UNASSIGNED: Childhood visual impairment has a significant effect on social life, educational performance, and professional choices, and can lead to poverty.
UNASSIGNED: To review the prevalence and causes of visual impairment among children aged 5-17 years in the Eastern Mediterranean Region (EMR).
UNASSIGNED: This study was conducted in 2021 using the Preferred Reporting Items for Systematic reviews and Meta- Analyses (PRISMA) method. We searched Google Scholar, PubMed, Web of Science, Scopus, Index Medicus for the Eastern Mediterranean Region, and Medline for studies published between January 2000 and April 2020. The articles included were epidemiological studies of prevalence and causes of childhood visual impairment published in peer-reviewed journals.
UNASSIGNED: Of the 12 705 articles screened, 23 from 9 countries met the inclusion criteria. The pooled prevalence of uncorrected, presenting, and best-corrected childhood visual impairment was 11.57%, 8.34% and 1.21%, respectively. The most common causes of childhood visual impairment were refractive error (51.89%), amblyopia (11.15%), retinal disorders (3.90%), corneal opacity (3.0%), and cataract (1.88%). There was a highly significant heterogeneity between the studies (P < 0.0001).
UNASSIGNED: The prevalence of visual impairment among children in the EMR was high, and the leading causes were uncorrected refractive error and amblyopia, which were avoidable. Access to eyecare services may help improve early diagnosis and treatment of preventable causes of childhood visual impairment.
استعراض منهجي وتحليل تَلَوي لضعف البصر في مرحلة الطفولة في إقليم شرق المتوسط.
سيف الرشيد.
UNASSIGNED: لضعف البصر في مرحلة الطفولة تأثيرٌ كبيرٌ على الحياة الاجتماعية، والأداء التعليمي، والخيارات المهنية، وقد يؤدي ذلك إلى الفقر.
UNASSIGNED: هدفت هذه الدراسة الى مراجعة معدل انتشار ضعف البصر وأسبابه لدى الأطفال الذين تتراوح أعمارهم بين 5 و17 عامًا في إقليم شرق المتوسط.
UNASSIGNED: أُجريت الدراسة في عام 2021 باستخدام بنود التبليغ المفضلة للاستعراضات المنهجية والتحليلات التلوية (PRISMA). وبحثنا في كلٍّ من Google Scholar، وPubMed، وWeb of Science، وScopus، والفهرس الطبي لإقليم شرق المتوسط، وقاعدة بيانات مدلاين (Medline)، للاطلاع على الدراسات التي نُشرت في الفترة بين يناير/ كانون الثاني 2000 وأبريل/ نيسان 2020. وشملت المقالات المُدرَجة دراسات وبائية نُشرت في مجلات طبية خاضعة لاستعراض الأقران، عن معدل انتشار ضعف البصر وأسبابه في مرحلة الطفولة.
UNASSIGNED: من بين المقالات التي دُرست والبالغ عددها 12705 مقالا استوفت 23 مقالةً من 9 بلدان معايير الإدراج. وقد بلغ معدل الانتشار المُجمَّع لضعف البصر غير المُصحَّح، والماثل، والمُصحَّح على أفضل وجه 11.57٪، و8.34٪، و1.21٪، على التوالي. وكانت أكثر الأسباب شيوعًا لضعف البصر في مرحلة الطفولة هي الخطأ الانكساري (51.89٪)، والغمش (11.15٪) واضطرابات الشبكية (3.90٪)، وعتامة القرنية (3.0٪)، والسادّ (1.88٪). وتب يََّّنَ وجود تبايُن كبير بين الدراسات (القيمة الاحتمالية < 0.0001).
UNASSIGNED: كان معدل انتشار ضعف البصر مرتفعًا بين الأطفال في إقليم شرق المتوسط، وتمثلت الأسباب الرئيسية وراء ذلك في الخطأ الانكساري، والغمش، اللذين يمكن الوقاية منهما. ومن شأن الحصول على خدمات رعاية العيون أن تُُحسِّن التشخيص المبكر وعلاج الأسباب التي يمكن الوقاية منها لضعف البصر في مرحلة الطفولة.
Analyse systématique et méta-analyse des déficiences visuelles chez les enfants dans la Région de la Méditerranée orientale.
UNASSIGNED: La déficience visuelle chez les enfants a un effet significatif sur la vie sociale, les résultats scolaires et les choix professionnels, et peut mener à la pauvreté.
UNASSIGNED: Examiner la prévalence et les causes des déficiences visuelles chez les enfants âgés de 5 à 17 ans dans la Région de la Méditerranée orientale.
UNASSIGNED: L\'étude a été menée en 2021 à l\'aide des directives PRISMA (Éléments de notification préférés à des fins d\'examens et de méta-analyse systématique). Nous avons recherché les études publiées entre janvier 2000 et avril 2020 dans Google Scholar, PubMed, Web of Science, Scopus, Index Medicus pour la Région de la Méditerranée orientale et Medline. Les articles retenus étaient des études épidémiologiques sur la prévalence et les causes de la déficience visuelle chez les enfants, publiées dans des revues à comité de lecture.
UNASSIGNED: Sur les 12 705 articles examinés, 23 provenant de neuf pays répondaient aux critères d\'inclusion. La prévalence globale des déficiences visuelles infantiles non corrigées, détectées et les mieux corrigées était respectivement de 11,57 %, 8,34 %, et 1,21 %. Les causes les plus fréquentes de déficience visuelle infantile étaient le vice de réfraction (51,89 %), l\'amblyopie (11,15 %), les troubles de la rétine (3,90 %), l\'opacité cornéenne (3,0 %) et la cataracte (1,88 %). L\'hétérogénéité entre les études était très significative (p < 0,0001).
UNASSIGNED: La prévalence des déficiences visuelles chez les enfants dans la Région de la Méditerranée orientale était élevée et les principales causes étaient le vice de réfraction non corrigé et l\'amblyopie, qui auraient pu être évités L\'accès aux services de soins oculaires peut contribuer à améliorer le diagnostic et le traitement précoces des causes évitables de déficience visuelle chez l\'enfant.

Granular corneal dystrophy type 2 (GCD2) is an autosomal dominant corneal stromal dystrophy that is caused by p.Arg124His mutation of transforming growth factor β induced (TGFBI) gene. It is characterized by well demarcated granular shaped opacities in central anterior stroma and as the disease progresses, extrusion of the deposits results in ocular pain due to corneal epithelial erosion. Also, diffuse corneal haze which appears late, causes decrease in visual acuity. The prevalence of GCD2 is high in East Asia including Korea. Homozygous patients show a severe phenotype from an early age, and the heterozygote phenotype varies among patients, depending on several types of compound heterozygous TGFBI mutations. In the initial stage, conservative treatments such as artificial tears, antibiotic eye drops, and bandage contact lenses are used to treat corneal erosion. Different surgical methods are used depending on the depth and extent of the stromal deposits. Phototherapeutic keratectomy removes anterior opacities and is advantageous in terms of its applicability and repeatability. For deeper lesions, deep anterior lamellar keratoplasty can be used as the endothelial layer is not always affected. Recurrence following these treatments are reported within a wide range of rates in different studies due to varying definition of recurrence and follow-up period. In patients who have undergone corneal laser vision-correction surgeries such as photorefractive keratectomy, LASEK, or LASIK including SMILE surgery, corneal opacity exacerbates rapidly with severe deterioration of visual acuity. Further investigations on new treatments of GCD2 are necessary.

BACKGROUND: Corneal opacity can be caused by various disease. Generally, the opacity gradually increases as the disease progresses. Sudden corneal opacity is mainly caused by corneal trauma, toxic drugs entering the cornea, or acute edema of the keratoconus. However, sudden corneal opacity caused by diabetes has not been reported.
METHODS: A 60-year-old man reported blurred vision and the black eye became white in appearance in the left eye for 5 days. The patient had a history of diabetes which had not been treated.
METHODS: He underwent slit-lamp examination, anterior segment optical coherence tomography, ultrasound bio microscopy, B-mode ultrasound, corneal endothelial examination, random blood glucose testing, and other examinations. The diagnosis of Diabetic Keratopathy was made.
METHODS: Topical glucocorticoids and dilating eye drops were administered and undergo blood sugar control treatment.
RESULTS: The corneal of the patient was completely transparent in a few days, and the flocculent exudation in the anterior chamber disappeared.
CONCLUSIONS: Although diabetes generally causes chronic corneal edema, acute corneal edema may also occur when blood sugar is poorly controlled. Therefore, when we see sudden corneal opacity without obvious incentives, we must consider systemic diseases, especially diabetes.

This report describes a very rare case of progeroid syndrome of De Barsy (Cutis laxa-corneal clouding syndrome).
A 2 year-old child presented to the pediatric ophthalmology outpatients with bilateral congenital corneal opacification along with dysmorphic facial features, including loose wrinkled skin, progeroid appearance, delayed milestones, short stature, multiple hyper-extensible joints, muscular hypotonia, pectus excavatum and congenital dislocation of the hip joint. The child underwent a detailed ophthalmic work up and systemic evaluation by a clinical geneticist.
Ophthalmic management in the form of bilateral sequential penetrating keratoplasties and a left eye trabeculectomy for medically uncontrolled angle-closure glaucoma was performed. Visual rehabilitation with glasses and amblyopia therapy is ongoing. Histopathology of the corneal button revealed loss of the bowman\'s layer which was replaced by a fibrous pannus while the stroma showed loss of stromal lamellar architecture with anterior and mid stroma showing vascularization. Genetic testing confirmed a mutation in the PYCR1 gene for a homozygous autosomal recessive cutis laxa type IIB.
Although rare, De Barsy syndrome is an important cause of corneal opacification at birth with multiple systemic abnormalities that requires intervention.

Mucopolysaccharidosis (MPS) is a group of genetic disorders with seven types and 13 subgroups which are characterized by an inherent deficiency of the enzymes responsible for the degradation of glycosaminoglycans (GAGs). Defective breakdown of GAG products leads to their widespread accumulation within the lysosomes of various organs involving the eye, central nervous system, skeletal, ocular, nervous, respiratory, cardiac, and the gastrointestinal systems. Clinical spectrum varies from mild systemic and ocular abnormalities with a normal life span to severe phenotype, fatal in the first few months of life. Visual disability due to corneal clouding, retinopathy, and optic nerve involvement causes additional impairment of physical and cognitive functions. Treatment modalities such as bone marrow transplantation and enzyme replacement therapies help in increasing the life span as well as the quality of life of the affected patients. For patients with significant corneal clouding, keratoplasty is the answer. The decision to proceed with keratoplasty is governed by various factors such as the motivation of the patient and his family, other systemic affections and anesthesia concerns. A detailed preoperative counseling should be done regarding the expected visual outcomes in the presence of other ocular comorbidities and the postoperative complication such as graft re-opacification, rejection and glaucoma. Future treatment options such as targeted gene therapy and substrate reduction therapy hold promise to reverse corneal clouding, thereby obviating the need for corneal transplantation. These treatment therapies are still in the experimental stages and human trials are needed to validate their outcomes.

BACKGROUND: Respiratory and gastrointestinal manifestations are the main causes of mortality and morbidity in cystic fibrosis. Although these symptoms are well recognized, ophthalmic involvement of cystic fibrosis secondary to vitamin A deficiency is uncommon and has been reported very rarely in the medical literature.
METHODS: Here, we report a 2.5-year-old Iranian boy who presented with bilateral corneal xerosis and corneal opacity secondary to vitamin A deficiency related to cystic fibrosis malabsorption.
CONCLUSIONS: Malabsorption of fat-soluble vitamins is a common presentation in cystic fibrosis, but corneal opacity secondary to vitamin A deficiency as the initial presentation of cystic fibrosis is a very rare manifestation of fat malabsorption. This highlights the importance of complete systemic examination besides ophthalmic examination in approaching a child with ophthalmic complaint.

This review assesses different clinical aspects of the various known drug-induced corneal deposits, based on the corneal layer involved (epithelium, stroma and/or endothelium), and based on the drug class. The most well-known condition caused by drug deposits is vortex keratopathy, or corneal verticillata, which is a whorl-like opacity in the corneal epithelium. Vortex keratopathy is commonly caused by certain cationic amphiphilic drugs such as amiodarone, antimalarials, suramin, tamoxifen, chlorpromazine and non-steroidal anti-inflammatory drugs. These deposits usually occur once a certain dose of the drug is reached. Most cases present with mild to moderate symptoms with minimal visual impairment. Most of these deposits resolve automatically, after months to years of drug cessation. Notably, other drug classes can cause deposits in all three layers of the cornea. Chlorpromazine, gold, rifabutin, indomethacin and tyrosine kinase inhibitors can cause stromal deposits, with reduced visual acuity when the anterior stroma is involved. Chlorpromazine and rifabutin can also cause deposits in the endothelial layer of the cornea. Regardless of the type of corneal deposit, local therapies such as topical lubricants or corticosteroids may help improve symptoms. Drug cessation or modification can also be helpful but should be weighed against the systemic risks of the underlying disease.

UNASSIGNED: Thygeson superficial punctate keratitis (TSPK) is clinically characterized by exacerbations and remissions of gray-white opacities within the corneal epithelium, most often bilateral but may be asymmetric. Symptoms typically include photophobia, tearing, blurring, and eye irritation. Although disease progression and prognosis are well described, the exact cause is unknown. Hypotheses exist implicating virus-mediated immunity as the cause of TSPK following cases of viral keratitis; however, several polymerase chain reaction studies refute the infectious process concurrently with symptomatic TSPK. This is further supported by the consistent lack of response to antiviral and antibacterial treatment. A subset of dendritic cells known as Langerhans cells (LC) found within the corneal epithelium has been positively correlated with exacerbations of TSPK. Langerhans cells proliferate to protect and mitigate the cornea\'s inflammatory response, but the inflammatory triggers and relapses associated with TSPK are not well understood. Several topical drugs exist to treat inflammation related to TSPK; however, drug delivery is a major barrier to treatment because of the tear film and epithelial barrier. Drug-eluting contact lenses that target intermediates of inflammation could serve as a more effective treatment modality because of the increased bioavailability of the drugs. This review is an in-depth survey of the literature regarding the relationship between the origin and pathophysiology of LC and TSPK at the immunologic level. We also discuss potential pharmacotherapeutic interventions for TSPK prevention and treatment.

BACKGROUND: Peters\' anomaly (PA) and Axenfeld-Rieger syndrome (ARS) are typical classifications of anterior segment dysgenesis (ASD) and ascribed to congenital eye diseases that encompass developmental defects in anterior segment structures. The aim of this study is to discuss the unusual association between PA and ARS and to determine the results of penetrating keratoplasty combined with extracapsular cataract extraction and anterior vitrectomy for this unusual ophthalmic phenotype.
METHODS: A 72-year-old female was referred to Changzhou No. 2 People\'s Hospital for a progressive decrease in visual acuity in both eyes in the past few decades.
METHODS: The patient was diagnosed with PA with cone-shaped polar cataracts in the left eye based on a series of ophthalmic examinations. ARS with retinal detachment was diagnosed in the right eye 2 years prior.
METHODS: Penetrating keratoplasty combined with extracapsular cataract extraction and anterior vitrectomy were performed to manage PA with cataracts in the left eye.
RESULTS: Her best corrected visual acuity did not improve significantly after the operation. Patients with ARS and PA should be treated cautiously because of fundus lesions.
CONCLUSIONS: This study revealed that cases with PA accompanied by iridocorneal adhesions, or other ocular anomalies, need to be treated cautiously for a very low success rate. It is of reference value for the evaluation of treatment prognosis for this joint occurrence of ophthalmic phenotypes.

Thygeson\'s superficial punctate keratitis (TSPK) is a chronic disorder with episodes of exacerbations and remissions which span over years to decades. Typical features of the disease include multiple, grayish white, intraepithelial corneal lesions with minimal or no conjunctival involvement. The exact etiopathogenesis of this entity is unknown. However, it may have a genetic association with HLA-DR3, an antigen proved to be associated with immunogenic responses. Treatment of the disease consists of artificial tears, topical corticosteroids, topical cyclosporine, topical tacrolimus, or usage of soft contact lenses. TSPK should be considered as a diagnosis of exclusion in cases of bilateral superficial punctate keratopathy of long duration. Thirteen patients of TSPK were examined during the last 6 years (2014-2019) at our Institute. Visual acuity was 20/20 to 20/30 in majority cases. All patients required lubricants.