Traumatic wound dehiscence after penetrating keratoplasty: Clinical features and outcome in 53 cases in Yemen.

AIMS: Penetrating keratoplasty (PKP) carries the risk of developing wound dehiscence, which can lead to vision loss. The main aim of this study is to analyze the management and outcome of surgery for traumatic wound dehiscence occurring in patients who had PKP. SUBJECTS AND METHODS: This retrospective study included post-PKP patients who sustained traumatic wound dehiscence at the Cornea Unit in Yemen Magrabi Eye Hospital between 2008 and 2016. Fifty-three eyes with a history of wound dehiscence were treated with primary wound closure. Patient files were reviewed for type and time of injury, distance visual acuity (VA), and outcome. RESULTS: Ruptured globe with dehiscence of wound occurred on average 2.4 years (3 months to 13 years) after PKP. The mean age at wound dehiscence was 22.27 years and males accounted for 77.4% (41). All patients were managed with primary closure of the wound. Lensectomy of traumatic or dislocated lens was the most frequent additional surgical procedure (14, 26.4%), followed by anterior vitrectomy (6, 11.3%). In the end, 43 (81.1%) grafts remained clear. In the last follow-up, 34 eyes (64.1%) had best-corrected VA of 20/200 or better and two eyes had no perception of light. CONCLUSION: Rupture globe and wound dehiscence occurs after PKP at the graft-host junction. Wound dehiscence is a lifelong risk after PKP and wound weakness persisted for a long period after PKP. Visual outcome and graft survival are generally poor after the injury, and the restoration of a satisfactory visual result is possible if treated early.

Clinical phenotyping of newly diagnosed type 2 diabetes in Yemen.

OBJECTIVE: To identify clinical phenotypes of type 2 diabetes (T2D) among adults presenting with a first diagnosis of diabetes. RESEARCH DESIGN AND METHODS: A total of 500 consecutive patients were subject to clinical assessment and laboratory investigations. We used data-driven cluster analysis to identify phenotypes of T2D based on clinical variables and Homeostasis Model Assessment (HOMA2) of insulin sensitivity and beta-cell function estimated from paired fasting blood glucose and specific insulin levels. RESULTS: The cluster analysis identified three statistically different clusters: cluster 1 (high insulin resistance and high beta-cell function group), which included patients with low insulin sensitivity and high beta-cell function; cluster 2 (low insulin resistance and low beta-cell function group), which included patients with high insulin sensitivity but very low beta-cell function; and cluster 3 (high insulin resistance and low beta-cell function group), which included patients with low insulin sensitivity and low beta-cell function. Insulin sensitivity, defined as median HOMA2-S, was progressively increasing from cluster 1 (35.4) to cluster 3 (40.9), to cluster 2 (76) (p<0.001). On the contrary, beta-cell function, defined as median HOMA2-ß, was progressively declining from cluster 1 (78.3) to cluster 3 (30), to cluster 2 (22.3) (p<0.001). Clinical and biomarker variables associated with insulin resistance like obesity, abdominal adiposity, fatty liver, and high serum triglycerides were mainly seen in clusters 1 and 3. The highest median hemoglobin A1c value was noted in cluster 2 (88 mmol/mol) and the lowest in cluster 1. CONCLUSION: Cluster analysis of newly diagnosed T2D in adults has identified three phenotypes based on clinical variables central to the development of diabetes and on specific clinical variables of each phenotype.

Emergency visits after corneal transplantation in Yemen.

PURPOSE: Awareness of symptoms and signs of possible complications after corneal transplantation is very important. Early presentation can enhance long-term survival of the cornea. This study evaluates the reasons for emergency presentation and management of postcorneal transplantation complications. PATIENTS AND METHODS: This retrospective study included a total of 134 postkeratoplasty patients at the cornea unit in Yemen Magrabi Eye Hospital in Sana'a between 2008 and 2010. RESULTS: The most common indication for keratoplasty was keratoconus in 103 patients (76.9%) followed by bullous keratopathy (4.5%) and corneal dystrophy (4.5%). 80 (59.7%) patients presented for emergency visits. Pain and foreign body sensation were the main presenting symptoms. Loose irritating sutures (29.9%) and graft rejection (10.4%) were the most common diagnoses. Twelve patients (8.9%) were admitted to the hospital for re-suturing. CONCLUSION: Proper postoperative care is critical for a successful keratoplasty; early intervention of sight-threatening complications increases the chance of graft survival and best-obtained vision. In our corneal transplantation service, all patients are routinely instructed to arrange a same day emergency visit if they experience any symptom in eyes that have undergone keratoplasty.