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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
October-December 2019
Volume 26 | Issue 4
Page Nos. 185-256

Online since Wednesday, January 29, 2020

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ORIGINAL ARTICLES  

Efficacy of Brückner's test for screening of refractive errors by non-ophthalmologist versus ophthalmologist: A comparative study p. 185
AR Rajalakshmi, M Rajeshwari
DOI:10.4103/meajo.MEAJO_121_19  
OBJECTIVE: The aim of this study is to assess the efficacy of Brückner's test as a screening tool for identifying refractive errors by a non-ophthalmologist and to assess the inter-observer variation. SUBJECTS AND METHODS: This was a quasi-experimental study conducted at a tertiary care medical college hospital. Brückner's test was performed by a non-ophthalmologist followed by an ophthalmologist. The results were confirmed by cycloplegic refraction. RESULTS: The study included 75 children (31 males and 44 females) with a mean age of 13.3 ± 1.2 years. The results of Brückner's test by both non-ophthalmologist and ophthalmologist showed good sensitivity and specificity when compared with cycloplegic refraction. There was a good strength of agreement between the observations of non-ophthalmologist and ophthalmologist. CONCLUSION: Brückner's test is simple, quick, reliable, and easy to administer on children of all age groups that can provide information about the presence of refractive errors by using a coaxial light source such as direct ophthalmoscope. The application of this test by training primary care providers would be of immense value in the early identification of refractive errors.
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Pediatric diabetic retinopathy: Experience of a tertiary hospital in Oman Highly accessed article p. 189
Puspalata Agroiya, Abdul Hakeem Alrawahi
DOI:10.4103/meajo.MEAJO_208_19  
PURPOSE: The aim of this study is to describe the prevalence and clinical profile of pediatric diabetic retinopathy (DR) among Omani diabetic children and adolescents attending a tertiary care hospital. METHODS: This retrospective cross-sectional study involved the record review of 216 diabetic children attending the diabetes retina clinic of the National Diabetes and Endocrine Centre in the period between June 2015 and November 2018. The retinal evaluation was conducted using direct ophthalmological examination and fundus photography. DR was graded using the Early Treatment DR Study criteria. The statistical analysis was performed using SPSS, version 20. RESULTS: The prevalence of DR among the study sample was 3.7% (95% confidence interval: 1.2–6.2). Mild and moderate nonproliferative diabetic retinopathy was seen in 2.8% (6) and 0.9% (2) of patients, respectively. Diabetic maculopathy was observed in 2 (0.9%) cases. Diabetic ketoacidosis was seen in 33.8% of children at presentation. DR was significantly associated with age (P = 0.01), duration (P < 0.001), Type 1 diabetes mellitus (P = 0.01), dyslipidemia (P = 0.005), microalbuminuria (P = 0.001), glycated hemoglobin (P = 0.003), total cholesterol (P = 0.001), high-density lipoproteins (P = 0.001), low-density lipoproteins (P < 0.001), and albumin/creatinine ratio (P < 0.001). CONCLUSIONS: This is the first study describing DR among the pediatric age group in Oman. This study reveals a relatively low prevalence of DR and maculopathy among the pediatric diabetic population. However, novel strategies are to be adopted at primary levels to achieve timely screening of diabetic children to enhance the early detection of DR.
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The effect of a reminder short message service on the uptake of glaucoma screening by first-degree relatives of glaucoma patients: A randomized controlled trial p. 196
Dora K Salihu, Olukorede O Adenuga, Patricia D Wade
DOI:10.4103/meajo.MEAJO_98_19  
PURPOSE: The purpose of this study was to determine the role of a reminder short message service (SMS) on the uptake of glaucoma screening by first-degree relatives (FDRs) of patients with primary open-angle glaucoma (POAG) in North-central Nigeria following a telephone invitation for screening. MATERIALS AND METHODS: A randomized controlled trial was conducted in the eye clinic of a tertiary hospital in Jos, North-central Nigeria. Two hundred FDRs of patients with POAG were invited through phone for free glaucoma screening and randomly allocated into two groups. The intervention group received a reminder SMS, whereas the control group did not receive a reminder. Those who failed to turn up for screening were contacted through phone to determine the reasons for their nonattendance. Chi-square test and bivariate analysis were used to compare attendance rate between the two groups. RESULTS: Sending a reminder SMS following a telephone invitation had no effect on the uptake of glaucoma screening. The response rate was lower in the phone call plus reminder SMS group (43.0% vs. 53.0%) though the difference was not statistically significant (P = 0.157). Competing needs such as work and lack of transport fare were the most common reasons given for not attending the screening. CONCLUSION: A reminder text message is not an effective tool for increasing the uptake of glaucoma screening in at-risk individuals in North-central Nigeria. Existing barriers to health care in the country need to be addressed before mobile phone technology can be effectively used in increasing the utilization of any free eye screening service.
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Investigation of CYP1B1 gene involvement in primary congenital glaucoma in Iraqi children p. 203
Suzanne Jubair, Salwa H N. Al-Rubae'i, Ali N M. Al-Sharifi, Ahmed Abdul Jabbar Suleiman
DOI:10.4103/meajo.MEAJO_116_19  
PURPOSE: Primary congenital glaucoma (PCG) is a severe type of glaucoma that occurs early in life. PCG is usually inherited in an autosomal recessive pattern. Cytochrome P450, family 1, subfamily B, polypeptide 1 (CYP1B1) gene is reported to be PCG-related gene. It codes for the CYP1B1 enzyme which is considered as phase I xenobiotic-metabolizing enzyme and its function is related to the eye oxidative homeostasis and correspondingly to the normal development of the eye. This is the first genetic study in Iraq that investigates the CYP1B1 polymorphisms behind the PCG disease. METHODS: Genomic DNA was extracted from the whole blood of 100 unrelated Iraqi PCG patients and 100 healthy children, all of them were aged between 1 month and 3 years. All the coding sequence of CYP1B1 gene was amplified using polymerase chain reaction; restriction fragment length polymorphism was used to follow G61E and E229K mutations. Direct sequencing was performed to screen for other mutations. RESULTS: CYP1B1 mutations were identified in 78 (78%) of the patients. We detected a total of eight mutations: Four missense mutations (c.182G>A, c.685G>A, g.6813G>A, and g.6705G>A), one silence mutation (D449D) and three insertions (g.10068ins10069, g.10138ins10139, and g.10191ins10192). Five mutations (g.6813G>A, g.6705G>A, g.10068ins10069, g.10138ins10139, and g.10191ins10192) are novel. G61E is the only mutation that was detected in patients merely. CONCLUSIONS: CYP1B1 mutation (G61E) is considered as PCG-related allele in the Iraqi population.
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Prevalence and severity of diabetic retinopathy among diabetic patients presenting to a tertiary eye hospital in Nepal p. 210
Govinda Paudyal, Mohan K Shrestha, Manish Poudel, Geoffrey C Tabin, Sanduk Ruit, Benjamin J Thomas
DOI:10.4103/meajo.MEAJO_65_18  
PURPOSE: The purpose of the study is to evaluate the prevalence and severity of diabetic retinopathy (DR) among all diabetic patients presenting to a tertiary eye care center in Nepal over a 3-year period. MATERIALS AND METHODS: This was a retrospective review of all clinical records from the initial presentations of diabetic patients at the Tilganga Institute of Ophthalmology (TIO) from 2012 to 2014. RESULTS: In total, 8855 patients were identified who presented to TIO with a prior diagnosis of diabetic mellitus (DM) during the study period. DR was found in 1714 patients (19.4%) at the time of initial presentation, 1305 (14.7%) of which had nonproliferative DR (PDR), while 617 (6.9%) demonstrated diabetic macular edema (DME) and 409 (4.6%) demonstrated PDR. Of the 1714 patients with DR, 825 (48.1%) required treatment at initial presentation for DME and/or PDR. Male gender, hypertension, age at presentation, and interval from diagnosis of DM to initial eye consultation were significantly associated with the presence of DR (P < 0.05). CONCLUSIONS: The prevalence of DR among patients with DM was 19.4%, which is lower than previously published estimates. However, among patients diagnosed with DR, over half presented with a vision-threatening complication warranting some measure of initial treatment.
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Making blind children see: Impact of correcting moderate and severe visual impairment in schools for the blind p. 216
Parikshit M Gogate, Tonmoy Chottopadhyay, Hardeep Kaur, Sravanthi Narayandas, Supriya Phadke, Meena Kharat, Ashok Dhangar, Minaj Inamdar, Akshay Badkere, Rohit C Khanna
DOI:10.4103/meajo.MEAJO_111_19  
PURPOSE: Childhood blindness and visual impairment accounts for enormous burden of blindness. This study aimed to analyze the causes of severe visual impairment and blindness in students attending schools for the blind and to identify those whose vision could be improved by optical aids. On dispensing such aids, the study also aimed to analyze the improvement in their vision function. METHODS: This was a prospective interventional study of 428 certified students from four special schools for blind. All the students underwent a comprehensive ophthalmic examination by a team of four ophthalmologists and four optometrists. The World Health Organization-Prevention of Blindness forms were used to record history and examination details. Spectacles and low-vision aids (LVAs) were dispensed to those whose vision could be improved. The main outcome measure was L V Prasad- Functional Vision Questionnaire (LVP-VFQ), which was used to compare the vision function before and 6 months after the intervention. RESULTS: Two hundred and thirteen (49.5%) students were girls. The causes of blindness in 370 children (<18 years) with vision <6/60 were whole globe involvement in 117 (31.6%) students (this included anophthalmos 47 [12.7%], microphthalmos 61 [16.4%], both 9 [2.4%]), nystagmus 29 (7.8%), optic atrophy 22 (5.9%), retinal causes 42 (11.3%), cataract 18 (4.9%), phthisis bulbi 24 (6.4%), corneal scarring in 40 (10.8%), and retinopathy of prematurity in 4 (1.1%). Fifty-four (12.6%) students were given spectacles and 41 (9.57%) LVA. There was a statistically significant difference in all questions (P < 0.01) of LVP-VFQ for the students dispensed with optical aids 6 months after the intervention. Twenty-four students had their vision improved to 6/60 or better, whereas 26 could now identify letters and print. CONCLUSION: A significant proportion of students in schools for the blind can be helped to improving vision function using optical aids. Students in schools for the blind, nay all visually impaired individuals, need periodic ocular examination and ophthalmic care.
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Outcomes and determinants of posterior dislocated intraocular lens management at a tertiary eye hospital in central Saudi Arabia p. 223
Mohammad A Hazzazi, Saba Al Rashaed
DOI:10.4103/meajo.MEAJO_162_19  
PURPOSE: The aim of this study is to evaluate the determinants of visual outcomes, complications after managing the posterior dislocated intraocular lens (IOL). METHODS: Patients with posterior dislocated IOL managed between 2002 and 2016 in our institute were reviewed. Ocular status and causes for dislocation were noted. Success was defined as uncorrected visual acuity (UCVA) of 20/20–20/200 at the last follow-up. The risk factors were associated with the success. RESULTS: Of the 79 eyes with posterior dislocated IOL, 40 (50.6%) eyes had vision <20/400 at presentation. Glaucoma and retinal detachment were present in 12 (15.2%) and 5 (6.3%) eyes. IOL was removed from 33 (41.8%) eyes. Secondary IOL was implanted in 25 (31.6%) eyes, and IOL was repositioned in 19 (24.1%) eyes. The median duration of follow-up was 2.1 years. The final UCVA was “20/20–20/60” and “>20/200” in 45 (57%) and 14 (17.7%) eyes. The main causes of Severe visual impairment (SVI) included glaucoma (5), corneal decompensation (5), retinal detachment (4), and macular edema (3). Young age (P = 0.02), late IOL dislocation (P = 0.005), primary IOL implant (P < 0.01), SVI (P = 0.09), IOL removal (P = 0.06), and no glaucoma at presentation were significantly associated to the success. Late IOL dislocation (P = 0.05) and no glaucoma (P = 0.05) were independently associated to the success. CONCLUSION: The management of the dislocation of IOL had promising visual outcomes. Glaucoma and early dislocation predict poor vision after dislocated IOL management. Close monitoring is needed to manage complications.
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Real-world retrospective consecutive study of ab interno XEN 45 gel stent implant with mitomycin C in black and afro-latino patients with glaucoma: 40% required secondary glaucoma surgery at 1 year p. 229
Daniel Laroche, Gideon Nkrumah, Chester Ng
DOI:10.4103/meajo.MEAJO_126_19  
PURPOSE: The aim of this study was to determine the postoperative course after the ab interno XEN45 Gel Stent implantation in Black and Afro-Latino, patients with glaucoma. METHODS: This was a single-center, retrospective study. All patients with glaucoma who underwent ab interno XEN implantation were included in the study. All of the patients were Black and Afro-Latino making up the demographics of the local community. Investigated parameters were intraocular pressure (IOP), the number of medications, visual acuity, IOP-follow-up, intraoperative and postoperative complications, and additionally performed surgeries. RESULTS: Of 20 eyes that had undergone the procedure with 1-year follow-up, eight failed before 12 months requiring additional glaucoma surgery. Of the 12 that were successful at 1 year, 9 (75%) eyes underwent XEN + cataract surgery and 3 (25%) had XEN surgery alone. Of the eyes that completed 12-month follow-up, the mean medicated IOP was 15.3 ± 6.2 mmHg at baseline, and 12.9 ± 4.5 mmHg at 12 months, a 16% IOP reduction. Mean medications dropped from 3.58 ± 0.7 preoperatively to 1.75 ± 1.5 at 12 months. CONCLUSIONS: The ab interno XEN gel implant as a standalone procedure or combined with cataract surgery demonstrated a safe and sustained IOP reduction for only 60% of patients after 12 months. In Black and Afro-Latino patients receiving the ab interno XEN implant, 40% of patients needed additional surgery within 12 months.
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Retinopathy of Prematurity Incidence and Risk Factors in a Tertiary Hospital in Riyadh, Saudi Arabia p. 235
Bader Al-Qahtani, Mohammed Al-Otaibi, Khaled Alabdulajabbar, Nawaf Bin Selayem, Waleed Alshehri, Aamir Omair, Saif Alsaif
DOI:10.4103/meajo.MEAJO_131_18  
PURPOSE: The purpose of the study was to determine the incidence of retinopathy of prematurity (ROP) in preterm infants in the neonatal intensive care unit (NICU), to identify the risk factors that predispose to ROP, and to assess the outcome of these infants. MATERIALS AND METHODS: This was a retrospective cohort study on premature infants with a birth weight (BW) of <1501 g or gestational age (GA) of <32 weeks. These infants were admitted to the NICU at a tertiary hospital in Riyadh, Saudi Arabia, from January 2010 to December 2014. RESULTS: Five hundred and ninety-three infants were included; data were available for 581 infants. Of them, 224 infants (38.6%) had ROP. Of these, 22 infants (10.4%) had stage 3 ROP. The mean BW of infants with ROP was 938.4 ± 257.9 g, and the mean GA at birth was 27 ± 2.4 weeks. A significant relationship with a P <0.05 was found between the occurrence of ROP and small GA at birth, low BW, low APGAR score at 1 min, and long duration of receiving oxygen (O2) therapy. Based on charts review, none of the infants had blindness. CONCLUSION: The incidence of ROP in our study falls in the range of incidence in developing countries. The low BW and small GA were the most significant risk factors. Furthermore, it is also recommended to control the amount and duration of O2therapy to as little as needed.
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CASE REPORTS Top

Cilioretinal artery branch avulsion secondary to surgical embolectomy: Management and outcome p. 240
Sergio E Hernandez-Da Mota, Gerardo Garcia-Aguirre, Raul Velez-Montoya
DOI:10.4103/meajo.MEAJO_36_18  
We report the trans-operative approach and short-term outcome of a patient who suffered a traumatic avulsion of the cilioretinal artery branch during the surgical management of a cilioretinal arterial branch occlusion (CRABO) with intraocular embolectomy. A patient with acute CRABO underwent a pars plana vitrectomy with in situ embolectomy. The blocked artery was incised using 25 gauge vertical scissors, and embolus manipulation was done using microsurgical forceps. During embolus extraction, the occluded cilioretinal artery and its branch were inadvertently avulsed and torn with subsequent intense bleeding. Laser and endodiathermy were used for acute hemostasis. The maneuvers created an unintended retinochoroidal anastomosis. Visual field improvement was noted 3 months after the surgery. In the event of a complicated surgical embolectomy with the avulsion of the artery, the formation of a retinochoroidal anastomosis and reperfusion of the occluded may occur along with the improvement of visual fields in some cases.
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Natural honey-induced Acanthamoeba keratitis p. 243
Alireza Peyman, Mohsen Pourazizi, Mohammadreza Peyman, Farzan Kianersi
DOI:10.4103/meajo.MEAJO_56_18  
Natural honey in spite of its usefulness is known to contain certain microorganisms. In the present study, we describe a case of Acanthamoeba keratitis after using topical honey administered by a traditional medicine therapist. A 32-year-old male came with red eye and blurred vision. The pain and other symptoms became more severe after the 1st week, with appearance of radial perineuritis at the cornea. A repeated interview revealed that 1 week before appearance of ocular symptoms, the patient had instilled a drop of natural honey in his left eye. Confocal microscopic cornea imaging demonstrated cyst and trophozoite of Acanthamoeba in the corneal stroma.
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Perioperative use of rho-kinase inhibitors has beneficial effect on corneal endothelium after phacoemulsification p. 246
Majed Alkharashi, Omar AlAbbasi, Moustafa Magliyah
DOI:10.4103/meajo.MEAJO_27_19  
PURPOSE: Does perioperative use of Rho-Kinase (ROCK) inhibitors have beneficial effect on corneal endothelial cells after phacoemulsification? SETTING: This study was conducted at King Abdulaziz University Hospital in Riyadh. DESIGN: This was a prospective study assessing the effect of ROCK inhibitors on corneal endothelium after phacoemulsification. METHODOLOGY: Three patients have used ROCK inhibitor 1 day before and 1 week after phacoemulsification surgery, and specular microscopy and Pentacam were done preoperatively and 3 months postoperatively. RESULTS: Endothelial cell density decreased to 11.3%, 9.45%, and 4.09% in eyes with ROCK inhibitors and 23.9% in one eye without ROCK inhibitor. CONCLUSION: Perioperative ROCK inhibitor use has a possible protective effect on corneal endothelium.
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Retinopathy and uveitis in congenital generalized lipodystrophy with hypertriglyceridemia and uncontrolled diabetes (Berardinelli–Seip Syndrome) p. 250
Khaled A Rubaie, Hussein Raef, Donald U Stone, Igor Kozak
DOI:10.4103/meajo.MEAJO_94_19  
Congenital lipodystrophy syndromes are characterized by a paucity of adipose tissue and are associated with metabolic abnormalities including insulin resistance, diabetes mellitus, and severe hypertriglyceridemia. Herein, we present a case of proliferative diabetic retinopathy with an attack of anterior uveitis in a young female with congenital generalized lipodystrophy – Berardinelli-Seip syndrome. To the best of our knowledge, this is the first description of ocular involvement in Berardinelli–Seip syndrome.
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Variable presentations of peripheral exudative hemorrhagic chorioretinopathy p. 253
Wael A Alsakran, Abdulaziz A Alshamrani, Yahya A Alzahrani
DOI:10.4103/meajo.MEAJO_138_19  
Three cases of peripheral exudative hemorrhagic chorioretinopathy (PEHCR), which mimicked other retinal pathologies, were reported. Different preliminary diagnoses were made initially, but thorough examination combined with the appropriate investigations led to the final diagnosis of PEHCR. Despite the rare occurrence of PEHCR, it must be included in the differential diagnosis for peripheral retinal diseases.
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