Bilateral Retinoblastoma Presenting in an in vitro Fertilization Infant with Retinopathy of Prematurity.

Retinopathy of prematurity (ROP) and retinoblastoma (RB) are well-described entities in premature babies. Although their pathogeneses are different, with ROP representing a disorder of interrupted development and RB a genetic disease, a few co-occurring cases have been reported, raising the possibility that the 2 conditions. Here, we report the sixth such case of co-occurring ROP and RB in an 8-month-old infant conceived by in vitro fertilization (IVF) who developed bilateral retinoblastoma a few months after treatment for advanced-stage ROP. While the ROP was initially adequately managed, bilateral RB necessitated bilateral enucleation. This case raises a number of important questions about whether IVF, ROP, and RB are causally related. Although the associations between IVF, ROP, and RB are likely to be coincidental, this case nevertheless highlights that ROP patients require regular follow-up for early diagnosis and treatment of ocular sequelae including RB.

Efficacy of Botulinum Toxin Injection in Exotropia Treatment.

PURPOSE: Botulinum toxin (Botox) therapy is a well-known option for strabismus management and is often used in managing esotropia. Exotropia is also a common type of strabismus; however, the effectiveness of Botox in improving exotropia is still ambiguous. In this study, we report our experience in using Botox to manage the various types of exotropia. METHODS: A retrospective cohort study was conducted at King Khaled Eye Specialist Hospital Riyadh, Saudi Arabia. Medical records of patients with exotropia who received Botox from 2014 to March 2020 were reviewed. The main success indicator was a remaining angle of less than 10 prism diopters (PD). RESULTS: A total of 97 cases were reviewed, with 57 (58.8%) males and 40 (41.2%) females. The age ranged from 2 months to 40 years. The most prevalent diagnosis was sensory exotropia. Overall, 28 patients (28.9 %) and 49 patients (50.5%) achieved an angle of deviation within 10 PD and within 20 PD, respectively. Female patients had a better response to Botox than males, with 32.5% of them achieving an angle of deviation within 10 PD and 60% achieving an angle of deviation within 20 PD. We found that the change in the angle of deviation increased as the Botox dose was increased. CONCLUSION: Botox represents a possible safe alternative to surgery in the management of some exotropia types. The success rate differs by type, with basic exotropia scoring the highest. The presence of poor vision and amblyopia leads to a significantly lower success rate.

Knowledge, attitude, and practice toward evidence-based medicine among hospital physicians in Qassim Region, Saudi Arabia.

OBJECTIVES: To determine the knowledge, attitude, and practice regarding evidence-based medicine (EBM) among hospital physicians in Qassim region of Saudi Arabia. METHODS: It is a cross-sectional study. A self-administered questionnaire survey was done among 288 physicians working in secondary and tertiary care centers. The study was conducted between June and September 2015. RESULTS: The overall response rate for the survey was 72%. Majority of the respondents had a positive attitude toward EBM and welcomed the concept. A total of 83% respondents stated that they used EBM in their daily practice and 93.5% agreed that practicing EBM improves patient care. There was a moderate level of awareness regarding extracting information from journals and clinical evidence databases. Although the respondents were aware and demonstrated familiarity with the process of knowledge extraction procedures to determine the best care, as many as 40% did not use them. The respondents had a poor overall understanding of the technical terms used in EBM. Among the respondents, 38.5% thought that the best way to move from opinion-based medicine to EBM was through learning the skills of EBM. The factors that positively affected physician awareness included: Academic qualification and professional title. Knowledge and attitude were affected by qualification, professional title and specialty. CONCLUSION: The attitude of most physician practitioners in this study is favorable toward EBM, but this was not correlated with knowledge and awareness. The inclusion of physician training courses in EBM concepts, technical terms and applied practice is highly recommended.