Treatment response and recurrence of conjunctival melanoma with orbital invasion treated with immune checkpoint inhibitors: case report and literature review.

INTRODUCTION: Conjunctival melanoma (CM) has genetic characteristics that are similar to primary cutaneous melanoma (PCM). The management of advanced CM with orbital metastasis was limited until the adoption of novel immunotherapy agents that significantly improved the survival of metastatic PCM. PURPOSE: To review and compare the immune checkpoint inhibitor (ICI) treatment response in cases reported in the English literature with orbital involvement secondary to CM versus PCM. In addition, we report a case of local recurrence of CM in a young female after successful treatment with ICI. METHODS: In addition to reviewing the chart of one patient who presented to our clinic, we conducted a comprehensive literature review to identify CM cases and cases with orbital metastasis secondary to advanced CM and PCM. Outcomes included patient demographics, response to ICI, and associated adverse effects. RESULTS: There were ten cases with orbital involvement, four were secondary to CM, and six were metastasis from PCM. Orbital metastasis from PCM regressed following treatment with ICI agents, whereas those secondary to CM resolved completely. There were 19 cases of CM without orbital invasion. Of the 29 cases identified, complete resolution of ocular melanoma was achieved in 15 patients, representing 52% of the cases collectively, and none of them reported recurrence except in our case. CONCLUSION: CM with orbital invasion responds well to ICIs, with manageable toxic effects. Despite the complete resolution, close observation is needed as the recurrence risk remains.

Retinocytoma: A Case Series.

Retinoblastoma is the most common ocular malignancy in children, considered fatal without treatment. Retinocytoma is a rare benign clinical entity of retinoblastoma that shows signs of tumor regression. The clinical presentation of retinocytoma usually includes a gray translucent mass, intralesional calcification, and retinal pigment epithelial alteration, along with the presence of chorioretinal atrophy. We report two cases of retinocytoma in patients presenting with strabismus in the Eastern Province of Saudi Arabia.

Brown McLean syndrome after congenital glaucoma surgery, unique case report and a literature review.

Purpose: Brown-McLean Syndrome (BMS) was first documented by Brown and McLean in 1969. To date, BMS is typically described in primarily cataract-related complications, and it is inextricably associated with long-term aphakia. Our purpose is to report a case that describes a unique association of BMS in the presence of patent peripheral iridectomy. Observation: A 35-year-old male known case of congenital glaucoma who has a history of bilateral trabeculectomy, presented to our clinic with a long history of mild progressive blurriness of vision for years. Upon examination, the patient was bilaterally phakic, with bilateral 360-degree of peripheral corneal edema sparing the center of the cornea with endothelial pigmentation and bilateral patent peripheral iridectomy in an otherwise stable ophthalmic examination. His uncorrected visual acuity was 20/20 in the right eye and 20/30 in the left eye with normal intraocular pressure. Our plan was to prescribe topical medications and schedule him for regular follow-up. At the last follow-up, our patient reported no improvement in his vision, and there were no signs of clinical improvement. Conclusion and importance: This case of BMS demonstrates the importance of the potential of such a disease to develop, albeit rarely, in phakic patients who are undergoing intraocular surgery. The preventive role of PI is also questionable. Categories: Ophthalmology, Pediatrics, Transplantation.

Bilateral Congenital Stromal Corneal Cysts: Report of a Unique Case.

The purpose of this report is to provide a comprehensive account of an exceptional case involving the presentation of congenital rubella syndrome (CRS) in a newborn. Furthermore, it aims to document the successful regression of CRS through medical treatment alone. We present the case of a five-day-old infant who was referred to our facility as a CRS case. The patient presented with bilateral white corneal opacity, which was observed shortly after birth. The mother was diagnosed as rubella-positive during pregnancy. Upon the initial examination under anesthesia, both eyes exhibited central white corneal opacity accompanied by large intrastromal cysts. Although a few breaks in Descemet's membrane were observed in both eyes, there were no signs of vascularization or the presence of iridocorneal or lenticular-corneal adhesions. After undergoing medical treatment consisting of topical sodium chloride and steroids, the cysts in both eyes completely regressed. Subsequently, the patient underwent penetrating keratoplasty to further address the dense scar. This case enhances our comprehension of ophthalmological complications associated with CRS and provides valuable insights into alternative therapeutic approaches for corneal stromal cysts.

Outcomes of Single-Step Transepithelial Photorefractive Keratectomy Compared With Alcohol-Assisted Photorefractive Keratectomy Using Wave-Light EX500 Platform.

Purpose To compare the visual outcome of transepithelial photorefractive keratectomy (PRK) against alcohol-assisted PRK in treating low-to-moderate myopia with or without astigmatism. Setting Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia. Design This is a retrospective study. Methods Forty eyes of 22 patients with myopia from -0.75 to -6.00 diopters (D) with or without astigmatism from 0 to -3D were included in this study. Preoperative and postoperative data of 20 eyes from 11 patients who underwent transepithelial PRK were compared with 20 eyes from 11 patients who underwent alcohol-assisted PRK were collected and analyzed. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest spherical equivalence (SE), manifest cylinder, vector analysis of astigmatism, and efficacy and safety indices were compared between the groups at a mean follow-up of one year postoperatively. Results Baseline characteristics were similar between groups, except the transepithelial PRK group had lower cylinder values than the alcohol-assisted PRK group by 0.69D. Regression analysis was used to control for the difference in the cylinder in all outcome parameters. Both groups had similar mean UDVA (p=0.73), CDVA (p=0.98), the proportion of eyes in either group achieved (20/20, 20/25, and 20/30) UDVA (p=0.72, 0.68 and 0.31 respectively) and percentage of eyes lost two lines of CDVA (p=1.0). There was no statistically significant difference between the two groups in regard to both efficacy and safety indices (p=0.55 and 0.67, respectively). Both groups had similar residual SE (p=0.72), the proportion of eyes within ±0.5D of SE (p=0.29), and residual refractive astigmatism (p=0.87). Both groups had similar difference vectors, surgically induced astigmatism, and correction index (p=0.82, 0.10, and 0.26, respectively). However, the transepithelial PRK group had lower target-induced astigmatism (TIA; p=0.01), higher magnitude of error (ME; p=0.05), and higher angle of error (AE; p=0.02) than the alcohol-assisted PRK group. Conclusion Transepithelial PRK had similar visual and refractive outcomes as alcohol-assisted PRK. This approach was considered as safe and effective as alcohol-assisted PRK in treating patients with low-to-moderate myopia with or without astigmatism.

Ophthalmology Self-medication Practices: A Questionnaire-based Study.

Purpose: The aim of the study was to identify patterns of self-medication practices in ophthalmology.Methods: We conducted an electronic cross-sectional descriptive survey of the Riyadh regional population in Saudi Arabia.Results: The study included 1354 subjects; 662 were males (49%), and 692 were females (51%). The rate of self-medication with prescription drugs (topical antibiotics and steroid-containing eye drops) in our sample was 37.2%. The number of respondents who reported using eye drops, whether it was an over-the-counter drug or a prescription drug, was 733 (54.1%). The most frequently used ophthalmic medications after lubrication drops were steroid-containing eye drops (32.6%), followed by topical decongestants (11%) and antibiotics (4.6%). The majority of steroid users (86.6%) were not aware of any steroid-related ocular complications.Conclusion: Our study showed a high rate of self-medication practices along with a low level of awareness of topical medication-related side effects. If left unaddressed, this combination may result in high rates of preventable and avoidable adverse events.

The Use of Social Media among Saudi Ophthalmologists: A Descriptive Cross-Sectional Study.

PURPOSE: The purpose of this study is to evaluate the use of and beliefs toward social media (SM) among Saudi ophthalmologists. METHODS: This was a cross-sectional descriptive study. A web-based, self-administered questionnaire was e-mailed to ophthalmologists within Saudi Arabia. RESULTS: Out of 392 recipients, 293 completed the survey (74.7% response rate). The vast majority (90.1%) used at least one platform for personal and professional purposes or either. The three most commonly used applications were Twitter (72.3%), Snapchat (65.9%), and Instagram (51.9%). The opinions of respondents with regard to the different aspects of SM varied widely. Around half (56.7%) believed that it was permissible for ophthalmologists to promote themselves on SM and 70.6% agreed that SM usage by health-care professionals should be regulated. Participants believe that SM had both a positive and a negative impact on their daily life and clinical practice. For example, 94 (32.1%) respondents stated that it improved their ability to educate patients, on the other hand, 80 (27.3%) reported that SM wastes quality time that can be spent on something more productive. CONCLUSION: Our results demonstrate an increased utilization of SM among Saudi ophthalmologists. The ethical aspects of SM usage were a matter of controversy among our respondents. This necessitates the establishment of guidelines by regulatory bodies and/or individual health-care organizations.

Ownership and Usage of Mobile Devices Among Ophthalmology Residents and Attending Physicians: Identifying the Generation Gap.

BACKGROUND: Ophthalmology residents strongly rely on digital technology in training. This characteristic may not be shared by their teachers, attending physicians. Therefore, the aim of this study was to describe the ownership and usage of mobile devices among Saudi ophthalmology residents and their attending physicians and to compare ownership and usage patterns between both groups. METHODS: A survey was conducted to determine the rates of ownership of mobile devices and the patterns of usage among Saudi ophthalmology residents and their attending physicians. The survey was sent to 305 eligible participants. RESULTS: The overall response rate was 81%. The mean age of residents and attendings was 27.4 and 48.6 years, respectively. The ownership of mobile phones was higher among attendings (1.21 ± 0.4 vs 1.36 ± 0.5, p = 0.02), whereas the ownership of tablets was higher among residents (1 ± 0.6 vs 0.7 ± 0.6, p = 0.01). Residents utilized mobile devices to access online educational resources more frequently compared to attendings. A statistically significant difference between residents and attendings was reported in the utilization of wikis (91% vs 46%), e-books (90% vs 54%), file sharing sites (84% vs 52%), and vodcasts (78% vs 58%). Both groups also differed with regards to reasons of utilization. While residents most commonly used mobile devices to answer clinical questions on demand (87%) and to acquire basic knowledge (84%), the main reasons of utilization cited by attendings were to look up controversial issues (77%) and to connect with peers (72%). CONCLUSION: The two studied groups differ from each other in the type of devices owned, reasons for usage, and frequency of utilization. The difference in behavior between educators and their students can lead to a generation gap that halts the progress of residents' training.

Awareness among the general population about lipid profile screening in individuals over 20 years old in Alriyadh, Saudi Arabia.

INTRODUCTION: Plasma cholesterol and triglycerides are clinically important because their abnormally high levels are major treatable risk factors for cardiovascular disease. This study aimed to evaluate the awareness, general knowledge, and attitudes about regular lipid profile screening among adult individuals in Al-Riyadh. MATERIAL AND METHODS: This is a cross-sectional study collected by convenience sampling method. Residents of Riyadh region older than 20 years were targeted through an electronic questionnaire distributed via Twitter and WhatsApp. The study was conducted between November 28, 2016 and December 31, 2016. Study results were analysed using the SPSS system. RESULTS: This study included 1383 participants; 646 (46.7%) were male and 737 (53.3%) female. Of them, 905 (65.4%) did not screen for their lipid profiles, while 478 (34.6%) screened. A visit to a primary health care facility or hospital was the reason for screening of lipid profile in 195 (14.1%) of the participants, whereas 64 (4.6%) of them were ordered by doctors. CONCLUSIONS: More educated participants were found to be more aware of the importance of screening lipid profile. Our results reflect poor awareness among the population regarding the importance of regular screening of lipid profiles. A visit to primary health care or hospital was the most frequent reason for screening of lipid profile. Screening lipid profiles was predominant among males and it was significantly related to the gender, age, and educational level. This shows the strong need in the community for health education about the importance of screening lipid profile at different levels of health care delivery.