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.

Posterior vitreous detachment and retinal detachment after implantation of the visian phakic implantable collamer lens

To evaluate the vitreoretinal complications in myopes after Visian implantable collamer lenses [ICL] implantation. 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. 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%. 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

To compare preoperative and postoperative visual outcomes, determine patient's satisfaction, and evaluate visual symptoms after implantable collamer lens [ICL] implantation. 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, Sanaa, 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. 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. 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

retrospective analysis of the first Yemeni experience on Artisan phakic intraocular lens for the treatment of moderate and high myopia

To evaluate the outcome and safety of the iris-fixated Artisan phakic intraocular lens [PIOL] for the correction of moderate and high myopia. 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. 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. 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

The objective of this study was to assess the ocular complications and visual loss among patients with severe vernal keratoconjunctivitis [VKC]. 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. 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 keratoco-nus [7]; steroid-induced cataract [5], central corneal scars [5] and steroid-induced glaucoma [3]. Two of the keratoconus cases developed acute hydrops. 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 unsuper-vised use of topically administered corticosteroids

Intraoperative and early postoperative complications of laser in situ keratomileusis in Yemen

To determine the intraoperative and early postoperative complications and visual outcome of laser in situ keratomileusis [LASIK] surgery for the correction of myopia. 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 complication were reviewed. 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. 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 keratorefractive surgery in patients seeking refractive surgery in a hospitAl based cohort in "Yemen"

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. 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. 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%]. 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

Vitreoretinal complications in Yemeni patients with keratorefractive surgery

To evaluate vitreoretinal complications in patients undergoing laser keratorefractive surgery. 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. 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. 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

Prophylactic measures used for the prevention of postoperative endophthalmitis after cataract surgery. A survey of routine practice in Yemen

This study documents the current practice of perioperative prophylactic methods used for cataract surgery in Yemen. It investigates the routine practice in antibiotic and antiseptic use in preventing postoperative endophthalmitis. This is a non-comparative survey. A telephone interview survey was conducted with 100 ophthalmologists' from different governorates in Yemen in September 2008. A questionnaire was used to ask the ophthalmic surgeons. The practices of 100 ophthalmologists were contacted. Five ophthalmologists did not perform cataract surgery routinely. Of the remaining 95 respondents, all performed extracapsular cataract extraction and 5 also performed phacoemulsification. Preoperative topical antibiotics were routinely prescribed by 12 [12.6%] cataract surgeons. Before the start of the procedure, 21 [22.1%] used 10% povidone-iodine to prepare the skin and 5 [5.3%] instilled 5% povidone-iodine in the conjunctival sac. Intracameral antibiotics or antibiotic in the irrigating fluid were not given by any of the surgeons. All gave subconjunctival antibiotics mostly gentamicin. Postoperatively, 25 [26.3%] used a combination steroid and antibiotic eyedrop and 70 [73.7%] gave a separate eyedrop and 39 [41.1%] gave systemic antibiotics. This study reveals a wide variation of prophylactic measures used by Yemeni ophthalmologists. All surgeons used intraoperative subconjunctival gentamicin and postoperative topical antibiotic. A significant majority [94.7%] are failing to use preoperative conjunctival povidone-iodine, despite its widespread acceptance as the only convincingly proven prophylactic method. The routine practices adopted reflect personal preferences, and were not necessarily evidence-based

Ninety degree conjunctival rotation autograft versus zero and 180 degree rotation autograft for pterygium surgery

To evaluate the safety, efficacy, and recurrence of pterygium following 90 degrees versus zero degrees and 180 degrees rotation autograft for treating primary pterygium. We included in this observational, prospective, and comparative study, 74 patients [47 males, 27 females] with advanced primary pterygium, with a mean age of 47.5 years [range 19-79 years]. This study was conducted in Kuwait University Hospital between February 2004 to March 2006. The excision was under local anesthesia using an operating microscope with rotation autograft taken from upper temporal bulbar conjunctiva by total excision, and free transposition to the bare sclera. We treated 38 eyes by 90 degrees rotation, 15 eyes by 0 degree rotation, and 21 eyes by 180 degrees rotation. With a one-year follow-up, the recurrence rates [regrowth of the pterygium more than 1 mm over the cornea] were 3% in 90 degrees rotation, 28.6% in 0 degree rotation, and 15.8% in 180 degrees rotation [p=0.033]. The overall recurrence rate for all rotation autograft surgeries was 10.8%. In this study, all techniques were effective, and 90 degrees rotation autograft is safe and an easy procedure to perform for management of pterygium, with a lower recurrence rate compared with the 0 degree and 180 degrees rotation autograft [p=0.033]. The position or the presence of stem cells of the corneal epithelium is not important in the outcome of the pterygium surgery

Orbital hydatid Cyst: an unusual presentation

To describe an unusually large hydatid cyst of the orbit causing loss of vision and proptosis of the eyeball. A detailed investigation, consisting of radiological and hematological studies, was carried out to determine the cause of the proptosis. The patient underwent orbital exploration for the presumed diagnosis of orbital echinococcosis. The cyst was removed surgically. The CT scan and surgical findings of the cyst removed confirmed the diagnosis of orbital hydatid cyst. Hydatid cyst is an endemic disease in Yemen. The diagnosis of orbital hydatid cyst should be considered in the differential diagnosis of unilateral severe proptosis. The main treatment for orbital hydatid cyst is complete surgical removal of the cyst