Attitudes of Saudi Arabian Undergraduate Medical Students towards Health Research

Objectives: This study aimed to evaluate attitudes, perceptions and perceived barriers towards health research among Saudi Arabian undergraduate medical students. Methods: This cross-sectional study took place between August and October 2014 and included 520 students from five medical schools across Saudi Arabia. An anonymous online survey with 21 close-ended questions was designed to assess students’ attitudes towards research, contribution to research-related activities, awareness of the importance of research, perception of available resources/opportunities for research, appreciation of medical students’ research contributions and perceived barriers to research. Responses were scored on a 5-point Likert scale. Results: A total of 401 students participated in the study (response rate: 77.1%). Of these, 278 (69.3%) were female. A positive attitude towards research was reported by 43.9% of the students. No statistically significant differences were observed between genders with regards to attitudes towards and available resources for research (P = 0.500 and 0.200, respectively). Clinical students had a significantly more positive attitude towards research compared to preclinical students (P = 0.007). Only 26.4% of the respondents believed that they had adequate resources/opportunities for research. According to the students, perceived barriers to undertaking research included time constraints (n = 200; 49.9%), lack of research mentors (n = 95; 23.7%), lack of formal research methodology training (n = 170; 42.4%) and difficulties in conducting literature searches (n = 145; 36.2%). Conclusion:Less than half of the surveyed Saudi Arabian medical students had a positive attitude towards health research. Medical education policies should aim to counteract the barriers identified in this study

Clinical Study Anesthesia for Pars Plana Vitrectomy with Insulin Needle, Is It Possible?

Peribulbar block is commonly used for ocular posterior segment surgery. This work aimed to compare the efficacy of using 12.5 mm to 25 mm standard needle length in performing single injection peribulbar block for retinal surgery. Peribulbar block was performed in 120 patients using either standard 25 mm or 12.5 mm 30 G needle (insulin needle). While applying digital pressure around the needle hub, 8-10 mL of local anesthetic are injected. Ocular movement was assessed at 5 and 10 min using simple akinesia score (0-8). If after 10 min score was >1, supplementary injection was given. Visual analogue scale (0-10) was used at the end of the procedure to assess surgeons' satisfaction and patients' intraoperative pain. No differences in akinesia score at 5 & 10 min (P = 0.34 and 0.36, resp.). Initial volume injected was comparable between groups (P = 0.31), however total volume of local anesthesia and supplementary injections were significantly higher in 12.5 mm group (P = 0.03 and 0.01, resp.). No difference as regard surgeons' satisfaction and patients' intraoperative pain (P = 1.0 and 0.18, resp.). Peribulbar block with 12.5 mm needle together with digital compression is a suitable alternative to the standard block with 25 mm needle length for retinal surgery

The use of a virtual reality surgical simulator for cataract surgical skill assessment with 6 months of intervening operating room experience

PURPOSE: To evaluate a haptic-based simulator, MicroVisTouch™, as an assessment tool for capsulorhexis performance in cataract surgery. The study is a prospective, unmasked, nonrandomized dual academic institution study conducted at the Wilmer Eye Institute at Johns Hopkins Medical Center (Baltimore, MD, USA) and King Khaled Eye Specialist Hospital (Riyadh, Saudi Arabia). METHODS: This prospective study evaluated capsulorhexis simulator performance in 78 ophthalmology residents in the US and Saudi Arabia in the first round of testing and 40 residents in a second round for follow-up. RESULTS: Four variables (circularity, accuracy, fluency, and overall) were tested by the simulator and graded on a 0–100 scale. Circularity (42%), accuracy (55%), and fluency (3%) were compiled to give an overall score. Capsulorhexis performance was retested in the original cohort 6 months after baseline assessment. Average scores in all measured metrics demonstrated statistically significant improvement (except for circularity, which trended toward improvement) after baseline assessment. A reduction in standard deviation and improvement in process capability indices over the 6-month period was also observed. CONCLUSION: An interval objective improvement in capsulorhexis skill on a haptic-enabled cataract surgery simulator was associated with intervening operating room experience. Further work investigating the role of formalized simulator training programs requiring independent simulator use must be studied to determine its usefulness as an evaluation tool

Surgical Treatment and Histopathology of a Symptomatic Free-Floating Primary Pigment Epithelial Iris Cyst in the Anterior Vitreous

We report the surgical removal of an iris pigment epithelial cyst that was floating freely in the posterior chamber of an 18-month-old child. The reason for surgical removal was disturbance in near vision secondary to the movement of the cyst across the visual axis. Visual disturbance secondary to a unilateral anterior vitreous iris cyst at this age is a rare presentation and, to the best of our knowledge, has not been reported previously as an indication for surgery. We performed histopathological study of the cyst aspirate to determine its contents and its possible origin

Anesthesia for Pars Plana Vitrectomy with Insulin Needle, Is It Possible?

Peribulbar block is commonly used for ocular posterior segment surgery. This work aimed to compare the efficacy of using 12.5 mm to 25 mm standard needle length in performing single injection peribulbar block for retinal surgery. Peribulbar block was performed in 120 patients using either standard 25 mm or 12.5 mm 30 G needle (insulin needle). While applying digital pressure around the needle hub, 8–10 mL of local anesthetic are injected. Ocular movement was assessed at 5 and 10 min using simple akinesia score (0–8). If after 10 min score was >1, supplementary injection was given. Visual analogue scale (0–10) was used at the end of the procedure to assess surgeons’ satisfaction and patients’ intraoperative pain. No differences in akinesia score at 5 & 10 min (P=0.34 and 0.36, resp.). Initial volume injected was comparable between groups (P=0.31), however total volume of local anesthesia and supplementary injections were significantly higher in 12.5 mm group (P=0.03 and 0.01, resp.). No difference as regard surgeons’ satisfaction and patients’ intraoperative pain (P=1.0 and 0.18, resp.). Peribulbar block with 12.5 mm needle together with digital compression is a suitable alternative to the standard block with 25 mm needle length for retinal surgery

Teleophthalmology image-based navigated retinal laser therapy for diabetic macular edema : a concept of retinal telephotocoagulation

Background: To determine the feasibility and efficacy of a retinal telephotocoagulation treatment plan for diabetic macular edema. Methods: Prospective, interventional cohort study at two clinical sites. Sixteen eyes of ten subjects with diabetic macular edema underwent navigated focal laser photocoagulation using a novel teleretinal treatment plan. Clinic 1 (King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia) collected retinal images and fundus fluorescein angiogram. Clinic 2 (Palmetto Retina Center, West Columbia, SC, USA) created image-based treatment plans based on which macular laser photocoagulation was performed back at clinic 1. The primary outcome of the study was feasibility of image transfer and performing navigated laser photocoagulation for subjects with diabetic macular edema between two distant clinics. Secondary measures were change in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) by spectral-domain optical coherence tomography at 3 months after treatment. Results: The teleretinal treatment plan was able to be successfully completed in all 16 eyes. The mean logMAR BCVA at baseline was 0.49 ± 0.1, which remained stable (0.45 ± 0.1) 3 months after treatment (p = 0.060). The CRT improved from 290.1 ± 37.6 μm at baseline to 270.8 ± 27.7 μm 3 months after treatment (p = 0.005). All eyes demonstrated improvement in the area of retinal edema after laser photocoagulation, and no eyes demonstrated visual acuity loss 3 months after treatment. Conclusion: This study introduces the concept of retinal telephotocoagulation for diabetic macular edema, and demonstrates the feasibility and safety of using telemedicine to perform navigated retinal laser treatments regardless of geographical distance

Serum molecular signature for proliferative diabetic retinopathy in Saudi patients with type 2 diabetes

Purpose The risk of vision loss from proliferative diabetic retinopathy (PDR) can be reduced with timely detection and treatment. We aimed to identify serum molecular signatures that might help in the early detection of PDR in patients with diabetes. Methods: A total of 40 patients with diabetes were recruited at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, 20 with extensive PDR and 20 with mild non-proliferative diabetic retinopathy (NPDR). The two groups were matched in age, gender, and known duration of diabetes. We examined the whole genome transcriptome of blood samples from the patients using RNA sequencing. We built a model using a support vector machine (SVM) approach to identify gene combinations that can classify the two groups. Results: Differentially expressed genes were calculated from a total of 25,500 genes. Six genes (CCDC144NL, DYX1C1, KCNH3, LOC100506476, LOC285847, and ZNF80) were selected from the top 26 differentially expressed genes, and a combinatorial molecular signature was built based on the expression of the six genes. The mean area under receiver operating characteristic (ROC) curve was 0.978 in the cross validation. The corresponding sensitivity and specificity were 91.7% and 91.5%, respectively. Conclusions: Our preliminary study defined a combinatorial molecular signature that may be useful as a potential biomarker for early detection of proliferative diabetic retinopathy in patients with diabetes. A larger-scale study with an independent cohort of samples is necessary to validate and expand these findings