Purpose:To evaluate risk factors for pediatric microbial keratitis and to describe the clinical picture, microbial spectrum, treatment modalities, posttreatment sequelae, and visual outcome in cases with pediatric microbial keratitis.Materials and Methods:All cases of microbial keratitis that occurred in children 16 years or younger who had an initial examination between January 2000 and December 2010 at a tertiary referral eye hospital in Riyadh, Saudi Arabia, were identified. A retrospective review of medical records was conducted using a computer-based diagnosis code. Demographic data, predisposing factors, clinical course, microbial culture results, and visual outcomes were recorded.Results:Sixty-eight eyes were included in this study. Predisposing factors were identified in 63 eyes (92.6%). All patients had unilateral microbial keratitis. The mean±SD age was 4.5 ± 4.8 years and 57.4% were male. Trauma was the leading cause [27 eyes (39.7%)], followed by systemic diseases [14 eyes (20.6%)], contact lens wear [11 eyes (16.1%)], and ocular diseases [11 eyes (16.1%)]. Corneal scraping was performed in all cases. Five patients needed general anesthesia to carry out the corneal scraping. Thirty-four (50.0%) eyes showed positive cultures. Gram-positive bacteria accounted for 67.8% and gram-negative bacteria for 38.2% of isolates. Streptococcus pneumoniae was the most commonly isolated organism [8 eyes (25.8%)], followed by Staphylococcus epidermidis [7 eyes (22.7%)]. Pseudomonas aeruginosa was the most commonly isolated gram-negative [6 eyes (17.6%)] organism. One eye had corneal perforation and required surgical intervention. Forty-five of 68 eyes (66.2%) had a best-corrected visual acuity evaluation at the last follow-up and 28 eyes (62.2%) of them had a best-corrected visual acuity of 20/40 or better.Conclusion:Children with suspected microbial keratitis require comprehensive evaluation and management. Early recognition, identifying the predisposing factors and etiological microbial organisms, and instituting appropriate treatment measures have a crucial role in outcome. Ocular trauma was the leading cause of childhood microbial keratitis in our study.
PurposeTo report anatomical and visual outcomes of Nd:YAG laser posterior hyaloidotomy (NYPH) in Saudi patients affected by Premacular subhyaloid haemorrhage (PMSHH).Methods8 eyes from 8 patients (7 males and one female) were treated with NYPH when no spontaneous resolution of PMSHH was noticed. The cause of PMSHH was proliferative diabetic retinopathy (PDR) in 3 cases, Central retinal vein occlusion (CRVO) in 2 cases, Valsalva retinopathy in 2 cases, and laser pointer injury in one case. The YAG laser was delivered using a Q switched mode and 3 mirrors contact lens. One attempt of laser delivery was enough in 6 cases and 2 cases needed 2 attempts. The laser power needed ranged between 2 and 4 mJ.ResultsAnatomical success was achieved in all cases. The mean LogMAR VA improved from 1.5 before treatment to 0.3 post-treatment. The difference is statistically significant (p = 0.012). No complications related to Nd:YAG laser therapy was reported in any of the study cases until the last follow up.ConclusionTo our knowledge, this is the first study to report the outcomes of NYPH for non-resolving PMSHH in Saudi cases. In this small cases series, the procedure seems to be safe, effective, simple, cheap, and non-invasive treatment modality for this disorder that is conducted in the outpatient setting. We think it should be considered as a first option for cases of SHH covering the fovea due to various aetiologies.
To improve compliance, merely educating patients is not sufficient and more efforts should be undertaken toward ensuring true sense of the problem and its impact. Factors affecting compliance due to the physical properties in the patch itself should be addressed too (heat, irritation, poor adhesive material and design).
We report two cases with foveal congenital simple hamartoma of the retinal pigment epithelium (CSHRPE), as both patients presented to our retina services complaining of a unilateral decreased vision. Full ophthalmic examination and multimodal imaging were performed including fundus photography, fundus autofluorescence, optical coherence tomography, fluorescein angiography, and electrophysiological testing. Both patients presented with 20/80 vision in the affected eyes. Foveal CSHRPE was found in both eyes, along with parapapillary hyperpigmented rim, multiple pinpoint macular lesions, and few posterior pole hyperpigmented lesions. Multifocal electroretinogram showed diminished central amplitude in both eyes, with three-dimensional topography map showing blunted foveal peaks in one eye and the absence of a central peak in the other patient. Both patients had a stable vision and clinical examination of the CSHRPE during 5 and 6 years follow up, respectively. Foveal CSHRPE is usually symptomatic and results in a decline in visual acuity. Follow-up of these patients showed stable vision and clinical examination.
Purpose: To report long term follow up of intraretinal fluid (IRF) and outer retinal tubulations (ORTs) in a case of choroidal osteoma (CO) over 54 month. Method: Case report.Results: A 35 Saudi female presented because of poor vision in her left eye. Her right eye was essentially normal with 20/20 vision (VA). Her left eye had 1/200 VA and showed peripapillary CO involving the macular area. OCT imaging showed intraretinal cystic spaces that were interpreted as a sign of an active choroidal neovascular membrane (CNV). 5 Avastin injections were administered into her left eye with no anatomical or visual improvement. On reviewing her imaging, no CNV was detected at any point. The IRF in this case seems related to RPE damage overlying the CO. ORTs were detected and increased over time. Conclusion:Clinicians should be careful when assessing cystic spaces in cases of CO. ORTs seem to represent a healing mechanism. IRF and ORTs in CO cases do not seem to benefit from anti-VEGF injections.
Background: Self-medication is defined as the selection of medicines by individuals to treat self-diagnosed ophthalmic symptoms without consultation of healthcare professionals. Topical steroids can produce severe eye-threatening complications, including the elevation of intraocular pressure (IOP) with possible development of glaucoma and infrequent optic nerve damage. In recent times, many over-the-counter (OTC) ophthalmic preparations are possible without a prescription. There are a lot of concerns about the safety of long-term use of nonprescription ophthalmic drugs, which may lead to a variety of serious ocular complications. Objective: To determine the prevalence of self-medication ocular topical steroid practices and associated factors among adult ophthalmic patients attending ophthalmology clinics at King Saud Medical City (KSMC) in Riyadh. Methods: A cross-sectional study targeted adults aged 18 or older who had used topical steroids eye drops. The data were collected through interviews, and an online questionnaire was distributed among patients who attended ophthalmology clinics between December 2022 and February 2023. Result: From a total of 308 responses, 92 (29.8%) were using ocular topical, 58 (18.8%) with a prescription, five (1.6%) without a prescription, and 29 (9.4%) with and without a prescription, while 216 (70.1%) did not use it. The frequency of using ocular topical steroids without a prescription among participants was 11 (12%) once and 33 (35%) many times. Additionally, 26 (28.3%) were having complications, mostly eye infections (11, 12.4%), glaucoma (8, 9%), and cataracts (6, 6.7%). The reasons for practicing self-medication of steroid eye drops among participants were 14 (15.2%) repeated symptoms, 11 (15.2%) had heard advice from friends, and 11 (15.2%) think they had enough knowledge. Conclusion: The study reported the use of self-medication with steroids in ophthalmology clinics at KSMC, even though detecting a high level of perception and acceptable practices among participants. This practice is mainly due to participants having repeated symptoms and thinking they have enough knowledge. Educating the patients would help in reducing the incidence of self-medication steroid eye drops and its associated complications.
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