King Khaled Eye Specialist Hospital Research Articles

The Impact of the COVID-19 Pandemic on Ophthalmology Residency and Fellowship Training: A Retrospective Study.

Background The COVID-19 pandemic has negatively affected many aspects of the healthcare system. Many meta-analysis studies showed that surgical training and medical education have faced the most negative effects. Aim In this study, we aim to study the impact of the COVID-19 pandemic on residency and fellowship training in terms of clinical load, surgical exposure, medical education, and research opportunities. Methodology This retrospective study was conducted at King Khaled Eye Specialist Hospital (KKESH), Riyadh, Saudi Arabia, to assess the effects of COVID-19 on the training program by comparing the years 2018 and 2019 before the COVID-19 pandemic to 2020 and 2021 after the COVID-19 pandemic. The sample was inclusive, including 117 KKESH graduates (residents and fellows in the surgical subspecialties) from 2018 to 2021. All the sample populations were included. The data was collected in a specifically designed form. All participants were ensured to have a full surgical logbook with no missing data in the documentation. Outpatient visits were collected through electronic records in the hospital registry. The teaching activities and grand rounds were collected through the residency and fellowship program. Results During 2018-2021, 18,669 surgeries were performed. The total number of surgeries performed was 3,980, 4,898, 4,813, and 4,978 in 2018, 2019, 2020, and 2021, respectively. There was a 23.1% (N = 918) increase in the number of surgeries done by trainees from 2018 to 2019, then a 1.7% (N = 85) reduction from 2019 to 2020, followed by an increase of 3.4% (N = 165) from 2020 to 2021. The mean number of surgeries performed by fellows showed a 25.2% (N = 1,042) increase from 2018 to 2019, a 7.3% (N = 107) reduction from 2019 to 2020, and a 15.1% (N = 550) increase (p = 0.018). In the case of residents, there was a 10.7% (N = 136) reduction from 2018 to 2019, a 2.1% (N = 24) increase from 2019 to 2020, and a 40% (N = 783) reduction in the total number of phacoemulsification surgeries (p < 0.001).In total, there was a 25.1% (N = 8,215) increase in the number of patients seen in outpatient clinics from 2019 to 2020. All activities were on-site during 2018 and 2019. A gradual shift occurred from on-site to virtual over 2020 and 2021 without any effect on the number. From 2019 to 2020, there was an increase in the number of papers submitted by the trainees. There was an increase of 25% (N = 10), 20% (N = 2), and 6.3% (N = 3) in the retrospective research, prospective research, and case reports, respectively. Conclusions The surgical exposure has not affected the fellows and residents of the hospital. However, the number of surgeries for the residents has been affected due to the stoppage of overseas surgical courses during the pandemic. The volume of the outpatient clinic has increased after the pandemic, which could be caused by the increased number of referrals to our tertiary hospital, mainly after the pandemic effect on other hospitals in the kingdom and the implementation of the virtual clinic and telephone call. Interestingly, research activity has also increased after the pandemic.

Differentiation of acanthamoeba keratitis from other non-acanthamoeba keratitis: Risk factors and clinical features.

Infectious Keratitis is one of the most common ocular emergencies seen by ophthalmologists. Our aim is to identify the risk factors and clinical features of Acanthamoeba Keratitis (AK). This retrospective chart review study was conducted at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, and included all the microbial keratitis cases, male and female patients of all ages. The main outcome is the differentiation between various microbial keratitis types. We included 134 consecutive eyes of 126 persons. We had 24 cases of acanthamoeba keratitis, 22 bacterial keratitis, 24 fungal keratitis, 32 herpetic keratitis, and 32 bacterial co-infection. Contact lens wear was found in 33 eyes (24.6%). Among acanthamoeba keratitis patients, 73% were ≤ 39 years of age, and 73% were females (P <0.001). Also, in AK cases, epithelial defect was found in all cases (100%), endothelial plaques were found in 18 eyes (69.2%), 12 cases had radial keratoneuritis (46.2%), and ring infiltrate was found in 53.8% of AK cases. We determined the factors that increase the risk of acanthamoeba infection and the clinical characteristics that help distinguish it from other types of microbial keratitis. Our findings suggest that younger females and patients who wear contact lenses are more likely to develop acanthamoeba keratitis. The occurrence of epitheliopathy, ring infiltrate, radial keratoneuritis, and endothelial plaques indicate the possibility of acanthamoeba infection. Promoting education on wearing contact lenses is essential to reduce the risk of acanthamoeba infection, as it is the most significant risk factor for this infection.

Cyclophotocoagulation versus Ahmed Glaucoma Implant in Neovascular Glaucoma with Poor Vision at Presentation.

To evaluate the outcomes of surgical intervention in eyes with neovascular glaucoma (NVG) and poor vision, comparing the Ahmed glaucoma implant with cyclophotocoagulation (CPC). This study is a double-armed cohort retrospective review of medical records of patients with NVG who had a visual acuity of 20/200 or less and underwent one of the two procedures as a primary intervention: Ahmed glaucoma valve (AGV) or cyclophotocoagulation (CPC). The study was conducted at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, from January 2014 to June 2019, with a total study period of 1 year. The main outcome measures included the surgical success rate, changes in intraocular pressure (IOP), the number of antiglaucoma medications, corrected distance visual acuity, and the reoperation rate for glaucoma. The preoperative IOP was 40.4 ± 10.6 mmHg (Median 40) in the CPC group and 39.4 ± 10.2 mmHg (Median 40) in the AGV group (P = 0.6). At 1 year, the IOP ranged from 12.5 to 28 mmHg (Median 18) in the CPC group and 14 to 21.5 mmHg (Median 17) in the AGV group (P = 0.016). Survival analysis showed a 51% success rate in the CPC group and an 89% success rate at 1 year in the AGV group (p>0.0001). CPC and AGV procedures yielded good outcomes with similar IOP levels 12 months after the surgery. However, AGV demonstrated a higher overall success rate and a lower medication requirement than CPC.

Assessment of Corneal Cross-Linking Effect on Progressive Keratoconus by Using the ABCD Grading System.

The aim of this study was to assess changes in corneal parameters 6 months after corneal cross-linking for progressive keratoconus, using the ABCD system. This retrospective study was conducted at the King Khaled Eye Specialist Hospital (Riyadh, Saudi Arabia) between January 1 and July 30, 2022. This study included 16 eyes of 16 patients with keratoconus who underwent corneal cross-linking at the same hospital and were at least 18 years old. At least one preoperative (T0) and one postoperative examination was performed for each patient. Six months after the procedure (T1), patients underwent corneal tomography. The parameters A, B, C, and D were also evaluated. Other parameters monitored included maximal keratometry (Kmax) (K1 and K2), Belin/Ambrósio Enhanced Ectasia Display, and index vertical asymmetry. The progression of ectasia was identified by a consistent change in at least two parameters: steepening of the anterior corneal surface or the posterior corneal surface, thinning or an increase in the rate at which the corneal thickness changed from the periphery to the thinnest point, where the magnitude of the change was greater than the normal noise of the testing system. Among the patients, 68.8% were men. The patients' average age was 25.8±5 years. Throughout the 6-month postoperative follow-up, parameters A, B, and C exhibited substantial changes (P = 0.000 for parameters A, B, and C). Parameter A increased 6 months after surgery, whereas parameters B and C decreased. Preoperatively and 6 months after surgery, Kmax, K1, and Belin/Ambrosio-enhanced ectasia demonstrated substantial differences. However, parameter D, K2, and the average pachymetric progression index did not change significantly. Anterior and posterior corneal curvatures and corneal thickness profiles can be useful for monitoring the progression of keratoconus and the success of the corneal cross-linking operation.

Profile of a large cohort of children with persistent fetal vasculature and their predictors of poor visual outcome in a tertiary eye hospital in Saudi Arabia.

To present the profile of a large cohort of children with persistent fetal vasculature (PFV) and identify their predictors of poor visual outcome in a tertiary eye hospital in Saudi Arabia. This was a single-center study. Medical records of children diagnosed with persistent fetal vasculature between January 1990 and January 2020 at King Khaled Eye Specialist Hospital (KKESH), Riyadh, were reviewed. Data were collected on PFV type, presenting features, management, and visual acuity. Poisson regression with robust error variance was used to identify the predictors of poor visual outcome. Data of 175 eyes of 170 children with PFV were analyzed. Most had unilateral disease (n = 165, 96.2%), and over half of them (57.1%) were males. The main presenting complaints were leukocoria (n = 126, 72.0%), followed by smaller eye (n = 36, 20.6%), poor vision (n = 15, 8.6%), and strabismus (n = 13, 7.4%). Anterior, posterior, and combined PFV were present in 30.9%, 10.9%, and 58.3% eyes, respectively. In eyes with measurable visual acuity (n = 124), BCVA at the last follow-up was ≥20/100, <20/100-20/400, CF/HM and LP/NLP in 11 (8.9%), 32 (25.8%), 43 (34.7%), and 38 (30.6%) eyes, respectively. In the multivariable poisson regression analysis, eyes with posterior PFV were approximately two times more likely to have a BCVA of CF or worse than those with anterior PFV (Adjusted incidence ratio: 1.82 (95%: 1.23, 2.70; P = 0.003). Compared with eyes with primary or secondary IOL implantation, aphakic eyes or those with no cataract surgery were significantly more likely to have BCVA of CF or worse (adjusted incidence ratio: 1.84 [95%: 1.18, 2.86], p = 0.007 and adjusted incidence ratio: 1.64 [95%: 1.08, 2.50], p = 0.020, respectively). The prognosis of PFV varies depending on the severity of the disease. Patients with posterior PFV had worse visual outcome than anterior or combined type. Whether primary or secondary, IOL implantation increases the probability of having BCVA better than CF.

Knowledge, attitude, and practice (KAP) towards glaucoma among new glaucoma patients and their first-degree relatives: A cross-sectional study in a tertiary eye care centre in Riyadh, Saudi Arabia.

Glaucoma, a disease characterized by optic nerve damage and associated visual field defects, is the main cause of irreversible loss of vision, both globally and locally. Appropriate management of glaucoma involves early diagnosis in addition to early and continuous control of the disease to protect the optic nerve from further damage. This study aimed to assess the knowledge, attitude, and practice (KAP) towards glaucoma among patients making their first visit to the glaucoma clinics, at King Khaled Eye Specialist Hospital in Riyadh, and their first-degree relatives. This cross-sectional study used self-administered questionnaires. Informed consent was obtained prior to questionnaire distribution. The questionnaire included four sections on sociodemographic data, and awareness, and KAP towards glaucoma. Overall, 120 participants were included in our study: 70 (58.3%) were glaucoma patients and 50 (41.7%) were first-degree relatives. Forty-four (62.9%) participants in the patient group and 39 (78%) in the relative group were men. Thirty-four (48.6%) patients were aged 41-65 years, whereas 41 (82%) relatives were aged 18-40 years. Thirty-six patients (52.2%) and 35 relatives (70%) had heard of the term 'glaucoma'. The correct definition of glaucoma was selected by only 12 participants (17.1%) in the patient group and 4 (8.2%) in the relative group. Living outside the central region of Saudi Arabia and having a negative systemic medical history were associated with poorer knowledge of glaucoma definition (p < 0.05). Although 84.8% of patients believed that compliance with anti-glaucoma medications helps in disease control, only 22.7% reported good compliance. The correct method of instilling eye drops was stated by 43.9% of the patients, and good hospital visit habits were reported by 53.03%. Eighty percent of glaucoma patients strongly recommended that their first-degree relatives be screened for glaucoma. Knowledge about glaucoma is still limited, and awareness programs need to be further activated to spread correct knowledge about the nature of glaucoma, the importance of compliance with treatment, the correct method of instilling eye drops, and the significance of screening at-risk individuals. Patient families should also be involved in educational programs.

Long-term outcome and determinants of primary pediatric cataract surgery.

This study aimed to evaluate the long-term outcomes of primary pediatric cataract surgery and to identify determinants of success and recommendations to improve the care of patients with pediatric cataracts. A cohort, retrospective study of cases who were operated as primary pediatric cataract surgery at King Khaled Eye Specialist Hospital. Patients who are 4 years old or younger and underwent primary cataract surgery with at least 3-year follow-up were enrolled in this study. Preoperative and postoperative evaluations were performed to determine the surgery outcomes. Two hundred and two eyes of 119 patients were enrolled in the study. Seventy percentage of the patients were diagnosed with bilateral cataracts and 30% with unilateral cataracts. Postoperative evaluation showed that 20% of the patients had best corrected visual acuity of 20/30 or better, 25% had 20/40-20/50, 20% had 20/60-20/80, and 29% had 20/100 or less, 6% as fixate and follow. In addition, the mean spherical equivalent was 1.50D. Amblyopia was present in 120 eyes. Fourteen percentage showed a significant myopic shift of more than -4.00D and it was more in eyes with primary intraocular lens (IOL) implantation. Glaucoma was reported in 19% of the patients. There was a significant postoperative myopic shift and it was more in eyes with primary IOL implantation. Glaucoma was the most common reported postoperative complication. The presence of strabismus and nystagmus may affect the visual outcomes. Early intervention might reduce the incidence of amblyopia.

Clinical use of cryopreserved ultra-thick human amniotic membrane for anophthalmic socket contracture.

To study the use of ultra-thick human amniotic membrane for management anophthalmic socket contracture. A prospective study done at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. Thirty-six patients (45 eyelids) were involved. Contracted socket caused by trauma, previous surgery or radiotherapy, delay in use of prosthesis, Congenital Anophthalmia/Microphthalmia, and Anophthalmia secondary to Enucleation/Evisceration were included in the study. Thirty-three patients (42 eyelids) underwent fornix reconstruction with cryopreserved ultra-thick human amniotic membrane. Mean ± SD age at surgery was (40.90 ± 17.32) years. Mean follow up was 10.5 months. Grade II fornix contracture was the most common type in 23 (54.8%) eyelids. The most common involved primary diagnosis was Anophthalmia secondary to Enucleation/Evisceration (n = 13). The incidence of pyogenic granuloma (PG) after surgery was seen in 8 eyelids (19.0%). Anophthalmic contracted socket secondary to significant history of multiple PG excision (> 5 times) and secondary to enucleation/evisceration were associated with good surgical outcome. Cryopreserved ultra-thick human amniotic membrane is an ideal material for the management of anophthalmic socket contracture.

Long-term functional and structural outcomes after large chorioretinectomy for ruptured globe following blunt trauma

BackgroundThe purpose of this study was to present a modified surgical technique involving pars plana vitrectomy with large chorioretinectomy for eyes with rupture of the globe due to severe ocular blunt trauma.MethodsThis retrospective study included consecutive patients with rupture of the globe due to blunt trauma who were treated at the King Khaled Eye Specialist Hospital (Riyadh, Saudi Arabia). All patients underwent 25-gauge pars plana vitrectomy with large chorioretinectomies involving all the tissue around the posterior scleral wounds. Outcome measures included best-corrected visual acuity (BCVA), anatomical success and globe survival, rates of complications.Results15 eyes of 15 patients were included. Mean BCVA was 2.88 ± 0.13 logMAR at presentation, and significantly improved to 0.83 ± 0.28 logMAR (P < 0.001), with 10 patients (67%) achieving a final BCVA ≥ 20/200. Anatomical success and globe survival were achieved in 11 (73%) and 15 (100%) of eyes, respectively. Postoperative complications included retinal detachment in 6 eyes (40%), epiretinal membrane in 6 (40%), hypotony in 4 (26%), PVR in 2 (13%).ConclusionsPars plana vitrectomy with large chorioretinectomy is an effective treatment for globe rupture following severe blunt trauma, yielding good visual outcomes and anatomical success rates.

Evaluation of Surgical Requirements and Competencies of the Saudi Ophthalmology Training Program in a Tertiary Eye Specialist Hospital- A Cross-Sectional Study.

To evaluate the adequacy of a Saudi ophthalmology training programs in achieving the competencies outlined by the Saudi Commission for Health Specialties (SCFHS) and the Accreditation Council for Graduate Medical Education (ACGME) and to assess resident satisfaction with their training. A cross-sectional survey was sent electronically to all trainees (n=50) enrolled in the King Khaled Eye Specialist Hospital (KKESH) ophthalmology training program by email and messaging app (Whatsapp). The survey was sent between January 20, 2021, and January 30, 2021. It evaluated the level of satisfaction with surgical training and skills. The surgical logbooks of all trainees were extracted, and identifiers were removed. Then they were compared with SCFHS and ACGME curriculums for ophthalmology training. Out of 50 invitees, 47 returned the questionnaire. All trainees were confident they could meet surgical requirements by the end of their training. Most trainees were satisfied (n=29, 61.7%) with their performance in core competency requirements. There was no difference between female and male trainees' comfort levels when performing surgical steps in core competency requirements (P=0.2). Senior trainees seem more satisfied with their performance, especially in core competency requirements (P=0.087). All trainees practice at the wet lab and a virtual reality simulator to improve their skills. Obstacles faced during training were highlighted, including low exposure in the operating theater (n=18, 37.50%), competition on cases (n=5, 10.42%), attending surgeons not willing to teach (n=5, 10.42%), COVID-19 pandemic (n=5, 10.42%), and complex cases (n=4, 8.33%). The outcomes of the current study indicate that trainees at KKESH were adequately satisfied with their surgical training in general. Also, competencies outlined by both the SCFHS and the ACGME were adequately fulfilled.

Risk Factors and Visual Sequel of Non-Arteritic Ischemic Optic Neuropathy in Saudi Arabia.

To provide the demographic data, risk factors, and visual prognosis of patients from a Saudi population diagnosed with non-arteritic anterior ischemic optic neuropathy (NAION). A retrospective observational case series of 120 patients (146 eyes) with NAION from the King Khaled Eye Specialist Hospital or King Abdulaziz University Hospital from 1998 to 2015. Patients with other retinal pathology or glaucoma were excluded from the study. Additionally, a subgroup analysis was performed to compare the long-term assessment between diabetic and non-diabetic patients and its effects on NAION. The mean duration of follow-up was 1.7 ± 2.4 years. The mean age of the study population was 55.0 ± 10.1 years. NAION was present in the fellow eye of 26 patients, and the median time for involvement was less than 1 year from the presentation. There was no significant difference in the best-corrected visual acuity between diabetics and non-diabetics at presentation or last visit (P = 0.868, P = 0.599, respectively). The majority of patients with NAION also had coexisting diabetes mellitus. Diabetes mellitus had no significant effect on NAION during the presentation, follow-up, and last visit.

Ophthalmic Manifestations of Arterial Tortuosity Syndrome: Case Series of Patient and Carriers

The aim of this study was to report the detailed ophthalmic findings in a young patient with genetically confirmed arterial tortuosity syndrome (ATS) and the findings in 8 family members who were carriers. Nine members of the same Saudi family were assessed at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, for ATS-related ocular changes after homozygosity for the pathogenic variant of SLC2A10 gene was confirmed in 1 member. All family members underwent complete ophthalmic examination, genetic testing, and corneal tomography at presentation and at 6-month follow-up. All ophthalmic features were manifested in our patient with ATS including schisis-like splitting of the stromal layer with greater peripheral thinning, pannus, deep posterior stromal opacities, myopia, high astigmatism, and keratoglobus. The ocular phenotype was also expressed in some carriers ranging from mild myopia to the full spectrum of corneal abnormalities associated with ATS. Our study provided further insights into the phenotype in both patients with ATS and carriers. Annual ophthalmic examination is warranted in both types of patients and must undergo from early life onward to detect progressive ectasia which may necessitate corneal crosslinking.

Bibliometric Analysis of Ophthalmology Publications from Arab Countries between 2012 and 2022.

The purpose of this study was to conduct a bibliometric analysis of articles published in Ophthalmology Journals from Arab countries from 2012 to 2022. This cross-sectional analysis of all original ophthalmology research and review articles published by authors with an affiliation with an institution from Arab countries and indexed in the ISI Web of Science between January 2012 and December 2022. For the years 2012-2022, 4292 articles published in Ophthalmology Journals by authors from Arab-based institutions were identified. A 2.11-fold progressive increase in the number of publications was observed over the last decade with a substantial increase in publication volume during the first 2 years of the COVID-19 pandemic. The countries with the highest number of publications were Egypt (38.51%), Saudi Arabia (35.56%), and the United Arab Emirates (7.88%). According to affiliation, authors from King Khaled Eye Specialist Hospital (KKESH) (n = 644) published the highest number of ophthalmology articles, followed by King Saud University (n = 585) and Cairo University (n = 393). Over the last decade, the overall productivity of research in the field of ophthalmology has significantly increased. Majority of the articles in ophthalmology were published by authors from Egypt and Saudi Arabia with KKESH as the most productive institution among Arab nations.

Spherical equivalent pre- and post-implantable collamer lens implantation in patients with myopia, hyperopia, and stable keratoconus.

Refractive errors are common in Saudi Arabia and keratorefractive surgeries are usually done to correct them. However, not all patients are fit and complications postoperatively are a concern. Implantable collamer lens (ICL) implantation can be used for patients who are not fit for keratorefractive surgeries. ICL can also be used for keratoconus. We elected to evaluate the outcomes of patients who had ICL implantation for refractive errors or keratoconus. We retrospectively reviewed patients aged between 21 and 45 years old, who attended the anterior segment clinic at King Khaled Eye Specialist Hospital and who had spherical equivalent (SE) ranging between (+16 to -23 diopters), and had ICL implantation between February 2015 and September 2017. The SE was documented before and after the surgery. Depending on the SE, patients were divided into two groups (myopia and hyperopia). Statistical analysis was done to evaluate the change in mean SE before and after surgery for patients. We identified 169 eyes and 155 (92%) were myopic before the surgery. Before surgery, the mean SE was -8.6 and the standard deviation (SD) was 4.4. Only 14 eyes (8%) were hyperopic before the surgery with a mean SE of +5.5 and SD of 4.8. The difference in the mean of SE between after and before the surgery for myopic eyes was statistically significant (mean difference: 7.8, SD: 5, P < 0.0001). The difference in the mean of SE between post- and pre-operatively was also significant for hyperopic eyes (mean difference: -6.1, SD: 5.2, P = 0.0007). In 32 eyes with keratoconus, the mean SE before surgery was -7.9 with an SD of 4.1. For the keratoconus eyes, the mean difference of SE between after and before surgery was statistically significant as the mean difference in SE was 7.2 with an SD of 4.6 (P < 0.0001). The effect of ICL implantation was significant in improving the SE for myopic, hyperopic, and keratoconus eyes.

Visual outcomes and recurrence rate of macular corneal dystrophy following phototherapeutic keratectomy in Saudi Arabia.

The purpose of the study was to evaluate the visual outcomes and recurrence rate of patients with macular corneal dystrophy (MCD) who have undergone phototherapeutic keratectomy (PTK). This retrospective, single-centered study enrolled patients from King Khaled Eye Specialist Hospital who had undergone PTK for MCD between 2000 and 2020. Pre-, intra-, and post-operative data were collected, and the primary outcome measures included uncorrected visual acuity, best-corrected visual acuity (BCVA), spherical equivalent, central keratometry, keratometric astigmatism, recurrence rate, and necessity of subsequent surgery. This study evaluated 42 eyes of 29 patients. BCVA improved from 0.41 (±0.17) preoperatively to 0.30 (±0.16) postoperatively. Sixteen out of 42 eyes (38%) had the recurrence of macular dystrophy deposits within the stroma; the average time from PTK to recurrence was 37 months (range: 5.5-115.4 months). The overall success rate of PTK at 2 years was 44.8%. Eleven eyes (26%) required subsequent surgery following PTK at an average of 43 months postoperatively. Deeper ablation and longer application of mitomycin C (MMC) were both found to be statistically significant factors associated with visual improvement and lower recurrence rate following PTK. PTK can be considered a treatment modality for younger patients to defer keratoplasty to a later stage. Deeper ablation is associated with improved postoperative visual acuity, and longer application of MMC is associated with lower recurrence rates of MCD.

Reasons for the Late Presentation of Diabetic Retinopathy in Saudi Arabia: A Survey of Patients Who Presented with Advanced Proliferative Diabetic Retinopathy to a Tertiary Eye Hospital.

This study aimed to understand the barriers that contribute to diagnostic and therapeutic delays in patients with advanced proliferative diabetic retinopathy (PDR). This cross-sectional study targeted patients with advanced PDR who never received any ocular intervention at King Khaled Eye Specialist Hospital in Saudi Arabia. An Arabic-language questionnaire was used to interview the participants over a period of 6 months. The questionnaire comprised sociodemographic questions followed by several sections to assess the causes of delay in diagnosis and management. Variables were analyzed descriptively and reported as numbers and percentages using SPSS 22. A total of 338 patients were included in the study. Most patients were older than 50 years (60.4%), and decreased vision was the main complaint at presentation (81%). Vitreous hemorrhage was the most common diagnosis (46%). Patients' lack of knowledge about the importance of DR screening programs and problems with healthcare system screenings were the most frequent causes of delay in diabetic retinopathy (DR) diagnosis and management. DR is still a major cause of permanent blindness that is treatable with regular follow-up and timely management. Even though DR screening and treatment in Saudi Arabia have improved drastically over the last years, socioeconomic and health system factors remain barriers to the improvement of outcomes of DR.

Awareness of Diabetic Retinopathy Among Diabetic Patients in King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia

Diabetic retinopathy (DR) is a leading cause of blindness. Over a third of the population with diabetes (DM) develop DR. Therefore, we aimed to investigate the awareness level of DR in the subjects with DM attending clinics at King Khaled Eye Specialist Hospital (KKESH) in Riyadh, Saudi Arabia. A cross-sectional study was carried out in KKESH. Responses from 360 subjects (men and women) with DM were collected using a validated questionnaire after obtaining informed consent. The questionnaire was constructed to assess the level of knowledge about DR, its screening, prevention, and treatment. The questionnaire responses were utilized thereafter to assess the association between the level of awareness of DR and the characteristics of the subjects. Pearson's chi-squared test was computed to exhibit the associationand a p-value of <0.05 was considered significant. Almost all the subjects answered six or more questions, thereby considered aware of DR. Only 3.6% of the subjects knew how often their eyes should be screened for DR. Only 3.2% of the subjects with DM type 1 (DM1) knew when their eyes should be examined after being diagnosed with DM. Men exhibited a significantly higher (p= 0.04) level of awareness compared to women. Comparing the other characteristics of the subjects exhibited no significant differences. In conclusion, although the studied population exhibited a good level of awareness about DR, they would benefit from further education on DR, especially on how regularly their vision is recommended to be examined to prevent DR and its consequences.

Trends in antibiotic resistance in ocular samples in a tertiary eye centre in Saudi Arabia in 2003–2019

ObjectifLa présente étude visait à analyser l'antibiorésistance dans des échantillons oculaires recueillis pendant 16 ans. MéthodesIl s'agissait d'une étude de cohorte rétrospective réalisée à l'hôpital King Khaled, spécialisé en ophtalmologie, situé à Riyad, en Arabie Saoudite, entre 2003 et 2019. On y a examiné des écouvillonnages cornéens et conjonctivaux de même que des échantillons aqueux et vitréens. RésultatsOn a observé une tendance significative vers une augmentation de la résistance des staphylocoques à coagulase négative au fil du temps envers l’érythromycine (p < 0,001), l'oxacilline (p < 0,001), l'acide fusidique (p < 0,001) et la moxifloxacine (p = 0,003). Staphylococcus aureus a également présenté une hausse significative de ses profils de résistance envers l'oxacilline (p = 0,001), l'ofloxacine (p = 0,003) et la moxifloxacine (p = 0,001). Streptococcus pneumoniæ, pour sa part, a manifesté une augmentation significative de ses profils de résistance envers l’érythromycine (p = 0,01) et l'ofloxacine, soit de 0,80 % en 2003 à 80 % en 2019 (p = 0,015). On n'a enregistré aucune hausse statistiquement significative de l'antibiorésistance de Pseudomonas. ConclusionsOn a observé une augmentation des profils d'antibiorésistance, notamment dans le cas des microorganismes gram-positifs. Compte tenu de ces résultats, il serait judicieux de réviser les stratégies habituelles de prescription des antibiotiques à usage oculaire et d'envisager le recours à des antibiotiques différents.

Conventional surgery versus botulinum toxin injection for the management of esotropia in children with Down syndrome

To compare the success rates of strabismus surgery and botulinum toxin injection (BTX) in treating esotropia in patients with Down syndrome (DS). This multicenter retrospective cohort study included all consecutive patients having DS with esotropia between 2014 and 2021 at King Abdullah Specialist Children Hospital, King Abdullah International Medical Research Center, and King Khaled Eye Specialist Hospital, Saudi Arabia. We divided the patients into two groups according to interventions. Success was defined as angle of deviation of <10Δ at final visit. A total of 53 patients were included: 23 in the surgery group and 30 in the BTX group. There were no significant differences between groups with regard to age, sex, diagnosis, spherical equivalent, and preoperative deviation angle. Before the intervention, the median angle of deviation was 30.0Δ (IQR, 30Δ-45Δ) in the surgery group and 37.5Δ (IQR, 28.8Δ-50.0Δ) in the BTX group (P = 0.802). Postoperatively, the median (IQR) deviation angle was 0.0Δ (0.0Δ-16.0Δ) in the surgery group and 22.5Δ (6.75Δ-30.0Δ) in the BTX group (P = 0.006). The success rate in the surgery and BTX groups was 65% and 30%, respectively (P = 0.011). Two patients developed dissociated vertical deviation in the surgery group. One patient presented consecutive exotropia and one inferior oblique overaction in the BTX group. In this study, conventional surgery showed a higher success rate than BTX in the management of esotropia.

Encounter glaucoma decision Aid trial.

A decision aid facilitates patient engagement in the decision-making process in ophthalmic practice. In particular, patients with open-angle glaucoma will benefit from such an intervention as it enhances their knowledge, compliance, and satisfaction with the healthcare services. The Encounter Glaucoma Decision Aid (GDA) was delivered to 145 patients with open-angle glaucoma at the King Khaled Eye Specialist Hospital. Evaluation was done using a pre-validated, semi-structured questionnaire. We compared the patients' knowledge, compliance, and decision conflict scale at baseline, before receiving Encounter GDA, and again three months later. The average age of the participants was 56.82 years. Most of the participants were male (67.6%). The mean duration since the participants were diagnosed with glaucoma was 9.39 years. After using Encounter GDA, 80% of participants had a statistically significant improvement in their level of knowledge, moving from poor to good (P = 0.001). There was also a statistically significant increase in adherence to medication, from 41.4% to 65.5% (P = 0.001). The decision conflict score decreased significantly after using Encounter GDA (before it was 60.94 ± 21.60 vs. after 19.18 ± 17.83). Using GDA cards as an educational measure has a significant effect on improving patient's knowledge and adherence to medications.