Vector Analysis and Prognostic Factors for Femtosecond Arcuate Keratotomy in Post-Keratoplasty Astigmatism.

Purpose: To analyze different tomographic and refractive parameters for predicting successful visual outcome following femtosecond laser-assisted arcuate keratotomy (FSAK) for post-keratoplasty astigmatism. Design: Retrospective. Methods: Retrospective study evaluating patients with astigmatism following penetrating keratoplasty (PKP) or deep anterior lamellar keratoplasty (DALK) who underwent FSAK. Vector analysis using the Alpins method was done to calculate surgically induced astigmatism (SIA). An improvement of 3 lines of Early Treatment Diabetic Retinopathy Study (ETDRS) lines was used for successful outcome. Outcome was measured at 3 months and 17 months. Results: This study included 106 eyes from 104 patients (65 males and 39 females). Mean age was 31.8±8.6 years, and 89.4% (n=93) of cases were keratoconus (KC), 3.8% (n=4) scar, 3.8% (n=4) granular dystrophy, 1.9% (n=2) post-LASIK ectasia, and 1.0% (n=1) macular dystrophy. Uncorrected visual acuity (UCVA) improved from 1.02±0.53 logarithm minimal angle of resolution (logMAR) to 0.87±0.49 logMAR (p=0.01) at 3 months and to 0.92±1.08 logMAR (p=0.57) at 17 months. Best spectacle-corrected visual acuity (BSCVA) improved from 0.41±0.30 logMAR to 0.31±0.19 logMAR (p<0.01) at 3 months and to 0.23±0.27 logMAR (p<0.01) at 17 months. Success was achieved in 50% (n=53) and 49% (n=52) at 3 and 17 months follow-up, respectively. Success group showed worse preoperative UCVA (1.21±0.56 vs 0.83±0.44 logMAR; p<0.01), worse preoperative BSCVA (0.50±0.36 vs 0.33±0.19 logMAR; p=0.01). Preoperative UCVA had an area under the curve of 0.721 (95% CI: 0.622-0.820; p< 0.01). The Youden's optimal cutoff point was 0.90 logMAR (equivalent Snellen 20/159) with 76.9% sensitivity and 35.2% specificity. Flattening index (FI) was 87% in DALK and 73% in PKP (p=0.14). Correction index (CI) was 99% and 86% (p=0.18) for DALK and PKP, respectively. Success of the astigmatic surgery for DALK and PKP was 44% vs 42% (p=0.29), respectively. Conclusion: Improvement of at least three lines was achieved in 49% of patients who underwent FSAK following PKP or DALK; this improvement was achieved in patients who had a worse preoperative UCVA.

Branch Retinal Artery Occlusion Following Rhinoplasty: A Case Report.

Central retinal artery occlusion (CRAO) is a sudden and vision-threatening condition with catastrophic consequences unless managed immediately by reestablishing the retinal circulation. Even though CRAO is a common ocular disorder, it is a very rare complication after non-ocular surgeries; only a few cases have been reported in the literature. Cardiac and spine surgeries are considered the most common causes of postoperative vision loss. In this case report, we present the case of a young female patient diagnosed with central retinal artery occlusion after a septoplasty. This is considered the first reported case in the Kingdom of Saudi Arabia. Branch retinal artery occlusion (BRAO) and CRAO are possible complications of otorhinolaryngology procedures, and both otorhinolaryngologists and ophthalmologists should be aware of these possible complications.

Prevalence and Determinants of Hoarseness in School-Aged Children.

Hoarseness in school-aged children may affect their educational achievement and interfere with their communication and social skills development. The global prevalence of hoarseness in school-aged children ranges between 6% and 23%. To the best of our knowledge, there is a scarcity of studies describing the prevalence or determinates of hoarseness in Saudi school-aged children. Our aim was to measure the prevalence of hoarseness among school-aged children and to identify its determinants. A cross-sectional questionnaire-based survey was used that included randomly selected primary and early childhood schools from private and governmental sectors in Saudi Arabia. The data were collected using a questionnaire which was self-completed by the children's parents and covered the following aspects: sociodemographic features, health and its related comorbidities about children and their families, attendance and performance in school, child's voice tone, past history of frequent crying during infancy, history of letter pronunciation problems and stuttering, the Reflux Symptom Index (RSI) and the Children's Voice Handicap Index-10 for parents (CVHI-10-P). Determinants of hoarseness were investigated using the SPSS software (version 20). The mean age of the study children (n = 428) was 9.05 years (SD = 2.15), and 69.40% of them were male. The rate of hoarseness in the participants was 7.5%. Hoarseness was significantly common in children with a history of excessive infancy crying (p = 0.006), letter pronunciation issues (especially 'R' and 'S'; p = 0.003), and stuttering (p = 0.004) and in those with a previous history of hoarseness (p = 0.023). In addition, having the symptoms of gastrointestinal reflux increased the risk of hoarseness by four times (OR = 4.77, 95% CI = 2.171, 10.51). In summary, hoarseness in children may be dangerously underestimated, as it may reflect the presence of speech problems, in addition to the presence of laryngopharyngeal reflux (LPR). Hoarseness was assumed on the basis of parental complaints. Therefore, further research with diagnoses based on a clinical assessment is needed to understand the magnitude of the hoarseness problem and its consequences in children.

Isolated Kimura Disease Presenting as a Brow Mass in a Saudi Male: A Rare Case Report.

This is a case of a 36-year-old male not known to have any medical illness complaining of left upper painless swelling in the eyebrow with no systemic symptoms, and normal physical examination apart from the eyebrow mass. Computed tomography (CT) of the head showed a well-defined hyperdense subcutaneous soft tissue lesion seen at the medial aspect of the left orbit (eyelid-extra orbital). Excisional biopsy of the eyebrow mass was done and sent for histopathological evaluation which reports consistent findings with Kimura disease (KD) as a definitive diagnosis.

Characteristics of Breast Masses of Female Patients Referred for Diagnostic Breast Ultrasound from a Saudi Primary Health Care Setting.

BACKGROUND: Breast masses are common among females presenting to primary health care (PHC) facilities. The family physician's role is crucial in detecting breast disease. Utilization of breast ultrasonography has been increasing recently as a diagnostic tool. OBJECTIVE: This study aims to determine the characteristics of masses detected on breast ultrasound, their associations with characteristics of females attending the PHC setting and explore the management of these cases by family physicians. METHODS: This registered based, cross-sectional study included 321 females who were referred for diagnostic breast ultrasound in the PHC center of the University hospital, Eastern province, Saudi Arabia (2017-2019). t-test, Chi-squared and Fisher's Exact tests were performed to assess associations between the presence of breast masses in the ultrasound and patients' characteristics. Moreover, to compare the breast masses in two groups of patients (< 40 years and ≥ 40 years) regarding their characteristics, ultrasound findings, and further management performed. P < 0.05 was considered statistically significant. RESULTS: Approximately 24% patients had a breast mass and 70.92% of cases were detected among females ≥ 40 years old. The odds of having a breast mass were highest among overweight, females complaining from a breast lump, and who had early menarche. Grand multiparous had lower odds of a breast mass. Females < 40 years old had higher rates of breastfeeding, increasing parity, and obesity than older females. Sonographic examined masses were larger in young females, and posterior enhancement of the mass was more reported in older. BI-RADs of the masses were not associated with the patient's age. CONCLUSION: Breast masses were prevalent among females who underwent breast ultrasound. The results support referral for investigation when a female complains of a breast lump. Family physicians have a vital role in encouraging protective behaviors from developing breast masses such as maintaining normal weight and breastfeeding.

Laparoscopic Management of Gallbladder Duplication: A Case Report.

Laparoscopic cholecystectomy has become one of the most commonly performed abdominal surgeries worldwide. Several anatomic variations and congenital malformations in the gallbladder and biliary anatomy have been described. We reported the case of a middle-aged woman who presented with jaundice and abdominal pain. Her laboratory investigations revealed an elevated bilirubin level (mainly the direct component). The patient showed an improvement in the clinical and laboratory parameters after conservative management. Then, the patient was prepared for a laparoscopic cholecystectomy which revealed a duplication of the gallbladder with two distinct cystic ducts draining independently to the common bile duct. The procedure was completed uneventfully. This type of gallbladder duplication is among the least common types. The case highlights the importance of having a meticulous intraoperative evaluation of the biliary anatomy to avoid potential complications and injuries.