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Refractive Surgical Procedures: HELP
Articles from Riyadh
Based on 69 articles published since 2009

These are the 69 published articles about Refractive Surgical Procedures that originated from Riyadh during 2009-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Editorial Indicators for monitoring cataract surgery outcomes; evolution and importance. 2015

Khandekar, Rajiv / May, W / Alasbali, T. ·King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. ·Nepal J Ophthalmol · Pubmed #26695598.

ABSTRACT: -- No abstract --

2 Editorial Refractive surgery: the never-ending task of improving vision correction. 2014

Al-Swailem, Samar A. ·Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. ·Middle East Afr J Ophthalmol · Pubmed #24669138.

ABSTRACT: -- No abstract --

3 Review Risks of Cefuroxime Prophylaxis for Postcataract Endophthalmitis. 2017

Al-Abduljabbar, Khaled A / Stone, Donald U. ·Research Department, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saud Arabia. · College of Medicine, King Saud University, Riyadh, Kingdom of Saud Arabia. · Department of Ophthalmology, Wilmer Eye Institute of Johns Hopkins University, Baltimore, MD, USA. ·Middle East Afr J Ophthalmol · Pubmed #28546689.

ABSTRACT: BACKGROUND: Endophthalmitis after cataract surgery is a rare but vision-threatening complication. Intracameral cefuroxime (ICC) has been reported to be effective at reducing the risk, but concerns regarding the risks associated with this intervention remain. METHODS: Systematic review and synthesis of the literature on ICC, with a focus on the risks of therapy. RESULTS: Level 2a evidence was found to support the use of cefuroxime in penicillin-allergic patients. Compounding or dilutional errors are associated with ocular toxicity, but the incidence and risk of this occurrence are unknown. Level 4 evidence supports interventions that reduce the risk of dilutional errors. The association of cefuroxime injection with toxic anterior segment syndrome (TASS) is not established; Level 5 evidence supports standard measures to reduce the incidence of TASS related to cefuroxime administration. CONCLUSION: Cefuroxime can be administered safely to penicillin-allergic patients, and steps should be taken to reduce the risk of compounding or dilutional errors to avoid negating the benefits of this intervention. Recommended practice patterns for endophthalmitis prophylaxis should consider the risks and benefits of ICC.

4 Review Boston Type 1 Keratoprosthesis versus Repeat Donor Keratoplasty for Corneal Graft Failure: A Systematic Review and Meta-analysis. 2016

Ahmad, Sumayya / Mathews, Priya M / Lindsley, Kristina / Alkharashi, Majed / Hwang, Frank S / Ng, Sueko M / Aldave, Anthony J / Akpek, Esen Karamursel. ·The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland. · Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. · Consultant, King Saud University, Riyadh, Saudi Arabia. · Cornea and External Disease, The Kresge Eye Institute, Wayne State University, Detroit, Michigan. · Cornea and Refractive Surgery Services, The Jules Stein Eye Institute, Los Angeles, California. · The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: esakpek@jhmi.edu. ·Ophthalmology · Pubmed #26545318.

ABSTRACT: PURPOSE: To compare repeat penetrating keratoplasty (PK) with Boston type I keratoprosthesis (KPro) implantation for full-thickness donor corneal graft failure. DESIGN: Previous donor graft failure is a common indication for both PK and KPro implantation. Selection of the surgical procedure is entirely dependent on the surgeon because there are no studies available for guidance. Therefore, a systematic review was undertaken to examine vision, device retention, graft clarity, and postoperative glaucoma and infection outcomes after repeat PK versus KPro implantation. METHODS: Articles with data regarding repeat PK published between 1990 and 2014 were identified in PubMed, EMBASE, the Latin American and Caribbean Health Sciences Literature Database, and the Cochrane Central Register of Controlled Trials and were reviewed. Results were compared with a retrospective review of consecutive, nonrandomized, longitudinal case series of KPro implantations performed at 5 tertiary care centers in the United States. Visual acuity at 2 years was the primary outcome measure. The proportion of clear grafts in the repeat PK group, device retention in the KPro group, and the development of postoperative glaucoma and infection were secondary outcome measures. RESULTS: The search strategy identified 17 128 articles in the PK analysis. After screening, 26 studies (21 case series and 5 cohort studies) were included in the review. Pooled analysis of the 26 unique studies demonstrated a 42% (95% confidence interval [CI], 30%-56%) likelihood of maintaining 20/200 or better at 2 years after repeat PK, compared with an 80% (95% CI, 68%-88%) probability with KPro implantation. The probability of maintaining a clear graft at 5 years was 47% (95% CI, 40%-54%) after repeat PK, whereas the probability of retention of the KPro at 5 years was 75% (95% CI, 64%-84%). The rate of progression of glaucoma at 3 years was 25% (95% CI, 10%-44%) after repeat PK and 30% in the KPro cohort. CONCLUSIONS: These results demonstrate favorable outcomes of KPro surgery for donor corneal graft failure with a greater likelihood of maintaining visual improvement without higher risk of postoperative glaucoma compared with repeat donor PK.

5 Review Impact of cataract surgery in reducing visual impairment: a review. 2015

Khandekar, Rajiv / Sudhan, Anand / Jain, B K / Deshpande, Madan / Dole, Kuldeep / Shah, Mahul / Shah, Shreya. ·Department of Research, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia. ·Middle East Afr J Ophthalmol · Pubmed #25624679.

ABSTRACT: PURPOSE: The aim was to assess the impact of cataract surgeries in reducing visual disabilities and factors influencing it at three institutes of India. MATERIALS AND METHODS: A retrospective chart review was performed in 2013. Data of 4 years were collected on gender, age, residence, presenting a vision in each eye, eye that underwent surgery, type of surgery and the amount the patient paid out of pocket for surgery. Visual impairment was categorized as; absolute blindness (no perception of light); blind (<3/60); severe visual impairment (SVI) (<6/60-3/60); moderate visual impairment (6/18-6/60) and; normal vision (≥6/12). Statistically analysis was performed to evaluate the association between visual disabilities and demographics or other possible barriers. The trend of visual impairment over time was also evaluated. We compared the data of 2011 to data available about cataract cases from institutions between 2002 and 2009. RESULTS: There were 108,238 cataract cases (50.6% were female) that underwent cataract surgery at the three institutions. In 2011, 71,615 (66.2%) cases underwent surgery. There were 45,336 (41.9%) with presenting vision < 3/60 and 75,393 (69.7%) had SVI in the fellow eye. Blindness at presentation for cataract surgery was associated to, male patients, Institution 3 (Dristi Netralaya, Dahod) surgeries after 2009, cataract surgeries without Intra ocular lens implant implantation, and patients paying <25 US $ for surgery. Predictors of SVI at time of cataract surgery were, male, Institution 3 (OM), phaco surgeries, those opting to pay 250 US $ for cataract surgeries. CONCLUSION: Patients with cataract seek eye care in late stages of visual disability. The goal of improving vision related quality of life for cataract patients during the early stages of visual impairment that is common in industrialized countries seems to be non-attainable in the rural India.

6 Review Pigmented hypopyon in association with Listeria monocytogenes endopthalmitis: an interesting case report following refractive surgery procedure with literature review. 2014

Alkatan, Hind M / Al-Dhibi, Hassan A / Edward, Deepak P / Al-Rajhi, Ali A. ·Department of Pathology and Laboratory Medicine, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. · Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. · Department of Research, Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. · Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. ·Middle East Afr J Ophthalmol · Pubmed #24669144.

ABSTRACT: PURPOSE: Listeria monocytogenes is an aerobic, motile, gram positive bacillus recognized as an intercellular pathogen in human where it most frequently affects neonates, pregnant women, elderly patients, and immunosuppressed individuals as well as healthy persons. Ocular listeriosis is rare, most frequently in the form of conjunctivitis, but has been also shown to cause rarely endophthalmitis with pigmented hypopyon and elevated intraocular pressure such as in our case. MATERIALS AND METHODS: We are reporting one immunocompetent patient presenting with dark hypopyon following laser refractive procedure. His clinical findings, investigations, and further management are all described with relevant literature review of similar cases. RESULTS: Diagnosis of ocular listeriosis was confirmed by positive culture of anterior chamber (AC) aspirate with identification of the above organism. His visual outcome was satisfactory with good preserved vision. CONCLUSION: We believe that his ocular infection was exogenous and that ophthalmologists should be aware of the causative organisms of colored hypopyon to avoid delayed diagnosis.

7 Review Clear corneal incision in cataract surgery. 2014

Al Mahmood, Ammar M / Al-Swailem, Samar A / Behrens, Ashley. ·Division of Anterior Segment, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia. · Division of Anterior Segment, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia ; Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. ·Middle East Afr J Ophthalmol · Pubmed #24669142.

ABSTRACT: Since the introduction of sutureless clear corneal cataract incisions, the procedure has gained increasing popularity worldwide because it offers several advantages over the traditional sutured scleral tunnels and limbal incisions. Some of these benefits include lack of conjunctival trauma, less discomfort and bleeding, absence of suture-induced astigmatism, and faster visual rehabilitation. However, an increasing incidence of postoperative endophthalmitis after clear corneal cataract surgery has been reported. Different authors have shown a significant increase up to 15-fold in the incidence of endophthalmitis following clear corneal incision compared to scleral tunnels. The aim of this report is to review the advantages and disadvantages of clear corneal incisions in cataract surgery, emphasizing on wound construction recommendations based on published literature.

8 Article An Objective Evaluation of the Upper Eyelid Position after Phacoemulsification Cataract Surgery. 2019

Marqués-Fernández, Victoria / Garcia-Zamora, Maria / Calabuig-Goena, Maria / Diez-Montero, Cecilia / Schellini, Silvana A / Khandekar, Rajiv / Galindo-Ferreiro, Alicia. ·a Department of Ophthalmology, Rio Hortega University Hospital , Valladolid , Spain. · b Oculoplastic Division, King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia. · c Department of Ophthalmology Faculdade de Medicina de Botucatu, UNESP , Botucatu , Brazil. ·Semin Ophthalmol · Pubmed #31314625.


9 Article Comparative Clinical Study of Medically Controlled Nonsevere Chronic Primary Angle-closure Glaucoma with Coexisting Cataract Surgically Managed by Phacoemulsification as against Combined Phacotrabeculectomy. 2018

Chelerkar, Vidya / Parekh, Puja / Kalyani, V K S / Deshpande, Madan / Khandekar, Rajiv. ·Department of Glaucoma, PBMA's H. V. Desai Eye Hospital, Hadapsar, Pune, Maharashtra, India. · Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. ·Middle East Afr J Ophthalmol · Pubmed #30765948.

ABSTRACT: PURPOSE: Comparative clinical study of medically controlled non-severe chronic Primary Angle Closure Glaucoma (PACG) with co-existing cataract surgically managed by phacoemulsification as against combined phacotrabeculectomy. METHODS: This randomized clinical trial was conducted between December 2011 and December 2013. Patients were randomly assigned to Phacoemulsification (PE) and Phacotrabeculectomy (PT) groups for surgery. Intraocular pressure, anti-glaucoma medications, Best Corrected Visual Acuity, anterior chamber angle widening and post-operative complications in both groups were compared after 12 months. RESULTS: There were 46 eyes with PACG in PE group and 45 in PT group. The IOP at 12 months in PE group was 11.5±1.3mmHg and 11.8±1.2mmHg in PT gr. (p = 0.28). The eyes requiring single anti-glaucoma medications at 12months in PE group was 0, PT group was 1 (p = 0. 495). The post op BCVA at 12months in PE group 0.3+-0.12 and 0.33±0.15 in PT group (p = 0.22). 3 cases in PT group required additional intervention whereas no additional intervention was required in PE group and this difference was statistically significant (p = 0.116). CONCLUSION: Phacoemulsification is equally effective in terms of intraocular pressure control and visual outcome as phacotrabeculectomy with better safety and less post-operative complication.

10 Article Clinical features of LONP1-related infantile cataract. 2018

Khan, Arif O / AlBakri, Amani. ·Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. Electronic address: arif.khan@mssm.edu. · Division of Pediatric Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. ·J AAPOS · Pubmed #29408517.

ABSTRACT: Biallelic mutations in the nuclear gene LONP1 (LON peptidase 1, mitochondrial) cause CODAS syndrome (cerebral, ocular, dental, auricular, and skeletal anomalies), a systemic disease that can include infantile cataract. However, we have found that biallelic mutations in the gene can also underlie infantile cataract in the setting of minimal or no apparent extraocular findings. This report highlights our clinical experience with children referred for the management of infantile cataract who were found to harbor biallelic LONP1 gene mutations. Ptosis, external ear abnormalities, and joint abnormalities were accompanying findings and thus should raise suspicion for mutations in the gene when one or more are present in children with infantile cataract.


Calvo, Pilar / Ferreras, Antonio / Al Adel, Fadwa / Dangboon, Wantanee / Brent, Michael H. ·IIS-Aragon, Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain. · University of Zaragoza, Zaragoza, Spain. · Department of Ophthalmology, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia. · Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand. · Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada. ·Retina · Pubmed #28196056.

ABSTRACT: PURPOSE: To analyze the effects of a dexamethasone intravitreal implant (DEX; Ozurdex 700 μg; Allergan) administered immediately after cataract surgery in diabetic patients. METHODS: This prospective, single-arm, open label study (NCT01748487 at ClinicalTrials.gov) involved Type 2 diabetic patients with at least mild diabetic retinopathy (DR) who underwent cataract surgery and DEX insertion after phacoemulsification, and intraocular lens implantation were enrolled. Best-corrected visual acuity and central retinal thickness (CRT) measured by spectral-domain optical coherence tomography were recorded at 1 week preoperatively, and 1 week, 1 month, and 3 months after surgery. Adverse events were also recorded. RESULTS: Twenty-four eyes of 24 patients (17 [70.8%] men; mean age 63.7 ± 8.7 years) with mild nonproliferative DR (41.7%), moderate nonproliferative DR (33.3%), severe nonproliferative DR (16.7%), or treated proliferative DR (8.3%) were selected. After DEX treatment, mean CRT changed from 241.1 μm (95% confidence interval, 227.5-254.6 μm) at baseline to 236.9 μm (95% confidence interval, 223.9-249.9 μm) at 1 week (P = 0.09), 238.9 μm (95% confidence interval, 225.5-252.3 μm) at 1 month (P = 0.44), and 248 μm (95% confidence interval, 232.4-260.8 μm) at 3 months (P = 0.15). No eyes showed a postoperative increase >50 μm in the CRT at any visit. A 10% increase in CRT was found in 8.3% of eyes. Mean best-corrected visual acuity significantly improved from 0.37 (20/50) at baseline to 0.19 (20/30) at 1 week, 0.12 (20/25) at 1 month, and 0.12 (20/25) at 3 months (P < 0.001 for each comparison). Mean intraocular pressure before surgery was 13.8 mmHg, and none of the patients developed an intraocular pressure ≥22 mmHg at any visit. None of the patients developed any serious adverse events during the follow-up. CONCLUSION: These short-term results suggest that a single DEX injection intraoperatively after phacoemulsification could avoid an increase in CRT after cataract surgery in diabetic patients.

12 Article Outcomes of Scleral-fixated Intraocular-lens in Children with Idiopathic Ectopia Lentis. 2017

Al Somali, Abdulaziz I / Al-Dossari, Faisal N / Emara, Khalid E / Al Habash, Ahmed. ·Department of Ophthalmology, King Faisal University, Al Ahsa, Kingdom of Saudi Arabia. · Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. · Division of Pediatric Ophthalmology, Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia. · Department of Ophthalmology, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia. ·Middle East Afr J Ophthalmol · Pubmed #29422749.

ABSTRACT: PURPOSE: The purpose of the study was to review the safety and stability of scleral-fixated intraocular lens (IOL) 2 years after implantation in children with idiopathic ectopia lentis (EL). METHODS: This retrospective case series enrolled children with EL managed between 2011 and 2015 at a tertiary eye hospital in the eastern of Saudi Arabia. Data were collected on age, gender, vision, isolated or syndromic pathology, intraoperative and postoperative complications, spherical equivalent refraction, and final best-corrected visual acuity (BCVA). RESULTS: The series included 18 eyes of 11 children with EL (6 males and 5 females). There were 7 bilateral and 4 unilateral cases. The median age was 3.5 years (25% quartile 1 year; range: 1-8 years). Preoperatively, fixation was absent in 3 eyes, 8 eyes were fixating but vision could not be recorded. In the remaining seven eyes, median distant visual acuity was 0.1 (25% quartile: 0.08). The median postoperative follow-up was 24 months (25% quartile, 7 months). Complications included two eyes with iris capture and one eye with lens subluxation requiring re-implantation. Postoperative BCVA was better than 20/60 in 15 (83%) eyes. At last follow-up, 6 eyes required myopic correction, 1 eye was emmetropic, and 11 eyes were hypermetropic. One eye with glaucoma was managed medically. CONCLUSION: Scleral fixated IOL in eyes of young children with EL had good visual outcomes and high stability. However, there is a high incidence of residual refractive error.

13 Article Real-time Optical Coherence Tomography Incorporated in the Operating Microscope during Cataract Surgery. 2017

Almutlak, Mohammed A / Aloniazan, Turki / May, William. ·Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. · Wilmer Eye Institute, Baltimore, MD, USA. ·Middle East Afr J Ophthalmol · Pubmed #29279657.

ABSTRACT: A 55-year-old male presented with reduced vision due to senile cataract. The patient consented to undergo real-time intraoperative anterior segment-optical coherence tomography (AS-OCT) during phacoemulsification with intraocular lens (IOL) implantation. Images were captured at various points during the surgery. The use of AS-OCT incorporated into the surgical microscope was evaluated as an adjunct to cataract surgery. We were able to successfully evaluate, in real-time, wound architecture, the attachment of Descemet's membrane, the posterior capsule, and IOL position. Real-time AS-OCT can be used to proactively address potential complications and verify IOL placement intraoperatively.

14 Article Outcome of Descemet Stripping Automated Endothelial Keratoplasty in Failed Penetrating Keratoplasty. 2017

Khairallah, Abdulrahman S. ·Department of Surgery (Ophthalmology), College of Medicine, King Khalid University, Abha, Saudi Arabia. · Department of Ophthalmology, Division of Surgery, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. ·Middle East Afr J Ophthalmol · Pubmed #28936052.

ABSTRACT: 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.

15 Article Changing patterns of cataract services in North-West Nigeria: 2005-2016. 2017

Muhammad, Nasiru / Adamu, Mohammed Dantani / Caleb, Mpyet / Maishanu, Nuhu Mohammed / Jabo, Aliyu Mohammed / Rabiu, Muhammad Mansur / Bascaran, Covadonga / Isiyaku, Sunday / Foster, Allen. ·Department of Ophthalmology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. · Department of Ophthalmology, University of Jos, Jos, Nigeria. · Sightsavers, Kaduna, Nigeria. · Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa. · Sokoto state eye health programme, Ministry of Health, Sokoto, Nigeria. · Helen Keller International, Abuja, Nigeria. · Prevention of Blindness Union, Riyadh, Saudi Arabia. · Clinical Research Department, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom. ·PLoS One · Pubmed #28817733.

ABSTRACT: PURPOSE: This study was conducted to assess the impact of the eye care programme on cataract blindness and cataract surgical services in Sokoto, Nigeria over a 12 year period 2005-2016. METHODS: Data from the 2005 population based cross-sectional study of blindness in Sokoto state was re-analysed to obtain baseline estimates of the prevalence of cataract blindness and cataract surgical coverage for persons 50 years and over in Wurno health zone. A population based survey of a representative sample of persons 50 years and over in Wurno health zone was conducted in July 2016. Data on eye health workforce, infrastructure and cataract surgical services between 2005 and 2016 were analysed from relevant documents. RESULTS: In 2005 the unadjusted prevalence of bilateral cataract blindness (<3/60) in people 50 years and over in Wurno health zone was 5.6% (95% CI: 3.1, 10.1). By 2016 this had fallen to 2.1% (95% CI 1.5%, 2.7%), with the age-sex adjusted prevalence being 1.9% (95% CI 1.3%, 2.5%). The CSC for persons with visual acuity <3/60, <6/60, <6/18 for Wurno health zone was 9.1%, 7.1% and 5.5% respectively in 2005 and this had increased to 67.3%, 62.1% and 34.7% respectively in 2016. The CSR in Sokoto state increased from 272 (1005 operations) in 2006, to 596 (2799 operations) in 2014. In the 2005 survey, couching (a procedure used by traditional practitioners to dislocate the lens into the vitreous cavity) accounted for 87.5% of all cataract interventions, compared to 45.8% in the 2016 survey participants. In 2016 18% of eyes having a cataract operation with IOL implantation had a presenting visual acuity of <6/60 (poor outcome) with the main causes being postoperative complications (53%) and uncorrected refractive error (29%). CONCLUSION: Between 2005 and 2016 there was a doubling in cataract surgical rate, a 7 times increase in cataract surgical coverage (<3/60), and a decrease in cataract blindness and the proportion of eyes being couched. However, there remains a high prevalence of un-operated cataract in 2016 indicating a need to further improve access to affordable and good quality cataract surgical services.

16 Article The Influence of Phacoemulsification on Intraocular Pressure Control and Trabeculectomy Survival in Uveitic Glaucoma. 2017

Almobarak, Faisal A / Alharbi, Ali H / Morales, Jose / Aljadaan, Ibrahim. ·*Department of Ophthalmology, College of Medicine ‡Glaucoma Research Chair, King Saud University †Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh §King Abdullah Medical City, Makkah, Saudi Arabia. ·J Glaucoma · Pubmed #28234676.

ABSTRACT: OBJECTIVES: To evaluate the influence of phacoemulsification on intraocular pressure (IOP) control and survival of mitomycin C (MMC)-enhanced trabeculectomy in uveitic glaucoma (UG). MATERIALS AND METHODS: Retrospective case-control study included 54 eyes from 40 patients with UG who underwent MMC-enhanced trabeculectomy as an initial procedure to treat glaucoma at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between 2002 and 2014. Eyes were divided into 2 groups: the first group included eyes that later underwent cataract surgery in the form of phacoemulsification, and the second group included eyes that did not have cataract surgery. The main outcome measures were changes in the IOP, the number of antiglaucoma medications, IOP control, and trabeculectomy survival. RESULTS: There were no differences in the overall trabeculectomy survival of eyes that underwent cataract surgery and those that did not (P=0.681, log-rank) nor the final IOP [15.54 mm Hg (±6.3) in the study group and 13.34 mm Hg (±5.6) in the control group, P=0.247]. However, more antiglaucoma medications were needed to control the IOP after cataract surgery at the last follow-up [1.59 medications (±1.4) in the study group and 0.50 medications (±0.7) in the control group; P=0.009]. CONCLUSIONS: UG eyes that underwent phacoemulsification following MMC-enhanced trabeculectomy required more medications to control the IOP than those that did not undergo cataract surgery and therefore less IOP control. Such changes in IOP control did not affect the overall trabeculectomy survival rate.

17 Article Risk of Breaking Haptic of Trifocal IOL and Its Management. 2016

Alasbali, Tariq. ·Department of Ophthalmology, College of Medicine, Imam Mohammed bin Saud Islamic University, Riyadh, Saudi Arabia; Department of Ophthalmology, Specialised Medical Hospital, Riyadh, Saudi Arabia. ·Middle East Afr J Ophthalmol · Pubmed #27994398.

ABSTRACT: Fracture of an intraocular lens (IOL) haptic is a rare complication of cataract surgery. A broken haptic can cause serious damage in the anterior and posterior segments. To the best of our knowledge, a broken haptic in a high-quality, commercially available trifocal IOL has not been documented in the literature. Prompt and proactive action at 1 day postoperatively aided in addressing the complication and restoring the vision. We suggest that the ophthalmologist performed a thorough evaluation on the 1

18 Article Comparison of Olive Tipped and Conventional Steven's Cannula for Sub-Tenon Ophthalmic Anesthesia. 2016

Al-Motowa, Saeed / Ahmad, Nauman / Khandekar, Rajiv / Zahoor, Abdul. ·Department of Outreach and Eligibility, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. · Department of Anesthesia, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. · Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. ·Middle East Afr J Ophthalmol · Pubmed #27994394.

ABSTRACT: PURPOSE: To compare the efficacy of the olive tipped (OT) cannula to the conventional Steven's cannula for sub-Tenon block (STB) before cataract surgery. METHODS: This prospective, randomized, double-masked compared STB delivered in cataract surgery patients with an OT cannula or a conventional Steven's cannula (ST). Outcome variables included the akinesia score and lid movement scores at 5 and 10 min. The patient perception of pain during delivery of the STB and surgery were also compared between groups. Surgeon satisfaction with anesthesia was compared between groups. RESULTS: There were sixty patients in each group. The age between groups was not statistically different ( CONCLUSION: An OT cannula is equally effective as the conventional Steven's cannula for delivering STB anesthesia before cataract surgery.

19 Article Removal of Retained Descemets Membrane Using Femtosecond Laser. 2016

May, William / Alrashidi, Sultan / Daoud, Yassine J. ·King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. · Department of Ophthalmology, College of Medicine, Qassim University, Qassim, Saudi Arabia. · The Johns Hopkins University School of Medicine, The Wilmer Eye Institute, Baltimore, MD, USA. ·Middle East Afr J Ophthalmol · Pubmed #27555712.

ABSTRACT: We present a unique method of retrocorneal membrane removal with a femtosecond laser (FSL). A 22-year-old male who had undergone penetrating keratoplasty had a retained retrocorneal membrane and a double anterior chamber postoperatively. The membrane was dissected completely with the FSL and the free-floating membrane was removed. Histopathological evaluation confirmed the diagnosis of retained Descemets membrane (DM). There was improvement in uncorrected visual acuity from 20/300 to 20/50. Central corneal endothelial cell count was 810 cells/mm(2) preoperatively and 778 cells/mm(2) postoperatively. Inadvertent retention of DM may be safely treated with the FSL. Clarity and viability of the existing graft can be maintained.

20 Article Two-Year COMPASS Trial Results: Supraciliary Microstenting with Phacoemulsification in Patients with Open-Angle Glaucoma and Cataracts. 2016

Vold, Steven / Ahmed, Iqbal Ike K / Craven, E Randy / Mattox, Cynthia / Stamper, Robert / Packer, Mark / Brown, Reay H / Ianchulev, Tsontcho / Anonymous5830877. ·Vold Vision, Fayetteville, Arkansas. · Department of Ophthalmology, University of Toronto, Toronto, Ontario, Canada. · Wilmer Eye Institute, Baltimore, Maryland; King Khaled Eye Specialists Hospital, Riyadh, Saudi Arabia. · New England Eye Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts. · Glaucoma Clinic, University of California-San Francisco Medical Center, San Francisco, California. · Oregon Health & Science University, Portland, Oregon. · Atlanta Ophthalmology Associates, Atlanta, Georgia. · Transcend Medical, Inc., Menlo Park, California; University of California-San Francisco, San Francisco, California. Electronic address: sean@ianchulev.com. ·Ophthalmology · Pubmed #27506486.

ABSTRACT: PURPOSE: We evaluated 2-year safety and efficacy of supraciliary microstenting (CyPass Micro-Stent; Transcend Medical, Inc., Menlo Park, CA) for treating mild-to-moderate primary open-angle glaucoma (POAG) in patients undergoing cataract surgery. DESIGN: Multicenter (24 US sites), interventional randomized clinical trial (RCT) (ClinicalTrials.gov identifier, NCT01085357). PARTICIPANTS: Subjects were enrolled beginning July 2011, with study completion in March 2015. Subjects had POAG with mean diurnal unmedicated intraocular pressure (IOP) 21-33 mmHg and were undergoing phacoemulsification cataract surgery. METHODS: After completing cataract surgery, subjects were intraoperatively randomized to phacoemulsification only (control) or supraciliary microstenting with phacoemulsification (microstent) groups (1:3 ratio). Microstent implantation via an ab interno approach to the supraciliary space allowed concomitant cataract and glaucoma surgery. MAIN OUTCOME MEASURES: Outcome measures included percentage of subjects achieving ≥20% unmedicated diurnal IOP lowering versus baseline, mean IOP change and glaucoma medication use, and ocular adverse event (AE) incidence through 24 months. RESULTS: Of 505 subjects, 131 were randomized to the control group and 374 were randomized to the microstent group. Baseline mean IOPs in the control and microstent groups were similar: 24.5±3.0 and 24.4±2.8 mmHg, respectively (P > 0.05); mean medications were 1.3±1.0 and 1.4±0.9, respectively (P > 0.05). There was early and sustained IOP reduction, with 60% of controls versus 77% of microstent subjects achieving ≥20% unmedicated IOP lowering versus baseline at 24 months (P = 0.001; per-protocol analysis). Mean IOP reduction was ↓7.4 mmHg for the microstent group versus ↓5.4 mmHg in controls (P < 0.001), with 85% of microstent subjects not requiring IOP medications at 24 months. Mean 24-month medication use was 67% lower in microstent subjects (P < 0.001); 59% of control versus 85% of microstent subjects were medication free. Mean medication use in controls decreased from 1.3±1.0 drugs at baseline to 0.7±0.9 and 0.6±0.8 drugs at 12 and 24 months, respectively, and in the microstent group from 1.4±0.9 to 0.2±0.6 drugs at both 12 and 24 months (P < 0.001 for reductions in both groups at both follow-ups vs. baseline). No vision-threatening microstent-related AEs occurred. Visual acuity was high in both groups through 24 months; >98% of all subjects achieved 20/40 best-corrected visual acuity or better. CONCLUSIONS: This RCT demonstrated safe and sustained 2-year reduction in IOP and glaucoma medication use after microinterventional surgical treatment for mild-to-moderate POAG.

21 Article Induced Higher-order aberrations after Laser In Situ Keratomileusis (LASIK) Performed with Wavefront-Guided IntraLase Femtosecond Laser in moderate to high Astigmatism. 2016

Al-Zeraid, Ferial M / Osuagwu, Uchechukwu L. ·Department of Optometry & Vision Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, P.O Box 10219, Riyadh, 11433, Saudi Arabia. · Department of Optometry & Vision Sciences, Faculty of Health, Ophthalmic and Visual Optics Laboratory Group (Chronic Disease & Ageing), Institute of Health and Biomedical Innovation, Q Block, Room 5WS36 60 Musk Avenue Kelvin Grove, Brisbane, QLD, 4059, Australia. osuagoul@aston.ac.uk. ·BMC Ophthalmol · Pubmed #27000109.

ABSTRACT: BACKGROUND: Wavefront-guided Laser-assisted in situ keratomileusis (LASIK) is a widespread and effective surgical treatment for myopia and astigmatic correction but whether it induces higher-order aberrations remains controversial. The study was designed to evaluate the changes in higher-order aberrations after wavefront-guided ablation with IntraLase femtosecond laser in moderate to high astigmatism. METHODS: Twenty-three eyes of 15 patients with moderate to high astigmatism (mean cylinder, -3.22 ± 0.59 dioptres) aged between 19 and 35 years (mean age, 25.6 ± 4.9 years) were included in this prospective study. Subjects with cylinder ≥ 1.5 and ≤2.75 D were classified as moderate astigmatism while high astigmatism was ≥3.00 D. All patients underwent a femtosecond laser-enabled (150-kHz IntraLase iFS; Abbott Medical Optics Inc) wavefront-guided ablation. Uncorrected (UDVA), corrected (CDVA) distance visual acuity in logMAR, keratometry, central corneal thickness (CCT) and higher-order aberrations (HOAs) over a 6 mm pupil, were assessed before and 6 months, postoperatively. The relationship between postoperative change in HOA and preoperative mean spherical equivalent refraction, mean astigmatism, and postoperative CCT were tested. RESULTS: At the last follow-up, the mean UDVA was increased (P < 0.0001) but CDVA remained unchanged (P = 0.48) and no eyes lost ≥2 lines of CDVA. Mean spherical equivalent refraction was reduced (P < 0.0001) and was within ±0.50 D range in 61% of eyes. The average corneal curvature was flatter by 4 D and CCT was reduced by 83 μm (P < 0.0001, for all), postoperatively. Coma aberrations remained unchanged (P = 0.07) while the change in trefoil (P = 0.047) postoperatively, was not clinically significant. The 4th order HOAs (spherical aberration and secondary astigmatism) and the HOA root mean square (RMS) increased from -0.18 ± 0.07 μm, 0.04 ± 0.03 μm and 0.47 ± 0.11 μm, preoperatively, to 0.33 ± 0.19 μm (P = 0.004), 0.21 ± 0.09 μm (P < 0.0001) and 0.77 ± 0.27 μm (P < 0.0001), six months postoperatively. The change in spherical aberration after the procedure increased with an increase in the degree of preoperative myopia. CONCLUSIONS: Wavefront-guided IntraLASIK offers a safe and effective option for vision and visual function improvement in astigmatism. Although, reduction of HOA is possible in a few eyes, spherical-like aberrations are increased in majority of the treated eyes.

22 Article Incidence and management of haemorrhagic Descemet membrane detachment in canaloplasty and phacocanaloplasty. 2016

Alobeidan, Saleh A / Almobarak, Faisal A. ·Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia. · Glaucoma Research Chair, King Saud University, Riyadh, Saudi Arabia. ·Acta Ophthalmol · Pubmed #26687402.

ABSTRACT: PURPOSE: To report the incidence and management of haemorrhagic Descemet membrane detachment (HDMD) in canaloplasty and phacocanaloplasty. METHODS: This study included 105 eyes of 92 patients with uncontrolled open angle glaucoma who underwent canaloplasty and phacocanaloplasty between 2010 and 2014. Eyes that developed either HDMD or non-HDMD were identified. The main outcome measures were the development of HDMD and non-HDMD, best corrected visual acuity, recovery time after Descemet membrane detachment (DMD), intra-ocular pressure (IOP) and number of antiglaucoma medications. Each eye was managed according to the time of development, type and extent of DMD. RESULTS: Ten eyes (9.5%) developed DMD- four eyes underwent canaloplasty (3.8%) and six eyes underwent phacocanaloplasty (5.7%). Three of 10 eyes developed non-HDMD while seven of 10 developed HDMD, the majority of HDMD cases occurred in combination with phacocanaloplasty (five of seven). The non-HDMD eyes resolved completely within 2 weeks without intervention. One eye with HDMD was observed for 2 weeks, before a 15% sulphur hexafluoride (SF6) intracameral injection was given. The patient developed a dense corneal stain that was resolving slowly over 30 months. One eye with HDMD underwent YAG laser membranotomy 2 weeks after being identified, which regained corneal transparency 1 month after treatment, while the remaining five eyes underwent immediate surgical drainage and regained corneal transparency 1 day post-procedure. CONCLUSION: HDMD occurred in up to 6.7% in canaloplasty and phacocanaloplasty procedures, mostly during catheter withdrawal and the viscodilation step. Early recognition and management prevented further manipulation.

23 Article Pathological and Immunohistochemical Alterations of the Cornea in Congenital Corneal Opacification Secondary to Primary Congenital Glaucoma and Peters Anomaly. 2016

Al Shamrani, Mohammed / Al Hati, Khitam / Alkatan, Hind / Alharby, Mosa / Jastaneiah, Sabah / Song, Jonathan / Edward, Deepak P. ·*King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia; and †Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD. ·Cornea · Pubmed #26684044.

ABSTRACT: PURPOSE: To examine the immunohistochemical alterations in the corneal stroma in Peters anomaly (PA) and congenital glaucoma (CG) compared with age-matched normals and acquired adult corneal scarring (AACS). METHODS: The clinical features of PA and CG patients who underwent penetrating keratoplasty were recorded. Immunohistochemistry of cornea and control tissue (normal and acquired corneal scars) was performed with antibodies against collagen types I, III, keratan sulfate, lumican, decorin, and smooth muscle actin followed by semiquantitative analysis of immunolabeling. RESULTS: Clinical features in 2 groups were consistent with PA and CG. Microscopy showed thickened stromal collagen bundles in PA (n = 15), CG (n = 11), and AACS (n = 20) compared with normals (n = 18). PA and CG had distinct immunophenotypes compared with controls. Type I collagen labeling was more intense in CG compared with PA (intensity grading (IG) 2.73 vs. 2.07; P < 0.001). Decorin, lumican, and keratan sulfate labeling was significantly less intense in PA versus AACS (IG; 1.91, 0.38, 1.75 in PA and 2.7, 1.11, 2.61 in AACS. respectively; P = 0.002, P = 0.001 and P = 0.004) and normals (IG 1.92, 1.06, 2.59 respectively; P < 0.001, P < 0.001 and P = 0.005). Collagen I labeling was less intense in CG versus AACS (IG 2.73 vs. 3.09) (P = 0.007). Collagen III labeling was more intense in PA/CG than in normals (IG 0.9, 0.64, 0.62 retrospectively) (P < 0.001 in both). CONCLUSIONS: The immunophenotype of the corneal scar in PA and CG differs from normal corneas and so does PA from AACS. The similarities between CG and AACS suggest that CG scarring has an acquired component.

24 Article Causes of elevated intraocular pressure following implantation of phakic intraocular lenses for myopia. 2016

Almalki, Salem / Abubaker, Abdullah / Alsabaani, Nasser A / Edward, Deepak P. ·King Khaled Eye Specialist Hospital, Al Aroubah Road, PO Box 7191, Riyadh, Kingdom of Saudi Arabia. salem804@hotmail.com. · King Khaled Hospital, Najran, Kingdom of Saudi Arabia. · King Khaled University, Abha, Kingdom of Saudi Arabia. · King Khaled Eye Specialist Hospital, Al Aroubah Road, PO Box 7191, Riyadh, Kingdom of Saudi Arabia. · Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA. ·Int Ophthalmol · Pubmed #26265323.

ABSTRACT: The purpose of this study is to present the causes and visual acuity outcomes in patients with elevated intraocular pressure (IOP) following implantable collamer lens (ICL) implantation. A chart review identified patients who developed high IOP at any postoperative examination and a minimum follow-up period of 3 months after ICL implantation. Data are reported out to 6 months postoperatively. Outcome measures included causes of elevated IOP, best-corrected visual acuity (BCVA) at last visit, number of glaucoma medications, other interventions, and glaucomatous damage. Elevated IOP occurred in 58 (10.8 %) of 534 eyes that received ICL. The mean age was 28 ± 7.2 years. The preoperative IOP was 16.3 ± 1.2 mmHg. Elevated IOP most commonly occurred on the first postoperative day (23/58 (39.7 %) eyes) due to retained viscoelastic. This was followed by steroid response in 22/58 (37.9 %) eyes at 2-4 weeks postoperatively. IOP elevation in 6 (10.3 %) eyes was related to high ICL vault and pupillary block, and in 4 (6.9 %) eyes due to synechial angle closure. At last visit, BCVA was 20/40 or better in 56/58 (96.6 %) eyes, and 5/58 (8.6 %) eyes remained on glaucoma medications due to persistent steroid response (2 eyes), synechial angle closure glaucoma (1 eye), and other causes (2 eyes). One eye showed glaucomatous damage. Two eyes with high vault and elevated IOP underwent ICL explantation. There is a moderate risk of transiently developing elevated IOP after ICL implantation. Thorough removal of viscoelastic and use of anti-glaucoma medications during steroid use will reduce the majority of cases with postoperative IOP elevation.

25 Article Cataract Surgery Audit at a Private Hospital in Saudi Arabia. 2015

Alasbali, Tariq / Lofty, Nancy Maher / Al-Gehaban, Saeed / Alkuraya, Hisham S / Alsharif, Abdulrahman M / Khandekar, Rajiv. ·Department of Ophthalmology, Imam Mohammed bin Saud Islamic University College of Medicine, Riyadh, Saudi Arabia ; Department of Ophthalmology, Specialised Medical Hospital, Riyadh, Saudi Arabia. · Department of Ophthalmology, Imam Mohammed bin Saud Islamic University College of Medicine, Riyadh, Saudi Arabia. · Department of Ophthalmology, Specialised Medical Hospital, Riyadh, Saudi Arabia. · Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. ·Middle East Afr J Ophthalmol · Pubmed #26692725.

ABSTRACT: BACKGROUND: To assess the visual outcomes following cataract surgeries at a Private Eye Hospital in Riyadh, Saudi Arabia. METHODS: This was a cohort study of cataract surgeries performed from January to June 2014. Preoperative data were collected on patient demographics presenting and best corrected distance visual acuity (BCVA) and ocular comorbidity. Data were also collected on the type of surgery, type of intraocular lens (IOLs) implanted, and complications. BCVA and refractive status at 6-8 weeks postoperatively were noted. The predictors of vision ≥ 6/18 were identified. RESULTS: Four hundred eyes of 400 patients underwent cataract surgery. There were 235 (59%) males. Presenting preoperative vision was < 6/60 in 52 (13%) eyes. There were 395 (99%) eyes that underwent IOL implantation following phacoemulsification and 4 eyes received a sulcus fixated IOL. A single piece aspheric IOL was implanted in 358 (90%) eyes and a toric IOL was implanted in 31 (8%) eyes. Postoperative BCVA was classified as a "good outcome" (≥ 6/18) in 320 (80%) and a "poor outcome" (< 6/60) in 24 (6%) eyes. Young age (adjusted odds ratio (OR) = 0.97, P = 0.01), male (adjusted OR = 2.4, P = 0.002), and ocular co-morbidities (adjusted OR = 0.2, P < 0.001) were predictors of vision ≥ 6/18. Complications included a dropped nucleus and a posterior capsular tear in 2 eyes each. Two hundred and fifty-two (63%) eyes were emmetropic or intentionally myopic for distance. Astigmatism < 2 D was present in 264 (66%) eyes and astigmatism > 2 D was present in 33 (8%) eyes. CONCLUSION: The recent trend of intentional overcorrection in one eye following modern cataract surgery in order to provide some functional near vision indicates that benchmark for success in getting "good visual outcomes" postoperatively (vision of ≥ 6/18) may need to be revised.