Retinal complications post posterior chamber phakic intraocular lens implantation at a tertiary eye hospital in the Eastern Province of Saudi Arabia.

PURPOSE: Phakic intraocular lenses treat higher degrees of myopia not possible previously with conventional refractive surgery. The aim of this study is to report the incidence and risk factors of retinal complications after posterior chamber PIOL implantation and assess the differences in biometric parameters between patients who developed such complications versus those who did not. METHODS: This retrospective study recruited 514 patients who underwent ICL implantation to correct myopia at a tertiary eye hospital center in the Eastern province of Saudi Arabia. Follow up period was at least one year. Medical records of the patients were reviewed to obtain the required data. Associations between respondents' characteristics and retinal complications were evaluated using the Chi-squared test. RESULTS: The mean (SD) age was 27.7 (± 6.5) years ranging from 18 to 47. Laser treatment was performed in 14 cases (2.7%). Retinal complications occurred in six cases (1.2%). The risk of retinal complication was significantly higher among patients with high axial length (OR = 1.3, 95% CI 1.2, 1.4) and patients with high pre-spherical equivalent before ICL (OR = 1.09, 95% CI 1.03, 1.4). CONCLUSION: Patients with higher axial length and higher pre-spherical equivalent before ICL implantation are at high risk of retinal complications.

DCR preferences among oculoplastic surgeons: Barriers and facilitators to adoption of endoscopic DCR.

OBJECTIVE: To determine the preference for dacryocystorhinostomy (DCR), patient selection criteria for endoscopic DCR, endoscopic DCR technique, and barriers to adoption of endoscopic DCR. METHOD: Cross-sectional study conducted from May-December 2021. A survey was sent to oculoplastic surgeons. Questions on demographic characteristics, type of clinical practice, technique preferences, barriers and facilitators to adoption of endoscopic DCR were included. RESULTS: 245 participants completed the survey. Most respondents were located at an urban site (84%), were in private practice (66%), and had been in practice for more than 10 years (58.9%). Sixty one percent perform external DCR as the first line procedure for treating primary nasolacrimal duct obstruction. The most common factor influencing the surgeon's decision to perform endoscopic DCR was the patient's request (37%) followed by endonasal exam (32%). The most common barrier for not performing endoscopic DCR was the lack of experience and lack of training during fellowship (42%). The most worrisome complication for most respondents was failure of the procedure (48%), followed by bleeding (30.3%). Eighty one percent believe surgical mentorship and supervision during initial cases would facilitate endoscopic DCR learning. CONCLUSIONS: External Dacryocystorhinostomy is the preferred technique for treating primary acquired nasolacrimal duct obstruction. Learning endoscopic DCR early during fellowship training and high surgical volume to improve the learning curve dramatically impacts the adoption of the procedure.

Postoperative Aspergillus Endophthalmitis With Iris Granuloma: A Case Report.

This report describes a rare case of a fungal iris granulomatous lesion in a 67-year-old female who underwent cataract surgery in the left eye and, one month later, developed culture-positive postoperative Aspergillus endophthalmitis. On initial presentation in the emergency room, slit-lamp examination of the left eye revealed subconjunctival hemorrhage, 360-degree subconjunctival hemorrhage, mild corneal edema with Descemet's folds, a deep anterior chamber with a fibrinous reaction causing pupillary membrane formation, and an in situ intraocular lens with no view of the fundus. A bright-scan (B-scan) ultrasound revealed mild vitreous opacities with a vitreal membrane, shallow choroidal detachment, and no significant retinal and choroid layer thickening. The patient was admitted into the anterior segment division for anterior chamber (AC) tap culture and AC washout for suspected retained cortical matter removal, intracameral antibiotics (vancomycin and ceftazidime), and IOL explantation in the left eye. The initial aqueous tap culture had no growth. Nine days later, repeat aqueous tap and pupillary membrane cultures were positive for Aspergillus spp. Intravitreal voriconazole was administered along with topical natamycin and amphotericin B eye drops. There was a resolution of the clinical picture, and three weeks later a rebound occurred, for which AC washout, pars plana vitrectomy (PPV), capsulectomy, and intravitreal vancomycin, ceftazidime, and voriconazole were given. A week later, the patient developed a fungal granuloma behind the iris, which was successfully managed with an AC washout, removal of the granuloma, and repeated intravitreal and intracameral voriconazole administration. The best-corrected visual acuity (BCVA) during the last visit was 20/80 in the affected eye, with a plan for a secondary IOL implant. Endophthalmitis is a rare but serious intraocular infection, with fungal endophthalmitis having a lower prevalence than bacterial endophthalmitis, which explains the lack of well-established guidelines for diagnosing and managing exogenous fungal endophthalmitis. This case highlights the rare presentation of post-cataract Aspergillus endophthalmitis with a fungal iris granuloma and demonstrates how the chronicity of this infection, along with surgical manipulation, may accelerate the seeding of these organisms into the anterior chamber structures.

Prevalence and Risk Factors of Dry Eye Disease among Adults in Saudi Arabia.

Background: Environmental and epidemiological factors increase the risk of dry eye in Saudi Arabia, but most studies have limited generalizability. Objective: To determine the prevalence of dry eye disease (DED) among adults across Saudi Arabia and the associated risk factors. The secondary objective was to estimate the economic burden of DED by calculating lubricant usage and its annual costs. Methods: This cross-sectional study invited adults from across Saudi Arabia to complete a questionnaire that collected data regarding demographics, symptoms related to DED, previous diagnosis of DED, use of contact lenses, and use of eye lubricants. Results: A total of 2042 responses were received, of which 784 (38.4%) respondents had previously been diagnosed with DED and 752 (36.8%) were symptomatic but undiagnosed. Between the DED diagnosed and symptomatic-undiagnosed groups, a significant difference was found in terms of age (P < 0.001), gender (P = 0.002), presence of diabetes mellitus (P = 0.004), smoking status (P = 0.007), duration of electronic screen use (P = 0.05), number of ocular complaints (P < 0.001), and frequency of lubricants use (P < 0.001). Between the DED-diagnosed and non-DED groups, significant differences were found in terms of age (P < 0.001), gender (P < 0.001), presence of diabetes mellitus (P = 0.001), allergy (P = 0.001), autoimmune disease (P = 0.005), smoking status (P < 0.001), and history of refractive surgery (P < 0.001). The mean estimated annual cost of using lubricating agents was SAR 328.2 ± 210.3 (USD 87.5 ± 56.1), and this was significantly higher in the diagnosed group (P = 0.01) than the symptomatic-undiagnosed group. Conclusions: The prevalence of DED is high among adults in Saudi Arabia. High-risk population include elderly, female, and using electronic screens for >2 hours/day.

Periocular subcutaneous granuloma annulare in a child: A case report.

PURPOSE: We describe a rare case of annular granuloma involving the eyelid of a child, a 6-year-old male, who presented with multiple subcutaneous nodular lesions involving the upper eyelid of the right eye. OBSERVATIONS: The slit-lamp examination of the eye was normal. Extra-ocular examination showed a lesion on the dorsal aspect of the right foot, which was resistant to treatment with topical corticosteroids. He underwent surgical excision of the eyelid nodules under general anesthesia. Histopathology with immunohistochemical staining of the excisional biopsy confirmed the diagnosis of annular granuloma, with positive Vimentin and CD68 stains in many palisading histiocytic cells, while Factor VIIIa, S100, and CD1a were negative. Tuberculosis was ruled out by negative Ziehl-Neelsen staining for acid-fast bacilli. CONCLUSIONS AND IMPORTANCE: This idiopathic granulomatous condition proved to be a benign, self-limiting cutaneous disease that can regress spontaneously. It affects the skin of the foot in more than 70% of all patients; however, involvement of the eyelid is extremely rare. We report this case to highlight such a rare entity and increase awareness regarding this dermatological condition among ophthalmologists.

Profile of Glaucoma in the Eastern Region of Saudi Arabia: A Retrospective Study.

BACKGROUND: Glaucomas remain asymptomatic until severe, indicating that the actual number of affected individuals may be higher than those diagnosed. OBJECTIVE: To study the clinical patterns of glaucoma cases in the Eastern Province of Saudi Arabia. PATIENTS AND METHODS: This retrospective study was conducted at King Fahd Hospital of the University, Al-Khobar, and Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia. The medical records of all patients with glaucoma who visited these hospitals from January 2015 to December 2018 were critically reviewed. Data regarding patients' demographic characteristic, clinical data and their medical and surgical management techniques were collected and analyzed. RESULTS: A total of 999 patients were included, of which 52.9% were males, 94.8% were Saudi, and the mean age was 58.8 years. Bilateral involvement was observed in 82.3% of cases. Primary open-angle glaucoma (POAG) was the most prevalent type of glaucoma (27.7%), followed by secondary glaucomas (26.7%), primary angle-closure glaucoma (PACG) (18.2%), primary congenital glaucoma (2.7%), and juvenile open-angle glaucoma (2.2%), which were the most frequent glaucoma subsets. CONCLUSION: The study population was most affected by POAG, secondary glaucomas and PACG. Knowledge regarding prevalence of glaucoma is important to plan services, allocate resources, and prevent blindness.