Association Between Keratoconus and Shoulder Dislocation: A Cross-Sectional Study.

Introduction Few studies have highlighted the correlation between shoulder dislocation and keratoconus (KC). This study aimed to examine the association between KC and shoulder dislocation using patients with KC and matched controls. Methods This cross-sectional study was conducted at Jordan University Hospital. We included patients diagnosed with KC from Jordan University Hospital's Ophthalmology Department between 2015 and 2018. We also included age- and sex-matched controls recruited randomly from fitness centers and shopping malls. All participants had complete ophthalmic and orthopedic assessments. KC was diagnosed by clinical examination followed by Pentacam (Scheimpflug Images, Oculyzer, WaveLight, Alcon, USA) confirmation. Results A total of 238 patients, with a mean age of 29.53 (±11.20) years, were included in this study. They were 144 (60.5%) men and 94 (39.5%) women. Moreover, 120 (50.4%) had KC while 118 (49.6%) did not have KC. Only 11 (4.6%) patients had previous shoulder dislocation. We did not find a significant difference in the frequency of shoulder dislocation between patients with and without KC (p = 0.512). Conclusion This study provides further evidence on the lack of association between shoulder dislocation and KC, an association that was presumed due to shared collagen characteristics.

The relationship between aldose reductase gene C106T polymorphism and the severity of retinopathy in Type 2 diabetic patients: A case-control study.

BACKGROUND: Hyperglycemia over-activates glucose reduction to sorbitol by aldose reductase (ALR) leading to osmoregulation disruption and cellular damage that cause diabetic complications. We investigated the association of C106T polymorphism of ALR2 gene with the severity of diabetic retinopathy (DR) in Jordanian Type 2 diabetic patients in this case-control study at the Ophthalmology clinic of the National Centre of Diabetes, Endocrinology, and Genetics. MATERIALS AND METHODS: A total of 277 subjects participated in the study (100 diabetics without retinopathy, 82 diabetics with retinopathy, and 95 controls). Blood samples were withdrawn followed by DNA extraction. C106T polymorphism was examined by polymerase chain reaction followed by restriction fragment length polymorphism and gel electrophoresis. Statistical analysis was performed by SPSS software using analysis of variance, multiple logistic regression or Chi-square test. RESULTS: The CT and TT genotypes were significantly more prevalent in DR patients than those without DR (CT 50% vs. 38%, TT 16.7% vs. 8%, P = 0.02 and 0.01, respectively). DR patients had T allele more frequently than those without it (41.7% vs. 27%, P = 0.007). Diabetics without retinopathy showed similar genotype and allele frequency to those of nondiabetic controls. No correlation between CT/TT genotypes and the severity of DR in affected subjects was found (χ2: 3.049, P = 0.550). CONCLUSION: C106T polymorphism increased the risk to develop retinopathy in Jordanian Type 2 diabetic patients. T allele of ALR2 was associated with DR. The severity of DR did not show an association with this polymorphism.

Lack of relationship between Alu repetitive elements in angiotensin converting enzyme and the severity of diabetic retinopathy.

BACKGROUND: Angiotensin-converting enzyme (ACE) stimulates angiogenesis that leads to the development of diabetic retinopathy (DR). Alu repetitive elements in ACE gene increase the expression of this enzyme. We investigated the frequency of Alu repetitive elements, insertion/deletion (I/D) polymorphism, in angiotensin-converting enzyme among diabetic retinopathy patients and whether this polymorphism is associated with the severity of retinopathy in Jordanians with type 2 diabetes. METHODS: A total of 277 subjects participated in this case/ control study (100 diabetic patients without DR, 82 diabetic patients with DR, and 95 healthy control). Blood samples were withdrawn, followed by DNA extraction. Alu repetitive elements were examined by polymerase chain reaction followed by gel electrophoresis. RESULTS: The genotype and allele frequencies among diabetic patients, were close to healthy controls (genotypes, II 44.4 vs. 44.7%, ID 44.4 vs. 42.6%, DD 12.2 vs. 12.8%, P = 0.402 and 0.677 respectively, alleles, I 65.6 vs. 66%, D 34.4 vs. 34%, P=0.863). Complicated diabetics with retinopathy showed similar genotype and allele frequency to those without complications. The severity of diabetic retinopathy in affected individuals was not correlated with I/D polymorphism (P=0.862). CONCLUSIONS: We conclude that the presence of Alu repetitive elements did not increase the development or progression risk to retinopathy in Jordanian type 2 diabetic patients. No association between I or D alleles with the severity of DR was detected.

Awareness and knowledge about glaucoma among patients attending outpatient clinics of Jordan University Hospital.

PURPOSE: To evaluate the level of awareness and knowledge about glaucoma among Jordanians and determine the relationship between glaucoma knowledge and selected variables. METHODS: This was a descriptive and cross-sectional study conducted at a central hospital. Face-to-face interviews were performed to obtain sociodemographic data and information about glaucoma from Jordanian participants attending different outpatient clinics of Jordan University Hospital (JUH). A convenient sample of 488 participants aged 16 years and above were recruited. Consent form was signed by each participant before starting the interview. RESULTS: The mean age of the study population was 45.71 ± 15.44 years, ranging 16 to 89 years. There were 163 (33.4%) females and 325 (66.6%) males. 81.6% of participants had heard of glaucoma. Only 34.2% of participants defined glaucoma correctly. 52.4% of participants had a low level of knowledge about glaucoma. The main source of information was from family members, relatives, and friends (66.6%); however, this source inversely influenced the level of knowledge. CONCLUSIONS: The results of this study indicate a high level of awareness of glaucoma among Jordanians but low-to-average knowledge about it. Health education programs should be activated at all levels of health- and eye-care services to increase knowledge about glaucoma and prevent the irreversible loss of vision due to the second main cause of blindness worldwide.

Platelet lysate promotes re-epithelialization of persistent epithelial defects: a pilot study.

PURPOSE: To study the use of autologous platelet lysate prepared in a standardized method for the healing of persistent corneal epithelial defects (PED). STUDY DESIGN: Clinical and experimental investigation. METHODS: In this prospective pilot study (ClinicalTrials.gov identifier NCT02979912), ten patients with a PED duration of a minimum 14 days were included. Autologous platelet lysate was prepared in a standardized methodology. Repeated freeze-thaw cycles were used to lyse the platelets. Patients were advised to apply the eye drops four times a day and were evaluated at baseline and on days 7, 14, 21, 28. RESULTS: No adverse events were reported due to the use of undiluted autologous platelet lysate. A total of 70% of patients had complete re-epithelialization within 28 days. Of these, 40% healed within 14 days (effective group) and 30% within 28 days (partially effective group). CONCLUSIONS: Undiluted autologous platelet lysate, prepared according to a standardized methodology, is a safe and effective adjunct therapy for the treatment of PED.

Autoimmune Thyroid Disease and Keratoconus: Is There an Association?

PURPOSE: The association between autoimmune diseases and keratoconus (KC) has been proposed based on previous retrospective studies and case reports. The aim of our study is to investigate whether KC is associated with autoimmune thyroid disease. Methods. A comparative study was conducted on 131 adult subjects from September 2015 to May 2017 at Jordan University Hospital, Amman, Jordan. Subjects were classified into 2 groups: subjects with autoimmune thyroid disease, including Graves' disease and Hashimoto's thyroiditis (n = 68), and a healthy group for comparison (n = 63). Subjects with any other conditions known to be associated with KC were excluded. The diagnosis of KC was based on clinical and corneal topographic findings utilizing the Oculus-Pentacam machine. In addition, TSH and total T4 levels as well as thyroid peroxidase antibodies were measured in all study participants. Antithyroglobulin antibodies, thyroid stimulating immunoglobulin, thyroid ultrasound, and thyroid uptake and scan were also selectively performed in some participants. RESULTS: This study included a total of 131 participants (101 females and 30 males), including patients and controls. In the multivariate analysis, autoimmune disease was not significantly associated with keratoconus (OR = 1.1; 95% confidence interval: 0.3, 3.8; p value = 0.353) after adjusting for age and gender. CONCLUSION: This study did not show a statistically significant association between autoimmune thyroid disease and KC.

Keratoconus Asymmetry between Both Eyes Based on Corneal Tomography.

PURPOSE: To characterize the asymmetry between both eyes in patients with keratoconus based on corneal tomography. MATERIALS AND METHODS: All patients with keratoconus who presented to the eye clinic at Jordan University Hospital between January 2008 and November 2011 were included in the study. Using computerized corneal tomography, the keratometric values and indices of both eyes of participants with keratoconus and normal controls were compared. For both eyes to be considered symmetrical, the difference between the mean curvature power (Km), flat curvature power (K1), or steep curvature power (K2) in both eyes was equal to or <2.5 diopters, and the difference between the thinnest corneal points was equal to or <25.0 µm between both eyes. RESULTS: Ninety-eight patients with keratoconus and 49 normal participants were evaluated. The mean age of the participants was 26.3 ± 6.6 years. The results showed two populations of patients with keratoconus: one with asymmetrical corneas who were more affected by the disease and another with symmetrical corneas. As the disease severity increased, the differences between the two eyes increased for patients with the asymmetrical form, while both corneas of patients with the symmetrical form were similar. CONCLUSIONS: Corneal tomography identified two forms of keratoconus: symmetrical and asymmetrical. The latter tended to be more severe and occurred in a younger age group. Questions remain about whether the two keratoconic forms are specific to the Middle Eastern population and whether there are ethnic or demographic forms of the disease.

Prevalence of blindness and diabetic retinopathy in northern Jordan.

PURPOSE: To estimate the prevalence of blindness, visual impairment, diabetes, and diabetic retinopathy in north Jordan (Irbid) using the rapid assessment of avoidable blindness and diabetic retinopathy methodology. METHODS: A multistage cluster random sampling technique was used to select participants for this survey. A total of 108 clusters were selected using probability proportional to size method while subjects within the clusters were selected using compact segment method. Survey teams moved from house to house in selected segments examining residents 50 years and older until 35 participants were recruited. All eligible people underwent a standardized examination protocol, which included ophthalmic examination and random blood sugar test using digital glucometers (Accu-Chek) in their homes. Diabetic retinopathy among diabetic patients was assessed through dilated fundus examination. RESULTS: A total of 3638 out of the 3780 eligible participants were examined. Age- and sex-adjusted prevalence of blindness, severe visual impairment, and visual impairment with available correction were 1.33% (95% confidence interval [CI] 0.87-1.73), 1.82% (95% CI 1.35-2.25), and 9.49% (95% CI 8.26-10.74), respectively, all higher in women. Untreated cataract and diabetic retinopathy were the major causes of blindness, accounting for 46.7% and 33.2% of total blindness cases, respectively. Glaucoma was the third major cause, accounting for 8.9% of cases. The prevalence of diabetes mellitus was 28.6% (95% CI 26.9-30.3) among the study population and higher in women. The prevalence of any retinopathy among diabetic patients was 48.4%. CONCLUSIONS: Cataract and diabetic retinopathy are the 2 major causes of blindness and visual impairment in northern Jordan. For both conditions, women are primarily affected, suggesting possible limitations to access to services. A diabetic retinopathy screening program needs to proactively create sex-sensitive awareness and provide easily accessible screening services with prompt treatment.

Ocular manifestations of Behçet's disease in Jordanian patients.

PURPOSE: To study the prevalence, manifestations and severity of ocular involvement of Behçet's disease in Jordanian patients. METHODS: The study population consisted of 43 patients diagnosed to have Behçet's disease through Rheumatologist's examinations conducted at Jordan University Hospital between January 2002 and July 2009. The sample involved patients who displayed ocular manifestations. This included 18 patients; 12 males and 6 females with a mean age of 35 years (SD = 17.26). Ophthalmological examinations and retrospective analysis of medical files were carried on. RESULTS: Ocular manifestations were seen in 41.9% of patients. The most common manifestation for Behçet's disease was vitritis with a prevalence of 55.6%, followed by anterior uveitis and retinal vasculitis (50% for each). On the other hand, the most frequent complications involved were cataract, cystoid macular edema (CMO), posterior synechiae and glaucoma with a prevalence of (44.4%), (33.3%), (11.1%) and (5.6%), respectively. CONCLUSION: The prevalence and severity of ocular lesions in Behçet's disease is relatively low in Jordanian patients. This result indicates that early diagnoses and intervention might delay or even prevent vision loss for those patients.

Intravitreal bevacizumab in the treatment of diabetic ocular neovascularization.

PURPOSE: To evaluate the efficacy of intravitreal bevacizumab for treating diabetic retinal and/or iris neovascularization. METHODS: Consecutive, prospective, interventional case series study of 60 eyes with diabetic retinal and/or iris neovascularization. Patients had a complete ocular examination before receiving 1.25 mg (0.05 mL) of intravitreal bevacizumab. Abnormal new vessels elsewhere in the retina, optic disk, or iris were graded by size and associated hemorrhage or glaucoma. Patients had complete postinjection ophthalmic evaluations with regrading of the abnormal new vessels at 3 months and 6 months. The main outcome measures included clinical partial or total regression of abnormal new vessels, changes in visual acuity, and complications related to the intravitreal injections. RESULTS: Twenty-six patients (47.3%) were men (mean age, 59 years). Abnormal new vessel regression at 6 months occurred in 65% of new vessels of the iris (P = 0.001), 45% of new vessels of the optic disk (P = 0.009), and 43% of new vessels elsewhere (P = 0.008). The visual acuity improved in 20% of eyes, which was not significant (P = 0.235); the visual acuity deteriorated in 23% of eyes (P = 0.163). No systemic or ocular side effects developed except for postinjection hypotony in one eye. CONCLUSION: Intravitreal bevacizumab is a well-tolerated medication that causes regression of abnormal diabetic neovascularization. New vessels of the iris responded more than new vessels of the optic disk and new vessels elsewhere.

Pseudoexfoliation syndrome at Jordan University Hospital.

PURPOSE: This study aimed to estimate the prevalence of pseudoexfoliation syndrome (PXS) and analyse its association with particular ocular diseases in patients attending the Department of Ophthalmology at Jordan University Hospital. METHODS: A total of 1195 consecutive patients, aged 40-90 years, who attended the Department of Ophthalmology at Jordan University Hospital between December 2005 and March 2007 were included in the study. Each patient underwent complete ophthalmic evaluation, including: relevant history; visual acuity testing; slit-lamp examination, applanation tonometry, gonioscopy and dilated fundus examination. Patients with typical pseudoexfoliative material on the anterior lens surface and/or the pupillary margin in either or both eyes were labelled as having PXS. RESULTS: Of the 1195 patients, 9.1% had pseudoexfoliation (PXF). Their mean age was 68.3 years (standard deviation [SD] 9.57). The prevalence of PXS had a tendency to increase with age but had no sex predilection. Pseudoexfoliation was bilateral in 65.7% of cases. It was significantly associated with cataract, glaucoma and phacodenesis. Of the eyes with PXF, 92.1% had cataract, 33.1% had glaucoma and 7.9% had phacodenesis. CONCLUSIONS: Although this study was not population-based, its findings increase our knowledge of PXS in a Middle Eastern country. Few data on PXS are available from this part of the world.

Late opacification of a hydrophilic acrylic intraocular lens.

Cataract extraction and intraocular lens implantation is considered to be a safe procedure in most cases. However, the new advances in the surgical technique namely phacoemulsification and hence the increased use of foldable intraocular lenses have given rise to new complications including late opacification of intraocular lenses. In this case we report late opacification of a foldable hydrophilic acrylic intraocular lens and the surgical technique for its exchange.

Risk Factors for Diabetic Retinopathy among Jordanian Diabetics.

PURPOSE: To identify the risk factors associated with diabetic retinopathy among diabetic patients at Jordan University Hospital. METHODS: A total of 986 patients with diabetes mellitus were assessed at Jordan University Hospital. The assessment included detailed relevant history, complete medical and ophthalmic evaluation. RESULTS: Out of the 1961 eye examined, 64.1 percent had one form of diabetic retinopathy; 54.8 percent had nonproliferative diabetic retinopathy (NPDR), 9.3 percent had proliferative diabetic retinopathy (PDR) and 30.8 percent had maculopathy. Of all participants, 23.5 percent had combined NPDR and maculopathy while 7.6 percent had PDR and maculopathy. Using logistic regression analysis it was shown that old age group, long duration of diabetes, poor glycemic control, uncontrolled blood pressure and the presence of nephropathy were significantly associated with diabetic retinopathy. The incidence of maculopathy was significantly associated with the presence of hypertension, protienuria and high cholesterol level. CONCLUSION: The challenge for the primary care physician and diabetologist is to attain excellent glycemic control, aggressive control of blood pressure and normalization of blood lipid in order to reduce the risk of blindness and lessen the burden from diabetic retinopathy.

Argon laser: a modality of treatment for trichiasis.

The purpose of this study is to evaluate the success rate and safety of argon laser photocoagulation as a modality of treatment for symptomatic trichiasis in a Middle Eastern country (Jordan). This simple descriptive study included 54 patients (68 lids) with symptomatic trichiasis. They were treated with argon laser and followed over 8 month period. After topical and infiltration anaesthesia, 30-40 shots of blue-argon laser were directed to the lash root to a depth of 2-3mm. Laser beam variables were: 50-100 µm spot size, 0.3 second duration and 0.50 Watt power. The maximum number of treated lashes per lid was five. Recurrence was defined as regrowth of one or more trichiatic lash. Up to two additional applications with the same laser parameters were done for recurrent trichiasis. The success rate after one treatment session was 61.1% and with up to a total of three sessions, it was 85.2%. The complication rate was 20.6% (14 lids) in the form of mild hypopigmentation in 8 lids and notching in 6 lids. The complication rate was higher among patients treated previously with cryotheray or lid surgery. Argon laser photocoagulation is a safe and effective office procedure for treatment of symptomatic trichiasis.