Central corneal pachymetry in Yemeni patients undergoing refractive surgery.

OBJECTIVE: To assess the preoperative central corneal thickness (CCT) of myopic and/or astigmatism patients presenting for refractive surgery in a tertiary hospital in Yemen. METHODS: In this hospital-based cross-sectional study, 2,304 subjects aged 18-50 years with myopia and myopic astigmatism who presented to the refractive surgery unit were recruited. Data for the current study was collected from our electronic pool of patients presenting to the refractive surgery clinics in Yemen Magrabi Hospital, Sana`a, Yemen, between January 2006 and December 2008. The inclusion criteria were absence of corneal or anterior segment disease, glaucoma, and any ocular surgery. Central corneal thickness was assessed by ultrasound pachymetry. Data from the right eye only was analyzed. RESULTS: All patients were Yemeni citizens, where the majority (1248; 54.2%) were women with a mean (+/-SD) age of 26.74 (+/-6.1), range 18-50 years. The mean (+/-SD) CCT was 521.7 (+/-31.62), range 432-643 um. The measured CCT was independent of gender (p=0.567) and did not differ between both eyes (p=0.371). Corneal thickness increased with age, correlated to vision (p=0.027), keratometric readings (K1 , K2) (p<0.001 for both), and increased with the increase in severity of myopia (p=0.026). CONCLUSION: Yemeni patients have thinner CCT compared to other populations. Refractive surgeons should be careful in choosing the suitable procedures. The available cornea for ablation in Laser-Assisted in situ Keratomileusis (LASIK) is very limited. Possible alternative treatments; namely photorefractive keratectomy (PRK) and phakic intraocular lens implantation options should be discussed with patients prior to surgery.

Posterior vitreous detachment and retinal detachment after implantation of the Visian phakic implantable collamer lens.

INTRODUCTION: To evaluate the vitreoretinal complications in myopes after Visian implantable collamer lenses (ICL) implantation. MATERIALS AND METHODS: This is a retrospective, observational, non-comparative clinical study that evaluated 617 consecutive myopes who underwent ICL implantation at the Department of Refractive Surgery, Yemen Magrabi Hospital, Sana'a, Yemen between July 2006 and May 2010. Follow up ranged from 6 months to 40 months. Preoperative and postoperative patient evaluation included manifest and cycloplegic refractions, uncorrected (UCVA) and best spectacle-corrected visual acuity (BSCVA), slit-lamp biomicroscopy, intraocular pressure and dilated retinal examination. Investigations included corneal topography, central corneal thickness, anterior chamber depth and white to white diameter. Retinal diseases and complications were recorded and analyzed preoperatively and postoperatively. RESULTS: Preoperatively, 61 (9.9%) eyes had posterior segment pathology requiring prophylactic laser photocoagulation. One eye developed spontaneous rhegmatogenous retinal detachment (RRD), one eye developed traumatic retinal detachment and two eyes required laser treatment postoperatively. The overall retinal detachment rate post-ICL was 0.32%. CONCLUSIONS: Posterior segment complications are rare after ICL implantation but dilated vitreoretinal assessment is important before and after the procedure. Patients with suspicious retinal lesions need a comprehensive vitreoretinal evaluation by a retinal specialist. If a patient develops floaters or blurry vision he/she requires further assessment by a vitreoretinal specialist.

Post-LASIK interface fluid syndrome caused by steroid drops.

Interface fluid syndrome after laser in situ keratomileusis (LASIK) is a rare but visually threatening postoperative complication. In this case series we present 8 post-LASIK eyes that developed interface fluid syndrome after prolonged steroid use. Patients presented with signs mimicking diffuse lamellar keratitis (DLK) that worsened with steroid treatment. Slit-lamp examination revealed corneal haze and an optically clear fluid-filled space between the flap and stroma. The IOP was high in all cases. Topical steroids were stopped and replaced with topical and systemic anti-glaucoma medications resulting in a dramatic improvement in visual acuity.

Reasons for not performing keratorefractive surgery in patients seeking refractive surgery in a hospital-based cohort in "yemen".

BACKGROUND: To determine and analyze the reasons why keratorefractive surgery, laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) were not performed in patients who presented for refractive surgery consultation. MATERIALS AND METHODS: A retrospective observational study was performed between January 2006 and December 2007 in the Yemen Magrabi Hospital. The case records of 2,091 consecutive new patients who presented for refractive surgery were reviewed. Information from the pre-operative ophthalmic examination, such as refractive error, corneal topography and visual acuity, were analyzed. The reasons for not performing LASIK and PRK in the cases that were rejected were recorded and analyzed. RESULTS: In this cohort, 1,660 (79.4%) patients were advised to have LASIK or PRK from the 2,091 patients examined. LASIK and PRK were not advised in 431 (21%) patients. The most common reasons for not performing the surgery were high myopia >-11.00 Diopters (19%), keratoconus (18%), suboptimal central corneal thickness (15%), cataract (12%) and keratoconus suspect (forme fruste keratoconus) (10%). CONCLUSION: Patients who requested keratorefractive surgery have a variety of problems and warrant comprehensive attention to selection criteria on the part of the surgeon. Corneal topographies and pachymetry of refractive surgery candidates need to be read cautiously. High-refractive error, keratoconus and insufficient corneal thickness were found to be the leading reasons for not performing keratorefractive surgery in this study.

Vitreoretinal complications in Yemeni patients with keratorefractive surgery.

OBJECTIVE: To evaluate vitreoretinal complications in patients undergoing laser keratorefractive surgery. METHODS: This retrospective observational non-comparative clinical study was carried out between June 2005 and March 2008, and included 4691 consecutive laser keratorefractive surgery procedures for 2480 patients performed in the Department of Refractive Surgery, Yemen Magrabi Hospital, Sana'a, Yemen. Patients were followed up for 12-36 months. The preoperative patient evaluation included manifest and cycloplegic refractions, uncorrected visual acuity, best spectacle-corrected visual acuity, slit-lamp biomicroscopy, and dilated vitreoretinal assessment. Retinal diseases were recorded and analyzed during the preoperative and postoperative care. RESULTS: Sixty-five (1.4%) of the 4691 eyes had posterior segment pathology requiring intervention. In the preoperative assessment, 57 eyes had prophylactic laser photocoagulation for retinal lesions. Seven eyes developed posterior vitreous detachment postoperatively, and 4 of these required prophylactic laser therapy for lattice degeneration and retinal breaks. Two eyes (0.04%) developed rhegmatogenous retinal detachment, which occurred spontaneously. One patient developed cystoid macular edema in both eyes. CONCLUSION: Most complications are related to the refractive outcome or to corneal and anterior segment injury. Posterior segment complications are rare, but dilated vitreoretinal assessment is important before and after laser keratorefractive procedures. Patients with suspicious retinal lesions need a comprehensive vitreoretinal evaluation by a retinal specialist.

Intraoperative and early postoperative complications of laser in situ keratomileusis in Yemen.

OBJECTIVE: To determine the intraoperative and early postoperative complications and visual outcome of laser in situ keratomileusis (LASIK) surgery for the correction of myopia. METHODS: The first 2000 consecutive myopic LASIK eyes operated at the Department of Refractive Surgery, Yemen Magrabi Hospital, Sana'a, Yemen from June 2005 to October 2006 were the study group. This is a retrospective observational noncomparative clinical study. The preoperative and postoperative spherical equivalent, best-corrected visual acuity, and corneal status was recorded. The intraoperative and early postoperative complications were reviewed. RESULTS: There were 15 (0.8%) intraoperative microkeratome-related flap complications recorded namely, buttonhole (5), incomplete cut (3), thin flap (3), epithelial defect (3) and eccentric flap (1). There were 4 (0.2%) non-keratome related surgical events of inability to obtain sufficient suction. There were 46 (2.3%) first-day postoperative complications. Nine eyes required repositioning of the flap for macro-striae (5), or displaced flap (4). Four needed washing under the flap for severe deep lamellar keratitis (2), and gauze debris under the flap (2). Laser enhancement was carried out in 28 eyes (1.4%), and uncorrected visual acuity of 20/40 or better was attained in 96.9% of treated eyes. Twenty-four eyes (1.3%) lost more than 2 lines of best-corrected vision. CONCLUSION: The LASIK is a safe and effective procedure for the correction of myopia. A small number of patients may suffer complications, most of which are not serious, and rarely lead to visual loss of more than 2 Snellen lines.

Prophylactic measures used for the prevention of postoperative endophthalmitis after cataract surgery. a survey of routine practice in Yemen.

OBJECTIVE: This study documents the current practice of perioperative prophylactic methods used for cataract surgery in Yemen. It investigates the routine practice in antibiotic and antiseptic use in preventing postoperative endophthalmitis. METHODS: This is a non-comparative survey. A telephone interview survey was conducted with 100 ophthalmologists' from different governorates in Yemen in September 2008. A questionnaire was used to ask the ophthalmic surgeons. RESULTS: The practices of 100 ophthalmologists were contacted. Five ophthalmologists did not perform cataract surgery routinely. Of the remaining 95 respondents, all performed extracapsular cataract extraction and 5 also performed phacoemulsification. Preoperative topical antibiotics were routinely prescribed by 12 (12.6%) cataract surgeons. Before the start of the procedure, 21 (22.1%) used 10% povidone-iodine to prepare the skin and 5 (5.3%) instilled 5% povidone-iodine in the conjunctival sac. Intracameral antibiotics or antibiotic in the irrigating fluid were not given by any of the surgeons. All gave subconjunctival antibiotics mostly gentamicin. Postoperatively, 25 (26.3%) used a combination steroid and antibiotic eyedrop and 70 (73.7%) gave a separate eyedrop and 39 (41.1%) gave systemic antibiotics. CONCLUSION: This study reveals a wide variation of prophylactic measures used by Yemeni ophthalmologists. All surgeons used intraoperative subconjunctival gentamicin and postoperative topical antibiotic. A significant majority (94.7%) are failing to use preoperative conjunctival povidone-iodine, despite its widespread acceptance as the only convincingly proven prophylactic method. The routine practices adopted reflect personal preferences, and were not necessarily evidence-based.