Retinopathy of Prematurity and Assisted Reproductive Technology: Is There an Association?

PURPOSE: This study aimed to determine the incidence of retinopathy of prematurity (ROP) and to assess whether assisted reproductive technology (ART) is a risk factor for ROP independent of the generation of multiple births by determining the occurrence and severity of ROP and the need for treatment. We will also evaluate other risk factors associated with the development of ROP among preterm infants. PATIENTS AND METHODS: We conducted a retrospective chart review for all premature infants who were screened for ROP according to the screening guidelines of the American Academy of Ophthalmology and born at King Abdulaziz University Hospital from 2015 to 2019. In addition to ophthalmological results, data on gestational age (GA), birth weight (BW), type of pregnancy (singleton or multiple), type of conception (natural or ART), infantile factors, and maternal factors were recorded. RESULTS: A total of 229 preterm babies met our criteria. The mean GA at birth was 29.35 weeks. Notably, 175 neonates were conceived naturally and 54 were conceived by ART. Furthermore, 33 infants in the natural conception group were products of multiple pregnancies, as were 49 infants in the ART group. ROP was noted in 96 of 229 infants (41.92%). No significant difference was found in the occurrence of ROP between multiple neonates in the natural and ART groups. However, ART birth babies in general were significantly associated with the development of ROP (P=0.045). On multiple regression analysis, early GA, low BW, and extended oxygen therapy were the variables most significantly associated with ROP (P≤0.001). CONCLUSION: In our sample, ART in multiple birth babies per se did not seem to be a risk factor for ROP. However, ART babies were more prone to develop ROP than natural conception birth babies, which seemed to be more severe.

Knowledge and attitudes regarding amblyopia among parents in Jeddah, Saudi Arabia: a cross-sectional study.

OBJECTIVES: To assess parents' perceptions about amblyopia and its causes, symptoms, risk factors, treatments, and the importance of follow-up and to evaluate their awareness regarding the consequences and critical complications. RESULTS: Parents or their companions (n = 401) were surveyed, and 52.9% were mothers, 81.8% of mothers and 85.7% of fathers were highly educated (diploma, college or university degree), and 58 (14.5%) had a child who was afflicted with amblyopia. The knowledge subscale (nine items) showed acceptable reliability. Twenty percent of the participants declared having adequate knowledge about amblyopia, but assessment by item showed low percentages of an adequate knowledge level, ranging from 0% for amblyopia causes, 35.9% for definition, and 59.9% for whether amblyopia is a hereditary disease. Thus, the rate of adequate knowledge (Knowledge Score ≥ 8) was 25.9%, and was associated with parents' nationality (p < 0.05) and self-declared knowledge about amblyopia (p < 0.001). No significant difference was observed among respondents who had a child with amblyopia. There was a lack of knowledge about basic information and different aspects of the disease, which emphasized the relevance of school-based screening programs and adequate use of trustworthy internet resources using easily understood medical information.

Dermatologists' Knowledge and Attitudes Toward Dry Eye Disease, Refractive Surgery, and Contact Lenses When Prescribing Isotretinoin in Saudi Arabia.

PURPOSE: This study assesses the knowledge and attitudes of dermatologists in Saudi Arabia with regard to dry eye disease, refractive surgery, and contact lenses when prescribing isotretinoin. METHODS: A total of 150 dermatologists from major cities in Saudi Arabia were included in this cross-sectional study. Data were collected through a consent interview questionnaire. RESULTS: Of the 150 dermatologists who participated, 77 (51.3%) were men. Seventy-three (48.3%) dermatologists always prescribed isotretinoin to patients and 71 (47.3%) sometimes prescribed it. One hundred forty-six (97.3%) dermatologists self-reported their awareness of the ocular side effects of the drug. One hundred twenty (80.0%) responded that it was not important to refer patients to an ophthalmologist for an eye examination before starting the isotretinoin course. Lubricant eye drops were routinely prescribed by 96% of the respondents during the isotretinoin course. Fifty (33.3%) dermatologists rarely or never asked patients about recent refractive surgery before starting the isotretinoin course. Sixty-six (44%) dermatologists rarely or never warned their patients to avoid refractive surgery for at least 6 months after the isotretinoin course is completed. One hundred ten (73.3%) dermatologists always informed their patients of contact lens intolerance as a result of isotretinoin use. CONCLUSION: Almost all participants prescribed lubricant eye drops routinely. Most participants self-reported their knowledge regarding the ocular side effects of isotretinoin; however, more than a third did not inquire about recent refractive surgery before starting the course, and less than half did not warn patients not to undergo refractive surgery 6 months after the end of the course. This demonstrates that a significant proportion of dermatologists do not follow the appropriate practices with respect to refractive surgery when they prescribe isotretinoin. Improving the dermatologists' awareness regarding isotretinoin prescription practice is essential with respect to laser refractive surgery to prevent ocular damage.

Corneal parameters 18 Months following collagen cross-linkage treatment (CXL) for keratoconus in western Saudi Arabia: A prospective cohort study.

INTRODUCTION: keratoconus is a common disease in the general population, with prevalence ranging up to 200 per 100 000 with a reported increase in Saudi Arabia. Collagen Cross-Linkage is now an established treatment in isolation and in conjunction with other modalities for managing keratoconus. Our aim is to evaluate using a cohort study the impact of the treatment over a course of 18 months. METHODS: To evaluate the impact of 18 months after collagen cross-linkage treatment and its determinants in eyes with keratoconus in Western Saudi Arabia. A one-armed prospective cohort study design on 45 patients with Stage I, II, III and IV keratoconus who were treated by Collagen Cross-Linkage modality was developed at our institute between 2018 and 2019 to establish the success rate of corneal ectasia stabilization of the disease. RESULTS: Demographic data and grades of keratoconus (Amsler - Krumiech classification) at presentation were correlated to changes in corneal parameters 18 months after CXL compared to that at presentation. Stage I, II, III and IV keratoconus were 13, 14, 2 and 16 eyes respectively. The study showed that the K max significantly declined (P = 0.05) while spherical equivalent refractive status changed from median -1.5D to -2.27D (P = 0.002). Meanwhile, Central corneal thickness significantly reduced (P = 0.001). CONCLUSION: CXL can prove to be efficient in the treatment of Keratoconus and more studies should study ways to improve and implement this treatment plan to such patients.

Large Angle Congenital Esotropia in a Child With Kabuki Syndrome: A Case Report.

Kabuki syndrome is an uncommon genetic disease associated with skeletal, cardiac, neurological, and ocular manifestations. Strabismus is an ophthalmic manifestation of Kabuki syndrome; however, it is infrequently documented in detail. We report a case of Kabuki syndrome in a patient who presented with large angle congenital esotropia. This case report highlights the importance of early eye examinations and subsequent interventions in patients diagnosed with Kabuki syndrome.

Population-level investigation of the knowledge of ocular chemical injuries and proper immediate action.

OBJECTIVE: Although the eyes occupy 0.1% of the total body surface, eye injuries are serious because vision is arguably the most important sense. We aimed to assess knowledge of Saudi Arabian residents regarding steps to be taken in cases of chemical eye injury, in order to promote awareness of such procedures. RESULTS: A cross-sectional design was done. A random sampling method was utilized to select 888 individuals in the Saudi community. Participants completed an electronic closed ended, validated, anonymous, self-administered questionnaire. Two experts assessed content and face validity. Respondents were 18-29 years of age. 74 (8.3%) had a history of chemical eye injury. Regarding the first step taken in case of chemical eye injury, 697 (78.5%) respondents indicated washing with water, 164 (18.5%) indicated visiting the emergency department, 11 (1.2%) indicated using eye drops, and 5 (0.6%) indicated covering the eye immediately. Seventy-five (8.4%) respondents agreed that an eye injured with an acidic material should be washed with an alkaline solution. These results should be confirmed by health authorities and appropriate interventions should be developed for improving knowledge among masses, thereby promoting a healthier society.

The Effect of Male Physicians' Outfits on the General Population's Perception in Saudi Arabia.

Overview Successful medical care depends on the trust developed between a physician and his patient. Professionally dressed doctors are likely to achieve a higher level of trust from their patients than those with a non-professional appearance.For many years, the physician's famous white coat has been the standard professional wear around the world. Few studies in Saudi Arabia have been conducted to analyze what kind of physician outfits patients prefer and whether the choice of attire affects the patient's level of trust. These studies were either done in a single health institute, or in few primary healthcare clinics in one city. This study aims to analyze whether the type of clothing worn by a physician improves the level of trust between a patient and a doctor. Participants were asked about different styles of clothing, including Western business attire, traditional Saudi outfits, and surgical scrubs, and whether wearing the white coat was preferred. Moreover, we sought to establish if differences in age, gender, nationality, or educational background affected the responses. Methods This cross-sectional study was carried out in August and September 2018. Participants living in Saudi Arabia anonymously filled out an electronic questionnaire, distributed by social media, which measured the effect of male physicians' outfits on the general population's perception in Saudi Arabia. Participants were shown photographs of possible dress styles for physicians. Data were collected on the participants' demographics, their most and least preferred doctor's outfits, and the effect of the physician's attire on their level of trust. Results A total of 8231 participants were included in the survey: 53% males, 87.9% with university-level education or higher, and 93.5% of Saudi nationality; 76.1% of the participants responded "yes" saying that the outfit would have an effect on how a patient might receive medical advice and follow the doctor's recommendations. The most preferred outfits chosen by the participants were surgical scrubs with a white coat (39.3%), followed by a Western shirt and tie with a white coat (30.3%). The least preferred outfit was the full (traditional) Saudi outfit with a white coat (25.4%), followed by a Western business suit without a white coat (23.2%). The choices of most and least preferred attire were found to be impacted by different demographic factors, such as age, gender, and nationality, but not the educational background. Conclusion Physicians practicing in Saudi Arabia should note that their attire will earn the patient's trust and encourage compliance with advice or treatment. The most preferred outfits were surgical scrubs with a white coat and a Western shirt and tie worn with a white coat, whereas the least preferred ones were the traditional Saudi thobe, with and without shemagh or ghutra, and the Western business suit without a white coat.

Transconjunctival suturing of the scleral flap for overfiltration with hypotony maculopathy after trabeculectomy.

OBJECTIVE: To assess the efficacy of transconjunctival suturing of the scleral flap in improving hypotony maculopathy resulting from overfiltration after trabeculectomy. DESIGN: Retrospective review. PARTICIPANTS: 35 eyes of 33 patients. METHODS: Patients underwent transconjunctival scleral flap suturing for hypotony maculopathy following trabeculectomy using mitomycin C. The scleral flap was sutured through the conjunctiva as an outpatient clinic procedure using a spatulated needle with a 10-0 nylon suture. RESULTS: The average age of the patients was 67.5 (SD 4.80, range 39-83) years, and 52% patients were male. The average duration of hypotony prior to transconjunctival suturing of the flap was 108.0 (SD 68.3) days. The median intraocular pressure (IOP) before suturing was 3 mm Hg, and the median IOP 6 months after the procedure was 9 mm Hg (p < 0.0001). The median best-corrected visual acuity (BCVA) before transconjunctival suturing of the scleral flap was 20/100, and the median BCVA 6 months after the procedure was 20/30 (p < 0.0001). Compared with visual acuity before suturing the average gain in BCVA was 4.9 (SD 0.8) lines. CONCLUSIONS: Transconjunctival suturing of the trabeculectomy scleral flap is an effective treatment to raise IOP and improve visual loss from hypotony maculopathy after trabeculectomy with overfiltering blebs.

A child with bilateral orbital cellulitis one day after strabismus surgery.

Orbital cellulitis is a rare complication of strabismus surgery. We report a case of a 4-year-old boy with bilateral orbital cellulitis after uneventful surgery to correct esotropia. Concomitant sinusitis was the likely source of infection. To our knowledge, this is the first case of bilateral orbital cellulitis following strabismus surgery.