Glaucoma among Saudi Arabian population:a scoping review

Despite its high risk of leading to permanent visual dysfunction,glaucoma remains underdiagnosed in primary care settings.About 11%of glaucoma patients in Saudi Arabia end up with bilateral blindness.This scoping review investigates and presents results on the glaucoma profile,including its prevalence,knowledge,attitude,and practice of Saudi Arabians towards the disease.An online search using four databases through online software(www.rayyan.ai)was performed to extract the relevant articles.Out of 76 records,21 articles were eligible for the analysis.All included studies were published between the years 2014 and 2022.Most studies were in Riyadh city,followed by Jeddah.All participants(n=11388)were adults>18 years old,and male participants were generally higher than females.The findings showed poor knowledge of glaucoma among the general population,while the knowledge among glaucoma patients was acceptable.The attitude was positive,while the compliance and practice were fair.More educational programs about glaucoma,its risk to the eyes,and the overall quality of life are highly recommended.

A novel terminologic “naming-meshing” system using anterior chamber sedimentation for early diagnosis and prompt treatment of ocular or systemic diseases: is it hypopyon or pseudohypopyon?

A novel,algorithmic“naming-meshing”system was introduced for the distinction of hypopyon from pseudohypopyon to make an early diagnosis and prompt treatment of anterior chamber collection standardized to encompass all sediment characteristics.For this reason,a literature review of“hypopyon”and“pseudohypopyon”was conducted in MEDLINE/PubMed,Scopus,and Web of Science from 1966 to May 15,2023.Two issues were clarified:1)which strategies should the ophthalmologist follow when asked to evaluate an eye with anterior chamber sedimentation to distinguish hypopyon from pseudohypopyon,and 2)in which systemic disorders should a non-ophthalmologist order a prompt ophthalmic consultation to distinguish pseudohypopyon from hypopyon.Pathognomonic characteristics of the sediment were examined;scleral show(warm/cold),location(corneal/anterior chamber/capsular/posterior),visibility(macro/micro/occult-angle),orientation(horizontal/vertical/oblique),number(single/double),shape(convex/triangular/pyramidal/ring/lumpy/inverse),and color(white/yellow/pink/brown/black).Associated findings were then assessed;acute/chronic,spontaneous/provoked,unilateral/bilateral,inflammatory/non-inflammatory,suppurative(nonsterile)/non-suppurative(sterile),granulomatous/nongranulomatous,recurrent/non-recurrent,shifting/nonshifting,and transient/persistent.The type of precipitation was named(naming)and matched(meshing)to a potential list of etiologies(inflammatory,infective,therapeutic,masquerades).Given that(pseudo)hypopyon predominantly afflicts younger patients in their most productive years,clinicians supervising such patients should be aware of all sediment characteristics.The ophthalmologist should never ask non-ophthalmologists to run the full battery of tests in a patient with(pseudo)hypopyon,and rather indicate which type of collection is present,what its pathognomonic feature is,and what the most likely diagnoses to be excluded are.

Anti-inflammatory potential of human corneal stroma-derived stem cells determined by a novel in vitro corneal epithelial injury model

BACKGROUND An in vitro injury model mimicking a corneal surface injury was optimised using human corneal epithelial cells(hCEC).AIM To investigate whether corneal-stroma derived stem cells(CSSC) seeded on an amniotic membrane(AM) construct manifests an anti-inflammatory, healing response.METHODS Treatment of hCEC with ethanol and pro-inflammatory cytokines were compared in terms of viability loss, cytotoxicity, and pro-inflammatory cytokine release, in order to generate the in vitro injury. This resulted in an optimal injury of 20%(v/v) ethanol for 30 s with 1 ng/mL interleukin-1(IL-1) beta. Co-culture experiments were performed with CSSC alone and with CSSC-AM constructs.The effect of injury and co-culture on viability, cytotoxicity, IL-6 and IL-8 production, and IL1 B, TNF, IL6, and CXCL8 mRNA expression were assessed.RESULTS Co-culture with CSSC inhibited loss of hCEC viability caused by injury. Enzyme linked immunosorbent assay and polymerase chain reaction showed a significant reduction in the production of IL-6 and IL-8 pro-inflammatory cytokines, and reduction in pro-inflammatory cytokine mRNA expression during co-culture with CSSC alone and with the AM construct. These results confirmed the therapeutic potential of the CSSC and the possible use of AM as a cell carrier for application to the ocular surface.CONCLUSION CSSC were shown to have a potentially therapeutic anti-inflammatory effectwhen treating injured hCEC, demonstrating an important role in corneal regeneration and wound healing, leading to an improved knowledge of their potential use for research and therapeutic purposes.

Diagnostic dilemma between intestinal Behet disease and inflammatory bowel disease with pyoderma gangrenosum

TO THE EDITOR I have read with great interest the very recent article rifled ＂Intestinal Behcet＇s disease with pyoderma gangrenosum： A case report＂ of Nakamura T et al that was published in your journal. The authors stated that they presented a very rare case of intestinal Behcet＇s disease with pyoderma gangrenosum in a 16-year old patient. However, I would like to make some important contributions and suggestions to the presented case and have a few questions to ask the authors.

Severe phimosis-like epiretinal membrane proliferation following internal limiting membrane peeling for macular hole

Dear Editor,I nternal limiting membrane(ILM)peeling with gas tamponade has been the preferred surgical technique for the macular hole treatment[1-2].Eckardt et al[1]achieved a complete closure of 92%of the macular holes.Generally,the procedure involves peeling of ILM from the macula using a microvitreoretinal blade with an intraocular forceps 500 mm superior to the hole,removal of membranes and releasing the traction around the macular hole.If a macular epiretinal membrane(ERM)is present,it should be peeled during the surgery[1-2].

Gene silencing in Xenopus laevis by DNA vector-based RNA interference and transgenesis

A vector-based RNAi expression system was developed using the Xenopus tropicalis U6 promoter, which transcribes small RNA genes by RNA polymerase Ⅲ. The system was first validated in a Xenopus laevis cell line, designing a short hairpin DNA specific for the GFP gene. Co-transfection of the vector-based RNAi and the GFP gene into Xenopus XR1 cells significantly decreased the number of GFP-expressing cells and overall GFP fluorescence. Vector-based RNAi was subsequently validated in GFP transgenic Xenopus embryos. Sperm nuclei from GFP transgenic males and RNAi construct-incubated-sperm nuclei were used for fertilization, respectively. GFP mRNA and protein were reduced by -60% by RNAi in these transgenic embryos compared with the control. This transgene-driven RNAi is specific and stable in inhibiting GFP expression in the Xenopus laevis transgenic line. Gene silencing by vector-based RNAi and Xenopus transgenesis may provide an alternative for ＇repression of gene function＇ studies in vertebrate model systems.

Intravitreally injected ranibizumab versus photodynamic therapy for CNV secondary to choroidal osteoma:a 7-year follow-up case report

Dear Editor,We present a case of bilateral choroidal neovascularization(CNV)secondary to choroidal osteoma involving the macula and investigate the effect of intravitreal injection of ranibizumab and photodynamic therapy(PDT)in a sevenyear follow-up.Informed consent for patient information and images to be published was obtained from the patient included in the study based on the Declaration of Helsinki,which was approved by the Ethics Committee of Southwest Hospital.

细胞因子基因多态性与英国特发性中间葡萄膜炎患者预后有无相关性

Background/aim: Competing levels of cytokines, either locally within the eye o r systemically, may influence the eventual out-come of ocular inflammation. Pol ymorphism in the promoter part of the genes controlling cytokine production may result in either higher or lower production of the relevant cytokine to a given stimulus. The authors hypothesised that such polymorphisms may relate to visual outcome in patients with idiopathic intermediate uveitis. Methods: DNA was obtai ned from 125 patients with idiopathic intermediate uveitis and analysed for the interleukin 10 IL-10-1082G/Aand IL-10-819C/T, and interferon γIFNγ874T/A g ene polymorphisms. Associations with disease were calculated by both allelic fre quency and haplotype analysis, and associations between ocular disease outcomes and the presence of polymorphismswere identified. A bad outcome was defined as l oss of vision <6/12 Snellen in both eyes at 5 years from presentation when the e yes were quiet. Results: An initial screen showed that the 874T allele of the IF Nγgene was more prevalent in patients than controls (χ2=7.9; p=0.004 OR 1.7; 9 5%CI 1.2 to 2.6 (Pc=0.02), whereas the IL-10-1082/-819 AT haplotype of the i nterleukin 10 (IL-10) gene was not. Analysis of disease outcome showed an assoc iation between IL-10-1082 AA homozygosity and bad outcome (χ2 =13; p=0.0003). Moreover, the two cytokine polymorphisms taken together showed that up to 75%o f patients with a poor visual outcome had the combined IFNγ874TA or TT genotype together with the IL-10-1082AA genotype (χ2=13.2 p=0.0008 OR 6.4; 95%CI 1.8 5 to 23.6 Pc=0.1). Conclusion: These results show that disease outcome in interm ediate uveitis may be partly determined by a complex interplay between cytokine genes and these results may have implications for future treatment with biologic al agents that target these cytokines.

Cosmetic outcome of femtosecond laserassisted pterygium surgery

Background:To examine the cosmetic outcome of femtosecond laser-assisted pterygium surgery(FLAPS)with conjunctival autograft(CAG)and its potential predictive factors.Methods:This Was a prospective interventional case series(NCT02866968).We included 29 patients(29 eyes)with primary pterygium who underwent FLAPS.Cosmetic outcome was graded by two graders(an ophthalmology resident and an experienced ophthalmologist)using Hirst classification system(1-4:excellent-poor).Weighted Cohen's kappa analysis was performed to examine the intra-and inter-rater reliability.The relationship between cosmetic outcome and various factors were determined by Spearman's correlation coefficients(r).Results:The preoperative severity of pterygium(Tan grading system)was mild/atrophic(7%),moderate/intermediate(62%),and severe/fleshy(31%).An ultrathin CAG(mean thickness of 74.5±9.8μm)was fashioned intraoperatively.An excellent cosmetic outcome of FLAPS(median±IQR)was observed at 3 months(1.0±1.0)and remained similar at 6 months(1.0±0.0)and 12 months(1.0±0.0)postoperatively.At final fllow-up,27(93%)patients achieved good-to-excellent cosmetic outcome,with 1(3%)patient having a poor outcome due to incomplete pterygium removal.Weighted kappa analysis of Hirst grading system showed excellent intra-rater(k:0.86-0.95)and inter-rater reliability(k:0.84-0.88).There was a weak and borderline significant correlation between good cosmetic outcome and reduced postoperative CAG thickness(r=0.38,P=0.06)but not with age,gender,preoperative pterygium severity,or intraoperative CAG thickness.Conclusions:FLAPS can result in an excellent cosmetic outcome,which may be attributed to the beneficial effect of an ultrathinCAG.Trial registration:ClinicalTrials.gov,NCT02866968.Registered in July 2016.

Outer retinal tubulation in diabetic macular edema following anti-VEGF treatment

Background:To address the presence and features of outer retinal tubulation(ORT)found in diabetic macular edema(DME)treated with anti-vascular endothelial growth factor(anti-VEGF)and to differentiate between ORT and cystoid DME,which have different plans of management.Methods:This was a retrospective review of a total of 514 patients investigated with spectral domain optical coherence tomography(OCT)in patients with diabetic macular edema treated with anti-VEGF.ORT was seen in 12 eyes of 11 patients.The morphologic characteristics of ORT and its progress over time were examined using OCT data.The retinal images were obtained by horizontal and vertical scans to analyze the possible presence of ORT and to explore their morphologic features and location in the retinal layers.Results:ORT was seen in DME treated with anti-VEGF.ORT was shown as round or ovoid hyporeflective spaces with hyperreflective borders on the B-scans,measuring 30 to 120μm high and 30 to 1775μm wide.The tubules generally remained stable over time.In a retinal practice specializing in advanced diabetic retinopathy clinic,this ORT was seen in 12 eyes of 11 patients during a 12-month period.ORT presented either after receiving 0.05 mL open-label intravitreal injections of 0.5 mg ranibizumab or 1.25 mg bevacizumab.Conclusion:ORT is found in DME treated with anti-VEGF that may show damage to the outer retina secondary to the severity and chronicity of the DME.ORT may be a result of underlying chronic and severe diabetic macular edema that may occur later possibly secondary to retinal layers rearrangement after several anti-VEGF injections.It is important to differentiate between ORT and cystoids DME.The presence of the ORT entity alone without the presence of DME does not require further anti-VEGF re-injections.

眼带状疱疹

一名70岁男性患者,左前额出现痛性水疱样皮疹2天,伴左眼红肿疼痛。皮疹出现前3天,他曾感到左前额刺痛。临床诊断为眼部受累型眼带状疱疹。带状疱疹是一种由原水痘感染后休眠于背根神经节的水痘带状疱疹病毒再激活引起的常见感染。眼带状疱疹占带状疱疹感染病例的10%~20%1。患者通常表现为影响三叉神经眼支(VI)皮区的痛性水疱样皮疹。诊断通常基于临床,但病毒拭子可以确诊。

Cosmetic outcome of femtosecond laserassisted pterygium surgery

Background:To examine the cosmetic outcome of femtosecond laser-assisted pterygium surgery(FLAPS)with conjunctival autograft(CAG)and its potential predictive factors.Methods:This was a prospective interventional case series(NCT02866968).We included 29 patients(29 eyes)with primary pterygium who underwent FLAPS.Cosmetic outcome was graded by two graders(an ophthalmology resident and an experienced ophthalmologist)using Hirst classification system(1-4=excellent-poor).Weighted Cohen’s kappa analysis was performed to examine the intra-and inter-rater reliability.The relationship between cosmetic outcome and various factors were determined by Spearman’s correlation coefficients(r).Results:The preoperative severity of pterygium(Tan grading system)was mild/atrophic(7%),moderate/intermediate(62%),and severe/fleshy(31%).An ultrathin CAG(mean thickness of 74.5±9.8μm)was fashioned intraoperatively.An excellent cosmetic outcome of FLAPS(median±IQR)was observed at 3 months(1.0±1.0)and remained similar at 6months(1.0±0.0)and 12months(1.0±0.0)postoperatively.At final follow-up,27(93%)patients achieved good-to-excellent cosmetic outcome,with 1(3%)patient having a poor outcome due to incomplete pterygium removal.Weighted kappa analysis of Hirst grading system showed excellent intra-rater(κ=0.86-0.95)and inter-rater reliability(κ=0.84-0.88).There was a weak and borderline significant correlation between good cosmetic outcome and reduced postoperative CAG thickness(r=0.38,P=0.06)but not with age,gender,preoperative pterygium severity,or intraoperative CAG thickness.Conclusions:FLAPS can result in an excellent cosmetic outcome,which may be attributed to the beneficial effect of an ultrathin CAG.