Unilateral Congenital Nasolacrimal Duct Obstruction, Is It An Amblyogenic Factor?

BACKGROUND/AIMS: To evaluate the refractive status, axial length, and prevalence of amblyopia among Saudi children with unilateral congenital nasolacrimal duct obstruction (UCNLDO) compared to the unaffected fellow eye. METHODS: A retrospective chart review was performed for children with UCNLDO at two eye institutes in Eastern Saudi Arabia from 2009 to 2015. The outcomes of syringing determined UNCLDO. The risk factors for amblyopia were defined as anisometropia of (spherical equivalent) >1.5 D, hyperopia >3.5 D, myopia >3.0 D, astigmatism >1.5 D at 90° or 180°, >1.0 D, any manifest strabismus, any media opacity >1 mm, or ptosis 1 mm or less margin reflex distance 1 along with blunting of vision in that eye. Matched-pair analysis was performed to correlate variables. P < 0.05 was considered statistically significant. RESULTS: We included 39 children with UNCLDO. The mean axial length was 21.4 ± 1.3 mm for the eyes with UCNLDO and 21.6 ± 1.0 mm for the fellow eye (P = 0.4). Hyperopia >+2 D was present in 17 (44%) eyes with UCNLDO and none of the fellow eyes. None of the participants had strabismus. CONCLUSION: Axial length and risk factors of amblyopia such as anisometropia, hyperopia, and strabismus were not associated with UCNLDO. UCNLDO is likely an isolated defect.

Surgical outcomes in children with primary congenital glaucoma: a 20-year experience.

PURPOSE: To describe demographic criteria of primary congenital glaucoma (PCG) subjects and to evaluate the surgical outcomes of children who underwent angle surgery over a 20-year period. METHODS: This is a retrospective study of patients diagnosed with PCG who underwent trabeculotomy, trabeculectomy, or combined trabeculotomy-trabeculectomy (CTT). The surgery was considered to be successful if intraocular pressure (IOP) was 21 mm Hg or less with or without treatment. RESULTS: A total of 148 eyes (85 patients) were included in the study. The majority of the patients were younger than 6 months of age (78.9%), with a median age of 2 months. Sex distribution was relatively even between girls and boys (45:40) (53%/47%). Bilateral disease was seen in 63 patients (74%). The overall success rate was achieved in 80.4%. The majority of the eyes needed only one surgery (105 [70.9%]), 34 eyes (23.0%) needed 2 surgeries, and 7 eyes (4.7%) had 3 surgeries. There was no statistically significant difference in success rate between types of surgery and number of performed procedures. A progressive decline in success rate over time was evident, as success rate dropped from 96.6% at 5 months to less than 50% after 11 years of follow-up. CONCLUSIONS: Excellent IOP control can be achieved in a majority of patients with equally effective results from all 3 surgical procedures. The surgical outcome of PCG was more favorable in infants presenting before the age of 6 months. Adjuvant topical antiglaucoma medications can augment the surgical success rate.

Age, gender and refractive error association with intraocular pressure in healthy Saudi participants: A cross-sectional study.

PURPOSE: To determine the distribution of intraocular pressure (IOP) and its association with age, gender and refractive error in non-glaucomatous Saudi participants. DESIGN: Hospital-based cross-sectional observational study during Vision Day Screening Program. PARTICIPANTS: 458 participants living in the Al-Khobar, Saudi Arabia. METHODS: Recruited participants (aged 20 years or over) underwent a comprehensive questionnaire and ocular examination, including measurement of IOP with Perkins hand-held applanation tonometry and autorefraction. MAIN OUTCOME MEASURES: The distribution of IOP of either of the eyes (right or left eye by randomization) and associations with age, gender and refractive error. RESULTS: Median IOP was 15.0 (range: 6-28) mmHg in the total population. There is no significant difference between the overall IOP of male participants, median 15 (range: 6-28) mmHg and female participants, median 16 (range: 6-28) mmHg (p = 0.180). No statistically significant difference in IOP in relation to age comparing 20-45 years group to 46-69 years group was documented (p = 0.751). There was no statistically significant relationship between refractive error category and IOP (p = 0.405). Ocular hypertension with IOP > 21 mmHg was found in 8.7% of the participants. CONCLUSION: Variation in IOP by gender, age group and type of refractive error was not statistically significant. The observations need confirmation by study with larger sample representing Saudi population.

Safety of Simultaneous Bilateral Intraocular Surgery Under General Anesthesia in Pediatric Patients.

OBJECTIVE: To evaluate the risks and benefits of simultaneous bilateral intraocular surgery (SBIS) in pediatric patients at a university hospital in the Kingdom of Saudi Arabia, who are placed under general anesthesia for the procedure. METHODS: This retrospective, noncomparative case study comprised 15 children, who underwent bilateral cataract surgery and/or primary or secondary intraocular lens (IOL) implantation in one sitting between November 2008 and July 2014. Seven patients had bilateral lensectomy primary posterior capsulotomy and anterior vitrectomy, and the remaining eight patients had bilateral IOL implantation at the capsular bag either primarily IOL implantation (two cases) at the time of cataract extraction or secondary IOL implantation at the capsular bag (six cases). Bilateral surgeries were performed sequentially by the same surgeon, with strict aseptic separation of the two surgeries, while the patient was under general anesthesia. RESULTS: The age of the patients at the time of the surgery ranged from 7 months to 9 years (mean age 2.13 years). The patients were followed up approximately for 4 months postsurgery. There were no catastrophic complications from the anesthesia (death, asphyxia, cardiac or respiratory arrest, or seizures) nor were there any intraoperative complications that necessitated cancelation of surgery in the second eye. Postoperatively, one patient was noted to have reproliferation of lens material in one eye. However, no serious postoperative complications such as endophthalmitis, aphakic glaucoma, and hyphema were noted. CONCLUSION: SBIS conducted during the same operative procedure is an alternative to sequential surgery in selected pediatric patients if operative guidelines and surgical asepsis are strictly followed.

Effect of Horizontal Strabismus Surgery on the Refractive Status.

PURPOSE: To evaluate the effects of horizontal strabismus surgery on the refractive and astigmatic status of eyes following horizontal muscle surgery using double-angle vector analysis. MATERIALS AND METHODS: This was a retrospective analysis of 137 patients (250 eyes) conducted between February 1997 and October 2010 in patients who had unilateral or bilateral recession or monocular recession and/or underwent resection of horizontal muscles by a single surgeon. Refraction data were obtained at 1-2 weeks preoperative and at 4-6 weeks and 4-6 months postoperative. Surgically induced refractive changes were calculated using double-angle vector analysis. RESULTS: The mean change in the spherical equivalent (SE) of the refraction was 0.23 ± 0.78 D for surgically induced refractive changes at 4-6 weeks postoperative (SIRC1; p < 0.0001) and 0.14 ± 0.85 D (p = 0.018) for surgically induced refractive changes at 4-6 months postoperative (SIRC2), indicating a small shift in the myopic direction with regression at 4-6 months. The mean amplitudes of the induced cylinders were 0.072 ± 1.22 D (p = 0.262) in SIRC1 and 0.20 ± 1.14 D (p = 0.012) in SIRC2, and the mean axis of the induced plus cylinder was 21.74° in SIRC1, indicating a small shift in the with-the-rule direction, but no statistically significant difference from zero (p = 0.331). The changes in the surgically induced refraction over time (SIRC d), ie, 0.05 ± 0.64 in SE (p = 0.255) and 0.09 ± 0.65 in the cylinder (p = 0.049), were stable. There was no significant correlation between the amounts of horizontal rectus muscle recession and/or resection and the cylinder power of individual induced astigmatism at 4-6 weeks after surgery (p = 0.266) and the myopic shift (p = 0.345). Moreover, there were no significant correlations between the ages of the patients and the spherical equivalent for SIRC1 (p = 0.858) and the induced cylinder for SIRC1 (p = 0.750). CONCLUSION: Horizontal rectus muscle surgery tended to induce a transient, statistically significant change in the spherical equivalent of refraction, with a myopic shift that was clinically not important. Our findings did not strongly support that the astigmatism induced changes. There was no correlation between the amount of recession and/or resection and the amount of induced refractive error.

Indications and techniques employed for keratoplasty in the Eastern province of Saudi Arabia: 6 years of experience.

BACKGROUND AND OBJECTIVES: Keratoplasty services in Saudi Arabia have progressed steadily in the past few decades. We sought to identify the leading indications and types of keratoplasty performed in the Eastern Province of Saudi Arabia over a six-year period and to compare these indications with published data. DESIGN AND SETTING: This was a retrospective descriptive analysis of the records of patients who underwent keratoplasty at four ophthalmology centers in the Eastern Province between 2008 and 2013. PATIENTS AND METHODS: All keratoplasty procedures were included in the analysis. The primary surgical indication and type of surgery were identified for each case. RESULTS: Keratoplasties included 570 penetrating keratoplasty, 217 deep lamellar keratoplasty, 80 triple procedures, 24 descemet stripping automated endothelial keratoplasty and 12 Boston keratoprosthesis implantations. The mean age of all patients was 28.8 years (range 14-72 years), and 58.9% of the patient were males. The lead.ing indication for keratoplasty was keratoconus 53.10%, bullous keratopathy 13.80%, corneal scarring 10.7%, regrafts 9.1%, and stromal dystrophies 4.9%. CONCLUSIONS: In this study, the leading indications for keratoplasty were keratoconus, bullous keratopathy, corneal scarring, regrafts and stromal dystrophies. A significant increasing trend for descemet's stripping automated endothelial keratoplasty surgeries was observed in spite of the number of cases.

A clinic-based study of refractive errors, strabismus, and amblyopia in pediatric age-group.

PURPOSE: The purpose of this cross-sectional observational study was to determine the distribution and patterns of refractive errors, strabismus, and amblyopia in children seen at a pediatric eye care. MATERIALS AND METHODS: The study was conducted in a Private Hospital in Dammam, Kingdom of Saudi Arabia, from March to July 2013. During this period, a total of 1350 children, aged 1-15 years were seen at this Center's Pediatric Ophthalmology Unit. All the children underwent complete ophthalmic examination with cycloplegic refraction. RESULTS: Refractive errors accounted for 44.4% of the cases, the predominant refractive error being hypermetropia which represented 83%. Strabismus and amblyopia were present in 38% and 9.1% of children, respectively. CONCLUSIONS: In this clinic-based study, the focus was on the frequency of refractive errors, strabismus, and amblyopia which were considerably high. Hypermetropia was the predominant refractive error in contrast to other studies in which myopia was more common. This could be attributed to the criteria for sample selection since it was clinic-based rather than a population-based study. However, it is important to promote public education on the significance of early detection of refractive errors, and have periodic screening in schools.

Macular and retinal nerve fiber thickness in recovered and persistent amblyopia.

The aim of this study was to investigate the presence of increased macular or retinal nerve fiber layer thickness (RNFLT) in amblyopic eyes, find if the increased macular or RNFLT is related to the lack of response in amblyopic eyes, and to explore whether the increased central macular thickness (CMT) in amblyopic eyes is purely related to the hyperopia. This is a prospective descriptive study. CMT and peripapillary RNFLT were measured by spectral-domain optical coherence tomography to evaluate 60 patients with unilateral-treated amblyopia (median age 11.00 year). Patients were divided into two groups: 33 patients in recovered amblyopia group and 27 patients in persistent amblyopia group. The mean CMT in the recovered group was 247.31 (±23.4) versus 246.8 (±32.7) µm (p = 0.95) for the persistent group. The mean peripapillary RNFLT was 99.13 (±12.1) versus 99.9 (±14.9) µm (p = 0.85) for the persistent group. In anisometropic amblyopia, there was no significant difference in CMT and RNFLT in either group. Also there was no relation between the type of refractive error and CMT or RNFLT. There was no significant difference in CMT and RNFLT in amblyopic eyes for both the recovered amblyopia group and the persistent amblyopia group to explain the lack of response in persistent amblyopic eyes. Additionally there was no relation between the type of refractive error and CMT or peripapillary RNFLT.

A peculiar case of a retained inert piece of fireworks as an intraocular foreign body in the anterior chamber.

This is a descriptive case report of a seven-year-old boy presented in January 2007 with decreased vision in the right eye, for 2 months after sustaining a trauma while he was playing with fireworks during the Eid holiday. He was treated in a suburban hospital for corneal laceration and was prescribed a topical antibiotic and a topical steroid. When the child presented to us, a slit lamp examination revealed a thread in the anterior chamber, his un-aided visual acuity was 6/60 on a Snellen chart. Surgery to remove the foreign body was scheduled, but the patient never attended. The patient was lost to follow-up and returned in January 2011 with an un-aided visual acuity of 6/12, although the foreign body was retained in the anterior chamber (AC) with a quiet eye and good vision. At that time, we decided to follow the patient without any surgical intervention. Again, the patient was lost to follow-up and returned with almost full vision in September 2012, with a visual acuity of 6/6 without correction. Thus, we concluded that thread like IOFBs in the AC can be considered inert materials that may not need any surgical intervention in a quiet eye that does not show any signs of inflammation and where the IOFB is non-mobile and located away from the endothelium.

Familial bilateral combined hamartoma of retina and retinal pigment epithelium associated with neurofibromatosis 1.

We report a family of three siblings followed between 2005 and 2011 with bilateral combined hamartoma of the retina and retinal pigment epithelium, with the age of diagnosis ranging from 7 to 13 years. The main reason for consultation was reduction of vision and squint. The diagnosis was determined based on the clinical findings on fundus examination: increased pigmentation at the macula with slightly elevated, gray-white macular lesion, tortuosity of perimacular blood vessels and glial epiretinal membrane. The elder brother was found to have left posterior subcapsular cataract. He was also confirmed to have neurofibromatosis type 1, the youngest sister fit in the diagnostic criteria for neurofibromatosis type 1, while the middle sister was presumed to have neurofibromatosis type 1. Follow-up showed stability of the retinal lesion in the three cases, with the progression to develop right posterior subcapsular cataract in the elder sister. This report is aimed to demonstrate that the occurrence of bilateral combined hamartoma of the retina and retinal pigment epithelium could raise the possibility of associated neurofibromatosis.