Adherence to Follow-Up and the Related Factors of Paediatric Glaucoma at a Tertiary Care Centre in Western Saudi Arabia.

INTRODUCTION: Glaucoma is a main cause of blindness globally. In Saudi Arabia, congenital glaucoma is believed to affect 1 in every 2500 live births. In this study, we identified the adherence and evaluated the factors associated with non-compliance (non-adherence) to recommended follow-up appointments at King Abdulaziz University Hospital, a tertiary centre in Jeddah, Saudi Arabia. METHODS: The medical records of paediatric patients diagnosed with glaucoma between 2009 and April 2022 were reviewed retrospectively. Demographic information, visit dates, scheduled follow-ups, and specific patients' glaucoma histories were all extracted from the records. Patients were categorized as adherent, non-adherent, or lost to tertiary follow-up (LTTF). RESULTS: Of 91 patients, 52 (57.1%) were adherent, 20 (22%) were non-adherent, and 19 (20.9%) were LTTF. Most adherent patients were Saudi (59.3% adherent, 26.5% non-adherent, 14.2% LTTF) (P = 0.02). Adherent patients were far likelier to live further away from the ophthalmology clinic (P = 0.03). The frequency of clinical encounters was statistically significantly different between adherence statuses. The non-adherent group had a higher average number of prescribed ocular medications (P = 0.03). The adherent patients had more frequent visits with elevated intraocular pressure (P = 0.02). CONCLUSION: A significantly high percentage of paediatric glaucoma patients were non-adherent to follow-up visits. When determining the non-compliance risk among paediatric glaucoma patients, physicians must consider the factors contributing to adherence status, which include nationality, distance to the ophthalmology clinic, and number of prescribed ocular medications.

The association of human leukocyte antigen B27 with anterior uveitis in patients from the western region of Saudi Arabia: a retrospective study.

BACKGROUND: The association of human leukocyte antigen B27 (HLA-B27) with anterior uveitis is well known. The prevalence of HLA-B27 and its relation to anterior uveitis is related to race and geographic location. The association is strongest in Western countries and weakest in Eastern countries. Data regarding this association from Middle Eastern countries are limited. Thus, we undertook the study reported here to evaluate the association of HLA-B27 with anterior uveitis in patients in a tertiary center in the western region of the Saudi Arabia. METHODS: The study involved a retrospective analysis of the records of patients with anterior uveitis, referred to the uveitis clinic in Magrabi Eye and Ear Hospital, Jeddah, Saudi Arabia, from 1999 to 2010. The cost-effectiveness of HLA-B27 testing was analyzed. RESULTS: Among the 587 cases of uveitis, 335 (57.1%; mean age 37.56±12.82 years; 203 male and 132 female) cases were of anterior uveitis. All patients with anterior uveitis were investigated for HLA-B27 positivity. Idiopathic anterior uveitis was the most common (80%), followed by Fuchs heterochromic cyclitis (7.45%) and ankylosing spondylitis (3.8%). Only two patients were HLA-B27 positive. The cost-effectiveness of HLA-B27 testing was found to be 165,000 Saudi riyals (44,594 US dollars) per positive case. CONCLUSION: HLA-B27-related uveitis appears to be very rare in our part of the world. Idiopathic uveitis is the most common type of anterior uveitis. The cost-effectiveness of HLA-B27 testing is low for patients with anterior uveitis in the western region of Saudi Arabia.

Causes of uveitis in a tertiary center in Western Saudi Arabia.

OBJECTIVE: To analyze the causes of uveitis and compare our results with national and international published studies. METHODS: This is a retrospective review of medical records of patients who attend the uveitic clinic of Magrabi Eye and Ear Hospital in Jeddah, Kingdom of Saudi Arabia from January 1999 to December 2011. RESULTS: We encountered 823 eyes of 587 uveitis patients (male: 319 [54%] and female: 268 [46%]). Native Saudi patients constituted 52% of our total population, expatriate Arabs 23%, and Afro-Asians 23%. Average age at presentation was 34.8+/-12.83 (range 5-70) years. Unilateral presentation was noted in 351 (60%) and bilateral in 236 (40%) patients. Idiopathic anterior uveitis was the most common diagnosis (n=268, 45.7%). Anterior uveitis was the most common anatomical diagnosis (n=335, 57.1%) followed by panuveitis (n=151, 25.7%), posterior uveitis (n=51, 8.7%) and intermediate uveitis (n=50, 8.5%). There were 50 patients (8.5%) of Behcet`s disease, 48 patients (8.2%) of Vogt-Koyanagi-Harada disease (VKH) and 35 cases (6%) of toxoplasmosis. CONCLUSION: The most common cause of anatomic diagnosis was anterior uveitis. Behcet`s disease was the most common identifiable cause of uveitis followed by VKH. The most common cause of infectious uveitis was toxoplasmosis. Idiopathic anterior uveitis was the most common uveitic entity.

Adalimumab in the treatment of recurrent idiopathic bilateral nodular scleritis.

Our objective is to report a case of bilateral nodular scleritis in a 34-year-old patient, resistant to steroids and traditional disease modifying anti-rheumatic drugs, who was successfully treated with subcutaneous injections of 40 mg adalimumab. Adalimumab resulted in rapid control of scleritis in both eyes within 3 months with no recurrence over 5 years of follow-up. No side effects were reported during treatment.Although a large prospective study and a longer follow-up are required to reach a conclusive result, adalimumab has a potential role in the treatment of the above condition with the control of inflammation.

Clinical experience with adalimumab in the treatment of ocular Behçet disease.

PURPOSE: To describe the clinical outcome of refractory ocular Behçet disease with adalimumab therapy. METHOD: Retrospective review of records. RESULTS: Twenty-one eyes of 11 male patients with ocular Behçet disease received adalimumab therapy. Of the 21 eyes, 17 had improvement of visual acuity by more than 3 lines after the average follow-up of 10.8 months. Ten out of 11 patients showed complete resolution of inflammation by 4 weeks. The dosages of corticosteroids and immunosuppressive drugs were reduced in most of the patients and stopped altogether in 3 and 6 patients, respectively. One patient on infliximab showed improvement of inflammation after switching over to adalimumab. No serious side effects were observed in any of the patients. CONCLUSION: Adalimumab appears to be effective in Behçet disease. It has been shown to improve visual acuity and also to have a corticosteroid and immunosuppressive sparing effect. It can induce and maintain sustained remission of the disease.

Coralline hydroxyapatite orbital implant (bio-eye): experience with 158 patients.

PURPOSE: To assess the problems seen in 158 patients with coralline hydroxyapatite (HA) orbital implants (Bio-Eye). METHODS: A consecutive case series of 170 patients receiving coralline HA implanted by two surgeons over a 5-year period were reviewed. The authors analyzed age, type of surgery, implant size, peg system, follow-up duration, time of pegging, problems encountered, and treatment. RESULTS: Twelve patients were lost to follow-up after 5 months, leaving 158 patients who were followed from 6 to 130 months (average, 39 months). Problems in unpegged implants occurred in 36 (22.8%) patients. Discharge occurred in 18 (11.4%) patients, implant exposure in 12 (7.6%), socket discomfort in 1 (0.6%), conjunctival thinning in 3 (1.9%), chronic conjunctival swelling in 2 (1.3%), and implant infection in 3 (1.9%). Problems after pegging occurred in 68 (50.7%) of 134 patients: discharge in 27 (20.1%), pyogenic granuloma in 24 (17.9%), conjunctiva overgrowing the peg in 4 (3.0%), implant exposure around the sleeve in 5 (3.7%), clicking in 6 (4.5%), peg on an angle in 2 (1.5%), loose sleeve in 1 (0.7%), peg falling out in 18 (13.4%), popping peg in 1 (0.7%), poor transfer of movement in 3 (2.2%), pain with movement in 1 (0.7%), and implant infection in 2 (1.5%). CONCLUSIONS: The Bio-Eye orbital implant represents a porous orbital implant that is biocompatible with orbital tissues and allows fibrovascular ingrowth and improved motility when coupled to the overlying artificial eye. It is more expensive than other commercially available porous orbital implants, such as synthetic FCI3 HA, porous polyethylene (Medpor), and aluminum oxide (Bioceramic) implant. Problems encountered with its use are similar to those problems seen in patients with the synthetic FCI3 hydroxyapatite and aluminum oxide orbital implants.

One-minute schirmer test with anesthesia.

PURPOSE: The 5-minute Schirmer test is a commonly described test for dry eye syndrome but is impractical for most ophthalmologists to perform routinely because of the 5-minute time frame. Hence, we decided to evaluate the intraindividual reliability of different wetting times of the Schirmer basal tear secretion test correlated to that of the standard 5-minute Schirmer test. METHODS: A prospective study was performed using 60 eyes of 30 patients. All patients had symptoms of dry eye syndrome. Patients were excluded if they had anatomic lid abnormalities that could interfere with the conduct of the test. The reliability of the Schirmer test at 30 seconds and 1, 2, 3, and 4 minutes was compared with that of the standard 5-minute test using the intraclass correlation coefficient (ICC). RESULTS: The ICC for each eye was only moderate at 30 seconds but was high to extremely high thereafter. Specifically, at 1 minute, the ICC for right eyes was 0.938 and for left eyes was 0.817. Furthermore, 100% of patients with severe dry eye (defined as a 5-minute Schirmer test of 5.5 mm or less) had a 1-minute Schirmer test less than or equal to 2 mm. Also, 80% of patients with a moderate dry eye (defined as a 5-minute Schirmer test between 5.5 to 10 mm) had a 1-minute test between 3 to 6 mm. CONCLUSION: Our results support the hypothesis that shorter durations of the 5-minute Schirmer test correlate highly with those of the 5-minute test. Specifically, the 1-minute test correlates highly with the 5-minute test and will make this test much more practical for ophthalmologists.