Search

Gorka Sesma,1 Tasnim Al Mairi,2 Heba Fareed Khashoggi,1 Shorog Ibrahim AlDhahi,1 Fahad Aljohar,3 Rajiv Khandekar,4 Abdulaziz Awad1 1Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 2Emergency Department, Almoosa Specialist Hospital, Al Mubarraz, Saudi Arabia; 3Diagnostic and Imaging Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 4Department of Vision Science, University of British Columbia, Vancouver, CanadaCorrespondence: Gorka Sesma, Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Al Urubah Branche Road, West Building 2nd Floor, Riyadh, 11462, Saudi Arabia, Tel +966 11 4849700, Fax +966 11 4821908, Email gsesma@kkesh.med.saPurpose: Optical coherence tomography angiography (OCTA) noninvasively images retinal microvasculature. Foveal avascular zone (FAZ) biomarkers can act as indicators of various forms of amblyopia, making them valuable tools for clinicians. The purpose of this study was to assess the effect of amblyopia therapy on the FAZ using OCTA to determine FAZ size in children with untreated amblyopia.Patients and Methods: This two-arm cohort study enrolled 23 children with untreated strabismic or anisometropic amblyopia who underwent OCTA between 2021– 2022. Each arm had 23 eyes, with one arm having amblyopic eyes and the other having normal eyes. FAZ area, perimeter, and circularity index were measured before and quarterly during 1 year of occlusion therapy. Differences in avascular zone biomarkers between amblyopic and fellow eyes were compared and linked to demographic and ocular factors.Results: Similar FAZ areas were found in the amblyopic (0.3 mm2) and nonamblyopic eyes (0.28 mm2) (P = 0.83), with no significant change in either group (P = 0.93). Amblyopic eyes showed a larger FAZ perimeter reduction (0.12 mm2) than fellow eyes (0.02 mm2), but the difference was not statistically significant (P = 0.09). The circularity index in amblyopic eyes matched with fellow eyes (0.67 mm2), P = 0.38. Initial visual acuity and strabismus correlated with changes in the follow-up FAZ area.Conclusion: Amblyopia treatment did not significantly alter FAZ area in this cohort. Perimeter variations between amblyopic and fellow eyes require further study. The conclusions were limited by the sample size and lack of randomization.Plain Language Summary: Amblyopia is a common vision problem in children in which one eye does not see the fellow eye. This can occur if the eyes are not lined up right or if their prescriptions are different. Amblyopia is treated by placing a patch over the stronger eye to help the weaker eye better see.Researchers have used a technique called optical coherence tomography angiography (OCTA) to compare the foveal avascular zone (FAZ) before and after treatment in children with amblyopia. The FAZ is a spot on the back of the eye where there are no blood vessels or light-sensitive cells. Changes in the FAZ may indicate the severity of amblyopia.The study included 23 children with untreated amblyopia. Over the course of more than a year, measurements of FAZ area, perimeter, and roundness were taken before and during occlusion therapy. The size of the FAZ was also compared between the eyes with and without amblyopia.At the start of the study and after treatment, there were no significant differences between the FAZs of amblyopic eyes and other eyes. There were some differences in the size of the FAZ between eyes. Changes in the FAZ area were linked to the initial state of vision and misalignment.Overall, this study found that occlusion therapy did not change FAZ area in children with amblyopia. More research is needed to determine why the FAZ perimeter can differ between the eyes. Larger randomized studies would provide more information about how the FAZ changes when treating amblyopia.Keywords: amblyopia, optical coherence tomography angiography, foveal avascular zone, occlusion therapy, biomarkers

Huda Al Ghadeer,1 Rajiv Khandekar2,3 1Emergency Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 2Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 3Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, CanadaCorrespondence: Huda Al Ghadeer, Emergency Department, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh, 11462, Saudi Arabia, Tel +966 1 4821234 ext. 2500, Email hghadeer@kkesh.med.saPurpose: To discuss the characteristics, etiological factors, and visual outcomes of open globe injuries (OGIs) in children at a tertiary eye hospital in Riyadh, Central Saudi Arabia.Methods: This was a hospital-based cohort study conducted in 2021. Children aged ≤ 16 years with OGI based on the Birmingham Eye Trauma Terminology classification were included. The age, gender, type, cause of OGI, and vision were recorded, as well as uncorrected and best corrected visual acuity (UCVA and BCVA, respectively). There was a change in the UCVA and BCVA one year after management. BCVA following management was linked to a variety of factors.Results: There were 664 eyes with OGI. [median age 5.1, 461 (69.6%) boys]. UCVA at presentation was < 20/400 in 525 (79%) of eyes with OGI. Injuries were mainly due to metallic objects in 195 (29.4%), glass in 102 (15.4%), and fireworks in 62 (9.4%). The Change in visual impairment grade in UCVA and BCVA after management compared to the initial presentation was significant (p < 0.001). Improvement of two lines of BCVA was noted in 345 (52%), no change in (

Mazen AlSamnan,1 Mohammed AlAmry,1 Saif aldossari,2 Mohammed Talea,2 Rajiv Khandekar,3 Huda AlGhadeer1 1Emergency Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 2Ophthalmology Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 3Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi ArabiaCorrespondence: Huda AlGhadeer, Emergency Department, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh, 11462, Saudi Arabia, Tel +966 1 4821234 ext. 2500, Email hghadeer@kkkesh.med.saPurpose: To assess true ocular emergencies based on the ocular emergency triage system compared to the existing method of serving patients “first come first serve” by attending ophthalmology resident and review the validity of the triage system by ophthalmic subspecialty.Methods: In this cross-sectional study of validity, new patients attending the ocular emergency department of a tertiary eye hospital in 2021– 2022 were examined by ophthalmology resident. The time required for registration, an eye exam, and total time in the emergency unit was determined. Using ophthalmic triage criteria, same patients were reviewed by senior ophthalmologist to categorize them as “top emergencies”, “emergencies”, and “not an emergency.” The reviewer was masked about grading by an ophthalmology resident. The agreement rate for true emergencies by both methods of grading was calculated by subspecialty.Results: One thousand patients with ocular emergencies were evaluated. The median overall time spent in the emergency unit was 92 minutes [interquartile range (IQR): 56; 142]. The revised triage system estimated 85% were “true emergencies.” Using both the revised triage and conventional methods, 172 (17.2%) patients were not considered as having an ocular emergency. The difference in patients grouped into “emergencies” (34.3% vs 21.4%) and “top emergencies” (46.5% vs 60.4%) was significant (P< 0.001) between methods. Uveitis (72%) had the lowest agreement between methods and pediatric ophthalmology (100%) had the highest agreement.Conclusion: The revised ophthalmic triage system seems to be more efficient than existing method. Subspecialist ophthalmologists may provide quicker and better treatment if ophthalmic emergency patients are prioritized utilizing the proposed redesigned triage method.Keywords: emergency, eye, ophthalmic, triage

Sara AlHilali,1 Samar A Al-Swailem,1,2 Norah Albdaya,2 Ahmed Mousa,2 Rajiv Khandekar2 1Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 2Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi ArabiaCorrespondence: Sara AlHilali, Anterior Segment Division, King Khaled Eye Specialist Hospital, P. O. Box 7191, Riyadh, 11462, Saudi Arabia, Tel +966544017155, Fax +966114829311, Email SaraAlHilali@gmail.comPurpose: Preventive measures to mitigate the spread of coronavirus, minimized workload on health-care systems and redirected resources to COVID-19 patients resulting in a reduction of elective procedures such as cataract surgery. We report the changes in monthly cataract surgery rate and its associated determinants at a tertiary eye hospital during different periods of the pandemic. Studying the impact of COVID-19 pandemic on cataract surgery rate will help health-care policymakers to better understand the barriers to overcome the expected surgical backlog.Methods: A retrospective review of medical records was performed for cataract surgeries from November 2018 to January 2022, five thousand and ninety-two eyes that underwent cataract surgery during different phases of the COVID-19 pandemic were included. The monthly cataract surgery rate (MCSR) was calculated and compared before (Phase 1), during (Phase 2) and after the COVID-19 pandemic (Phase 3 and 4). Changes in monthly cataract surgery rate during and after the pandemic were presented as ratios and compared pre- to post-pandemic levels to evaluate the impact of different determinants.Results: Of 9701 cataract patients, 5092 (52.5%) were operated in P1, 71 (0.73%) in P2, 116 (1.2%) in P3 and 4422 (45.6%) in P4. The MCSR varied significantly based on the degree of visual impairment in the operated and fellow eyes, and by the type of operating surgeon (P < 0.05). Age, gender, laterality, and place of residence were not significantly different throughout the study period. During phase 1135 (2.6%) eyes had rupture of the posterior capsule (PCR), while 6 eyes (8.4%) had PCR in phase 2.Conclusion: The monthly cataract surgery rate declined during the pandemic and has not recovered to pre-pandemic levels. This should alert the key stakeholders to address the identified barriers to surpassing the baseline monthly surgical rate as this is crucial to eliminate the surgical backlog after the pandemic.Keywords: cataract, Covid-19, surgery, rate, backlog

Huda Al-Ghadeer,1 Mohammed Al Amry,1 Khalid A Aldihan,2 Omar S Alobaidan,2 Ghadah Mohammed S AlQahtani,2 Rajiv Khandekar3 1Emergency Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 2Ophthalmology Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 3Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi ArabiaCorrespondence: Huda Al-Ghadeer, Emergency Department, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh, 11462, Saudi Arabia, Tel +966 1 4821234 ext. 2500, Email hghadeer@kkkesh.med.saBackground: Eye injuries in children due to chemicals constitute a medical emergency since they result in severe ocular damage.Objective: To determine the factors and management outcomes of chemical burns in the eyes of Saudi children. The study was performed at a tertiary eye center in the Kingdom of Saudi Arabia.Methods: Children aged 16 years and under who had ocular chemical burns from 2009 to 2021 were enrolled in a single-armed cohort study. Data collection was done on patient demographics, injury type, and previous treatment. A modified Roper-Hall classification was used to grade the ocular injuries. The research study revealed the outcome to be best-corrected visual acuity (BCVA), one year after presentation and management.Results: This study included 185 eyes from 147 children with chemical burns. The main profile of this study comprised the following categories: male (72.1%), grade 4 injury (27.6%), injury by acid (57.1%), burns at home (66%), and first aid was given to (35.4%) of the children. One year after treatment, there were 58 (31.4%) eyes with BCVA from 20/20 to 20/60, 31 cases (16.8%) with BCVA from 20/60 to 20/200, and 86 (46.5%) cases with severe visual impairment (SVI). Treatments included the release of symblepharon in 34 (18.4%) eyes and amniotic membrane transplantation (AMT) in 27 (14.6%) eyes. Poor visual outcomes were correlated with chemical burn severity (RR = 1.45, P=0.04). First aid administration (P = 0.86) and type of chemical (acid vs non-acid) (P = 0.83) did not differ significantly in association with SVI at the one-year follow-up.Conclusion: Visual outcomes of chemical burns in children were not promising even after one year of treatment. Public health initiatives are critical to prevent chemical burns in mitigating the poor visual prognosis.Keywords: burns, chemical, child, cornea, eye, injuries, stem cell

Huda AlGhadeer,1 Rajiv Khandekar2 1Department of Emergency, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 2Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi ArabiaCorrespondence: Huda AlGhadeerDepartment of Emergency, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh, 11462, Saudi ArabiaTel +966 1 4821234 ext 2500Fax +966 1 4821234 ext 3727Email hghadeer@kkesh.med.saBackground: Fireworks are a culturally significant part of celebrations in many parts of the world but can lead to blinding injuries.Objective: To decipher the profile and management outcomes of fireworks-related eye injuries at a tertiary eye hospital in central Saudi Arabia.Methods: This was a retrospective review of cases with fireworks-related eye injuries managed at our institution between 2003 and 2019. Demographic information, clinical features at presentation, mode of management, and visual outcome were evaluated at the last follow-up.Results: A total of 155 eyes of 150 patients with a median age of 10 years [127 male (84.7%) and 69 (46%) right eyes, 76 (50.7%) left eyes, and 5 patients with bilateral injury] were enrolled for the study. Among the injured individuals, 59 (39.3%) were bystanders and 91 (60.7%) had ignited the fireworks. The fireworks included bangers (53; 35.3%), rockets in bottle (42; 28%), firecrackers (41; 27.3%). Closed globe injury (CGI) was the most common type of eye injury (100; 64.5% eyes) while Open globe injury (OGI) was noted in (55; 35.5% eyes). Management used for treatment included penetrating injury repair (55; 35.5%), lens removal/lens implant (51; 32.9%). Corrected distance visual acuity obtained after 6 months was 20/20 to 20/60 (74; 47.7%), 20/70 to 20/200 in (31; 20%), < 20/200 to 20/400 in (9; 5.8%) and < 20/400 in (41; 26.5%) eyes. Treatment was able to restore vision and salvage blindness in 50 (32.3%) eyes.Conclusion: Mainly males were found to suffer from fireworks-related eye injuries and the main fireworks responsible for them were bangers. Visual disability remained in one-third of the treated patients.Keywords: fireworks, injuries, ocular trauma, visual loss

Nasser G Alsaedi,1,2 Ruba M Alselaimy,3 Abdulaziz A Alshamrani,1 Muhammed AlAjmi,4 Rajiv Khandekar,1 Hassan Al-Dhibi,1 Abdulelah A Al-Abdullah1 1King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 2King Abdullah Medical City, Makkah, Saudi Arabia; 3College of Medicine, King Saud University, Riyadh, Saudi Arabia; 4Albahar Eye Centre, Kuwait City, KuwaitCorrespondence: Abdulelah A Al-AbdullahVitreoretinal and Uveitis consultant, Vitreoretinal division, King Khaled Eye Specialist Hospital, P. O. Box 7191, Riyadh, 11462, Saudi ArabiaTel +966114821234 extension 2655Email hasadoc@gmail.comPurpose: To compare the visual and anatomic outcomes of aflibercept versus ranibizumab as a second line treatment for persistent diabetic macular edema (DME) after initial bevacizumab injections.Methods: In this retrospective cohort study, patients with center-involved DME of ≥ 300 μm thickness after bevacizumab intravitreal injections in 2015– 2019 were included. Those treated with ranibizumab (R) and aflibercept (A) were grouped as group R and group A, respectively. The change in central macular thickness (CMT) measured by optical coherence tomography (OCT) and the best corrected distance visual acuity (BCVA) before and after three-monthly anti-VEGF injections (anti-VEGF) in group R and group A were compared and reviewed.Results: There were 80 eyes of 75 patients in group R and 80 eyes of 72 patients in group A. The initial bevacizumab injections in group R and group A varied significantly (p = 0.01). The median change of the CMT after the three injections was not significantly different in group R (80 μm) and group A (81.5μm) (p = 0.7). The improvement of BCVA in group R and group A was not significant (p = 0.5). Dry macula was noted in 1 vs 14 eyes in group R vs group A.Conclusion: After treating refractory DME with initial bevacizumab injections, 3 injections of either aflibercept or ranibizumab had similar anatomic and functional outcomes. Aflibercept achieved dry macula in more eyes with refractory DME compared to ranibizumab.Keywords: aflibercept, bevacizumab, persistent DME, ranibizumab, VEGF switch, vascular endothelial growth factor

Adel Salah Alahmadi,1,2 Hatlan M Alhatlan,3 Halah Bin Helayel,4 Rajiv Khandekar,4 Ahmed Al Habash,5 Sami Al-Shahwan6,7 1Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 2Department of Ophthalmology, MOH, Madinah, Saudi Arabia; 3Department of Ophthalmology, King Fahad Hospital, MOH, Hofuf, Saudi Arabia; 4Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 5Department of Ophthalmology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 6Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 7Residency and Fellowship Office, King Khaled Eye Specialist Hospital, Riyadh, Saudi ArabiaCorrespondence: Ahmed Al HabashDepartment of Ophthalmology, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, King Faisal Road, Dammam 31952, Saudi ArabiaTel +966 138966666 Ext 1323Fax +966 138966770Email ahmedalhabash@gmail.comPurpose: To evaluate the impact of the current pandemic on ophthalmology residency training in Saudi Arabia, focusing on its effects on clinical education, training, and the mental well-being of the trainees.Methods: An online self-administered questionnaire was distributed among residents in the Saudi ophthalmology training programs between July 7 and 14, 2020. In this study, we explored residents’ opinions regarding training disruption and virtual education. The patient health questionnaire (PHQ-9) was used to assess the COVID-19 pandemic’s impact on their mental health. We used descriptive statistics for data analysis.Results: Out of 183 registered ophthalmology residents, 142 participated in this study. Ninety-six participants (35.4%) were rotated at a specialized eye hospital during the COVID-19 pandemic, while 52 (19.2%) had rotations in the ophthalmology department at general hospitals. Those who rotated in both types of hospitals were 123 (45.4%). According to the participants, there was a significant decline in exposure to surgical and office-based procedures compared to emergency eye consultations (Friedman P < 0.001). The COVID-19 pandemic’s effect on mental health was reported by 100 (70.5%) participants. Eighty-five (55.4%) respondents were satisfied with the virtual method of education.Conclusion: COVID-19 pandemic has disrupted residents’ clinical and surgical training in the Saudi ophthalmology training programs. Additionally, we believe that COVID-19 may have a negative impact on trainees’ mental health. Fortunately, the current pandemic provided an innovative education method that will likely be used even after the pandemic.Keywords: ophthalmology training, curriculum, outbreak, mental health, Saudi Arabia, Residency training program, COVID-19, medical education

The magnitude of diabetic retinopathy, its determinants, and coverage of laser treatment for diabetic retinopathy among registered people with diabetes in Oman are presented. 2249 randomly selected subjects representing 5564 [...]

Aim: To determine the magnitude and causes of low vision and blindness in the Gurage zone, central Ethiopia. Methods: A cross sectional study using a multistage cluster sampling technique was [...]

Aims: To estimate the magnitude and the causes of blindness through a community based nationwide survey in Oman. This was conducted in 1996-7. Methods: A stratified cluster random sampling procedure [...]

Zucchini (Cucurbita pepo L.) belongs to the family Cucurbitaceae and has been regarded as a highly polymorphic vegetable. A field research was conducted to study the effect of spacing and fertilizer levels on flowering and yield of zucchini. Trial was conducted in a split plot design with four spacing and three nitrogen levels. The parameters assessed were flowering and yield characters. Results showed that the interaction effects of spacing and nitrogen treatments had significant effect on flowering and yield traits. Highest number of female flowers (8.85), lowest sex ratio (15.33), highest number of fruits per plant (8.21), fruit yield per plant (3.86 kg), yield per plot (138.45 kg) and yield per hectare (74.78 t) was recorded in S (60cm x 60cm). Among the various nitrogen levels, treatment N (150 kg N ha) produced maximum days to last harvest (68.05 days), highest number of fruits per plant (6.66), fruit yield per plant (3.19 kg), yield per plot (99.82 kg) and yield per hectare (53.9 t). Treatment combination S N (60 cm x 60 cm and 150 kg N ha) produced significantly highest number of fruits per plant (8.26), fruit yield per plant (3.92 kg), yield per plot (139.94 kg) and yield per hectare (75.59 t). Based on the results of this study, it is recommended to apply 150 kg N ha and follow 60 cm x 60 cm spacing for getting highest production of Zucchini. [ABSTRACT FROM AUTHOR]