Influence of GlideScope assisted endotracheal intubation on intraocular pressure in ophthalmic patients

Traditional Macintoch laryngoscopy is known to cause a rise in intraocular pressure [IOP], tachycardia and hypertension. These changes are not desirable in patients with glaucoma and open globe injury. GlideScope is a video laryngoscope that functions independent of the line of sight, reduces upward lifting forces for glottic exposure and requires less cervical neck movement for intubation, making it less stimulating than Macintosh laryngoscopy. The aim was to assess the variations in IOP and hemodynamic changes after GlideScope assisted intubation. After approval of the local Institutional Research and Ethical Board and informed patient consent, 50 adult American Society of Anesthesiologist I and II patients with normal IOP were enrolled in a prospective, randomized study for ophthalmic surgery requiring tracheal intubation. In all patients, trachea was intubated using either GlideScope or Macintoch laryngoscope. IOP of nonoperated eye, heart rate and blood pressure were measured as baseline, 1 min after induction, 1 min and 5 min after tracheal intubation. IOP was not significantly different between groups before and after anesthetic induction and 5 min after tracheal intubation [P = 0.217, 0.726, and 0.110 respectively]. The only significant difference in IOP was at 1 min after intubation [P = 0.041]. No significant difference noted between groups in mean arterial pressure [P = 0.899, 0.62, 0.47, 0.82 respectively] and heart rate [P = 0.21, 0.72, 0.07, 0.29, respectively] at all measurements. GlideScope assisted tracheal intubation shown lesser rise in IOP at 1 min after intubation in comparison to Macintoch laryngoscope, suggesting that GlideScope may be preferable to Macintosh laryngoscope

Resources for eye care at secondary and tertiary level government institutions in Saudi Arabia

To evaluate the number of healthcare personnel and equipment resources for eye care at government institutions in different administrative zones of the Kingdom of Saudi Arabia [KSA] and to recommend measures for increasing resources to address deficiencies. Data on resources [personnel and equipment] for eye care were collected from all governmental eye units in 2012. The data was regrouped by zones and administrative areas. The mid-2012 population projections were used to calculate the ophthalmologist to population ratio and optometrist to population ratio. The equipment available for eye care was reviewed. All 60 institutions in 13 administrative areas and five zones of KSA participated in this study. There were 407 ophthalmologists and 147 optometrists. The ophthalmologist to population ratio was 1:43,000 [1:12,900 in the northern zone to 1:80,300 in the western zone]. By 2015, 700 ophthalmologists will be required, and by 2020, 1,100 ophthalmologists will be required. The optometrist to population ratio was 1:95,000 [1:34,100 in the northern zone to 1:146,700 in the western zone]. Nearly 2,800 and 4,400 allied eye care personnel will be needed by 2015 and 2020. Diagnostic and treatment equipment such as lasers, electrophysiologic and ultrasound equipment, and fundus cameras were not available at all institutions. Data from the private sector need to be included to draw conclusions on the human resource index for eye care in the Kingdom. An unequal distribution of resources in different zones and administrative areas requires attention. Better utilization of available resources is recommended before fulfilling the demand for additional resources.

Management of recurrent pterygium

To evaluate the outcome following surgical excision of recurrent pterygium, the efficacy of adjunctive therapy utilized in conjunction with excision of recurrent pterygium, and the complications of surgical intervention. A retrospective study of 77 eyes of 77 patients at the King Khaled Eye Specialist Hospital in Riyadh who had surgical excision of recurrent pterygium between January 1991 and December 2000, and were followed up for more than three months. Fifty-one patients had simple excision with conjunctival autograft, 12 patients had simple excision, 7 had simple excision with application of mitomycin C, 4 had simple excision with conjunctival autograft and mitomycin C, 2 had excision of pterygium with amniotic membrane transplant [AMT], and 1 had excision with cryotherapy of the pterygium bed. The rate of recurrence was 27, 17, 1.4, 0.0, 0.0, and 100 percent respectively; no serious complication was encountered for any of these procedures. As the recurrent rate in secondary pterygium is high, simple excision cannot be considered as the only option. Simple excision and AMT showed impressive and promising results, and could be considered as a first procedure for recurrent pterygium

Corneal perforation in a patient with behcet's disease

To report a rare case of Behcet's disease with corenal perforation as an ocular manifestation. a young patient was presented with corenal perforation as an ocular manifestation for behcet's disease. Young patient with a known case of systemic behcet's disease presented with corenal perforation treated by cyanocarylate glue as primary stage then lamellar keratoplasty to improve his visual acuity. behcet's disease can present rarely with corenal perforation as ocular manifistation with perilimbal vascularization. this unusual case reiterates that behcet's disease is essentially a clinical diagnosis. an awareness of the varied presentation, together with a detail history and physical examination, as well as consultations among various specialties is essential in order not to miss the diagnosis

Acanthamoeba keratitis at the King Khaled Eye Specialist Hospital

Purpose: To quantify the number of cases and clinical course of Acanthamoeba keratitis treated at the King Khaled Eye Specialist Hospital [KKESH] between December 1982 and May 2005, and to review their clinical course and response to medical and surgical therapy. Retrospective review of medical records of all patients with Acanthamoeba keratitis diagnosed by the KKESH Microbiology or Pathology Laboratory since the opening of the hospital. During a period of over 22 years, only six cases of confirmed Acanthamoeba keratitis were diagnosed and treated at KKESH. In two cases the diagnosis was made by cornea1 biopsy, while four cases required examination of a histopathologic specimen obtained at the time of therapeutic keratoplasty to establish the diagnosis. One eye was cured by medical therapy, while five eyes required one [4 eyes] or two [1 eye] therapeutic penetrating keratoplasty [PKP] to achieve a clinical cure. Three eyes achieved good visual acuity [20/40, 20/50, 20/60], one eye achieved fair visual acuity [20/160], and two eyes suffered profound visual loss [hand motions]. The incidence of Acanthamoeba keratitis may be less in Saudi Arabia than that reported in Western countries although the clinical course is similarly complicated, with most cases requiring therapeutic keratoplasty for definitive eradication of the organism