Mutations in the ALMS1 gene have been linked to isolated inherited retinal dystrophy or Alström syndrome. This report illustrates the unique pattern of ALMS1-associated diseases in a set of three simplex Saudi patients originating from unrelated consanguineous families. A detailed ophthalmological assessment was performed at the Department of Ophthalmology at King Saud University, Riyadh, Saudi Arabia. Next-generation sequencing vision panel revealed recessive ALMS1 mutations (reference sequence NM_015120). As a result, three distinct pathogenic ALMS1 mutations were identified; the first one is a nonsense mutation (c.8158C>T: p.R2720X) which has recently been identified in a Chinese patient, while the other two are known to have a founder effect in the Saudi population (the frameshift: C.848dupA: p.E283fs and the splicing: C.11870-2A>T: p.?). Clinically, a prominent nerve fiber layer was observed in the three studied patients with variable expectations of vessel attenuation. In addition, two of our patients observed unusual presentation of specific retinal pigment epithelium pigmentations in semi/halo-arrangement around the macula. Thus far, our report expands the phenotypic–genotypic spectrum of ALMS1-associated diseases and supports the principles of applying precision medicine in Saudi Arabia by utilizing the fact that common founder mutations were identified and unique phenotype was observed.

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PURPOSE: To evaluate the effects of hemodialysis (HD) on visual acuity (VA), central corneal thickness (CCT), intraocular pressure (IOP), and macular thickness (MT) in chronic kidney disease (CKD) patients and also to investigate the relationship between the ocular parameters and blood biochemical parameters such as serum albumin, creatinine, sodium, and urea levels. METHODS: A prospective cohort study including a total of 24 CKD patients of both genders (above 18 years old) undergoing HD in XXX was conducted. The participants were divided into three sub-groups based on the primary cause of renal failure, group 1: Hypertensive kidney disease, group 2: Diabetic kidney disease, group 3: Other causes. All subjects underwent full ophthalmological examinations including measurement of VA using LogMAR, IOP, CCT, and CMT. Comparisons between different ocular parameters during pre- and post-HD sessions were done using the paired t-test. The relationship between changes in ophthalmologic and blood biochemical parameters was calculated using Pearson correlation coefficient. RESULTS: HD did not significantly alter any ocular parameter within and between CKD groups. Spherical equivalent changes were found to be significantly correlated with serum K (r = −0.315; P = 0.038), and IOP results were positively correlated with serum creatinine (r = 0.330; P = 0.029) and negatively correlated with hemoglobin (r = −0.349; P = 0.020). Bodyweight alterations were significantly correlated with CCT (r = −0.03; P = 0.0001). However, no correlation between ocular parameters and duration of HD was detected. CONCLUSION: Following a single HD session, ocular parameters did not alter significantly.

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Arab and Muslim scientists were pioneers in the development of medical sciences, treating patients, and performing operations in many medical specialties. This article reviews their major contributions in ophthalmology that led to the development of this field. Considering the little-known role of Arab and Muslim scientists in the history of ophthalmology, this article provide insights into the great physicians from the 10th to the 13th century. Despite the destruction of Islamic civilizations by the Mongols in the late 14th century, some of their books and manuscripts are still preserved, testifying to their influence, including the first detailed drawing of the eye anatomy by Hunayn AlAbadi (808 A.D.), proposing the first occlusive treatment for amblyopia by Thabit Alharrani (823 A.D.), discovering the science of optics and theory of vision related to light reflection by Al-Hasan ibn Al-Haytham (965 A.D.), inventing of the hollow needle used to aspirate cataract by Ammar Al-Mawsili (1010 A.D.), and drawing surgical instruments by Khalifah ibn Al-Mahasin (1256 A.D.).

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PURPOSE: Developmental delay occurs when a child exhibits a significant delay in the acquisition of milestones, in one or more domains of development. This study was planned to determine the distribution of ocular disorders and to assess the correlation between ocular findings and systemic co morbidity, antenatal and postnatal factors, and perinatal history. METHODS: This cross-sectional study included children with developmental delay <16 years of age. All children underwent complete ophthalmological evaluation including full cycloplegic refraction. Vision assessment was done as appropriate for age. Spearman's correlation test was used to analyze the correlation between ocular findings and causes for developmental delay and antenatal, perinatal, and postnatal history. RESULTS: A total of 128 children were evaluated. Mean age of the study group was 5.59 ± 2.12 years, 64.8% were males, and 76.6% of children were from rural area. Ocular findings were seen in 110 (85.93%) children, refractive error being the most common finding seen in 87 children (astigmatism n = 47, hypermetropia n = 28, and myopia n = 12). Strabismus was seen in 65 children, esotropia being the most common (n = 36). Vision impairment was present in 39.84% of children. Other ocular findings included disc pallor, cataract, ptosis, amblyopia, keratoconus, telecanthus, lagophthalmos, blepharitis, retinitis pigmentosa, and morning glory syndrome. Spearman's correlation showed no statistical association between ocular findings and various causes for developmental delay. There was a weak negative correlation between antenatal history, mode of delivery, gestational age, and ocular findings. CONCLUSION: More than three-fourths of children with developmental delay had ocular findings which necessitates the need for ocular evaluation.

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PURPOSE: We present the KAP levels and the determinants for diabetic retinopathy (DR) screening and management at a private hospital in Riyadh, Saudi Arabia. METHODS: A chart review was performed of DM patients to collect the demographics and diabetes related information in June to December 2017. A close ended questionnaire was used that queried knowledge (7), attitude (5) and practice for DR screening (7). RESULTS: Two hundred participants were interviewed half from endocrinology unit and half from the eye clinic. An excellent knowledge of the ophthalmic effects of diabetes was noted in 91 [45.5% (95% Confidence Interval CI 38.6–52.4) of participants. Thirty-eight [19% (95% CI 13.6–24.4)] participants had a positive attitude. None had an excellent grade of practice and poor practice was noted in 168 [74% (95% CI 78.9–89.1)] participants. Longer duration of DM (P=0.07) and systemic complications (P=0.06) were associated with good knowledge. Attitude was not significantly associated with any determinants. Good practice was associated with the presence of systemic complications of DM (P<0.01) and those recruited to the eye clinic (P= 0.06). Only 35% of patients had undergone an annual DR screening. Only 4 patients had a history of laser treatment. CONCLUSION: The KAP of diabetic patients regarding DR screening and management is less than desired. Establishing protocols and public health promotion activities directed at early detection and management are urgently needed in private sectors of Saudi Arabia.

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PURPOSE: The purpose of the study was to study the relationship between pseudoexfoliation (PES) and other predictors in the development of complications in cataract surgery by phacoemulsification in patients with PES. METHODS: A retrospective cohort study of patients undergoing cataract surgery by phacoemulsification in the health area of Cee in northwestern Spain during the 2-year period from 2009 to 2010. Capsule rupture, choroidal hemorrhage, and vitreous loss were included as complications and intraoperative nucleus or lens dislocation as the independent variable. PES, age, hardness, type of cataract, myopia, preoperative visual acuity, antiplatelet use, anticoagulant uses, alpha agonist use, mydriasis prior to surgery, anterior chamber depth, and axial length were included as predictor variables. All predictive hierarchical models were tested using as a selection criterion the one minimizing the Akaike index. RESULTS: A total of 551 patients were initially identified from hospital register, of which 48 were excluded due to the presence of an exclusion factor. After the initial selection, the final sample was 681 eyes of 503 patients. Of the 8192 possible models, a model with the following seven variables was selected: PES, steroid use, alpha agonist use, nuclear hardness, mydriasis, anterior chamber depth, and axial length. The selected model had an Akaike index of 435.4 and an area under the curve of 0.7895 corresponding to a sensitivity of 6.2% and a specificity of 98.5%. CONCLUSION: PES, nuclear hardness, and alpha agonist use are risk factors strongly predictive of complications.

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Purpose: To determine the prevalence of refractive errors among Saudi adults in Riyadh, Saudi Arabia. Methods: A cross-sectional study was conducted targeting healthy Saudi adults (20–40 years old) at two major gatherings in Riyadh, Saudi Arabia from December 2018 to January 2019. Refractive errors were measured, and data pertaining to age, sex, region of origin, and spectacle use was collected. Clinically significant myopia was defined as SE ≥ -0.50 D, hyperopia as SE ≥ 0.50D, and astigmatism as cylindrical error ≥ 0.50D. Refractive error measurements were assessed using Topcon's Auto-Kerato-Refractometer, KR-800. Results: A total of 660 adult individuals (1,319 eyes) were included in this study, of which 321 participants (48.7%) were found to be myopes, 167 subjects (25.2%) were hyperopes, and 438 individuals (66.3%) had astigmatism. With regards to correlations, myopia was highly correlated with being male (P-value = 0.036), belonging to age group 20–25 years (P-value = 0.033), originating from the northern regions of Saudi Arabia (P-value <0.001). Similarly, hyperopia was significantly correlated with being male (P-value = 0.048), age groups 20–25 years (P-value = 0.04), and 31–35 years (P-value = 0.011) and was higher in people from northern region (P-value = 0.011). In contrast, astigmatism was only found to be correlated with age group 36–40 years (P-value = 0.002). Additionally, 71.7% of myopic participants and 76.1% of astigmatic individuals opted not to wear spectacles (P-value <0.001). Conclusion: In this study, the refractive error with the highest prevalence among Saudis was astigmatism, followed by myopia and hyperopia. Gender, region of origin, and spectacle wear were all observed to be highly correlated with higher rates of refractive error.

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PURPOSE: The purpose was to determine the minimum near-addition power needed using Proclear^® multifocal D-Design contact lens (adds: +1.50 D, +2.50 D, +3.00 D, and +3.50 D) to invert the pattern of relative hyperopic defocus in the peripheral retina into relative myopic defocus among the eyes of myopic schoolchildren. METHODS: Twenty-seven right eyes (24 females and 3 males) of 27 myopic schoolchildren aged between 13 and 15 years were included in this study. The measurements of central refraction, peripheral refraction (between 35° temporal and 35° nasal visual field in 5° steps), and lag of accommodation were conducted using the Grand-Seiko WR-5100K open-field autorefractometer initially without correction (WC), followed by with correction using four different addition powers of Proclear^® multifocal D-Design contact lens in random sequence. Axial length was measured using a handheld probe ultrasound A-scan (Tomey AL-2000). RESULTS: The relative peripheral refractive error showed high hyperopic defocus of +1.08 ± 1.24 D at 35° nasal and +1.06 ± 1.06 D at 35° temporal visual field WC. All Proclear multifocal contact lenses (MFCLs) decreased the peripheral hyperopic defocus with increasing addition powers (F [2.938, 47.001] = 13.317, P < 0.001). However, only +3.00 D addition and +3.50 D addition (P = 0.001) could invert the peripheral hyperopic defocus into peripheral myopic defocus. Apart from that, the +3.00 D addition lens showed the lowest lag of accommodation (+1.10 ± 0.83 D) among the other MFCL adds (P = 0.002). CONCLUSION: A +3.00 D addition Proclear MFCL is the optimal addition power that can invert the pattern of peripheral hyperopic defocus into myopic defocus.

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PURPOSE: The current study aimed to assess Saudi parents' awareness regarding pediatric eye diseases that can be screened and treated. METHODS: A cross-sectional study was conducted in Riyadh, Saudi Arabia. Targeted participants were selected randomly. An online questionnaire was used for data collection. A Chi-ANOVA test was used with considering a confidence interval of 95%. RESULTS: Of 1500 participants, 1070 (71%) Saudi adults responded. Most of the participants' knowledge test score about eye health and care was poor (91.9%). The majority of those who had acceptable knowledge were married with 94.3%. Knowledge about the eye problem in diabetes was the highest with 82.8%, then 54.3% had acceptable knowledge about eye emergencies, general eye health with 36.5%, and 26.2% for refractive error problem, whereas knowledge about strabismus, visual deprivation, glaucoma, and eye tumors was lowest (18.9, 16.1, 10.6, and 9.6%, respectively). The most commonly reported sources of knowledge were community members. Those who were at the university level of education had a higher level of acceptable knowledge (64.4%) with a mean of 5.63. Retired participants had the highest mean level of knowledge (7.25). After that, it showed that those in the medical field had the second highest mean level of knowledge (6.55). However, students recorded the lowest mean knowledge score with 2.47. CONCLUSION: The current study found evidence of a lack of awareness among parents about common pediatric eye diseases and proper eye care behaviors. Therefore, awareness programs should be targeting both parents with a focus on mothers. The higher the educational level, the higher the chances of health awareness.

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Purpose: To assess the ocular toxicity in patients on high doses of hydroxychloroquine (HCQ) per weight, as per the latest American Academy of Ophthalmology (AAO) screening guidelines for HCQ toxicity. Methods: This is a multi-center study looking at consecutive patients attending the ophthalmology clinics at a tertiary hospital and a private clinic in Saudi Arabia. A data collection sheet was used to collect patient's information regarding the dose per body weight, duration of HCQ use and any risk factors associated with the use of the medication as per the latest AAO guidelines for HCQ screening. Ancillary testing including fundus photography, automated visual field (10-2) and spectral domain ocular coherence tomography were done. Further testing with fundus auto-fluorescence and multifocal ERG were done when needed. The presence or absence of toxicity was recorded. Results: A total of 63 patients were included in the study, 58 females and 5 males. The average patient age was 45 years (range 18–72). The mean dosage of HCQ was 3.9 mg/kg. Fourteen (22%) patients were on doses higher than 5 mg/kg. The duration of treatment ranged from 1-30 years (average 8.3). Thirty six (57%) patients were on the drug for more than 5 years. We found only one (1.58%) patient with HCQ toxic retinopathy over a mean of 8 years treatment period. Conclusion: A significant number of our patients were found to be on doses of >5 mg/kg of HCQ, which may put them at a higher risk for retinal toxicity. Low dose HCQ such as 100 mg tablets should be made available to help physicians in adjusting the dose as per the latest reported guidelines by the AAO.

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A 2-year-old girl presented with pain, itching, photophobia, and tearing in her left eye. These symptoms started after contact with a caterpillar. The patient was initially taken to another hospital, where the local ophthalmologist prescribed topical prednisolone acetate 1%, a topical antibiotic, and cyclopentolate 1% eye drops. However, 3 weeks later, the patient presented to our hospital with no symptomatic improvement. Slit-lamp examination showed moderate conjunctival injection and diffuse superficial punctate corneal epithelial erosions with numerous caterpillar hairs embedded in the bulbar and tarsal conjunctiva, and in the superficial and deep corneal stroma, extending into the anterior chamber (AC). In addition, the AC had 2+ cells with caterpillar hairs on the iris surface. The lens was clear, and the fundus examination was normal. The patient underwent AC wash and setae removal under general anesthesia; this was repeated 4 months later when symptoms recurred owing to retained setae. There was no evidence of any additional setae or ocular inflammation in 8 months of follow-up, and symptoms resolved completely. Caterpillar hairs can migrate intraocularly and induce an ocular inflammatory response. Immediate and thorough irrigation, continued scrupulous examinations for any retained setae, and meticulous setae extraction are crucial for treating this condition.

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Orbital cellulitis in children rarely occurs secondary to smoking water pipe. A 3-year-old girl who presented with fever, eyelid swelling, pain, and proptosis of the left eye for 4 days after water pipe consumption. The patient was given the usual course of antibiotics for a few days along with subperiosteal abscess drainage however no improvement was noticed for a week. Cultures were positive for methicillin-resistant Staphylococcus aureus and pseudomonas aeruginosa. Intravenous dexamethasone was co-administered in three courses for 3 weeks, during which residual symptoms was slowly resolving. In conclusion, attempt of dexamethasone in children can shorten hospital stay and augment full recovery.

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PURPOSE: The study aims to evaluate and see if experiential learning theory for teaching cataract surgery can improve the ability of students to retain more knowledge compared to the classical or traditional way of teaching. METHODS: A pre and post control group design of 32 graduates was conducted in 2016 at King Saud University, Riyadh, Saudi Arabia to examine the effect of experiential learning as an applicable way for teaching cataract surgery. The total of graduates including males and females were divided into control and experimental groups to which the educational materials about cataract surgery were presented as a lecture and as wet lab session respectively. All the data collected were entered in SPSS version 22 for analysis and a P≤0.05 was considered significant. RESULTS: Both control and experimental groups showed good retention rate of knowledge. However, the gain of knowledge was more in the Wet lab group. The scores mean increased more than 5 points in this group compared to 2.5 points only in the lecture groups. CONCLUSION: Both teaching modalities were effective in improving the knowledge rate of the students. However, in the experiential learning group (Wet lab group), the gain of knowledge was higher compared to that in the traditional group (lecture group).

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Purpose: To compare the postoperative alteration of central corneal thickness (CCT) and visual outcomes between phacoemulsification (group A) and manual small incision cataract surgery (MSICS) (group B) in grade II and III nuclear cataracts (NS II and III) with pseudoexfoliation syndrome (PXF). Methods: It is a double masked prospective randomised interventional study. A total of 60 eyes of 60 patients were assigned randomly to either the phacoemulsification (group A) or MSICS (group B) groups. All eyes had nuclear sclerosis grade II and III (LOCS II grading system) with pseudoexfoliation material either over the pupillary margin, anterior lens capsule, or both. All surgeries were done by a single surgeon. Postoperative evaluation was scheduled on the 1st, 30th, 90th, and 180th-day. Statistical analyses were done using appropriate methods. Outcome of the study were measured with changes in central corneal thickness (CCT), Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) and the spherical equivalent in the operated eye up to 6 months post surgery. Results: The mean preoperative CCT showed no difference between the groups (0.9659). The mean rise in CCT on the 1st postoperative day (POD) showed a significant difference between the groups {24.65 (SD 9.32) [group A (Phacoemulsification)] and 33.34 (SD11.68) [group B (MSICS)] (P < 0.0023)}. At the 1st, 3rd, and 6th month postoperative visits, there was no significant difference. The mean uncorrected distance visual acuity (UDVA) on the 1st POD was 0.189 (SD 0.118) in Group A and 0.302 (SD 0.121) in group B (P < 0.0005) which was significantly better with the phacoemulsification procedure. At the 1st month it was 0.039 (SD 0.084) in group A and 0.148 (SD 0.089) in group B (P < 0.004), which remained almost stable after that. The mean corrected distance visual acuity (CDVA) at the 1st, 3rd, and 6th-month postoperative visits showed no significant difference (P 0.8). The mean spherical equivalent was 0.29 in group A and 0.8 in group B. Conclusion: In moderately hard nuclear cataracts with PXF, phacoemulsification provides better unaided visual outcomes with less endothelial dysfunction than MSICS in the immediate and subsequent postoperative period.

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The aim of this study is to report the side effects of oral topiramate in two young patients presented with bilateral ocular blurring and discomfort, causing unique development of secondary acute angle closure (AAC) after discontinuation of oral topiramate. Both patients, with a history of seizure and migraine, respectively, were taking oral topiramate to control their mentioned diseases. Both had secondary AAC and high intraocular pressure, after discontinuing topiramate. They were treated with topical medications and underwent initial and subsequent multimodal imaging to track up their response to the management. Ocular side effect, during topiramate use and possibly even after discontinuation, will improve early detection of secondary AAC. Topical management along with multimodal imaging of such cases can give optimal results.

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Presently the management of glaucoma is limited to lowering of intra-ocular pressure (IOP). Since this modality does not appear to be successful in all cases there is increasing focus on non-IOP lowering medications. Coenzyme Q is a naturally occurring compound similar to vitamins. There are a few reports suggesting the neuroprotective efficacy of this agent in glaucoma models. The present systematic review was undertaken to study the pharmacology, physiology, metabolism and role of Coenzyme Q in glaucoma. An English-language search for relevant items was undertaken using PubMed, Google Scholar, Scopus and other databases. The present review found a positive outcome of Coenzyme Q as a neuroprotectant being reported in all studies. However, the review also found that the majority of studies on Coenzyme Q have been reported by a single group of researchers. In order to have a more wide-ranging impact regarding the efficacy of Coenzyme Q in glaucoma, it would be useful to undertake further multi- center trials.

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Purpose: There has been a recent increase in accidental retinal injuries due to the careless use of handheld laser devices. The scenarios under which these incidents occur suggest a lack of awareness of the sight-threatening hazards of some handheld lasers. This study aimed to assess knowledge of the population to plan awareness programs and establish protective health policies. Methods: This observational cross-sectional study used a newly-developed, validated, and pilot-tested questionnaire to survey attendees of football matches in Saudi Arabia between September to October 2018. Results: Five-hundred and sixty-nine attendees were surveyed, and 76% of respondents knew laser pointers were harmful and could damage the eye. However, 73% of respondents did not think that the blue laser was dangerous, indicating poor awareness regarding this particular laser. Only 38% knew which ocular structure is most commonly damaged, and 15.6% did not realize that brief exposure can cause vision loss. Females had better knowledge compared to males. Respondents between 25 and 40 years old, females, and married individuals had the highest levels of a positive attitude. There was no statistically significant difference in the mean knowledge score between those in the medical field and other fields (P = 0.5). Conclusion: There is an inadequate knowledge of protective measures against handheld lasers. However, there's an overall positive attitude towards spreading awareness about this issue. Yet, targeted awareness campaigns are still needed in addition to more strict government laws to prevent importing or using high-powered handheld laser pointers.

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Purpose: To assess the incidence and quantification of corneal haze after myopic photorefractive keratectomy in virgin and post corneal transplant eyes with dark irides. Methods: In this retrospective study at the tertiary eye hospital, the corneal haze was evaluated by slit-lamp and quantified by Pentacam Scheimpflug densitometry after myopic photorefractive keratectomy with mitomycin C in virgin eyes (group I) and post corneal transplant eyes (group II) with dark irides over 12 months. Results: Group I compromised 126eyes from 77patients (35males and 42females) aged 31.31 years (24.11–36.18 years), and group II compromised 44eyes from 33patients (18males and 15females) aged of 32.25 years (26.15–36.66 years). The incidence of corneal haze was 9.5% (95%CI: 5.0%–16%) and 6.8% (95%CI: 1.4–18.7%) in group I and II respectively (P = 0.587). The corneal densitometry was 22.69 ± 8.28GSU preoperatively and 17.98 ± 3.13GSU at 12 months postoperatively (P = 0.010) in group I. The corneal densitometry was 21.86 ± 6.22GSU preoperatively and 21.23 ± 4.29GSU at 12 months postoperatively (P = 0.815) in group II. High corneal maximal densitometry was associated with the thin central corneal thickness (P = 0.027), the presence of haze (P = 0.028), post-keratoplasty (P = 0.004), steep keratometry (P = 0.035). Conclusion: The incidence of corneal haze was comparable in virgin and post corneal transplant eyes. The Pentacam Scheimflug densitometry can be helpful in the diagnosis of corneal haze; however, the cutoff values need to be studied further in larger studies.

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Purpose: To describe the clinical presentation, management, and outcome of hospitalized patients having date palm tree eye injuries. Methods: This is a retrospective study of consecutive patients who were admitted to Al-Ain hospital following date palm tree eye injuries between 2012 and 2017. Patients' demography, symptoms and signs at presentation, surgical intervention, visual acuity (VA) before and after treatment, hospital stay, and causes for VA limitation were studied. Results: Sixteen patients were studied. Their median (range) age was 38.5 (7–58) years, all were males. Majority (87.5%) were from the Indian subcontinent and had their injuries at farms. Eye pain (94 %) was the most common presenting symptom while keratitis (62.5%) and corneal perforation (43.8%) were the most common physical findings. Vision showed a statistical trend for improvement after treatment (P = 0.1, Wilcoxon singed rank test). Five patients (31%) were blind in the injured eye. Conclusion: Palm date tree eye injuries which mainly occur at farms are a significant cause for visual loss at United Arab Emirates (UAE). Use of eyes protective goggles combined with legislative eye safety regulations will reduce palm tree eye injuries.

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PURPOSE: The purpose of the study was to study the association between diabetic retinopathy (DR) and periodontal disease (PD) in a South Indian cohort. METHODS: This was a cross-sectional, observational, interdisciplinary hospital-based study wherein patients with diabetes mellitus visiting the ophthalmology department of a university teaching hospital in coastal Karnataka, south India, during the study period, were screened independently for retinopathy by an ophthalmologist and PD by a periodontal surgeon. All the patients were above 18 years of age and did not have juvenile or gestational diabetes. A total of 213 patients consented to participate in the study. The data were analyzed for association using the Chi-square test. RESULTS: There was a statistically significant association between the presence of DR and PD (P = 0.02). The increasing severity of DR was associated with an increase in the components of PD including plaque index (P < 0.001) and gingival index (P < 0.001). CONCLUSION: There is a significant association between DR and PD. The awareness of this association can aid in the screening of potentially sight-threatening retinopathy in diabetics presenting to the dental clinic with PD.

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Purpose: This retrospective case-control cross-sectional study compared the outcomes of sulcus placement of glaucoma drainage devices (GDD) versus traditional anterior chamber (AC) to test the hypothesis that sulcus placement results in fewer complications whilst maintaining similar efficacy. Methods: This study included 45 patients in the sulcus group and 60 patients in the anterior chamber (AC) group who had undergone surgery from January 2014 to December 2017. Data were collected on pre-operative demographics, operative details and post-operative intraocular pressure and complications. The IOP, number of medications and complications between the two groups was compared. A P value of <5% was considered statistically significant. Results: The sulcus group had significantly lower overall complications compared to the AC group with a comparable IOP decrease between groups. There were significantly lower rates of hyphaema in the sulcus (3 cases) compared to AC group (17 cases) (P < 0.05). Severe or late complications (implant exposure, corneal decompensation, endophthalmitis, poor vision, choroidal hemorrhage and cornea edema) were significantly lower in the sulcus group [2 eyes; 4.4%] compared to the AC group [13 eyes; 21.7%] (P < 0.05). The sulcus group required fewer medications during the follow-up period. Conclusion: Sulcus implantation of GDD resulted in less postoperative hyphaema and severe complications compared to AC implantation. Our findings concur with the literature that sulcus implantation is safe and effective for controlling IOP for various types of glaucoma. The long-term effects of endothelial cell loss for sulcus versus AC implantation require further evaluation.

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PURPOSE: The aim of this study is to investigate the outer retina reconstruction using postoperative spectral domain optical coherence tomography (SD OCT) in large diameter macular holes (MHs) treated with the inverted internal limiting membrane (ILM) flap technique. METHODS: A retrospective study of 14 consecutive eyes that had vitrectomy and inverted ILM flap technique for MHs with a base diameter of 400 μ or greater. Preoperative and postoperative SD OCT images were assessed for MH closure and for outer retina presence; represented by the external limiting membrane (ELM) and ellipsoid zone (EZ), in the subfoveal and parafoveal areas. RESULTS: The average MH base diameter was 963 μ. Postoperative SD-OCT revealed an absence of the outer retina in six eyes, a continuous (regular) presence of the outer retina in four eyes, and a discontinuous (interrupted) presence in four eyes. There was an inverse relationship between MH size and presence or absence of ELM and EZ. A larger MH base diameter size was associated with a higher probability of an absent ELM and EZ (P = 0.04). Eyes in which an outer retina was present postoperatively achieved 6/18 and better vision compared to eyes without (P = 0.08). CONCLUSION: The outer retina in some large MHs treated with ILM flap technique can undergo reconstitution and remodeling which improves over time. The average size for MHs with complete reconstitution was 652 μ, 855 μ for those with interrupted reconstitution, and 1242 μ for eyes with no outer retina reconstruction. This suggests that MHs having a size within the limit of the no outer retina reconstitution MH group may be candidates for other surgical techniques in which postoperative outer retina presence is expected.

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PURPOSE: Extramedullary hematopoiesis (EMH) usually occurs in patients with loss of bone marrow hematopoietic function, and in a vast majority of cases, it involves the liver, the spleen, or the lymph nodes. We report EMH in the iris of patients enucleated for choroidal melanoma (CM). METHODS: We report a series of three patients with CM, two treated with primary enucleation and one with secondary enucleation. RESULTS: Histopathology revealed EMH in the iris of all patients. CONCLUSION: EMH of the iris can be associated with CM in the absence of any hematological or systemic disorders. To the best of our knowledge, our work is the first report of this abnormal histopathological finding.

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Purpose: This study provides an overview of neuro-ophthalmology in Saudi Arabia, evaluates the clinical practice of neuro-ophthalmology in the country, identifies the challenges, and implements recommendations to improve practice in this field. Methods: This cross-sectional study consisted of two surveys: The first survey was conducted with 32 general ophthalmologists and neurologists, while the second was conducted with six practicing neuro-ophthalmologists in Saudi Arabia. Results: All six neuro-ophthalmologists reported that they were Saudi Arabian nationals who worked either in Riyadh or other major cities in the Eastern and Western regions of the country. Only one of the six neuro-ophthalmologists was trained as a neurologist. Fifty percent of the neuro-ophthalmologists were trained in Saudi Arabia. Two out of the six neuro-ophthalmologists also reported providing services that were related to other specialties. Poor salary prospects for a neuro-ophthalmologist and the lack of availability of local fellowship programs were the most frequently reported reasons accounting for the lack of career interest in neuro-ophthalmology among medical residents. Conclusion: The study findings revealed that there is inadequate access to neuro-ophthalmologists in Saudi Arabia and that career interest in neuro-ophthalmology is very low among Saudi ophthalmologists and neurologists. Provision of sponsored subspecialty training opportunities, local fellowship programs, and early exposure may help increase interest in the field. The future of neuro-ophthalmology in Saudi Arabia will be determined by curious, creative, and passionate young physicians.

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PURPOSE: To report the epidemiological data, clinical profile, management, and outcomes of canalicular lacerations in the pediatric age group in a tertiary eye care hospital in Saudi Arabia. METHODS: This retrospective study evaluated pediatric patients who underwent canalicular laceration repair in the last 15years at King Khalid Eye Specialist Hospital (KKESH), Saudi Arabia. Demographics, causes of injury, type of trauma, surgical approach, and outcomes were analyzed. The success of repair was defined as the absence of epiphora after canaliculus repair with negative dye disappearance test (DDT). Success within subgroups was compared. P<0.05 was considered statistically significant. RESULTS: The study sample was comprised of 43 patients, with a median age of 6.35years (range, 1.77–17.96years). Most of the patients were males (69.8%). Sharp objects were the most common cause of canalicular laceration (46.5%), being 9 (20.9 %) caused by a metallic clothing hanger. Lower canaliculus was involved in 65.1%, upper canaliculus in 32.6%, and both canaliculi in 2.3% of patients. Canaliculus repair was performed with a bicanalicular stent in 58.1 % and monocanalicular stent in 41.9 % of patients.The success rate and risk of complications using bicanalicular or monocanalicular stent did not differ (P=0.065). Functional success was achieved in 87.5% of patients. CONCLUSION: Canalicular laceration is common in male children, mainly affecting the lower canaliculus. There was no difference in success rate between monocanalicular and bicanalicular stent. As canalicular laceration could be related to social determinants, the main causes should be highlighted in community health education initiatives.

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