Development of a web-based glaucoma registry at King Khaled eye specialist hospital, Saudi Arabia: a cost-effective methodology

In this brief communication, we present the steps used to establish a web-based congenital glaucoma registry at our institution. The contents of a case report form [CRF] were developed by a group of glaucoma subspecialists. Information Technology [IT] specialists used Lime Survey softwareTM to create an electronic CRF. A MY Structured Query Language [MySQL] server was used as a database with a virtual machine operating system. Two ophthalmologists and 2 IT specialists worked for 7 hours, and a biostatistician and a data registrar worked for 24 hours each to establish the electronic CRF. Using the CRF which was transferred to the Lime survey tool, and the MYSQL server application, data could be directly stored in spreadsheet programs that included Microsoft Excel, SPSS, and R-Language and queried in real-time. In a pilot test, clinical data from 80 patients with congenital glaucoma were entered into the registry and successful descriptive analysis and data entry validation was performed. A web-based disease registry was established in a short period of time in a cost-efficient manner using available resources and a team-based approach.

Transcorneal tube erosion of an Ahmed valve implant in an adult

Ahmed valve implants are currently used to manage high-risk complicated adults and pediatric glaucoma when standard filtration surgery is unsuccessful. Despite its success, the Ahmed valve shunt has significant complications particularly in the anterior segment. We report an unusual case of transcorneal tube erosion of an Ahmed valve implant in an adult that resulted from long-standing tube-corneal touch. Periodic observation of tube position is recommended

Glaucoma after pediatric cataract surgery

To compare glaucoma after pediatric cataract surgery in children who did and children who did not undergo primary posterior chamber lens [PCIOL] implantation. Retrospective case series. An institutional retrospective chart review was performed of all patients who underwent pediatric cataract surgery with and without primary PCIOL implantation before the age of 12 years [from January 1985 to February 2003]; the review excluded microcornea and any condition independently associated with glaucoma. Patients had a minimum of 5 years [60 months] postoperative follow up, which had to include intraocular pressure measurements. The outcome measure was the presence or absence of post pediatric cataract surgery glaucoma, defined as persistently elevated intraocular pressure >/= 28 mmHg, as measured on at least 2 occasions with confirmation of the diagnosis by the treating ophthalmologist. A total of 489 pseudophakic eyes and 269 aphakic eyes met our inclusion criteria. Eight eyes [1.6%] out of the 489 pseudophakic eyes were diagnosed with glaucoma, whereas 62 eyes [23%] out of the 269 aphakic eyes were diagnosed with glaucoma. Mean age at time of surgery for the pseudophakic eyes was 45.6 months [standard deviation [SD] +/- 32.3] and for the aphakic eyes was 10.1 months [SD +/- 18.9]. Mean follow up period postoperatively was 70.4 months [SD +/- 12.5] and 123.7 months [SD +/- 66.2] in the pseudophakic and aphakic eyes respectively. The presence of postoperative complication [s] as well as the need for further intraocular surgery was risk factors for glaucoma development in the aphakic eyes. Glaucoma was diagnosed at an earlier onset in the pseudophakic eyes compared with the aphakic eyes [15.8 months +/- 18.8 vs 59.0 months +/- 44.0, P <0.0001]. Glaucoma control was more difficult in the aphakic eyes than in the pseudophakic eyes. Pseudophakic eyes had a significantly lower glaucoma incidence than aphakic eyes; however, because surgery was performed later in pseudophakic eyes we cannot conclude a protective effect from primary PCIOL implantation. Early age at cataract surgery as well as the presence of postoperative complication [s] and the need for further intraocular surgery [s] are risk factors for glaucoma development. Glaucoma after cataract surgery before 10 months of life tends to occur later and to be more difficult to control

Glaucoma in phacomatosis pigmentovascularis type II B associated with sturge-weber syndrome

We report a 28-year-old lady with phacomatosis pigmentovascularis type lib associated with Sturge-Weber syndrome, with ocular evidence of both conditions. Phacomatosis pigmentovascularis type lib is a rare condition characterized by coexistence of naevus flammeus and pigmentary naevi. This is the second phacomatosis pigmentovascularis and the first glaucoma case associated with phacomatosis pigmentovascularis described in Saudi Arabia

Outcome of capsule excision for bleb encapsulation after Ahmed glaucoma valve implantation

To assess the outcome of surgical intervention for bleb encapsulation after Ahmed implant. We reviewed the records of 9 patients who developed bleb encapsulation after Ahmed implant and who underwent bleb revision because of uncontrolled glaucoma despite medical treatment. After a mean follow-up of 36 months [range 2 to 84], the mean intraocular pressure [IOP] after bleb revision [16.6 +/- 4.3] was significantly lower than the mean preoperative IOP [28.7 +/- 5.3] [P value <0.05]. Successful outcome was defined as a final IOP between 6 and 22 mmHg with the same or less medication than pre-operatively; this was achieved in seven eyes [77.80%]. Capsular excision after failure of an Ahmed Glaucoma Valve caused by fibrous encapsulation is a useful approach for re-establishing function and lowering the IOP

Nodular episcleritis in a young patient

To report a case of nodular episcleritis at the limbus associated with corenal deposits in a young patient. Observational case report. A 16-year-old Saudi girl developed a pinkish-white, soft, well-demarcated mass, 6 x 5 mm in size and 1mm in height, in the superonasal limal area of the right eye. It was associated with yellowish deposits in the adjacent cornea. histopathological evaluation of the excised lesion revealed chronic inflammation in the deep layer of the episclera with infiltration by lymphocytes and epithelioid cells, in addition to capillary proliferation. subsequently, the patient didn't develop any systemic manifistation or recurrence during the one-year follow-up period. Although nodular episcleritis tends to occure in an older age group, it can also present in young patients. Surgical excision can result in an excellent clinical outcome

Malignant glaucoma after Ahmed valve implant

To report and describe the clinical presentation of malignant glaucoma after Ahmed glaucoma valve implant [AGVI] in 2 patients. Chart review of 2 patients who developed malignant glaucoma after AGVI at the King Khaled Eye Specialist Hospital, Riyadh. Both patients developed high intraocular pressure [IOP] associated with axial shallowing of the anterior chamber despite patent iridotomies and normal posterior segment anatomy following AGVI surgery. Both of them did not respond to medical or laser treatment. However, the anterior chamber deepened and the IOP was controlled in both cases after pars plana vitrectomy and anterior chamber reformation. Malignant glaucoma can develop after AGVI. Successful clinical outcomes can be achieved with posterior segment surgery

fixed and dilated pupil [Urrets-Zavalia Syndrome] after penetrating keratoplasty for keratoconus

A fixed and dilated pupil [Urrets-Zavalia Syndrome] is an uncommon postoperative complication after penetrating keratoplasty [PKP] and other intraocular procedures. Although the clinical features have been well described, precise etiology of this syndrome is unknown. We describe a case of fixed dilated pupil [Urrets-Zavalia Syndrome] following PKP for keratoconus encountered at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia