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Middle East African Journal of Ophthalmology Middle East African Journal of Ophthalmology
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   Table of Contents - Current issue
Coverpage
July-September 2021
Volume 28 | Issue 3
Page Nos. 143-202

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ORIGINAL ARTICLES  

The ahmed versus Baerveldt study at King Khaled Eye Specialist Hospital: Three-year treatment outcomes p. 143
Nouf Abdulkalq Alzendi, Sami Alshahwan, Areej Alwehaib, Khawlah Alzaben, Sara Alhilali, Abeer Alkahtani
DOI:10.4103/meajo.meajo_89_21  
PURPOSE: The purpose of this study was to analyze the outcomes of two frequently used surgical valves in treating refractory glaucoma. METHODS: This was a retrospective and nonrandomized study comparing patients aged 18 years or older who underwent implantation using standardized surgical techniques. RESULTS: A total of 86 patients were included in the study, 48 in the Ahmed group and 38 in the Baerveldt group. The overall success rate was 63.1% in both the groups. At the 3-year follow-up, the Ahmed group had a mean intraocular pressure (IOP) of 14.0 ± 4.8 mmHg (60% reduction) compared with 15.8 ± 6.2 mmHg (53.3% reduction) in the Baerveldt group (0.536). The Ahmed group required an average of 1.6 ± 1.3 medications (59% reduction) compared with 2.1 ± 1.7 (40% reduction) in the Baerveldt group (P < 0.001). CONCLUSION: Despite a high failure rate, both devices were effective in lowering IOP and the need for medications. Lower IOP and medications were needed in the Ahmed group.
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Diagnosis and management of corneal abrasion perception of (primary health care physicians and emergency physicians) and its determinants in Saudi Arabia – A survey p. 151
Waseem Aalam, Maan Barry, Majed Alharbi, Shadi Tamur, Ahmad Wazzan, Deepak P Edward
DOI:10.4103/meajo.meajo_96_21  
PURPOSE: The purpose of the study was to determine knowledge, practice, and resources available to primary care physicians to diagnose and manage corneal abrasion in Saudi Arabia. METHODS: This cross-sectional survey was held in 2017. Family physicians and emergency physicians attending an international conference were surveyed. The questions related to demography, invagination, and tools available in their institute were collected. The questionnaire on how to diagnose and how they manage case of corneal abrasion was also collected using tablet-based software. RESULTS: Two hundred and twenty-five participants participated in the survey. Exposure to eye patients in two-third of participants was too low (93; 39.6%). Resources for diagnosing corneal abrasion were available in limited centers (51; 21.7%). The rate of good practice to manage corneal abrasion was 21.2% (95% confidence interval 16.0; 26.5). Certified emergency physicians (P < 0.001) and western and central regions (P < 0.001) were positively associated with good practice. Availability of slit lamp (P = 0.2) was not significantly associated with the level of practice to manage corneal abrasion. Fluorescein staining and use of cobalt blue light are essential for diagnosing corneal abrasion as per 40% of participants. About 44.7% of participants replied that antibiotics and lubricants should be used to treat. Nearly one-fourth of participants suggested urgent reference to the ophthalmologist. Use of specific antibiotic varied widely; however, ofloxacin was the main choice of antibiotic in treating corneal abrasion. CONCLUSION: The knowledge and practice among physicians about corneal abrasion were low. Integrating primary eye care into emergency services through provision of required resources and training physicians is recommended.
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The use of social media among saudi ophthalmologists: A descriptive cross-sectional study p. 159
Omar Al Abbasi, Abdulaziz Al Taisan, Bader S Alqahtani, Khalid Alburayk, Saad H Alenezi, Adi Mohammed Al Owaifeer
DOI:10.4103/meajo.meajo_125_21  
PURPOSE: The purpose of this study is to evaluate the use of and beliefs toward social media (SM) among Saudi ophthalmologists. METHODS: This was a cross-sectional descriptive study. A web-based, self-administered questionnaire was e-mailed to ophthalmologists within Saudi Arabia. RESULTS: Out of 392 recipients, 293 completed the survey (74.7% response rate). The vast majority (90.1%) used at least one platform for personal and professional purposes or either. The three most commonly used applications were Twitter (72.3%), Snapchat (65.9%), and Instagram (51.9%). The opinions of respondents with regard to the different aspects of SM varied widely. Around half (56.7%) believed that it was permissible for ophthalmologists to promote themselves on SM and 70.6% agreed that SM usage by health-care professionals should be regulated. Participants believe that SM had both a positive and a negative impact on their daily life and clinical practice. For example, 94 (32.1%) respondents stated that it improved their ability to educate patients, on the other hand, 80 (27.3%) reported that SM wastes quality time that can be spent on something more productive. CONCLUSION: Our results demonstrate an increased utilization of SM among Saudi ophthalmologists. The ethical aspects of SM usage were a matter of controversy among our respondents. This necessitates the establishment of guidelines by regulatory bodies and/or individual health-care organizations.
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Efficacy of botulinum toxin injection in exotropia treatment p. 164
Seham S Al Hemaidi, Gorka Sesma, Khabir Ahmad, Ruba Saleh Alghofaili, Raseel A Awad
DOI:10.4103/meajo.meajo_269_21  
PURPOSE: Botulinum toxin (Botox) therapy is a well-known option for strabismus management and is often used in managing esotropia. Exotropia is also a common type of strabismus; however, the effectiveness of Botox in improving exotropia is still ambiguous. In this study, we report our experience in using Botox to manage the various types of exotropia. METHODS: A retrospective cohort study was conducted at King Khaled Eye Specialist Hospital Riyadh, Saudi Arabia. Medical records of patients with exotropia who received Botox from 2014 to March 2020 were reviewed. The main success indicator was a remaining angle of less than 10 prism diopters (PD). RESULTS: A total of 97 cases were reviewed, with 57 (58.8%) males and 40 (41.2%) females. The age ranged from 2 months to 40 years. The most prevalent diagnosis was sensory exotropia. Overall, 28 patients (28.9 %) and 49 patients (50.5%) achieved an angle of deviation within 10 PD and within 20 PD, respectively. Female patients had a better response to Botox than males, with 32.5% of them achieving an angle of deviation within 10 PD and 60% achieving an angle of deviation within 20 PD. We found that the change in the angle of deviation increased as the Botox dose was increased. CONCLUSION: Botox represents a possible safe alternative to surgery in the management of some exotropia types. The success rate differs by type, with basic exotropia scoring the highest. The presence of poor vision and amblyopia leads to a significantly lower success rate.
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Prevalence of color vision anomalies among dental professionals p. 169
Zodinliana Ngente, Baliram Jadav, Syed Aafaque, Abhijit Patil, Rajtilak Govindarajulu, Prabu Muthusamy, J Suresh Babu, C Swarnalatha, Abhishek Singh Nayyar
DOI:10.4103/meajo.meajo_529_20  
PURPOSE: Color blindness is one of the potential disabilities affecting the ability of color perception by the eye. The aim of the present study was to evaluate the prevalence of color blindness among dental professionals. METHODS: For the present study, a total of 198 dental professionals were randomly selected as subjects who were asked to fill the required questionnaire followed by which their color vision status was evaluated using the Ishihara test. The results obtained were subjected to statistical analysis. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 17.0 (SPSS Inc., Chicago, IL, USA). The prevalence of color blindness, age specificity, and the ratio of the occurrence of color blindness in relation to gender were assessed using Chi-square test for independence and Chi-square test with Yates's correction for independence when the expected frequency was <5. P < 0.05 was considered statistically significant. RESULTS: The present study reported 3.54% prevalence of color blindness among the study population. A higher number of cases were reported from males (9.26%) than females (1.39%). (P < 0.05) Furthermore, the prevalence of color blindness was found to be more in faculty members (5.88%) than in students with a reported prevalence of 3.31%. CONCLUSION: The present study reported high prevalence of color blindness in dental professionals while they were totally unaware of it.
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Corneal hysteresis, central corneal thickness, and intraocular pressure in rheumatoid arthritis, and their relation to disease activity p. 174
Ashraf Ahmed Nossair, Mona Kassem Kassem, Rasha Mounir Eltanamly, Yomna Amr Alahmadawy
DOI:10.4103/meajo.meajo_434_20  
PURPOSE: To evaluate biomechanical properties, corneal thickness, and intraocular pressure (IOP) in patients with rheumatoid arthritis (RA) and correlate them with rheumatoid activity. PATIENTS AND METHODS: Forty RA eyes were enrolled in a cross-sectional study. Clinical Disease Activity Index (CDAI) was used to assess the rheumatoid activity by a rheumatologist. Corneal hysteresis (CH), corneal resistance factor (CRF), and IOP corneal compensated, IOP Goldmann corrected were assessed using ocular response analyzer (ORA), Corneal thickness was measured using optical coherence tomography, and IOP using Goldman applanation tonometer (IOP GAT). RESULTS: There was a positive correlation between CH and CRF (P < 0.001 and r = 0.818) and (P < 0.001 and r = 0.714) in the active and inactive groups respectively, also between CRF and central corneal thickness (CCT) (P value 0.05 and r = 0.0435) in Inactive Group only. No correlation was found between CDAI score and ORA parameters. There was a negative correlation between CDAI and CCT in Active Group only (P < 0.001 and r = −0.823). CONCLUSION: Corneal biomechanical properties could be affected in rheumatoid patients in both active and remission phases, which may indicate that any corneal changes may be irreversible. These changes are of important significance regarding IOP measurement in rheumatoid patients. CCT may be a new parameter in the follow up of disease activity.
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Virtual consultation for red eye: Accuracy assessment in a primary care center p. 180
Raseel A Awad, Gorka Sesma, Suhaib Y Neyaz, Khabir Ahmad, Seham S Al Hemaidi, Abdulaziz H Awad
DOI:10.4103/meajo.meajo_306_21  
PURPOSE: The purpose of the study was to evaluate the accuracy of teleexamination of red eye by a trained general practitioner (GP) compared to the gold standard (in-office consultation by an ophthalmologist). METHODS: This was a study of diagnostic accuracy. We included consecutive male or female patients aged ≥6 months who presented to a primary care clinic in Riyadh, Saudi Arabia, with red eye. All the patients were initially evaluated by a trained GP using a standardized checklist and consulted virtually with an ophthalmologist. This was followed by an in-office eye examination conducted at a well-equipped ophthalmology clinic by a well-trained ophthalmologist. Data were analyzed using STATA 17.0 (StataCorp LLC, College Station, TX, USA). RESULTS: A total of 54 patients with red eye presented to the primary care clinic during September–November 2021 and were initially examined virtually and then in-office. The mean age of the patients was 39.72 ± 21.70 years (range 5–90 years). Thirty-three patients (61.1%) were males. The most common cause of red eye was conjunctivitis (46.3%) followed by dry eye (31.5%). There was a significant association between viral conjunctivitis and age (P < 0.001), and between dry eye and age (P = 0.002). Tele eye examination accurately identified the etiology of red eye in all 54 patients. CONCLUSION: Telemedicine has the potential to correctly diagnose patients with red eye and can result in a substantial decrease in the number of people visiting the health-care centers.
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CASE REPORTS Top

Corneal perforation as a complication of fungal interface infectious keratitis after deep anterior lamellar keratoplasty p. 184
Wael Otaif, Abdulaziz Ismail Al Somali, Amar Almulhim
DOI:10.4103/meajo.meajo_114_21s  
Deep anterior lamellar keratoplasty (DALK) is a surgical intervention for corneal diseases that do not affect the endothelium. The creation of an interface between the donor graft and recipient bed is a typical feature of DALK. Interface infectious keratitis (IIK) is an uncommon complication that originates at this point of contact. The onset of IIK following lamellar keratoplasty can cause delayed visual loss and subsequent endophthalmitis, with primarily fungal etiology (e.g., Candida spp.) and occasionally bacterial etiology. Infection of the lamellar interface may be attributed to contamination of the donor material or to precipitating factors such as loose sutures, persistent epithelial defects, and prolonged topical steroid use; fungal IIK is frequently resistant to medical treatment. Here, we describe the previously unreported occurrence of corneal perforation as a complication of fungal IIK after DALK. A 26-year-old otherwise healthy woman underwent uneventful DALK for advanced keratoconus in the left eye. She was discharged with instructions to apply topical prednisolone acetate and topical moxifloxacin. Culture of the donor corneoscleral rim showed growth of Candida glabrata, although the patient exhibited no clinical signs of infection. Approximately 3 months later, the patient exhibited mild blurring of vision in her left eye. Therefore, treatment was modified to topical amphotericin B and oral voriconazole. One week later, the patient developed multiple, sheath-like whitish creamy infiltrates, primarily in the lamellar interface; a positive Seidel test result indicated the presence of corneal perforation. As treatment for IIK, excisional penetrating keratoplasty (PK) was performed, followed by topical amphotericin B and topical prednisolone acetate treatment. During 12 months of follow-up after PK, the corneal graft was clear and there was no clinical evidence of recurrent keratitis. Prompt excisional PK prevented the progression of IIK to endophthalmitis in our patient. Early intervention with excisional PK should be considered when a diagnosis of fungal IIK is suspected in a patient with a positive donor rim culture, and in whom the condition does not respond to medical treatment. This early intervention is essential to prevent delayed treatment, which could result in corneal perforation and endophthalmitis, with ultimately poor visual outcomes.
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Laser-induced maculopathy masquerading as hereditary macular dystrophy p. 189
Fadwa Al Adel, Abdulrahman F AlBloushi
DOI:10.4103/meajo.meajo_234_21  
There has been an emergence of permanent macular injury due to the misuse of handheld laser pointers. The clinical phenotype of laser-induced maculopathy can mimic hereditary retinal dystrophies. This report describes the clinical phenotype and the results of multimodal imaging in a 27-year-old woman who was referred with a bilateral progressive decrease in vision over 2 months. She was initially diagnosed elsewhere with hereditary macular dystrophy. Examination of her fundus showed bilateral creamy-to-gray irregular lesions in the posterior pole. The results of multimodal imaging of her retina suggested self-inflicted laser-induced maculopathy. The patient was referred to a psychiatrist with a working diagnosis of factitious disorder. A high index of suspicion and the utilization of multimodal imaging allowed early and correct diagnosis and prevented further loss of vision.
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Unusual manifestation of choroidal metastasis as late presentation of treated lung cancer with floaters p. 193
Mohamed Osman, Bashar Alwash, Ahmed Elkady, Sara Zeineldin
DOI:10.4103/meajo.meajo_255_21  
Metastatic tumors to the choroid are the most common intraocular malignancies. Choroidal metastasis from lung cancer is uncommon. Visual affection or other ocular manifestations as the initial clinical presentation of lung cancer primarily are rare. We report a case of a 71-year-old female patient presented with eye floaters in her right eye. Examination of the right eye visual acuity of 20/30 and fundoscopy revealed a pale choroidal mass superior to optic disc. Ocular coherent tomography showed subretinal fluid at the site of choroidal lesion. The patient is currently treated with radiotherapy and chemotherapy for secondary metastasizes in liver. In spite of floaters is very common nonserious symptoms in ophthalmology practice, but it should be taken seriously to rule out lifesaving condition.
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Manifestation of panuveitis after intraocular surgery in a child with blau syndrome p. 196
Moustafa S Magliyah, Abdullah M Khan, Mohammed AlShamrani, Patrik Schatz, Hassan A Dhibi
DOI:10.4103/meajo.meajo_15_21  
Blau syndrome (BS) is a rare granulomatous disease with autosomal dominant inheritance. It is characterized by a triad of dermatitis, arthritis, and recurrent uveitis. This case presents the onset of panuveitis in BS after intraocular surgery. A 10-year-old boy presented to the outpatient clinic with retinal detachment in the left eye after 6 years following early-onset cataract surgery. Bilateral panuveitis occurred 3 weeks after surgical repair and resulted in a total visual loss in the left eye and was persistent to conventional treatment in the right eye. Genetic testing revealed a mutation in NOD2 gene. The addition of adalimumab to the treatment regimen resulted in long-term uveitis control and maintenance of 20/70 vision in the right eye. We propose that NOD2-mediated inflammatory cascade can be activated by intraocular surgery and results in the manifestation of BS.
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Central retinal vein occlusion in a young healthy COVID-19 patient: A case report and literature review p. 199
Mohamed Al-Abri, Adil Al-Musalami, Bader Al-Rawahi, Ahmed Al-Hinai, Nawal Al-Fadhil
DOI:10.4103/meajo.meajo_271_21  
Coronavirus disease (COVID-19) has been declared by the World Health Organization as a pandemic on March 11, 2020. COVID-19 predispose patients to multisystem thromboembolic events, including pulmonary emboli and deep vein thrombosis. We report a 33-year-old previously healthy man, with previous history of COVID-19 infection presented with left eye central retinal vein occlusion (CRVO) with secondary macular edema. All possible risk factors for thromboembolic events were excluded. After a single dose of intravitreal injection of aflibercept (2 mg in 0.05 ml), gradual improvement in the clinical manifestation of CRVO with complete resolution of macular edema in the left eye was observed. To the best of our knowledge, this is the first report of CRVO post-COVID-19 in Oman.
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