Outcomes of Corneal Topography among Progressive Keratoconus Patients 12 months following Corneal Collagen Cross-Linking.

PURPOSE: This study aimed to assess the overall and specific topographic changes among patients who underwent corneal collagen cross-linking (CXL) due to progressive keratoconus. METHODS: This retrospective case series study was conducted at a single-arm hospital in King Abdulaziz Medical City, Riyadh. All progressive keratoconus patients who underwent CXL between January 2017 and December 2018 were included consecutively. The epi-off crosslinking technique (Dresden protocol) was applied in all patients. The topographic values were measured preoperatively and 12 months postoperatively. Patients with a history of a previous corneal procedure, corneal trauma, or any corneal scarring were excluded. RESULTS: Among our population (29 eyes of 24 patients), 58.6% of eyes were for male patients, and the mean age of the population was 27.76 ± 4.21 years. Based on the topography results, the mean values of corneal thickness at central 3 mm decreased from 473.45 ± 38 µm to 465.72 ± 41.78 µm following CXL (Z = -1.93, 95% confidence interval [CI] = 0.048-0.057, p= 0.053). Clinically significant astigmatism measurements were present in 28 (96.6%) eyes before CXL compared to 26 (89.7%) eyes after CXL. The mean values of astigmatism among the patients were 3.37 ± 2.25 diopters before and 3.67 ± 2.61 diopters after CXL (Z = -1696, 95% confidence interval [CI] = 0.085-0.096, p = 0.09). After CXL, the mean values of the front elevation at the apex changed from 33.90 ± 20.13 µm to 36.10 ± 21.09 µm (Z = -2.792, 95% [CI] = 0.003-0.006, p = 0.005). The mean values of the back elevation at the apex changed from 68.4 ± 35.66 µm to 69.90 ± 35.89 µm (Z = -0.934, 95% CI = 0.343-0.366, p = 0.35). CONCLUSION: The topographic corneal parameters improved significantly in the patients with corneal ectasia after CXL. These results revealed the safety and efficacy of CXL in stabilizing keratoconus progression among Saudi patients at 1 year of follow-up.

Prevalence and risk factors of gestational diabetes mellitus among pregnant patients visiting National Guard primary health care centers in Saudi Arabia.

OBJECTIVES: To measure the prevalence of gestational diabetes mellitus (GDM) and its risk factors in Saudi Arabia, in comparison with developed and developing countries worldwide.  Methods: We enrolled pregnant women aged 15-45 years who visited 3 National Guard-Health Affairs' primary health care centers in Jeddah, Saudi Arabia between January 2017 and December 2017. We used stratified samples and computer-generated random numbers to collect data. This data includes demographics, obstetric history, blood pressure, non-fasting 1-hour glucose challenge test (GCT), 3-hour oral glucose tolerance test (OGTT), hemoglobin level, rubella immunization status, hepatitis B surface antigen status, urinalysis results, and labor, and delivery notes. We categorized the patients into 2 groups, GDM and non-GDM, based on GCT and OGTT. Results: We enrolled 347 women in the study (mean age, 28.8±6 years; range, 18-45 years). On GCT, 36.6% of women showed abnormal values and 6.9% exhibited diagnostic values. Oral glucose tolerance test indicated impairment in 18.7% of patients and a diagnostic finding in 15% of patients. Women diagnosed with GDM tended to be older and have greater body mass index (BMI) values. Conclusion: The prevalence of GDM in Saudi Arabia is high compared to other countries. Advanced maternal age and higher BMI values were associated with increased prevalence of GDM. Thus, early prevention and management of GDM is vital to minimize the risks to both the mother and fetus.

One of the First Cases with PIK3CA-related Overgrowth Spectrum (PROS) in Saudi Arabia: A Case Report and Literature Review.

PIK3CA-related overgrowth spectrum (PROS) is an umbrella that includes a broad range of rare disorders, ranging from isolated digit enlargement to extensive overgrowth of the limbs, abdomen, or brain. One of these disorders is megalencephaly capillary malformation polymicrogyria syndrome (MCAP), which is characterized by cutaneous capillary malformations, megalencephaly, cortical brain malformations, abnormalities of somatic growth with body and brain asymmetry, developmental delay, and characteristic facial dysmorphism. The diagnosis of PROS syndrome is based on the clinical features of a patient and confirmed by a pathogenic variant in one PIK3CA allele in a biopsy of the affected tissue. However, MCAP may be diagnosed by testing a blood or saliva sample. The management of patients with MCAP syndrome includes evaluation after the initial diagnosis, treatment of manifestations, and surveillance for potential complications. To date, there is no curative treatment for patients with MCAP syndrome. Therefore, reporting such cases will help us understand them and thus develop an appropriate treatment for them. Our patient was a 46-month-old boy, who is diagnosed with MCAP syndrome. The diagnosis was based on clinical presentation, imaging studies, and whole-exome sequencing (WES). Clinically, the patient had speech and developmental delay, macrocephaly, joint hyperlaxity, unsteady gait, and subtle dysmorphic facial features. The facial features include low-set ears, frontal bossing, depressed nasal bridge, and bilateral esotropia. MRI studies showed megalocephaly, bilateral perisylvian polymicrogyria, bilateral peri-regional, high T2 signal intensities, and cerebellar tonsil ectopia with crowding of the posterior fossa. Finally, the diagnosis was confirmed by WES, which detected changes in the PIK3CA gene. The patient is on overgrowth protocol for PIK3CA, which includes alpha-fetoprotein and abdominal ultrasound every three months until the age of eight years. To the best of our knowledge, this is one of the first cases of PROS in Saudi Arabia, which illustrates the classical findings of MCAP syndrome. Further studies and investigations on PROS syndrome are needed to aid in making a definitive classification and treatment of such complex and rare diseases.