Outcomes of Consecutive Exotropia Surgery at a Tertiary Eye Hospital in Saudi Arabia.

Purpose: This study aimed to evaluate surgical outcomes, compare success rates, and identify potential risk factors for failure of various surgical procedures for consecutive exotropia. Patients and Methods: This retrospective cohort study was conducted at a tertiary eye hospital in Saudi Arabia and included patients with consecutive exotropia treated between 2007 and 2020. Patients with a follow-up of <3 months were excluded. The type of surgery performed was based on surgeon experience and factors, such as the angle of deviation, adduction limitation, and intraoperative findings. Successful outcome was defined as a deviation of ≤10 prism diopters (PD) at the last follow-up visit. Results: A total of 59 patients were included in this study. Preoperatively, the mean near and distance deviations were 33 ± 14 PD and 32 ± 14 PD, respectively. Among the included patients, 27.1% underwent medial rectus advancement with or without resection, 28.8% underwent lateral rectus recession, and 44.1% underwent combined surgery. At 12 months postoperatively or the last follow-up visit, the overall success rate of distance-deviation correction and near-deviation correction were 80.6% and 67.8%, respectively. Success rates of different surgeries were not significantly different. The severity of amblyopia and number of muscles operated on did not influence the success rate. Conclusion: Medial rectus advancement and combined medial rectus advancement with lateral rectus recession were associated with better surgical outcomes than lateral rectus recession alone, although the difference was not statistically significant. The only factor that negatively affected the outcome was a high preoperative near angle of deviation.

Pediatric Non-Viral Microbial Keratitis: Predisposing Factors, Microbiological Profile, Treatment Modalities, and Visual Outcome.

Purpose: To describe the predisposing factors, causative organisms, treatment modalities, and visual outcomes of childhood non-viral microbial keratitis in our region. Patients and Methods: All cases with the clinical or microbiological diagnosis of non-viral microbial keratitis in patients ≤18 years presenting to Dhahran Eye specialist Hospital, a tertiary eye care hospital in Dhahran, Eastern Province, Saudi Arabia, between 2010 and 2020 were included. A retrospective chart review was conducted. Demographic data, predisposing factors, clinical characteristics, isolated microorganisms, and visual outcomes were recorded. Results: Fifty-nine patients were included in this study, of which three cases were bilateral. The mean age was 9.3 ± 6.3 years (range: 14 days - 18 years). Predisposing factors were identified in 89.8% (n=53) of cases. Contact lens wear was the leading cause 35.6% (n=21), followed by trauma 27.1% (n=16), ocular diseases 11.9% (n=7), systemic diseases 10.2% (n=6), and ocular surgery 5.1% (n=3). Out of all cases, 66.1% (n=39) have undergone corneal scraping, out of which 43.6% (n=17) showed positive growth. Gram-negative organisms accounted for 47.1% (n=8) isolates of all culture-positive cases. Pseudomonas aeruginosa was the most common pure isolate, which accounted for 41.2% (n=7) of culture-positive cases, followed by Staphylococcus aureus 11.8% (n=2). The most common complication was corneal scar in 71.2% (n=42). Nineteen (32.2%) patients had poor outcome. Seven patients (11.9%) required further intervention, these included penetrating keratoplasty (n=1), deep lamellar keratoplasty (n=3), Photorefractive keratectomy (n=2), and Phototherapeutic keratectomy (n=1). Conclusion: Childhood non-viral microbial keratitis is uncommon; however, it carries significant risks. Most cases were associated with preventable risk factors, with contact lens wear being the leading cause. Early detection and management are mandatory to reduce the risk of vision-threatening complications. The difficulty in assessment should not jeopardize proper evaluation and management of suspected cases.

Scleral Fixated Intraocular Lens in Aphakic Patient with Bilateral Microcornea and Microphthalmia.

We are reporting a case of a 22-year-old lady with bilateral microphthalmia and microcornea, in which a modified technique for sutureless scleral fixated intraocular lens implantation provided a successful aphakic rehabilitation alternative with a good visual outcome and significant improvement in quality of life. Management of aphakia in microphthalmic eyes is challenging due to the anatomical abnormalities and limited literature on managing such cases. Visual rehabilitation for aphakia using contact lenses is limited by intolerance and poor lens fitting. Significant optical aberrations may limit aphakic spectacle use, further exacerbated in patients with nystagmus. Thus, secondary IOL implantation seems to be a reasonable rehabilitation alternative; however, it is surgically challenging in microphthalmic eyes.