Purpose
The aim of this study was to report our experience with eyes that presented with an initial GDD exposure and their subsequent outcome in terms of re-exposure.
Methods
A retrospective review of charts of 42 patients (43 eyes) who presented with a GDD exposure during the period 2008–2015 in a tertiary eye care center was performed. Demographic data, past ocular history, pre-operative and post-operative information including the surgical technique of GDD surgery and exposure repair were recorded. The patients were followed for further exposure to the date of the last follow-up clinic visit. For each type of repair technique, details were collected on risk and timing of GDD exposure. The baseline features of eyes that had further exposure after initial exposure were compared to eyes without further exposure.
Results
Forty-three eyes were identified which had repair after an initial exposure. The mean ± SD age was 54 ± 27 years. Of the GDDs, Ahmed FP7 was performed in 31 eyes, Ahmed FP8 in two eyes, Ahmed S2 in five eyes, Krupin valve in two eyes and Baerveldt 350 GDD in three eyes. The methods of repair and the relative risk [95% CI] of re-exposure were: conjunctival closure only (n=4; RR=2.10 [0.84–5.23]); repair with patch graft and conjunctival repair (n=18), RR=1.24 [0.51–3.01]; tube repositioning, use of patch graft and conjunctival repair (n=14), RR=1.0; tube removal with replacement in a different quadrant, patch graft and conjunctival repair (n=3), RR=1.87 [0.64–5.48]. After the first exposure, 18 eyes had a second re-exposure, four eyes had a third re-exposure, and 1 eye had a fourth exposure.
Conclusions
The GDD exposure rates at our institution are consistent with other reports. Lack of a patch graft for repair is associated with a two-fold risk of subsequent re-exposure.
OCT can play an important role in the diagnosis and measurement of eccentric fixation in eyes with microtropia, providing high sensitivity. [J Pediatr Ophthalmol Strabismus. 2018;55(3):171-177.].
Purpose: To report the profile of newly referred glaucoma patients to the largest tertiary eye care hospital in Saudi Arabia.
Patients and Methods: Medical records of all Saudi nationals who presented with glaucoma to the Glaucoma Clinics at King Khaled Eye Specialist Hospital (KKESH) as a first visit through the Eligibility Department, Screening Clinic or Emergency Department between March 2019 and August 2019 were reviewed. Patients underwent a comprehensive glaucoma workup and a detailed documentation of their demographics, clinical exam findings, type and stage of glaucoma at presentation along with previous and offered management. Upon presentation, the stage of glaucoma was compared between eyes with primary glaucoma including primary open-angle glaucoma (POAG), primary angle-closure glaucoma (PACG) and eyes with Secondary glaucoma.
Results: A total of 532 patients newly presented to KKESH during the study period. The median (interquartile [IQR] range) age of the patients was 63 (17) years, 47.9% of the patients were female. The majority of referred cases came from Riyadh (46.6%), Najran (9.8%) and AlQassim (9.4%) provinces. PACG was the most predominant form of glaucoma (30.5%), followed by POAG. Pseudoexfoliation glaucoma (PSXG) and neovascular glaucoma (NVG) were the most common subtypes among secondary glaucoma. Two out of every five eyes presenting with glaucoma (41.5%) had severe disease.
Conclusion: In this tertiary setting, PACG was the most commonly encountered glaucoma. A significant proportion of the patients, particularly those with POAG (“the silent thief of sight”) presented with an advanced disease. To limit the irreversible visual loss and socio-economic burden of glaucoma, a large community-based study is required to look into the epidemiology of glaucoma among all Saudi provinces followed by the implementation of a national screening and intervention program.
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