Long-term outcomes of Ahmed tube implantation in pediatric glaucoma after multiple surgeries.

PURPOSE: To report success of Ahmed glaucoma valve (AGV) implantation in eyes with pediatric glaucoma and subconjunctival scarring from previous surgeries. METHODS: A retrospective review of pediatric glaucoma patients who underwent AGV implantation after ≥ 2 previous surgeries with conjunctival scarring. Preoperative and postoperative parameters were recorded to study success, defined as intraocular pressure (IOP) < 22 mmHg with or without medications and without serious complications. RESULTS: Eleven eyes of 10 patients were included, and the mean age was 12.7 years. Diagnoses included primary childhood glaucoma, aphakic glaucoma, and anterior segment anomalies. Mean number of prior ocular surgeries was 3.3 (± 1.3). Final mean IOP was 17.5 (± 4.3) mmHg, significantly different from the preoperative mean of 24.8 (± 6.8) mmHg, p = 0.01. Mean number of anti-glaucoma medications also decreased significantly from 2.8 (± 1.5) to 1.4 (± 1.5), p = 0.02. The success rate was 82% at a mean follow-up of 51.6 (± 10.8) months. Complications were minor and transient. CONCLUSION: Subconjunctival scarring did not increase the risk of failure of tube shunt surgery.

Mini-cognitive testing in patients with age-related macular degeneration.

PURPOSE: To compare Mini-Cognitive (Mini-Cog) Screening test results between patients with age-related macular degeneration (AMD) and age-matched controls. PARTICIPANTS: Two hundred and twenty-nine patients were included in the study. Patients were divided into 3 groups: 56 patients with exudative AMD, mean age of 76 ± 8 years; 82 patients with dry AMD, mean age of 77 ± 9 years; and 91 controls, mean age of 75 ± 8 years. METHODS: The Mini-Cog test, used to screen patients with early cognitive impairment, was introduced to the three groups of patients at the settings of an ophthalmology outpatient clinic. Test scores were compared between the groups. RESULTS: The mean for the Mini-Cog test scores was 3.5 (95% confidence interval, 3.15-3.85) for the dry AMD group, 3.95 (95% confidence interval, 3.51-4.39) for the exudative AMD group, and 4.63 (95% confidence interval, 4.45-4.80) for the control group. There was no statistically significant difference between the scores of AMD groups, however, both AMD groups received significantly lower scores than controls (P < 0.0001). CONCLUSION: Patients with age-related macular degeneration in this study demonstrated lower mean scores in the Mini-Cog test than age-matched controls. The Mini-Cog test may be easily applied at an office setting of ophthalmology outpatient clinics, and may help in the early diagnosis of cognitive impairment in the patients with AMD.

Amblyopia screening for first and second-grade children in Jordan.

AIM: To share the results of a national screening program for amblyopia in school children in the north of Jordan. METHODS: This is a prospective national screening study for amblyopia. The program rolls first and second-grade children (6 to 7 years old) in the north of Jordan. The eye examination included: best-corrected visual acuity, cover-uncover test, and cycloplegic retinoscopy. Monocular visual acuity was tested using an ETDRS visual acuity chart without correction. Moreover, children were tested with full cycloplegic refraction when the test criteria were met. Unilateral amblyopia was defined as a best-corrected visual acuity difference of 2 or more lines. In comparison, bilateral amblyopia was defined as a best-corrected visual acuity of 20/40 or worse in the best eye. RESULTS: The prevalence of amblyopia for the total sample tested (n=17 203) was 2.78% (n=479). The most common cause of amblyopia was hypermetropia (64.45%), followed by previous ocular surgeries (15.1%), myopia (10.43%), strabismus (9.39%), and congenital cataract (0.63%). CONCLUSION: This is the first and only study, identifing modifiable risk factors in Jordanian children with amblyopia. In their first couple of years of elementary education, many Jordanian children are affected by amblyopia and pass unnoticed. A more governmental effort is needed into screening programs to improve vision in the Jordanian population.

Role of bevacizumab intraocular injection in the management of neovascular glaucoma.

AIM: To assess the long-term effects of intraocular bevacizumab (Avastin) injections as an adjunctive drug to manage patients with neovascular glaucoma (NVG). METHODS: A retrospective study was conducted consisting of 34 eyes with secondary NVG caused by proliferative diabetic retinopathy (n=25), ischemic central retinal vein occlusion (n=8), and retinal ischemia resulting from persistent detachment (n=1) were managed by intraocular injections of bevacizumab (1.25 mg/0.05 mL), in addition to other treatments. The main outcome measure was the change in the degree of iris neovascularization. Secondary outcomes included intraocular pressure and the number of additional interventions or antiglaucoma medications administered after injection. RESULTS: All patients were followed-up for at least 12mo. At the last follow-up, complete regression of rubeosis irides was detectable in 13 (38.2%) eyes and incomplete regression in 21 eyes (61.8%). The mean intraocular pressure was 45.32±7.185 mm Hg at baseline and significantly decreased to 26.15±5.679 mm Hg at the last follow-up visit (P=0.000005). Patients received an average of 4.97 injections. As additional treatments, 12 eyes (35%) received laser photocoagulation and 6 eyes (18%) underwent retinocryopexy. No further treatment was needed in 16 eyes (47.1%). CONCLUSION: Intravitreal bevacizumab injection can have a favorable effect in controlling intraocular pressure and pain control in patients with NVG because it decreases the angiogenesis and helps to augment the results of conventional procedures. The primary cause of retinal ischemia should be always targeted.

Adverse drug reactions experience in a teaching hospital in Jordan.

BACKGROUND: Adverse drug reactions (ADRs) represent a major health care problem. OBJECTIVE: To identify the most common ADRs, drugs implicated in ADRs, and to assess their causality, severity, preventability and risk factors predisposing to reported ADRs in Jordan. SETTING: Al-Karak teaching hospital, southern of Jordan. Method A cross sectional observational study was carried out for 11 months from January to November 2013. Suspected ADRs were recorded in ADRs report forms and analyzed for causality, severity, and preventability. MAIN OUTCOME MEASURE: Most common ADRs, drugs involved in these ADRs, causality, severity, and preventability of suspected ADRs. RESULTS: A total of 64 reports were received. Some patients suffered more than one ADR. The total number of ADRs identified was 108. Forty one drugs were involved in causing these ADRs. About 2/3 of adverse reactions (73.4 %) did not cause admission to the hospital, whereas 26.6 % of the ADRs resulted in admission. Majority of the ADRs were type A (62.5 %). Most of ADRs (92.2 %) were assessed as probable. Nearly, 65.6 % of ADRs were categorized as mild. Majority of ADRs were assessed as "not preventable" (75 %). The most common classes of drugs involved in ADRs were antibiotics, analgesics, vaccines and antiepileptics. The most commonly identified ADRs were abdominal pain, skin rash, shortness of breath, fever, upper gastrointestinal bleeding and vomiting. Risk factors contributed to ADRs were age and polypharmacy. CONCLUSION: Jordanian healthcare providers should be aware of the importance of detecting and reporting ADRs, in order to prevent and reduce the incidence of ADRs. Awareness of risk factors predisposing to ADRs may help in identifying patients with higher risk and therefore reducing the risk of these ADRs and improving patient outcome.

Management of congenital lacrimal (anlage) fistula.

BACKGROUND/AIMS: To review management choices and outcomes for congenital lacrimal (anlage duct) fistulae performed by a single ophthalmologist over a 10-year interval. METHODS: All cases of congenital lacrimal fistulae with minimum follow-up of 1 year, seen and managed by the senior author (PJD) from 2000 to 2010, were retrieved from electronic medical records. Recorded data included demographic features, associated abnormalities of the lacrimal outflow apparatus and type of surgical intervention and outcome. RESULTS: 15 cases of lacrimal fistulae were identified. 67% were males, and mean age of presentation was 5 years. All presented with tearing from the eye or fistulous opening. Two patients had Down syndrome (13%). Mean follow-up was 7.3 years. While two cases required excision combined with endonasal dacryocystorhinostomy (DCR) or intubation, 9 of 11 (82%) operated cases were successfully treated with simple excision alone. Spontaneous resolution of symptoms occurred in 27% following successful treatment of concurrent nasolacrimal duct obstruction with lacrimal sac massage; in two of these cases, the fistulae were probed and found to have sealed spontaneously. The most common site of the fistula was at the inferior medial canthal area and was connected to the lacrimal sac or common canaliculus in all cases. CONCLUSIONS: Congenital lacrimal fistulae may be successfully treated with simple excision alone in most cases. Adjunctive DCR or intubation can be reserved for those identified to have lacrimal outflow tract abnormalities.

Neonatal orbital abscess.

Orbital complications due to ethmoiditis are rare in neonates. A case of orbital abscess due to acute ethmoiditis in a 28-day-old girl is presented. A Successful outcome was achieved following antimicrobial therapy alone; spontaneous drainage of the abscess occurred from the lower lid without the need for surgery. From this case report, we intend to emphasize on eyelid retraction as a sign of neonatal orbital abscess, and to review all the available literature of similar cases.

Ophthalmology residency training in Jordan: an evaluation of quality and comparison with international standards.

AIM: To evaluate Jordanian ophthalmology residency programs in achieving competencies outlined by the International Council of Ophthalmology (ICO) and residents' satisfaction with available training programs in Jordan, and to highlight weakness points that may be improved and strengthened. METHODS: A closed-ended questionnaire was circulated to all ophthalmologists who completed their training in Jordanian institutions between 2006 and 2011, to measure the quality of residency training and satisfaction level with regards to clinical conferences, journal clubs, scientific lectures, wet lab sessions, simulations, outpatient clinics and operating room training. Barriers to a successful board exam were cited. All ophthalmologists had official residency training in Jordanian Hospitals; this includes military, university, governmental and private sector hospitals. RESULTS: Sixty-one questionnaires completed out of 69 circulated. Males (75.4%) were more than females. Mean age was 32.5±3.27y. A total 21 (34.4%) responders expressed an overall satisfaction, 38 (62.3%) were dissatisfied and 2 (3.3%) were equivocal. Respondents reported insufficient exposure to low-vision rehabilitation 57 (93.4%), or refraction and glasses prescription 34 (55.7%). Regarding operative experiences, the mean cataract extraction per-resident was 43 cataracts; the number of phacoemulsification surgery was 2.96 per-resident, 46 (75.4%) of responders never did a single phacoemulsification during residency. Nine (14.8%) had training in refractive surgery, and 15 (24.6%) assisted orbital surgery. Forty-four (72.1%) never assisted in vitreoretinal surgery. Among The graduates surveyed, 14 (23.0%) passed Jordanian licensing board exam at the first attempt, and felt that their residency programs adequately prepared them for the examinations. CONCLUSION: Around two thirds (62.3%) of ophthalmologists expressed dissatisfaction with residency training at Jordanian programs, further study is required to assess each program separately and evaluate the system of accreditation in Jordanian residency programs.

Visual recovery after impalement injury of the orbit by reinforced steel bar.

Impalement injuries to the head and neck are quite rare, commonly lethal, and vision threatening when involving the orbit. Here, a case of impalement injury involving a steel bar to the neck and left orbit with full visual recovery is presented. The bar was removed, leaving non-displaced fractures of the floor of the left orbit and ethmoid bone. The disinserted left medial rectus was resutured. The perforated upper eyelid was sutured. The patient ended with mild ptosis.

Long-term visual outcomes of intravitreal bevacizumab in inflammatory ocular neovascularization.

PURPOSE: To assess the long-term role of bevacizumab (Avastin; Genentech Inc, South San Francisco, California, USA) in inflammatory ocular neovascularization. DESIGN: Retrospective multicenter consecutive case series of inflammatory ocular neovascularization. METHODS: settings: Multicenter institutional and private practices. STUDY POPULATION: Patients with inflammatory ocular neovascularization in one or both eyes of varying etiologies who failed standard therapy. intervention: Intravitreal injection of bevacizumab. MAIN OUTCOME MEASURES: Improvement of best-corrected visual acuity (BCVA) expressed as logarithm of minimal angle of resolution (logMAR), and decrease in central foveal thickness as measured by optical coherence tomography at 6, 12, 18, and 24 months of follow-up. RESULTS: Mean logMAR BCVA (central foveal thickness) following intravitreal bevacizumab was as follows: baseline, 0.65 (6/27 or 20/90) (338 microm; 99 eyes of 96 patients); 6 months, 0.42 (6/16 or 20/53) (239 microm; 2.0 injections; 81 eyes); 12 months, 0.39 (6/15 or 20/49) (241 microm; 2.3 injections; 95 eyes); 18 months, 0.40 (6/15 or 20/50) (261 microm; 3.0 injections; 46 eyes); and 24 months, 0.34 (6/13 or 20/44) (265 microm; 3.6 injections; 27 eyes). Paired comparisons revealed significant visual improvement at 6 months of 2.4 lines (P = .000), at 12 months of 2.5 lines (P = .000), at 18 months of 2.5 lines (P = .001), and at 24 months of 2.2 lines (P = .013). Paired comparisons revealed significant central foveal flattening at 6 months of 78 microm (P = .000), at 12 months of 85 microm (P = .000), at 18 months of 90 microm (P = .003), and at 24 months of 77 microm (P = .022). Three eyes developed submacular fibrosis and 1 eye submacular hemorrhage. CONCLUSION: Intravitreal bevacizumab led in the long-term to significant mean visual improvement of > or =2.2 lines and significant foveal flattening in a wide variety of inflammatory ocular diseases without major complications.