had peribulbar local anesthesia by 2-site injections. Group A had significantly greater pain scores during injection (p=0.000821) and intraoperatively (p=0.000001), but there was no difference in pain score postoperatively. CONCLUSIONS: Khat consumption decreases pain threshold and affects patients' comfort during local anesthesia and during surgery in routine cataract surgery. Patients consuming Khat need more care during local anesthesia to make the surgery comfortable.

Point prevalence of pseudoexfoliation syndrome in patients scheduled for cataract surgery in eye camps in yemen.

PURPOSE: To study the point prevalence of pseudoexfoliation syndrome (PXS) among Yemeni patients in different governorates with age-related cataract scheduled for surgery. SETTINGS: Eye camps organized by the Nibras Health Society to perform cataract surgeries during the years 2002-2006. All patients aged 40 years and above were included in the study. MATERIALS AND METHODS: A total of 2535 eyes of 2535 patients from 13 governorates, scheduled for cataract surgery in eye camps, were included. All eyes underwent complete eye examination before the surgery and were evaluated for the signs of pseudoexfoliation material in the pupil, iris and lens capsule on dilated slit lamp examination. RESULTS: The study found 495 of the 2535 eyes (19.53%) with PXS with males more commonly affected than females (55.2 and 44.8%, respectively). The mean age of patients with PXS was 66.2 years while it was 64.6 years in non-PXS patients. The prevalence of pseudoexfoliation syndrome increased with age (10.1% in the age group of 41-50 years that increased to 28.8% in the age group of more than 81 years old). The rate of PXS detection in camps in 13 governorates ranged from 13.33 to 24.22% with an overall rate of 19.53%. The lowest rate was noticed in Sana'a and the highest in Al-Dhale governorate. CONCLUSION: This pilot study confirms that PXS was common in patients undergoing cataract surgery in Yemen with an increased detection rate with age. This study also highlights the prevalence of an ocular disease that is associated with systemic and ocular complications; however, further studies based on population studies are needed.

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.

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.

Reasons for not performing LASIK in refractive surgery candidates in Yemen.

PURPOSE: To determine and analyze the reasons that laser in situ keratomileusis (LASIK) was not performed in patients who requested refractive surgical correction of their refractive errors. METHODS: A retrospective observational study was performed in Yemen Magrabi Hospital between June 2005 and October 2006; the case records of 1596 new consecutive patients who presented for refractive surgery at our refractive surgery unit were reviewed. Data on the ocular status, refractive problems, and investigations performed were analyzed. The reasons for not performing LASIK in the cases that were rejected were recorded and analyzed. RESULTS: A total of 1191 patients (74.6%) were advised to have LASIK of the 1596 patients examined. LASIK was not advised in 405 patients (25.4%). The most common reasons for rejecting LASIK were suboptimal central corneal thickness (25.9%), high myopia >-11.00 D (17.0%), keratoconus (15.5%), cataract (11.4%), and suspicious corneal topography (forme fruste keratoconus) (9.4%). CONCLUSIONS: Patients who request refractive surgery have a variety of problems and attention must be given to these patients. Suboptimal corneal thickness, high amount of refractive error, and keratoconus were found to be the leading causes of not performing LASIK in Yemeni patients.