Transpalpebral intraocular pressure measured by Diaton tonometer before, 1 week, and 1 month after transepithelial photorefractive keratectomy in young myopic Saudi patients and its determinants.

PURPOSE: To present changes in transpalpebral intraocular pressure (tpIOP) in eyes after transepithelial photorefractive keratectomy (TPRK) in myopic Saudi patients and its determinants. METHODS: This one-armed cohort included the myopic eyes of Saudi adolescents treated with TPRK in 2020-2021. The difference in tpIOP before surgery, 1 week after surgery, and 1 month after surgery using Diaton was the main outcome. Central corneal thickness (CCT), myopia grade, gender, age, and corneal epithelial thickness before surgery were independent factors. Matched-pair analysis was conducted. The determinants of tpIOP post-TPRK were studied. RESULTS: Our cohort included 193 eyes of 97 participants (25.6 ± 5.8 years). Mild, moderate, and severe myopia were present in 93, 79, and 21 eyes, respectively. tpIOP was 22 mmHg or more in 5 and 8 eyes at 1-week and 1-month follow-up, respectively. The change in tpIOP ranged from - 7.00 to + 11.0 mmHg at 1 week and - 8.0 to + 26.0 mmHg at 1 month. The median change of CCT at 1 month was 59 µ. Change in tpIOP was not correlated with change in CCT at 1 month (r = -0.107, Pearson P = 0.14). Change of tpIOP was significantly correlated to spherical equivalent (SE) before surgery (matched-pair P < 0.001). SE (Mann-Whitney U P = 0.02) and tpIOP (Mann-Whitney U P = 0.02) before TPRK were significantly correlated to tpIOP >22 mmHg after TPRK. CONCLUSION: The changes in tpIOP following refractive surgery correlate to the refractive status of the eye and tpIOP before surgery.

Transpalpebral intraocular pressure measurement by Diaton compared to Goldman applanation tonometer in myopic eyes before and after transepithelial photorefractive keratectomy in Saudi Arabia.

AIM: To compare intraocular pressure (IOP) measured via the trans palpebral IOP (tpIOP) method using a Diaton or with a Goldman applanation tonometer (GAT) and study the determinants of IOP difference in eyes undergoing transepithelial photorefractive keratectomy (TPRK) for myopia. METHODS: This cross-sectional validation study was held in 2020 in an eye hospital in Saudi Arabia. IOP was measured by Diaton and GAT before treatment, after one week, and one month of TPRK. It is considered if IOP difference by Diaton and GAT was less than ±2 mm Hg acceptable. The IOP difference was tested if correlated to spherical equivalent (SE), central corneal thickness (CCT), age, gender, or tpIOP. RESULTS: Totolly 200 myopic eyes of 100 patients were included in the study. The mean difference of IOP measured by two methods before TPRK, 1wk, and 1mo after TPRK were 0.790, -0.790, and -0.920 mm Hg, respectively (P<0.001). Diaton could measure IOP effectively 89.5% eyes before TPRK and 82% and 84% at 1wk and 1mo after TPTK, respectively. At week 1, IOP differences were significantly correlated to baseline CCT (P=0.02) and tpIOP at week 1 (P<0.001). One month after TPRK, only tpIOP was significantly correlated to the difference in IOP (P<0.001). CONCLUSION: Diaton is a good screening tool for IOP before TPRK. It helps in monitoring IOP after surgery. Although more practical, it is less efficient than GAT. In eyes with high myopia and low tpIOP before surgery, IOP post-TPRK by Diaton and GAT could differ.

COVID-19-Related Awareness and Behaviors of Non-Saudi Travelers and Their Satisfaction with Preventive Measures at Saudi Airports.

Airports could serve as hotspots for the spread of the COVID-19 infection. We aimed to assess the awareness, attitude, and behaviors of non-Saudi travelers about COVID-19 and their satisfaction with preventive measures at Saudi airports. A cross-sectional study was conducted among non-Saudi travelers arriving in Saudi Arabia at two international airports. Data were collected using a questionnaire in Arabic, Hindi, and Urdu languages. Awareness, attitude, behavior scores, and satisfaction levels were calculated. Linear regression analyses were done to assess the predictors of awareness, attitude, and behaviors. A total of 633 participants were included in the study. The mean awareness, attitude, and behavior scores were 16.3/22, 18.3/24, and 3.2/5, respectively. Nationality, education, and income were significant predictors of awareness. Nationality was the only significant predictor of attitude, while gender and nationality were predictors of behaviors. Overall satisfaction with preventive measures was: transportation (94%), lounges and corridors (96%), counters (98%), and airport staff (97%). There was overall good awareness and attitude among travelers. Behavior scores were relatively low, which needs to change as air travel poses a threat to the spread of infectious diseases. Airport authorities need to manage passengers properly to ensure adequate distancing to prevent the potential transmission of infections.

The Comparison of Intraocular Pressure Measured by Transpalpebral Method Using Diaton and Rebound Tonometry by iCare in the Eyes Before and After Transepithelial Photorefractive Keratectomy (TPRK) in Saudi Arabia.

INTRODUCTION: Intraocular pressure (IOP) measurement is vital to select and monitor a patient undergoing ocular surgery. The validity of tonometry by independent researchers is useful. In this paper, we compare intraocular pressure (IOP) by rebound tonometry using iCare (Tiolat Oy, Helsinki, Finland) with transpalpebral IOP (tpIOP) method by using Diaton (Bicom Inc., NY, USA) before and after transepithelial photorefractive keratectomy (TPRK) in Saudi Arabia. METHODS: This cross-sectional validity study was held at a private ophthalmology hospital in central Saudi Arabia from January 2021 to February 2022. The tonometry was performed before, at week 1 (W1), and month 1 (M1) after TPRK. The tpIOP and IOP by iCare were compared using matched-pair analysis. The agreement in IOP by two methods was reviewed using the Bland-Altman plot. Central corneal thickness (CCT), spherical equivalent (SE) before surgery, and gender were correlated to the difference in IOP by two tonometers. The main outcome was the difference in IOP measured by Diaton and iCare. RESULTS: We studied 202 eyes of 101 patients. The median difference in IOP by Diaton and iCare was -1.0 mmHg before, at W1, and M1 follow-ups. Before surgery, tpIOP by Diaton was 15.0±2.8 mmHg and by iCare was 16.0±3.7 mmHg (P<0.001). At W1, tpIOP was 15.9±2.5 mmHg and 16.9±3.4 mmHg by iCare (P<0.001). At M1, tpIOP was 15.7±4.1 mmHg and 16.5±5.4 mmHg by iCare (P<0.001). IOP by two methods was within ±2 mmHg in 73.3%, 69.8%, and 75.2% of the eyes before, at W1, and M1 of TPRK. Pre-CCT (P<0.001) was the significant predictor of the difference in IOP by two methods at W1 and M1 (P=0.001). iCare gave the overestimation of IOP compared to Diaton in 18.3%, 22.8%, and 17.8% of the eyes before, W1, and M1 follow-ups. CONCLUSIONS: IOP by iCare and Diaton was similar. Central corneal thickness was the predictor of IOP differences by tonometers.

Trans Palpebral Intraocular Pressure Measurement by Diaton Tonometer and Central Corneal Thickness in Eyes before and after Transepithelial Photorefractive Keratectomy of Saudi Patients.

PURPOSE: The influence of central corneal thickness (CCT) on intraocular pressure (IOP) measurement by Diaton is debatable. We present a correlation of CCT to transpalpebral IOP (tpIOP) and its determinants in patients undergoing transepithelial photorefractive keratectomy (TPRK) in Saudi Arabia. METHODS: In this cross-sectional study held in 2022, the IOP of patients undergoing TPRK was measured by Diaton tonometer. The CCT was measured before and 1 week after refractive surgery. The correlation coefficient of CCT and IOP and its Pearson P value were estimated. The effects of gender, type of refractive error (RE), and corneal epithelial thickness (CET) on the correlation of IOP to CCT were reviewed. RESULTS: We studied 202 eyes in 101 patients (Male: Female, 47:53; age 25.7 ± 5.8 years). The tpIOP was 15.1 ± 2.8 mmHg before, 15.9 ± 2.8 mmHg 1 week after, and 15.7 ± 4.1 mmHg 1 month after TPRK. The CCT was significantly correlated with tpIOP before surgery (Pearson correlation 0.168, P = 0.017) and after tPRK (Pearson correlation 0.246, P < 0.001). Gender (P = 0.96), CET (P = 0.43), and type of RE (P = 0.99) were not significant determinants of correlation between CCT and tpIOP before TPRK. The correlation of tpIOP and CCT was not affected by gender (P = 0.07), CET (P = 0.39), and type of RE (P = 0.13). CONCLUSION: CCT should be considered before interpreting tpIOP measured by with Diaton. Diaton could be a useful tool to monitor IOP changes in young patients undergoing refractive surgery.

Frequency and risk factors of narrow angles in patients with pseudoexfoliation: a case-control study.

PURPOSE: To determine the frequency and risk factors of narrow angles in pseudoexfoliation (PXF) patients. METHODS: A prospective case-control study was conducted during the period from March 2017 to December 2020. Adult patients (above 40 years) presenting with PXF were consecutively enrolled (study group). Cases were matched with individuals above 40 years presenting to a comprehensive ophthalmology clinic without evidence of PXF (control group). RESULTS: We enrolled 196 PXF patients and 98 controls. The occurrence of narrow angles was 25% in the PXF group and 5.1% in the control group (P = 0.0001). Compared to controls, PXF patients were older (72.6 ± 9.6 vs. 64.4 ± 8.5, P < 0.0001) and had a lower mean ACD (2.79 ± 0.4 vs. 3.05 ± 0.4, P < 0.0001). There was no difference in AL measurements between both groups (23.3 ± 1.4 vs. 23.7 ± 1.0, P = 0.0714). After stratification by age group and gender, the risk of narrow angles was higher in PXF patients above 70 years (OR, 4.15; 95% CI, 0.91-23.87; P, 0.044). There was no gender difference in the risk of developing narrow angles. CONCLUSION: Narrow angles are more frequently encountered in PXF patients compared to controls. Advanced age (> 70 years) is significantly associated with an increased likelihood of developing narrow angles.

Bilateral angle closure glaucoma in a teenage girl - A rare presentation in Arab population - A case report.

Primary angle closure glaucoma (PACG) usually presents as unilateral and has acute onset. In Arab population, the proportion of open- and closed-angle glaucoma is similar. To the best of our knowledge, chronic PACG in very young age is rare. We share a case report of a teenage girl with advanced glaucomatous changes and, on gonioscopy, had synechia and closed angle of anterior chamber. She was treated by bilateral laser iridotomy and topical glaucoma medication. The author concludes that, even at very young age, in the absence of predisposing factors for secondary glaucoma, the patient should be investigated for PACG and managed accordingly.

Profile and management outcomes of glaucoma cases at Qassim University Hospital.

OBJECTIVE: In view of the paucity of community-based data about glaucoma in Saudi Arabia, better planning to address visual disabilities due to glaucoma is a challenge. Providing hospital-based data from semi-urban places will complement the picture based on information of tertiary eye hospitals of capital. METHODS: This is one-armed cohort study. All patients attending glaucoma subspecialty unit at our university hospital during 2014-2015 were evaluated for their demographic details, ocular status at presentation, management modalities, and follow-up status of treated eyes. The qualified and absolute success rates (intraocular pressure <22 mmHg with/without medication) were estimated. The determinants of success were analyzed. RESULTS: We assessed 219 eyes of 122 patients of glaucoma patients. Bilateral glaucoma was in 97 (79.7%) patients. Primary chronic angle closure glaucoma in 102 (46.6%) eyes and primary open angle glaucoma (POAG) in 56 (25.6%) were the main types of glaucoma. More than half of the eyes with glaucoma had a normal functional vision, while 9.2% had vision <20/400. At presentation, 133 (60.7%) had undergone surgical procedure including laser iridotomy. At last follow-up, 135 (62%) of glaucomatous eyes were not using glaucoma medications. The decline in a number of glaucoma medications at last follow-up compared to 1st visit was statistically significant (P < 0.001). CONCLUSIONS: At tertiary eye center of semi-urban area of Saudi Arabia had primary chronic angle-closure glaucoma (PCACG) as the main type of adult glaucoma. Vision does not seem to understand the severity of glaucoma at presentation. POAG cases were medically managed while PCACG cases were managed both with laser and surgeries.

Intraocular Pressure Outcomes Following Transscleral Diode Cyclophotocoagulation Using Long and Short Duration Burns.

PURPOSE: The purpose of this study was to compare outcomes of transscleral diode cyclophotocoagulation using short duration (SD) versus longer duration (LD) treatment. PATIENTS AND METHODS: Data were collected retrospectively on patients with glaucoma who underwent cyclophotocoagulation with LD (4000 ms) treatment with variable power ≤1000 mW versus SD using 1500 ms with variable power ≤2000 mW. The outcome measures included: intraocular pressure (IOP) at 12 months, decrease in number of antiglaucoma medications, complications and visual acuity (VA) at the final follow-up visit. RESULTS: There were 71 patients and 70 patients in the SD and LD groups, respectively. The mean IOP±SD pretreatment baseline was 33±10 versus 36±10 mm Hg for SD and LD groups, respectively (P>0.05). At 1 year postoperatively, the IOP decreased significantly in both groups (16.7 vs. 17.4 mm Hg for SD and LD, respectively; P<0.0001). This decrease in IOP was comparable between groups (P=0.5). The average number of IOP lowering medications were 2.5 and 2.9 at baseline in the SD and LD groups, respectively, and decreased to 1.3 in both groups (P=0.83). The mean LogMAR VA decreased significantly from 1.87 at baseline to 1.96 at 1 year in the SD group (P=0.276), and 2.03 to 2.3 (P≤0.001) in the LD group, this change was comparable (0.19; P=0.075) between the 2 groups. Complications were also comparable. CONCLUSIONS: Both LD and SD burns during cyclophotocoagulation effectively lowered IOP at 1 year. Neither treatment resulted in a greater reduction of IOP. LD treatment appeared to result in a decrease in VA and greater postoperative inflammation.

Prevalence and histopathological characteristics of corneal stromal dystrophies in Saudi Arabia.

PURPOSE: The aim was to determine the frequency and describe the main histopathologic features of corneal stromal dystrophy in Saudi Arabia. METHODS: A single-center, retrospective analysis of 193 corneal specimens diagnosed with stromal dystrophy. All samples were retrieved from the Histopathology Department at King Khaled Eye Specialist Hospital over a 10-year period (2002 to December 31, 2011). Cases of stromal dystrophy undergoing keratoplasty were included in the study. Routine histopathologic stains and specific stains were used to determine a diagnosis. The corresponding demographic data and basic clinical/surgical information were collected via chart review. RESULTS: The study sample was comprised of 193 eyes. The final diagnoses were macular corneal dystrophy (MCD) in 180 (93.26%) eyes, granular corneal dystrophy (GCD) in 9 (4.66%) and lattice corneal dystrophy (LCD) in 4 (2.07%) eyes. The mean age at presentation was 27.03 years for MCD, 26.33 years for GCD and 53.75 years for LCD. The interval between diagnosis and surgical intervention was not statistically different between the macular and granular groups (P = 0.141). There was a positive family history for the MCD (37.22%) and GCD (44.44%) groups. All eyes underwent penetrating keratoplasty (PKP) except 10 MCD cases that underwent lamellar keratoplasty. Diffuse stromal deposits were present in 87.2% of MCD corneas and 66.67% of GCD corneas. Seventeen eyes with MCD were misdiagnosed as GCD. None of the LCD cases were clinically identified since all of these cases were diagnosed as corneal scarring. In eyes with MCD that underwent PKP, there was diffuse stromal involvement (in 87.22% eyes) and changes in Descemet's membrane (in 53.5% eyes). CONCLUSION: This pathological study suggested that MCD was the most common corneal stromal dystrophy that required keratoplasty in Saudi Arabia. Patient with MCD and GCD presented at a significantly younger age than LCD. The clinical diagnosis of MCD is not achieved in all cases likely due to a more severe phenotype in the Saudi population or the presence of corneal scarring that is associated with previous trachoma, which obscures the classical appearance of LCD. We believe that PKP is first-line surgical treatment, especially for MCD because it involves all corneal layers. However, deep stromal involvement and changes in Descemet's membrane in MCD should be considered when selecting the surgical procedure.