|Year : 2010 | Volume
| Issue : 1 | Page : 44-47
|Date of Web Publication||18-Feb-2010|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Abstract. Oman J Ophthalmol 2010;3:44-7
Eur J Ophthalmol. 2009 Nov 12. [Epub ahead of print].
Visual acuity at 6 weeks after small incision cataract surgery and role of audit in predicting visual acuity
Khandekar RB, Jain BK, Sudhan AK, Pandey KP
British Columbia Center for Epidemiologic and International Ophthalmology, University of British Columbia - Canada.
Purpose: We present the best-corrected visual acuity (BCVA) at 6 weeks after small incision cataract surgery (SICS) and review the role of audit in predicting visual acuity (VA). Materials and Methods: This was a retrospective data analysis of 14,393 SICS performed during 2007-2008 at a hospital in central India. Ophthalmologists noted preoperative, operative, and postoperative details. The BCVA before and 1 day and 6 weeks after surgery were noted. We identified factors associated with BCVA at 1-day and 6-week follow-up. Results: Six weeks after surgery, 12,522 (87%) and 1473 (10.2%) patients had BCVA >/5 6/18 and 6/2426/60, respectively. Vision improved between 2 follow-ups in 6695 eyes (46.5% (95% confidence interval (CI) 45.7-47.3)), remained the same in 7117 eyes (49.4%), and deteriorated in 544 (3.8%) eyes. BCVA at 6 weeks was negatively associated with blindness (VA <3/60 in the better eye) before surgery (odds ratio (OR) = 0.73, 95% CI 0.58-0.92), surgeon's experience (OR = 0.75, 95% CI 0.71-0.81), and male patients (OR = 0.73, 95% CI 0.67- 0.80). BCVA at 6 weeks was positively associated with older age (OR = 1.02, 95% CI 1.01-1.03) and intraoperative complications (OR = 1.44, 95% CI 1.14-1.83). The association of VA <6/60 1 day after surgery with improved vision between the 2 follow-ups was not statistically significant (OR = 0.005, P = 0.98). Conclusions: BCVA at 6 weeks after SICS was >/ 5 6/18 in 87% of operated eyes. By performing surgical audit, one can identify high-risk groups that need proactive subsequent follow-ups.
Acta Ophthalmol. 2009 Nov 19. [Epub ahead of print].
Consecutive exotropia after surgical treatment of childhood esotropia: A 40-year follow-up study
Ganesh A, Pirouznia S, Ganguly SS, Fagerholm P, Lithander J
Department of Ophthalmology, Sultan Qaboos University, Muscat, Oman.
Purpose: To determine the incidence of consecutive exotropia (XT) following successful surgical correction of childhood esotropia (ET) and identify factors associated with its development. Materials and Methods: This is a retrospective study of 85 patients with ET, aged 2-24, who underwent strabismus surgery by a single surgeon between 1958 and 1969 in Sweden, until they were successfully aligned to ET within 10 prism dioptre, after primary or reoperation(s). The charts of these patients were reviewed, and data regarding age at onset of strabismus, surgery performed and outcome were recorded. The patients were recalled for a complete orthoptic examination in 2001-2003. Results: The incidence of consecutive XT in this cohort was 21% (18/85). Patients who had undergone multiple surgeries had a higher risk of developing consecutive XT compared to those successfully aligned with one surgery (P = 0.00036). Restriction of adduction and convergence postoperatively was associated with a high risk of consecutive XT (P = 0.0437). The incidence of consecutive XT did not vary with the level of visual acuity in the operated eye (P = 0.6428). Age of onset, age at surgery and amount of surgery did not appear to influence the risk for developing consecutive XT (P > 0.05). Conclusion: This 40- year postoperative follow-up of patients with childhood ET who underwent strabismus surgery by a single surgeon in Sweden showed that multiple surgeries and presence of postoperative adduction deficit were the most important factors influencing the incidence of consecutive XT after surgery. Presence of uncorrected amblyopia did not alter the prognosis for long-term development of consecutive XT.
J Refract Surg. 2009 Oct;25 (10 Suppl) : S927-30. DOI: 10.3928/1081597X-2009915-05.
LASIK with the optimized aspheric transition zone and cross-cylinder technique for the treatment of astigmatism from 1.00 to 4.25 diopters
Magrabi Eye and Ear Center, Muscat, Oman.
E-mail: [email protected] hotmail.com
Purpose: The predictability and safety of LASIK with the optimized aspheric transition zone (OATz) and cross-cylinder technique were evaluated for the surgical correction of myopia with 1.00 to 4.25 diopters (D) of astigmatism. Materials and Methods: In this prospective study, 74 eyes of 48 consecutive LASIK patients with astigmatism ranging from 1.00 to 4.25 D were evaluated. All eyes underwent laser ablation with profile 7 of the OATz algorithm with the NIDEK CXIII excimer laser platform. Refractive outcomes, visual acuity, and patient satisfaction were assessed based on 6-month postoperative data. Results: Preoperative manifest refraction spherical equivalent (MRSE) was 22.10 +/2 1.19 D (range: 20.50 to 25.75 D) and mean cylinder was 21.94 +/2 0.89 D (range: 21.00 to 24.25 D). At 6 months postoperatively, the mean MRSE for all eyes was 0.01 +/2 0.37 D (range: 20.75 to +1.00 D). Postoperatively, 78.3% (58/74) of eyes achieved uncorrected visual acuity (UCVA) of 20/20 or better, and 97.3% (72/74) of eyes achieved UCVA of 20/40 or better. Regarding predictability, 94.6% (70/74) of eyes were within +/2 0.50 D of intended MRSE and 98.6% (73/74) of eyes were within +/2 1.00 D of intended MRSE. Four (5.3%) eyes lost two lines of best spectacle-corrected visual acuity at 6 months. Stability was reached between 1 and 3 months and verified at 6 months postoperatively. Conclusions: LASIK with OATz and the cross-cylinder technique is safe and predictable for the treatment of patients with astigmatism up to 4.25 D. Copyright 2009, SLACK Incorporated.
Indian J Ophthalmol. 2009 Nov-Dec;57(6):443-9.
Gender inequality in vision loss and eye diseases: Evidence from the Sultanate of Oman
Khandekar R, Mohammed AJ
Eye and Ear Health Care, Department of Non-Communicable Disease Control, Director General of Health Affairs, Oman. -Email: [email protected]
Purpose: The data from surveys of vision loss and monitoring of services were used to assess changes in gender inequality in Oman. Study Design : Retrospective review of data collection instruments. Materials and Methods: The data sets of 12 years between 1996 and 2007 were abstracted to assess the gender equality for vision loss, eye disease prevalence, and service use. They included two surveys (1996 and 2005), Health Information from eye units (1998 and 2007), and eye screening in schools. Results: In 1996, the prevalence of bilateral blindness in > or = 40 years of age was higher in females [Odd's Ratio (OR) = 0.36 (95% Confidence Interval (CI) 0.24 - 0.53)]. Gender differences in the prevalence of cataract [OR = 0.82 (95% CI 0.63 - 1.03)] were not significant while trachomatous trichaisis (TT) was less in males [OR = 0.33 (95% CI 0.22-0.48)]. In 2005, gender differences in the prevalence of bilateral blindness [OR = 0.97 (95% CI 0.71 - 1.34)] and TT [OR = 0.66 (95% CI 0.42- 1.04)] were not statistically significant.But males were associated with higher prevalence of cataract [OR 5 1.26 (95% CI 1.00 - 1.59)]. Surgery rates for cataract, glaucoma and TT were not different by gender. More male compared to female patients with diabetic retinopathy were treated. Myopia was significantly higher in girls. Compliance of spectacle wear was higher in girls. Conclusions: Gender inequality for eye care seems to have reduced in the last 10 years in Oman. However, apart from TT and glaucoma patients the difference in service utilization by gender was not statistically significant.
Indian J Ophthalmol. 2009 Nov-Dec;57(6):437-42.
Evaluation of 'vision screening' program for three to six-year-old children in the Republic of Iran
Khandekar R, Parast N, Arabi A
Ophthalmologist and Epidemiologist, Low Vision Care expert, Advisor, Eye and Ear Health care, Ministry of Health, Oman. E-mail: [email protected]
Background: Since 1996, vision screening of three to six-year-old children is conducted every year in Iran. We present outcomes of project review held in August 2006. Materials and Methods: Kindergarten teachers examined vision by using Snellen's illiterate 'E' chart. They used torchlight to detect strabismus. On a repeat test, if either eye had vision <20/30, the child was referred to the optometrist. A pediatric ophthalmologist examined and managed children with strabismus or amblyopia. Provincial managers supervised the screening program. The evaluator team assessed the coverage, yield, quality and feasibility, and cost-effectiveness of vision screening, as well as magnitude of amblyopia, and its risk factors. Result: In 2005, 1.4 million (67%) children were examined in all provinces of Iran. Opticians examined 90,319 (61%) children with defective vision that were referred to them. The prevalence of uncorrected refractive error, strabismus and amblyopia was 3.82% (95% CI 3.79 - 3.85), 0.39% (95% CI 0.38 - 0.40) and 1.25% (95% CI 1.24 - 1.26) respectively. Validity test of 7,768 children had a sensitivity of 74.5% (95% CI 72.7 - 76.3) and specificity of 97.2% (95% CI 96.7 - 97.7). The cost of amblyopia screening was US $ 1.5 per child. While the cost of screening and treating one child with amblyopia was US $ 245. Conclusion: A review of the vision screening of children in Iran showed it with screening and useful exercise and had a yield of 1:21. The coverage of vision screening was low and the management of children with amblyopia, low vision and refractive error needed strengthening.
Diabetes Technol Ther. 2009 Oct;11(10):675-9.
Diabetic retinopathy and ocular co-morbidities among persons with diabetes at sumail hospital of Oman
Khandekar RB, Tirumurthy S, Al-Harby S, Moorthy NS, Amir I
Eye and Ear Health Care, Department of Control of Non-Communicable Diseases, Director General of Health Affairs, Ministry of Health, Muscat, Oman. E-mail: [email protected]
Purpose: We evaluated the magnitude of diabetic retinopathy (DR) and other ocular co-morbidities among patients with diabetes in 2006. We also assessed resources for eye care at Oman's Sumail Hospital. Materials and Methods: We reviewed the DR register in May 2008. Physicians diagnosed diabetes. Ophthalmologists used a biomicroscope to identify ocular co-morbidities. The best-corrected vision of each eye was noted. DR grading, as recommended by the World Health Organization, was adopted. The prevalence of DR was calculated. Grades of DR were correlated to vision. Projections of patients with diabetes mellitus and DR were compared to the study outcomes. Results: We randomly picked 418 (49%) of the 843 registered persons with diabetes for our study. The prevalence of DR was 7.9% (95% confidence interval 6.6, 9.2). Sight-threatening DR was found in 43 of 689 (5.3%) eyes. Prevalence of DR was 6.3% among persons with diabetes who were screened for the first time; it was 9.3% among those rescreened. Diabetic macular edema was present in 42 (5%) eyes. Patients with DR had a higher risk of blindness (vision less than 6/60) compared to those without DR (odds ratio 5.0; 95% confidence interval 3.74, 6.69). Laser surgery had to be used for 85 (20.3%) DR patients. Early cataract and trachomatous corneal opacities were main co-morbidities. Conclusions: The coverage of screening for diabetes and DR in our study area was less than the national coverage. Better management facilities for DR could improve patients' eye care at Sumail Hospital. Good vision in persons with diabetes could be a reason for them not accepting regular eye check-ups and laser treatment.
J Refract Surg. 2009 Nov;25(11) :991-9. DOI: 10.3928/1081597 X-20091016-04. Epub 2009 Nov 13.
LASIK for myopia with Aspheric "aberration neutral" ablations using the ESIRIS laser system
Arbelaez MC, Vidal C, Jabri BA, Arba Mosquera S
Muscat Eye Laser Center, Muscat, Sultanate of Oman. E-mail: [email protected]
Purpose: To evaluate the clinical outcomes of LASIK using optimized "aberration neutral" ablation profiles. Materials and Methods: Laser in situ keratomileusis was performed in 231 eyes (120 patients) with a mean spherical equivalent refraction of 24.12 +/22.26 diopters (D) (range: 20.37 to 29.50 D) using a SCHWIND Pendular microkeratome with a 130-microm cutting head and the SCHWIND ESIRIS excimer laser. In all cases, pre- and postoperative autorefractor measurements, manifest refraction, best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), topography and corneal wavefront analysis, and ocular wavefront analysis as well as complications were analyzed. Ablations were calculated using the ORK-CAM software. Clinical outcomes were evaluated in terms of efficacy, predictability, stability, refractive outcome, safety, and wavefront aberrations. Results: At 3 months, mean spherical equivalent refraction was 20.10 +/20.33 D (range: + 0.86 to 21.18 D). Of 231 eyes, 201 (87%) were within +/20.50 D of attempted correction. Uncorrected visual acuity was 20/16 or better in 71% (164 eyes), 20/20 or better in 92% (213 eyes), and 20/32 or better in 100%. Average root-mean-square higher order aberrations increased 0.05 microm after treatment, mean spherical aberration increased 0.08 microm after treatment, and mean coma increased 0.04 microm after treatment (all for 6.0-mm analysis diameter). Conclusions: Our results show that non-customized "aberration neutral" ablation profiles derived from wavefront analysis are able to minimize the amount of induced aberrations of both the cornea and the eye. Copyright 2009, SLACK Incorporated.
Eur J Ophthalmol. 2010 Jan-Feb;20(1):218-20.
Necrotizing retinopathy simulating acute retinal necrosis causing rhegmatogenous retinal detachment in sarcoidosis: A case report
Shenoy R, Al Burwani B
Department of Ophthalmology, Armed Forces Hospital, Muscat - Omaan.
Purpose: To report on the occurrence of necrotizing type of retinopathy resulting in rhegmatogenous retinal detachment in a patient with asymptomatic sarcoidosis. Materials and Methods: A 38-year-old healthy man presented with poor vision of 0.1 in his left eye of 3 days duration and was found to have panuveitis with occlusive periarteritis and inflammatory infiltrates in the peripheral retina. He was diagnosed with asymptomatic systemic sarcoidosis based on blood investigations and total body gallium scan and was treated with pulse methylprednisolone followed by oral steroids. Results: Anterior uveitis, vitritis, and retinal infiltrates resolved with pulse methylprednisolone therapy, and there was complete visual recovery. However, deterioration occurred later with development of rhegmatogenous retinal detachment. Conclusions: Necrotizing retinopathies simulating acute retinal necrosis have not been reported before in patients with sarcoidosis.
Eur J Ophthalmol. 2009 Sep-Oct;19(5):729-32.
Treatment of primary pterygium: Role of limbal stem cells and conjunctival autograft transplantation
Soliman Mahdy MA, Bhatia J
The Ophthalmic Department, Rustaq Hospital, Rustaq - Sultanate of Oman. E-mail: [email protected]
Purpose: The limbus and its stem cells are important in the pathogenesis of pterygium. In this study, the usefulness of limbal stem cells and conjunctival autograft transplantation for the treatment of primary pterygium is assessed. Materials and Methods: In this prospective noncomparative cohort study, 42 eyes of 42 patients with grade I-III primary pterygium underwent pterygium excision followed by superotemporal limbal stem cells and conjunctival autograft transplantation. Pterygium recurrences and complications within a mean follow-up period of 18.26 months (range, 10-28 months) were assessed. Results: There were no recurrences of pterygium growth except in 2 cases (4.75%). In addition, no significant complications were noted. No further surgical interventions were needed in any case except for reoperation in the 2 recurrent cases. Conclusions: Although limbal stem cells and conjunctival autograft transplantation is a time-consuming procedure, it is a safe and effective technique for the treatment of different grades of pterygium. It is useful in prevention of pterygium recurrence, which is a major problem in pterygium surgery.
Eur J Ophthalmol. 2010 Jan-Feb;20(1):115-9.
Intravitreal phacoemulsification with pars plana vitrectomy for management of posteriorly dislocated nucleus or lens fragments
Soliman Mahdy M, Eid MZ, Shalaby KA, Hegazy HM
Al-Hussein University Hospital, Al-Azhar University, Cairo - Egypt, Rustaq Hospital - Sultanate of Oman.
Purpose: Dislocation of crystalline lens nucleus/fragments into the vitreous cavity during phacoemulsification is a potentially serious, sight-threatening, uncommon complication of cataract surgery. It is associated with significant intraocular inflammation and can lead to poor visual outcome. The current study assesses the outcome of immediate intravitreal phacoemulsification with pars plana vitrectomy in management of posteriorly dislocated nucleus/lens fragments. Materials and Methods: In this retrospective case series, records of 23 patients who underwent immediate pars plana vitrectomy and intravitreal phacoemulsification for removal of dislocated nucleus/lens fragments at the same sitting of phacoemulsification were reviewed. Data including patients' preoperative and postoperative vision and intraoperative and postoperative complications were recorded. Results: The mean follow-up period was 16.5 months (range, 5-31 months). Preoperative visual acuity ranged from 0.05 to 0.5. The final postoperative visual acuity ranged between HM and 1.0. Fifty-two percent of eyes (12 eyes) had a final postoperative visual acuity of 0.5 or better. Complications included 2 cases of cystoid macular edema and 2 cases of retinal detachment. Conclusions: Immediate vitrectomy and intravitreal phacoemulsification is a surgical option in the management of posteriorly dislocated nucleus/lens fragments without much risk of retinal damage. It is relatively safe and most patients achieved a good visual outcome. The risk of postoperative complications including uveitis, secondary glaucoma, and cystoid macular edema could be minimized.
SQU Med J 2009;9(3):338-340
Culture negative confoscan positive acanthamoeba keratitis: A relentless course
Nadia S Al Kharousi and Upender K Wali
Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman. Abstract: Acanthamoeba keratitis is a protozoal infection of the eye, mainly due to the use of non-sterile solutions, like saline for disinfecting contact lenses. We report a case where delay in the diagnosis of acanthamoeba keratitis due to inadequate laboratory investigations and clinical management led to an excruciatingly painful course of the disease. The importance of non-invasive imaging techniques of confocal microscopy in the diagnosis of acanthamoeba keratitis, in the absence of positive culture reports, is highlighted in this case.
OMJ JAN 2009 VOL.24 NO.1 P.1 DOI:10.5001/OMJ.2009.1.
Electronic medical record system: Have we bitten off more than we can chew?
Anuradha Ganesh, Abdullah Al-Mujaini
Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman.
First used for management and administrative purposes, Electronic Medical Record (EMR) systems are now being increasingly employed to collect and synthesize medical information. The EMR system offers support in medical decision-making, promotes use of guidelines, increases coordination between different health care providers and is believed to improve overall quality of care. The Sultan Qaboos University Hospital (SQUH) had a functioning Healthcare Information System (HIS) since its inception in 1991, which mainly functioned in the Departments of Radiology, Laboratory Medicine and Pharmacy. The hospital adopted a fully integrated EMR system for patient care and administrative purposes in June 2006. As the hospital acclimatizes to new technology, the need for assessment of quality and improvement of patient care and health delivery has been perceived.
OMJ JAN 2009 VOL.24 NO.1 P.7 DOI:10.5001/OMJ.2009.4.
Assessment of visual gain following cataract surgeries in Oman: A hospital-based cohort study
Rajiv Khandekar 1 , Abdulatif Al Raisi 2
1 Department Of Ophthalmology And Epidemiology, Eye and Ear Health Care, Ministry Of Health, 2 Al Nahdha Hospital, Muscat, Oman.
Objectives: The post-operative vision is used as benchmark to determine the quality of cataract surgery. However, late presentation and co-morbidities influence the visual gain and they should also be considered while auditing cataract surgeries. The authors present method of analysis of cataract surgeries for older than 30 years of aged patients performed by ophthalmologists in Oman during 2003. Materials and Methods: Ophthalmologists evaluated visual and ocular status of eyes with cataract. Cataract was operated using operative microscope and lens was implanted in the eye. The vision was recorded six weeks after surgery and visual gain was grouped from postoperative vision in relation to the preoperative vision. Presence of co-morbidities like glaucoma, corneal opacities, macular degenerations and others were considered while evaluating visual outcomes. Results: 3,485 eyes operated were included in our study. 3,003 (86.2%) of them were operated by extra-capsular cataract extraction and lens implantation. Following surgery, 960 (27.5%) eyes had vision $6/18. 1,483 (42.6%) eyes had vision between 6/60 and 6/18. 233 (6.8%) eyes had vision <3/60. Excellent grade of vision gain in relation to preoperative visual status was found in 2,250 (64.6%) eyes, 'good' visual gain was in 422 (12.1%) eyes and 'poor' visual gain was in 335 (9.6%) eyes. Postoperative visual status was significantly associated to the co-morbidities. (P < 0.001). Nearly 14% of persons were lost to the follow up. Conclusion: In countries like Oman with high prevalence of trachoma, glaucoma and diabetes, the proposed grading of visual gain that accounts for the preoperative vision and the presence of co-morbidity could be better option for auditing the cataract surgery.
OMI JAN 2009 VOL.24 NO.1 P.30 DOI:10.5001/OMJ.2009.8.
Effect of 10% phenylephrine eye drops on systemic blood pressure in normotensive and hypertensive patient
Jagdish Bhatia, Mathew Varghese, Arti Bhatia
Department of Ophthalmology, Po Box: 421, Postal Code: 329, Rustaq, Sultanate Of Oman.
Objectives: A prospective study to evaluate the effect of 10% Phenylephrine eye drops on systemic blood pressure in normotensive and hypertensive patients. Materials and Methods: The sample comprised of 55 normotensive patients and 34 hypertensive patients were subjected to 10% Phenylephrine eye drops during routine eye examination. Results: No statistically and clinically significant increase in blood pressure after the instillation of 10% Phenylephrine eye drops was seen in 87% of normotensive patients and 76% of hypertensive patients. Mild rise of blood pressure was seen in 11% of normotensive patients and in 15% of the hypertensive patients. Only one patient (3%) had severe rise of blood pressure in the hypertensive group. Conclusion: This study shows that pupillary dilatation with 10% Phenylephrine eye drops did not significantly increase systemic blood pressure in normotensive and hypertensive patients. Although precautions should be taken when used in hypertensive patients.
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