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Middle East African Journal of Ophthalmology Middle East African Journal of Ophthalmology
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   2017| April-June  | Volume 24 | Issue 2  
    Online since September 7, 2017

 
 
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ORIGINAL ARTICLES
Prevalence and risk factors of dry eye symptoms in a Saudi Arabian population
Abdulaziz A Alshamrani, Abdulwahab S Almousa, Abdulrahman A Almulhim, Abdullah A Alafaleq, Mohammed B Alosaimi, Abdulrahman M Alqahtani, Ammar M Almulhem, Mohammed A Alshamrani, Ahmad H Alhallafi, Ismail Z Alqahtani, Abdullah A Alshehri
April-June 2017, 24(2):67-73
DOI:10.4103/meajo.MEAJO_281_16  PMID:28936049
Background: The information about dry eye epidemiology in Saudi Arabia is few in literature. Purpose: To estimate the prevalence and identify determinants of dry eye symptoms (DES) in Al-Ahsa, Saudi Arabia. Methods: Using a multi-stage proportionate sampling technique, Saudis of both genders from 6 urban and 4 rural Primary Health Care centers in Al-Ahsa were enrolled. They were interviewed to gather data on sociodemography, symptoms of dry eye, factors potentially related to dry eye, and chronic comorbidities. If one or more of DESs present often or constantly, we labeled the person with DES. Results: We examined 1858 Saudi adults with mean age of 39.3 ± 14.1 years. The age-adjusted prevalence of DES was 32.1% (95% confidence interval [CI] = 30.0–34.3). Multivariate logistic regression analysis showed that female gender (adjusted odds ratio [aOR] = 2.1, 95% CI = 1.7–2.6), older age (>56 years; aOR = 1.5, 95% CI = 1.0–2.1), current smoking (aOR = 1.4, 95% CI = 1.1–1.8) and history of diabetes mellitus (aOR = 1.5, 95% CI = 1.2–2.0) were significantly associated with DES. Nonsignificant variables included residence (urban/rural); work status; wearing contact lenses; multivitamin use; caffeine use; history of trachoma, hypertension, bronchial asthma, coronary artery disease, thyroid disease, arthritis, hemolytic blood diseases (sickle cell-thalassemia), gout, and osteoporosis. Conclusion: DES are highly prevalent among the adult population of Al-Ahsa. Females, persons more than 55 years of age, smokers and diabetics were associated to DES.
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Bacterial contamination of multi-dose eye drops at ophthalmology department, University of Gondar, Northwest Ethiopia
Asegedech Tsegaw, Asamere Tsegaw, Tefera Abula, Yared Assefa
April-June 2017, 24(2):81-86
DOI:10.4103/meajo.MEAJO_308_16  PMID:28936051
Purpose: Ophthalmic solutions used for both diagnostic and therapeutic purposes were found to be contaminated with bacteria pathogens and caused serious ocular infections such as keratitis and endophthalmitis. The objective was to assess the magnitude and pattern of bacterial contamination of multi-dose ophthalmic medications and investigate the drug susceptibility pattern of the isolates in the Department of Ophthalmology at Gondar University Teaching Hospital. Methods: A total of 100 ophthalmic medications in-use by patients and eye-care workers have been taken and cultured for potential bacterial contamination in the Microbiology Department after 1 week and >1 week of use. The dropper tip and the residual eye medications were examined for contamination. The contaminating bacteria were identified using a standard procedure and drug susceptibility testing to selected antimicrobial agents was done. Results: Eleven ophthalmic medications were contaminated by different bacterial species with a prevalence of 11%. Multi-use and longer duration of use of eye medications were associated with higher rate of contamination. The contamination level ranges from 0% for antibiotics, 20% for local anesthetics, and 40% for povidone iodine. Among bacteria identified, Staphylococcus aureus and coagulase-negative Staphylococcus species were resistant to methicillin while others were sensitive to the antibiotics tested. Conclusion: The prevalence of contamination was low, but methicillin-resistant Staphylococcus was a potential risk. It is recommended that the Department of Ophthalmology should design set of rules about duration of use and safe handling of ophthalmic medications by the staff and patients.
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Comparative evaluation of corneal endothelium in patients with diabetes undergoing phacoemulsification
Pramod K Sahu, Gopal K Das, Sumeet Agrawal, Sabitabh Kumar
April-June 2017, 24(2):74-80
DOI:10.4103/meajo.MEAJO_242_15  PMID:28936050
Purpose: The purpose of this study is to determine if phacoemulsification with posterior chamber foldable intraocular lens implantation has a greater impact on the corneal endothelium of type 2 diabetic patients as compared to nondiabetic controls. Materials and Methods: This study compared the corneal endothelial status in sixty patients with diabetes with good glycemic control and sixty nondiabetic controls before and after (1 week, 1 month, 2 month, and 3 month) uneventful phacoemulsification. Central corneal endothelial cell density, percentage hexagonality, and coefficient of variation were measured using a noncontact specular microscope. Central corneal thickness was taken as a surrogate marker for endothelium functional status. Results: Data were age and sex matched. Patients with diabetes showed significantly higher loss in endothelial cell count as compared to nondiabetic controls. Furthermore, the patients with diabetes showed a slower recovery trend in the endothelial healing response as evidenced by lower change in the coefficient of variation. Significant correlation was found between energy used and change in endothelial count as well as coefficient of variation in nondiabetics only. Conclusion: In spite of good glycemic control, patients with diabetes have significantly more endothelial damage in comparison to nondiabetic controls with similar nuclear grading and phaco energy used. This warrants a more careful use of phaco energy in patient with diabetes.
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BRIEF COMMUNICATIONS
Patterns of intermediate uveitis in children presenting at a tertiary eye care center in South India
Radha Annamalai, Jyotirmay Biswas
April-June 2017, 24(2):94-99
DOI:10.4103/meajo.MEAJO_264_15  PMID:28936054
Purpose: To study the patterns of intermediate uveitis in the pediatric age group in a referral eye care center in South India. Methods: This is a study of twenty consecutive patients under 16 years of age with intermediate uveitis, conducted at a tertiary referral center. Numerous variables were assessed, including age and gender distribution, laboratory data, the presence of systemic diseases, onset and course of ocular inflammation, clinical features, their complications, therapeutic strategies with their outcomes, remission, final visual acuity (VA), and characteristics associated with poor visual outcome. Results: Bilateral involvement was observed in 80% of the patients. Remission was observed in five out of 7 patients (78%) with completed follow-up of 5 years. Final VA improved by at least two lines in 11 patients, remained stable in 6 patients, and worsened in 3 patients. The etiological diagnosis showed one patient with Bechet's disease, one with juvenile idiopathic arthritis, 1 with human leukocyte antigen B27 associated uveitis, 9 with laboratory proven tuberculosis, and 3 with sarcoidosis and 5 where it was idiopathic. The mean follow-up was 4.8 years (range 3–8 years). Cataract was the most frequent complication observed (40%). Glaucoma, choroidal neovascularization, and amblyopia accounted for worsening of vision in three patients. Conclusion: Median time of development of complications is about 3 years based on our study. Intermediate uveitis of childhood might exhibit a self-limiting course after several years. Visual recovery is good in the majority, and visual loss is limited despite the high rate of ocular complications.
  3,910 173 -
CASE REPORTS
Multifocal choroiditis with retinal vasculitis, optic neuropathy, and keratoconus in a young Saudi male
Yousef Dhafiri, Khalid Al Rubaie, Omar Kirat, William N May, Quan D Nguyen, Igor Kozak
April-June 2017, 24(2):109-112
DOI:10.4103/meajo.MEAJO_331_16  PMID:28936058
The purpose of this study is to describe an association of unilateral multifocal choroiditis (MFC), retinal vasculitis, optic neuropathy, and bilateral keratoconus in a young Saudi male. A 27-year-old male patient with stable bilateral keratoconus presented with a painless vision loss in his left eye. Ophthalmic examinations revealed multiple foci of idiopathic chorioretinitis, retinal vasculitis, and mild optic disc leakage on fluorescein angiography, all of which resolved on systemic therapy with mycophenolate mofetil and prednisone after 3 months. Systemic medication was stopped after 8 months. One year after presentation, patient's visual acuity has improved and remained stable. Systemic immunomodulatory therapy can be effective in managing and leading to resolution of MFC, retinal vasculitis, and optic disc leak in young patients.
  3,785 97 -
A case of unilateral retinitis pigmentosa associated with full thickness macular hole
Lama Enani, Igor Kozak, Ehab Abdelkader
April-June 2017, 24(2):113-115
DOI:10.4103/meajo.MEAJO_97_17  PMID:28936059
A 44-year-old Saudi female presented with poor right eye vision for 3 years. Visual acuity (VA) was 20/400 in the right eye and 20/20 in the left eye. Examination and imaging showed all the typical features of retinitis pigmentosa in the right eye associated with full thickness macular hole (FTMH) and an essentially normal left eye. The case underwent pars plana vitrectomy with internal limiting membrane peeling and gas tamponade that resulted in anatomical closure of the FTMH, but VA remained the same.
  3,515 128 -
Infectious crystalline keratopathy after corneal cross-linking
Mohammed Al-Amry, Tariq Mudhaiyan, Reem Al-Huthail, Huda Al-Ghadeer
April-June 2017, 24(2):100-102
DOI:10.4103/meajo.MEAJO_346_16  PMID:28936055
To report a rare case of infectious keratitis after collagen cross-linking (CXL) for keratoconus. A 20-year-old male patient underwent CXL for keratoconus in his right eye. Four weeks after the procedure, he reported blurred vision and redness with increasing pain in the treated eye. Ophthalmic examination revealed a corneal epithelial defect with corneal infiltrates that exhibited branching needle-like opacities. The patient was diagnosed with infectious crystalline keratopathy (ICK). Corneal scrapings and culture indicated the presence of Streptococcus sanguinis. The patient was successfully treated with fortified vancomycin and ceftazidime over several weeks. ICK is a potential post-operative complication of CXL that can lead to corneal scarring with a permanent reduction in visual acuity.
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BRIEF COMMUNICATIONS
Outcome of descemet stripping automated endothelial keratoplasty in failed penetrating keratoplasty
Abdulrahman S Khairallah
April-June 2017, 24(2):87-90
DOI:10.4103/meajo.MEAJO_248_15  PMID:28936052
Purpose: The purpose of this study was to report the outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) surgeries in eyes with failed penetrating keratoplasty (PKP). Methods: This was a retrospective, noncomparative, descriptive case series. Patients who underwent DSAEK following PKP from January 2007 to December 2012 were reviewed. Data were collected on best-corrected visual acuity (BCVA) before and 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years following DSAEK. Intra- and post-operative complications, changes in intraocular pressure (IOP) were also documented. Demographics were associated with the visual outcomes. Results: Fifteen eyes of 15 patients with failed PKP comprised the study group. BCVA improved by 2 or more lines at 6 months after DSAEK in ten (66.6%) eyes. In the five eyes that did not experience an increase in BCVA, four had complications; detached lenticule (2 eyes), rejection (1 eye), and dislocation of the graft (1 eye). One eye had ocular comorbidity causing poor vision. The mean IOP at 12–15 weeks postoperatively was 17.4 ± 6.8 mmHg. Conclusion: DSAEK for failed PKP resulted in improved vision in two-third of cases. Selection of cases for this repeat surgery seems to be a key in successful outcomes.
  3,199 109 -
Using the postoperative visual acuity to monitor the quality of cataract surgery: Does the day one visual acuity following cataract surgery correlate with the final visual acuity?
Halimatu Aliyu, Hamzah Mustak, Colin Cook
April-June 2017, 24(2):91-93
DOI:10.4103/meajo.MEAJO_279_16  PMID:28936053
Purpose: Monitoring the visual acuity following cataract surgery is used as a measure of the quality of the surgery in blindness prevention programs in middle- and low-income countries. While the day 1 visual acuity is usually available, the (final) visual acuity after several weeks may not be available, as the majority of patients may not return for review. This study was undertaken to ascertain if the early and late visual acuities are correlated and if the day 1 visual acuity can be used to predict the likely final visual acuity. Methods: A retrospective case note review was undertaken of all eyes having cataract surgery over a 6-month period. Results: There was a positive correlation between the day 1 and week 6 visual acuities in both the World Health Organization categories (Spearman coefficient = 0.4666, P = 0.001) and the logMAR visual acuity scores (Spearman coefficient = 0.5425, P = 0.001). Conclusion: In blindness prevention programs in middle- and low-income countries with poor postoperative follow-up where it is not possible to document the final visual acuity in all the operated cases, there is merit in documenting and monitoring the day 1 visual acuity as a quality control measure.
  3,128 134 -
CASE REPORTS
Endophthalmitis due to Proteus vulgaris after pars plana vitrectomy with devastating outcome
Abdullah S Al-Kharashi, Abdulmajeed S Al-Kharshi, Yasser H Al-Faky
April-June 2017, 24(2):116-118
DOI:10.4103/meajo.MEAJO_134_15  PMID:28936060
Postoperative infectious endophthalmitis is rare, yet devastating loss of vision or loss of the eye can occur due to a highly purulent microorganism or uncontrolled endophthalmitis that may spread to all coats of the eye. We report, herewith, a case of rapidly progressive postoperative endophthalmitis after pars plana vitrectomy which ended up with enucleation. The isolated microorganism was Proteus vulgaris which has not been reported as causative bacteria of postoperative infections following pars plana vitrectomy.
  3,151 93 -
Syringocystadenoma papilliferum of sweat gland of caruncle: A unique case report
Anuradha Raj, RC Nagpal, Meena Harsh, Harsh Bahadur
April-June 2017, 24(2):103-105
DOI:10.4103/meajo.MEAJO_195_15  PMID:28936056
Syringocystadenoma papilliferum (SP) is a rare benign hamartomatous malformation of skin which arises from apocrine or eccrine sweat glands. Skin of the head and neck is the usual site for this but rarely involves the eyelids. It is also called as a childhood tumor since it usually appears at birth or during puberty. The diagnosis is confirmed on histopathological examination after surgical excision. We are first to report a case of SP involving the caruncle in an elderly female.
  3,138 77 -
Unusual case of acute corneal hydrops in Mooren's ulcer treated with intracameral injection of perfluoropropane
Manisha Acharya, Abhishek Dave, Umang Mathur
April-June 2017, 24(2):106-108
DOI:10.4103/meajo.MEAJO_23_16  PMID:28936057
A 15-year-old boy was diagnosed with Mooren's ulcer in the right eye at our cornea clinic. On treatment, he developed acute corneal hydrops, and the vision in the right eye dropped to perception of light. The patient was treated with intracameral injection of perfluoropropane (C3F8) gas which resulted in complete resolution of corneal edema. Contact lens fitting yielded a good visual outcome with a best-corrected visual acuity of 20/80. To the best of our knowledge, this is the only case reporting the occurrence of acute corneal hydrops in a child with Mooren's ulcer.
  3,078 90 -
EDITORIAL
To realize universal eye health we must strengthen implementation research
Jacqueline Ramke, Babar Qureshi, Clare E Gilbert
April-June 2017, 24(2):65-66
DOI:10.4103/0974-9233.214183  PMID:28936048
  2,991 95 -
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