Introduction keratoconus is a common disease in the general population, with prevalence ranging up to 200 per 100 000 with a reported increase in Saudi Arabia. Collagen Cross-Linkage is now an established treatment in isolation and in conjunction with other modalities for managing keratoconus. Our aim is to evaluate using a cohort study the impact of the treatment over a course of 18 months. Methods To evaluate the impact of 18 months after collagen cross-linkage treatment and its determinants in eyes with keratoconus in Western Saudi Arabia. A one-armed prospective cohort study design on 45 patients with Stage I, II, III and IV keratoconus who were treated by Collagen Cross-Linkage modality was developed at our institute between 2018 and 2019 to establish the success rate of corneal ectasia stabilization of the disease. Results Demographic data and grades of keratoconus (Amsler - Krumiech classification) at presentation were correlated to changes in corneal parameters 18 months after CXL compared to that at presentation. Stage I, II, III and IV keratoconus were 13, 14, 2 and 16 eyes respectively. The study showed that the K max significantly declined (P = 0.05) while spherical equivalent refractive status changed from median −1.5D to −2.27D (P = 0.002). Meanwhile, Central corneal thickness significantly reduced (P = 0.001). Conclusion CXL can prove to be efficient in the treatment of Keratoconus and more studies should study ways to improve and implement this treatment plan to such patients.

Introduction: The aim of this study was to present the clinical presentation and short-term outcomes of uncomplicated rhegmatogenous retinal detachment managed by pneumatic retinopexy at a tertiary eye hospital in western Saudi Arabia. Materials and methods:  This one-armed retrospective cohort study evaluated selected cases of rhegmatogenous retinal detachment managed by pneumatic retinopexy between 2017 and 2018. Data were collected on patient demographics, preoperative ophthalmic assessment, surgical details, follow up at six months postoperatively, complications and the need for additional surgery. Anatomic success was defined as retinal attachment at 6 months and functional success was defined as vision >20/200 at six months postoperatively. The association of lens status and concomitant laser treatment to anatomical success rates were evaluated. Results: The study sample consisted of 15 eyes with rhegmatogenous retinal detachment in the upper quadrant. In 14 cases, C3F8 gas was used. Anatomic and functional success was noted in 73.3% [95% confidence interval (CI) 51.0: 95.7] and 86.7% (95% CI 69.2; 100) of eyes, respectively. The association between anatomical success and lens status was not significant [RR = 4.5 (95% CI 0.6 ; 37.5), P=0.1]. There was no significant association between anatomical success and concomitant laser treatment. [RR = RR = 1.7 (95% CI 0.7 ; 4.0), P=0.2]. A 2nd retinal surgery was not required in 33.3% of eyes (95% CI 9.5 ; 57.2).  Conclusion: If stringent selection criteria are used for managing rhegmatogenous retinal detachment with pneumatic retinopexy,  anatomical and functional success by six months postoperatively is achieved in the majority of cases. Additional surgeries could further improve outcomes.

BACKGROUND Keratoconus (KC) is a progressive, bilateral, asymmetric corneal degeneration. KC is as a common disease in the general population, with prevalence ranging up to 200 per 100 000. Twenty percent of keratoconus patients present with irregular astigmatism leading to severe visual deterioration (1) . The inciting mechanism for keratoconus remains unknown, however genetic and environmental factors have been implicated. Environmental factors include excessive eye rubbing, allergy and sun exposure which can lead to greater expression of reactive oxygen species (2). Collagen cross linkage (CXL) is now an established treatment in isolation and in conjunction with other modalities of manging keratoconus (3, 4) . Keratoconus is highly prevalent in Saudi Arabia (5). CXL is also an established procedure in different eye institutions of the Kingdom with promising outcomes (6, 7). The earlier publications from central, eastern and western cities of the Kingdom had one year follow up. To the best of our knowledge, outcome of intervention from Macca city of western Saudi Arabia with a long term follow up is not available that could add to literature. We present outcomes of collagen cross linkage treatment and its determinants after 18 months in eyes with keratoconus at Macca, Saudi Arabia. OBJECTIVE To evaluate impact of 18 months after collagen cross linkage treatment and its determinants in eyes with keratoconus in Western Saudi Arabia. METHODS This was a one armed cohort study. Cases of keratoconus treated by Collagen cross linkage treatment (CXL) at our institute between 2015 and 2016 were included. Demographic data and grade of keratoconus (Amsler - Krumiech classification) at presentation were correlated to change in corneal parameters 18 months after CXL compared to that at presentation. RESULTS Our cohort had 45 eyes with keratoconus. Stage I, II, III and IV keratoconus were 13,14,2 and 16 eyes respectively. The K max significantly declined (Wilcoxon P = 0.05). The success of stabilizing corneal ectasia was achieved in 29/39 = 74.4%. Spherical equivalent refractive status changed from median -1.5D to -2.5D (WP =0.002). Central corneal thickness significantly reduced from median 471 to 460 ((WP =0.001). The Best corrected Visual acuity remained same 0.6 at 18 months follow up. Kmax based stabilization of cornea was not associated to the grade of keratoconus. (c2 = 2.2, P = 0.1). Stabilization of keratoconus was not associated to gender (P = 0.9) and laterality (P = 0.3). CONCLUSIONS The steepening of cornea stabilized 18 months after collagen cross linkage treatment. But vision remained same and cornea thinned out. There was a myopic shift for refractive status. Stabilization of corneal parameters did not vary significantly by grades of keratoconus. CLINICALTRIAL Keratoconus; corneal dystrophies; corneal ectasia; collagen cross linkage; CXL.