Müller muscle-Conjunctival Resection (MMCR) Surgery: A Comprehensive Literature Review.

PURPOSE: This literature review aims to provide a comprehensive overview of the current understanding, indications, techniques, outcomes, and complications of Müller muscle-conjunctival resection (MMCR) surgery. It also addresses areas of debate with MMCR such as predictability concerning Phenylephrine response as well as the amount of muscle resection required. METHOD: This literature review was compiled based on the available evidence from PubMed from 1975 to August 2023. RESULTS: The success rate of MMCR ranges from 72% to 95%, with high patient satisfaction reported in most studies. The exact range of eyelid elevation after MMCR is variable, with a reported average of 2.1 mm MRD1 elevation. CONCLUSION: MMCR is a well-established surgical technique used to correct upper eyelid ptosis that results from dysfunction or attenuation of the levator aponeurosis. MMCR proved to be a safe and effective procedure with a high patient satisfaction rate and low risk of complications.

Trypan Blue and Endoillumination-Assisted Phacoemulsification in a Patient With Advanced Keratoglobus.

Keratoglobus is a rare subset of noninflammatory corneal ectasia, which is a group of disorders characterized by corneal thinning, projection, and scarring. Patients with keratoglobus commonly present with poor vision. A case of advanced keratoglobus was managed by a modified phacoemulsification surgical technique using endoillumination and capsular staining with trypan blue. In this case, we present a 54-year-old man with keratoglobus. In January 2023, a modified phacoemulsification surgical technique using endoillumination was described with a video in a patient with bilateral corneal opacification, neovascularization, significant peripheral thinning, and moderate to severe corneal opacity in which cataract surgery had to be performed alone without considering penetrating keratoplasty. Postoperatively, the patient was doing well with no leaks. We may conclude that this method allows for better visualization during surgery and decreases the risk of intraoperative complications due to poor visualization in patients with severe corneal opacity.

Tacrolimus Ointment in Periorbital Atopic Dermatitis.

Periorbital atopic dermatitis (AD) is a common sign in ophthalmological practice and usually has a persistent and relapsing course. Treatment with topical corticosteroids has various side effects associated with their usage. Tacrolimus topical ointment has unique immunomodulatory properties that decrease skin inflammation and pruritus in AD. In this case series, we present a prospective case series of five patients (three males and two females) who received topical application of tacrolimus ointment 0.1-0.03% in the periorbital area twice daily for one to four weeks. The pre- and post-treatment images of all patients were recorded to compare the effects of the treatment. The cases were selected from patients attending the outpatient clinics of East Jeddah Hospital, Saudi Arabia. All patients were suffering from AD. Patients underwent a clinical assessment by tactile inspection (location, size, color, and surface condition) in the first week, secondweek, third month, and first year. We may conclude from this study that tacrolimus showed promising outcomes and is safe and effective for the treatment of flares or resistant periorbital AD in both adults and children.

Pediatric optic nerve and globe measurements on magnetic resonance imaging: establishing norms for children.

BACKGROUND: Normal optic nerve diameter (OND) and optic nerve sheath diameter (ONSD) may be beneficial for describing optic nerve pathway abnormality reflecting increased intracranial pressure. Nonetheless, magnetic resonance imaging (MRI) measurement of the normal ONSD range and its associations with clinical factors and eyeball transverse diameter (ETD) are not well established in children. PURPOSE: To establish normal OND, ONSD, ETD, and OND/ONSD and ONSD/ETD measurements in children and their associations with age and sex. MATERIAL AND METHODS: We evaluated and analyzed 336 brain MRI studies of children aged 0.5 months to 18 years. We measured a total of 672 optic nerves. The OND and ONSD were measured 1 cm anterior to the optic foramina and 3 mm behind the optic disc on an axial T2 sequence. RESULTS: The mean OND 3 mm and 1 cm, ONSD 3 mm and 1 cm, and ETD were 0.23 ± 0.05 mm and 0.16 ± 0.04 mm, 0.53 ± 0.08 mm and 0.38 ± 0.06 mm, and 2.3 ± 0.13, respectively. Only ONSD 1 cm was independent of age (P = 0.247). ONSD 3 mm and ETD were significantly wider in boys compared to girls and significantly influenced by age (both P < 0.001). Age at scan and ETD were significantly correlated (P < 0.001). CONCLUSION: We established MRI-based OND, ONSD, ETD, and ONSD/ETD and OND/ONSD ratio normative values in children, which can be helpful in pediatric populations with disease.

Attitude toward refractive error surgery and other correction methods: A cross-sectional study.

BACKGROUND: Refractive errors are the most common vision problem and prove to be a significant health issue. There are several methods for correction of refractive errors including spectacles, contact lenses and refractive surgery. Nowadays, the reliance on contact lenses and glasses is decreased by means of refractive eye surgery. Our study aimed to determine the awareness of refractive surgery among undergraduate medical students and their preferred method of refractive error correction. METHOD: This was a cross-sectional study that was conducted among a sample size of 374 medical students at King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia in June-August 2020. Data were collected through a questionnaire which consisted of 20 questions to assess the demographics, awareness about refractive surgery and preferred method of correction. The data were entered using Microsoft Excel 2016 and analyzed by SPSS version 21. RESULTS: Our results showed that 177 of participants had refractive errors. Most participants complained of myopia (66.7%) and the most preferred correction method was spectacles (45.8%). Among users of spectacles, 53.7% found the spectacles comfortable due to ease of use. Majority of the students (92.1%) were aware of refractive surgery and 73% of them were willing to undergo refractive surgery. Many obtained their information regarding these procedures from family and friends (55.1%). The remaining refused to undergo surgery and the primary reason was fear of the complications of the procedure (14.1%). CONCLUSION: Though corrective refractive surgery is a commonly performed procedure, extensive knowledge regarding this correction method and its complications is poor among medical students. The results showed that the majority have heard of refractive surgery, however, fear of undergoing surgery was still present. We suggest that refractive error correction surgery be taught by physicians during Ophthalmology rotations so that knowledge may be gained from more reliable sources.

The Use of Internet and Social Media for Health Information and Its Consequences Among the Population in Saudi Arabia.

BACKGROUND: The Internet is being increasingly used in our lives. Along with Internet use, social media sites are especially popular and are used by many people on a daily basis. Many studies were conducted to see the people's perception and their attitude towards the use of the Internet for health information. Such studies were also carried out in Saudi Arabia, but most have been limited to a specific target sample of the population. Our study aimed to assess the perception towards and use of different platforms and search engines to seek health information in Saudi Arabia. METHOD: A cross-sectional study was conducted in Saudi Arabia during the year 2021. An Arabic online questionnaire using Google forms was sent to a randomized sample. Microsoft Excel 2016 was used for data entry, and statistical analysis was performed using IBM© SPSS© Statistics version 25 (IBM© Corp., Armonk, NY, USA). RESULT: Among the 1363 participants, 56.2% were females and 43.8% were males with a mean age of 30.73 ± 12.3. The majority were living in Western region. The most used social media platforms were WhatsApp (91.5%), YouTube (84.6%), and Twitter (82.6%), respectively. The most common medical websites browsed were the Saudi Ministry of Health (67%) and the Food and Drug Administration (54.4%). Some 40.1% of the participants had a medical consultation online from a doctor, and most of them (67.8%) trusted the online physician. Finally, most of the participants (90.9%) thought that health information on the Internet or social media contributes to raising the level of health awareness among the general population. There was a significant relationship between educational level and gender and online health-seeking behavior (p > 0.05). CONCLUSION: The study reinforced that health information that is sought from the Internet and social media platforms has a great impact on the population, emphasizing the need for credible information sources and how to access them.

Arnold-Chiari Malformation Type II and CYP1B1 Congenital Glaucoma: A Possible Association.

BACKGROUND: We describe a case of an infant with Arnold-Chiari Malformation Type II (ACM-II) who was born with lumbosacral myelomeningocele, hydrocephalus, and primary congenital glaucoma (PCG) together with dysmorphic features (scaphocephaly, frontal bossing, hypotelorism, entropion, and flat nasal bridge), which according to our knowledge, is a combination that has yet to be described in literature. Primary diagnosis. A 2-year-old female who is known to have ACM-II was referred due to abnormal eye examination done in a peripheral hospital that suggested infantile glaucoma in both eyes. Findings. During her last physical exam (postop), she was vitally stable, conscious with good feeding. Ophthalmic assessment revealed buphthalmia, superior paracentral scar, deep anterior chambers (AC), and round pupils with positive red reflex, clear lens, and an IOP of 16, 14 mm Hg, respectively. Neurological exam showed paraparesis and moving upper extremities and has axial hypotonia. Genetic testing showed CYP1B1 gene mutation. CONCLUSION: The aim of reporting this case is to share the findings in this infant as it may be a new association. The main learning message here is that ACM-II patients may present with certain ocular symptoms, including glaucoma-related ones that may mimic neurological disorders. This report brings information that could alert general practitioners, neurologists, and neurosurgeons. A deeper understanding of this rare disorder may aid the diagnosis of cases with similar characteristic physical findings by referring them to an ophthalmology clinic for further evaluation. Case presentation. A 2-year-old female who is known to have Arnold Chiari Malformation Type II (ACM- II) was referred due to abnormal eye examination done in a peripheral hospital that suggested infantile glaucoma in both eyes. MRI at 3 months of age showed lumbosacral myelomeningocele and hydrocephalus. Genetic testing confirmed a CYP1B1 mutation. These combinations of symptoms were never described in the literature before.