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Table of Contents
January-March 2022
Volume 29 | Issue 1
Page Nos. 1-65
Online since Wednesday, November 23, 2022
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ORIGINAL ARTICLES
External versus endoscopic dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction
p. 1
Mohammad Taher Rajabi, Kianoosh Shahraki, S Saeed Mohammadi, Atefeh Nozare, Zahra Moravej, Sepideh Tavakolizadeh, Reza Erfanian Salim, Farideh Hosseinzadeh, Shabahang Mohammadi, Azadeh Farahi, Kourosh Shahraki
DOI
:10.4103/meajo.meajo_238_21
PURPOSE:
The purpose of the study is to compare the surgical outcomes and success rates of external dacryocystorhinostomy (EX-DCR) versus endoscopic endonasal DCR (EN-DCR) for the treatment of primary acquired nasolacrimal duct obstruction (PANDO).
METHODS:
This retrospective nonrandomized study was conducted at Farabi Eye Hospital and Noor Eye Hospital, Iran. A review of electronic medical records of all patients with PANDO who underwent EX-DCR or EN-DCR between January 2016 and 2018 was carried out.
RESULTS:
A total of 803 patients underwent surgery, of which 618 patients (77%) were managed by EX-DCR and 185 patients (23%) by EN-DCR. The majority of cases (62%) were female. The mean age of the patients in EX-DCR and EN-DCR groups was 40.8 ± 14.2 and 34.3 ± 9.2 years, respectively. EX-DCR resulted in significantly less amount of pain compared to EN-DCR (
P
< 0.05). The success rate of surgery among EX-DCR and EN-DCR groups was 92.4% and 91.1%, respectively, and did not show statistically significant difference. A higher incidence of intraoperative hemorrhage requiring intervention was noted in the EN-DCR group (16.7% vs. 4.5%). Postoperative patient's satisfaction with EN-DCR and EX-DCR was 73% and 82%, respectively.
CONCLUSION:
Both EX-DXR and endoscopic DCR surgeries have high success rates and low incidence of failure. The choice of DCR technique should be based on the experience of the surgeon and patient's lacrimal and nasal anatomy and preferences.
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The quality of life of medically versus surgically treated primary open-angle glaucoma patients at a Nigerian hospital
p. 7
Femi C Oduneye, Kareem O Musa, Sefinat A Agboola, Oluwatobi O Idowu, Adeola O Onakoya
DOI
:10.4103/meajo.meajo_146_22
PURPOSE:
The purpose of this study is to compare the quality of life (QoL) of medically treated versus surgically treated primary open-angle glaucoma (POAG) patients attending Lagos University Teaching Hospital, Lagos, Nigeria.
METHODS:
The study was a hospital-based, comparative cross-sectional study. Consecutive consenting POAG participants who met the inclusion criteria were recruited until the sample size was achieved. QoL of all participants was assessed using the glaucoma QoL-15 and National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) questionnaires. Analysis was done using the IBM statistical package for the social sciences version 25.0.
RESULTS:
The study involved 81 participants who were only on medical treatment for POAG and 81 age- and sex-matched POAG participants who had trabeculectomy surgery. Surgically treated participants had a lower mean intraocular pressure 11.68 mmHg when compared to the medically treated participants 14.82 mmHg. Medically treated participants however had a better overall mean glaucoma QoL using the glaucoma QoL-15 (medical 34.36 ± 10.4, surgical 39.11 ± 13.9
P
= 0.015) and NEI-VFQ-25 questionnaires (medical 68.32 ± 15.0, surgical 62.44 ± 18.8
P
= 0.029). Controlling for the severity of glaucoma using the glaucoma QoL-15 questionnaire, medically treated participants had a better QoL only among participants with severe POAG (medical 49.13 ± 5.9, surgical 54.06 ± 4.6
P
= 0.003). While using the NEI-VFQ-25 questionnaire, medically treated participants had a significantly better QoL only among participants with moderate (medical 74.70 ± 6.6, surgical 67.07 ± 15.6
P
= 0.012) and severe POAG (medical 54.52 ± 6.3, surgical 45.51 ± 10.0
P
= 0.004).
CONCLUSION:
The study demonstrated that although participants that had trabeculectomy had a lower mean intraocular pressure, their overall mean QoL was reduced compared to the medically treated participants.
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Clinicopathological study of meibomian carcinoma of eyelids – An experience of two years in a tertiary care center
p. 15
Senjuti Dasgupta, Parul Jain, Nirmal K Bhattacharyya, Rojina Khatoon
DOI
:10.4103/meajo.meajo_298_21
PURPOSE:
Meibomian carcinoma is a rare and aggressive malignant neoplasm of the eyelids. The clinical presentation often mimics benign conditions thereby making the diagnosis challenging. The aim of the study was to analyze cases of meibomian carcinoma, the specimens of which were received, in the past 2 years in the pathology department.
METHODS:
This retrospective observational study was undertaken for 2 years and included 9 patients of meibomian carcinoma. For each case, detailed history and clinical findings were retrieved from the hospital records. Histopathological examination was undertaken in all cases after preparing hematoxylin and eosin-stained slides from tissue blocks preserved in the department.
RESULTS:
The mean age of the patients was 55 ± 15 years. Six (66.7%) patients were females, and the other three (33.3%) were male. Following surgery, gross examination of the specimens revealed that the mean size of the excised tumors was 2.45 ± 1.45 cm. The tumors were classified based on histopathological features according to growth pattern, cell type, and cytoarchitecture. Most cases had lobular growth pattern (5, 55.6% cases), consisted of epidermoid cells (5, 55.6% cases), and exhibited infiltrative cytoarchitecture (8, 88.9% cases).
CONCLUSION:
Early diagnosis of meibomian carcinoma is important to reduce mortality from the aggressive tumor. The knowledge of clinicopathological aspects of the tumors that were biopsied in the department of pathology in the past 2 years will help in diagnosis and management of such tumors in future.
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Visual impairment among adult diabetic patients and associated factors at debre brihan referral hospital, Central Ethiopia, 2017
p. 19
Ketemaw Z Demilew, Nebiyat F Adimassu, Destaye S Alemu
DOI
:10.4103/meajo.meajo_459_20
PURPOSE:
The study aimed to assess the proportion of visual impairment and associated factors among diabetic patients at Debre Berhan Referral Hospital (DBRH).
METHODS:
A hospital-based cross-sectional study was carried out from April 27 to May 19, 2017. All adult diabetic patients attending DBRH during the study period were included in the study. A pretested, structured questionnaire and clinical examinations were used for data collection. The collected data were entered into Epi Info 7 and exported to the Statistical Package for Social Sciences version 20 for analysis. The descriptive analysis was summarized by frequency, percent, and summary statistics. Association between visual impairment and independent variables was determined via bivariable and multivariable binary logistic regressions.
P
< 0.05 was considered statistically significant. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to determine the strength of association. Hosmer and Lemeshow goodness of fit was used to check for model fitness.
RESULTS:
A total of 388 study subjects with a 92% response rate took part in the study. The prevalence of visual impairment was 29.38% (95% CI: 24.83%–33.93%). Age >56 years (AOR = 5.24, 95% CI: 1.37–20.04), physical inactivity (AOR = 2.34, 95% CI: 1.33–4.14), presence of visual symptoms (AOR = 4.48, 95% CI: 2.35–8.57), lower body mass index (AOR = 6.23, 95% CI: 1.87–20.68), and diabetic retinopathy (AOR = 5.12, 95% CI: 1.91–13.70) had a statistically significant association with visual impairment.
CONCLUSION:
A high proportion of diabetic patients had visual impairment. Independent variables older age, physical inactivity, presence of visual symptoms, lower body mass index, and diabetic retinopathy had a positive statistically significant association with visual impairment.
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Perception of medical professionalism among ophthalmology residents in Saudi Arabia: A national survey study
p. 27
Fahad A Alghulaydhawi, Reem M Hersi, Sami Al-shahwan
DOI
:10.4103/meajo.meajo_239_21
PURPOSE:
Studies have shown that there are significant differences in the concepts of medical professionalism among residents. Very few studies have specifically evaluated the perception of medical professionalism in a specific specialty. The aim of the study is to evaluate the perception of medical professionalism among ophthalmology residents and to assess the differences in the concept of professionalism between junior and senior residents.
METHODS:
This cross-sectional study used a questionnaire to survey ophthalmology residents enrolled in different regions of Saudi Arabia in 2020. The ophthalmology residents included both junior and senior residents. In this study, “professionalism” concurred with the definition in the American Board of Internal Medicine's “Project Professionalism” and the Accreditation Council for Graduate Medical Education.
RESULTS:
A total of 167 participants were recruited in the study. Out of the 127 participants who completed the survey, 60 (47.24%) were junior residents and 67 (52.76%) were senior residents. The scores for the attributes varied markedly. The lowest score obtained was 6.54 ± 3.349 for the attribute “In an emergency putting the welfare of others over my own safety” in the “Altrusim” domain and the highest score obtained was 9.62 ± 0.854 for the attribute “respect for co-workers” in the “Respect for others” domain. Out of the total residents who completed the survey (
n
= 127), 84 (66.14%) agreed that professionalism is teachable through a residency curriculum and 85 (66.93%) thought that it is testable.
CONCLUSION:
The characteristics of different attributes of professionalism varied significantly among the residents. The findings of the present study highlights that the conceptualization and perception of professionalism is changing and there is a need to focus on the resident curriculum to instill the values of professionalism. Targeted training is needed on the concepts of professionalism to develop behaviors consistent with medical professionalism and to evaluate the levels of professionalism among residents.
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Fate of abstracts presented at the saudi ophthalmology society conferences 2015–2018
p. 33
Abdulaziz K Alsarhani, Abdullah I Almater, Mansour A Alobrah, Rahaf M Al Malawi, Waleed K Alsarhani
DOI
:10.4103/meajo.meajo_67_22
PURPOSE:
The aim of the study was to determine the publication rates of abstracts presented at the annual Saudi Ophthalmology Society (SOS) Conferences from 2015 to 2018.
METHODS:
This is a cross-sectional study on abstracts collected from the scientific programs for the SOS meetings from 2015 to 2018. Titles and first authors' names were used in the search process on PubMed. A Chi-square test was conducted to compare between the categorical variables. Kruskal–Wallis test was used for nonnormally distributed variables.
RESULTS:
A total of 365 abstracts were presented in the SOS Conferences from 2015 to 2018. In the SOS meetings (2015–2018), the publication rate was 45.7%. Seventy-two (43.1%) of the published abstracts were published in journals with an impact factor. The mean impact factor was 1.4 ± 1.9. The median time to publication was 12.0 months (range: 0–60 months). On univariate analysis, basic science (
P
< 0.001), abstracts on rare diseases (
P
= 0.003), affiliation with eye hospitals (
P
< 0.001), and public hospitals (0.007) were associated with a higher publication rate. On multivariate analysis, basic science studies (odds ratio [OR]: 4.23, confidence interval [CI]: 1.77–10.12,
P
= 0.001), rare topic-related abstracts (OR: 2.03, CI: 1.22–3.38,
P
= 0.007), and eye center affiliation (OR: 1.67, CI: 1.03–2.68,
P
= 0.036) were associated with a better publication rate. The factors associated with publication in high impact factor journals were oral abstracts (
P
= 0.007) and noncase report abstracts (
P
= 0.023).
CONCLUSION:
Basic science studies, rare topic-related abstracts, and first author affiliation with an eye center were all associated with a higher publication rate. Orally presented and noncase report abstracts increased the chance of publication in higher impact factor journals.
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REVIEW ARTICLES
Multimodal imaging, tele-education, and telemedicine in retinopathy of prematurity
p. 38
Nada H Almadhi, Eliot R Dow, RV Paul Chan, Sulaiman M Alsulaiman
DOI
:10.4103/meajo.meajo_56_22
Retinopathy of prematurity (ROP) is a disease that affects retinal vasculature in premature infants and remains one of the leading causes of blindness in childhood worldwide. ROP screening can encounter some difficulties such as the lack of specialists and services in rural areas. The evolution of technology has helped address these issues and led to the emergence of state-of-the-art multimodal digital imaging devices such fundus cameras with its variable properties, optical coherence tomography (OCT), OCT angiography, and fluorescein angiography which has helped immensely in the process of improving ROP care and understanding the disease pathophysiology. Computer-based imaging analysis and deep learning have recently been demonstrating promising outcomes in regard to ROP diagnosis. Telemedicine is considered an acceptable alternative to clinical examination when optimal circumstances for ROP screening in certain areas are lacking, and the expansion of these programs has been reported. Tele-education programs in ROP have the potential to improve the quality of training to physicians to optimize ROP care.
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Tubercular episcleritis: A review of literature
p. 51
Tariq M Aldebasi, Abdulelah A Alasiri, Muhannad A Alnahdi, Abdulrahman Alfarhan
DOI
:10.4103/meajo.meajo_315_21
Episcleritis is rarely reported to be associated with tuberculosis (TB). In this review, we highlight this underreported entity and elaborate on the natural history of the reported cases in the literature. Eighteen articles were found to describe numerous cases throughout the past century. Forty patients diagnosed with tuberculous episcleritis were found in the literature. The majority of the patients presented with a latent form of TB and fewer cases were linked with active/pulmonary disease. The natural history of episcleritis was found to have chronic and recurrent attacks refractory to traditional treatment, and the most commonly reported type was the nodular form. The described cases were eventually treated by quadruple antituberculous therapy, and fortunately, recurrence after treatment completion was not documented. It is imperative to highlight such entities that may be underreported in endemic countries, as successful therapy would decrease ocular morbidity and prevent potential unforeseen tuberculous complications.
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CASE REPORTS
Branch retinal artery occlusion following cocaine inhalation: Case report and review of the literature
p. 56
Waleed K Alsarhani, Abdullah I Almater, Ahmed M Abu El-Asrar
DOI
:10.4103/meajo.meajo_65_22
Cocaine abuse has been reported to cause devastating systemic and ocular side effects. Retinal vascular occlusion following cocaine abuse has been scarcely reported in the literature. Herein, we are describing a rare case of branch retinal artery occlusion (BRAO) following intranasal cocaine use in a young female. She presented to the emergency department 1 month after having blurred vision in the left eye, which started 1 day after cocaine nasal inhalation. Fundus examination of the left eye showed an inferotemporal BRAO. In conclusion, cocaine should be considered in the differential diagnosis of retinal arterial occlusion in young healthy patients.
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Intermediate uveitis in retinitis pigmentosa associated with a novel homozygous splice site mutation in
PRPF8
p. 59
Abdulrahman H Badawi, Moustafa S Magliyah, Patrik Schatz, Abdulaziz Al-Shehri, Abdulelah A Alabdullah
DOI
:10.4103/meajo.meajo_98_22
The manifestation of intermediate uveitis (IU) in patients with retinitis pigmentosa (RP) is uncommon and poses diagnostic and management challenges. In this case, we describe the clinical features and management outcomes in an RP patient with a novel homozygous splice site mutation in PRPF8. A 21-year-old male presented with unilateral decrease of vision in the right eye for 1 week. Retinal dystrophy features were present in the left eye. After 2 weeks of topical steroid therapy, near-total resolution of IU was achieved and vision improved to 20/30. Signs of (RP) were present bilaterally, with the right eye more affected than the left. Genetic testing indicated a novel homozygous c. 3061-6_3061-3del mutation in the
PRPF8
gene. IU in young patients with RP can be effectively treated with a short course of topical steroids, sparing the need for systemic immunosuppressives. After the improvement in IU, the right eye showed more advanced RP changes.
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Toxic keratopathy induced by self-application of seawater
p. 63
Huda AlGhadeer, Thamer Bukhari, Mohammed AlAmry
DOI
:10.4103/meajo.meajo_ 313_21
To report a case of toxic keratopathy secondary to the self-application of seawater eye drops. A 60-year-old male who presented with unexplained unilateral decrease in vision and corneal thinning. Best-corrected visual acuity was 20/400 OD, slit-lamp examination indicated diffuse corneal edema with central thinning, intact sensation, and no vascularization. Laboratory analysis of the eye drops in conjunction with clinical symptoms and findings was consistent with toxic keratopathy. Toxic keratopathy can masquerade as the other forms of keratopathy, and a thorough history taking and laboratory analysis may help elucidate the diagnosis and avoid significant visual morbidity.
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© Middle East African Journal of Ophthalmology | Published by Wolters Kluwer -
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Online since 10
th
March, 2009