Aim This work aimed to analyze the ocular aberrations induced by wavefront-optimized (WFO) ablation profiles using I-Trace aberrometer (ray tracing). Settings and design This is a prospective noncomparative nonrandomized clinical study that was carried out at Rooya Eye Center, Alexandria, Egypt. Patients and methods The study included 20 eyes of 10 cases that underwent laser in situ keratomileusis with WFO ablation profile. Cases were followed up at 1 and 3 months after surgery to analyze the ocular aberrations done using I-Trace Visual Functional Analyzer (ray tracing technology). Results The mean preoperative total high-order aberration was changed from 0.33±0.2 to 0.38±0.21 after 1 month (P=0.107) and became 0.35±0.15 at 3 months (P=0.265), which was statistically insignificant, with an increase of 6.074%. The mean preoperative coma was 0.27±0.17 and changed to 0.29±0.2 after 1 month (P=0.345) and became 0.32±0.22 at 3 months (P=0.107), which was statistically insignificant, with an increase of 17.6%. The mean increase in spherical aberrations was from 0.086±0.06 preoperatively to 0.18±0.15 after 1 month (P=0.018) and to 0.19±0.24 at 3 months (P=0.036), which was statistically significant, with an increase of 119.4%. The secondary astigmatism mean preoperative value was 0.06095±0.0439 and increased to 0.0787±0.0535 after 1 month (P=0.103) and became 0.1059±0.0592 at 3 months (P=0.098), which was statistically insignificant, with an increase of 73.7%. The trefoil preoperative mean was 0.18±0.13 and changed to 0.16±0.09 after 1 month (P=0.125) and became 0.15±0.07 at 3 months (P=0.251), which was statistically insignificant, with a decrease of −13.7%. Conclusion There was no significant total high-order aberrations increase after WFO ablation profile for low to moderate myopia.

Purpose The aim of this study was to assess the safety, efficacy, and predictability of wavefront-guided photorefractive keratectomy with simultaneous half-fluence accelerated collagen cross-linking (WFG-PRK Xtra) in myopic eyes with suspicious or borderline corneal tomography. Patients and methods A total of 67 eyes of 40 patients with myopia or myopic astigmatism (sphere <−5.0 D and cylinder <−3.0 D), with abnormal corneal tomography not amounting to forme fruste keratoconus, were included in this retrospective comparative study. Eyes were divided into two groups: 37 eyes (group 1) had WFG-PRK Xtra, whereas 30 eyes (group 2) had conventional PRK with accelerated collagen cross-linking (PRK Xtra). All cases completed at least 1 year of follow-up. Results In group 1 (WFG-PRK Xtra), the mean uncorrected visual acuity improved from 0.96±0.3 to 0.05±0.06 (logMAR) and the mean spherical equivalent decreased from −5.22±2.03 to −0.14±0.32 D. The spherical aberration showed statistically significant increase from 0.05 μm preoperatively to 0.09 μm postoperatively. Three patients developed significant haze and two patients showed overcorrection. However, in group 2 (conventional PRK Xtra), the mean uncorrected visual acuity improved from 0.97±0.35 to 0.04±0.05 (logMAR) and the mean spherical equivalent decreased from −4.98±1.88 to −0.15±0.29 D, whereas the spherical aberration increased from 0.04 to 0.05 μm. Two patients developed significant haze and one patient showed regression. No cases of postoperative ectasia were detected in either group. Conclusion The results of this study suggest that both WFG and conventional PRK with simultaneous half-fluence corneal collagen cross-linking were safe, effective, and predictable in refractive candidates with abnormal or borderline corneal tomography.

Aim The aim of this study was to assess the corneal endothelial cell loss after toric implantable collamer lens (TICL) implantation for correction of myopia and astigmatism after penetrating keratoplasty (PKP). Setting and design This is a prospective noncomparative nonrandomized clinical study that was carried out at Alex Eye Center, Alexandria, Egypt. Patients and methods The study was conducted on 12 eyes of eight patients who underwent PKP for keratoconus. After a full preoperative assessment, VISIAN TICL was implanted after a minimum of 1 year with stable refraction. Cases were followed up for 1 year postoperatively for refraction, visual acuity, endothelial cell density (ECD), adverse events, and postoperative complications. Results The refractive and visual outcome in this study proved to be satisfactory regarding efficacy, predictability, and stability. The ECD loss was reduced from a preoperative mean of 2238.6±113.3 cells/mm² (range=2033–2367 cells/mm²) to a postoperative mean of 2124.8±107.6 cells/mm² (range=1930–224 cells/mm²) at 6 months postoperatively, with a percentage of loss of −5.09%, and to a mean of 2023.4±109.2 cells/mm² (range=1833–2192 cells/mm²) at 1 year postoperatively, with a percentage of loss of −9.61%. Both were statistically significant (P=0.042 and 0.0016, respectively). Conclusion TICLs were effective for correction of high ametropia after PKP, with high efficacy, predictability, stability, and safety. However, ECD loss was reported postoperatively up to 1 year. Further studies are required to assert upon these results.

Background and aim Diabetic retinopathy and maculopathy are major tragedies in ophthalmology. Lipoprotein (Lp) (a) is a pro-atherogenic and a pro-thrombotic risk factor. It has an antifibrinolytic effect with increasing risk of clotting and blood vessel occlusion. Elevated Lp (a) concentrations can also damage the microcirculation by its oxidative effect. The aim of this study was to investigate the relationship between serum level of Lp (a) and the development of maculopathy in diabetic patients by measuring the central macular thickness (CMT) using optical coherence tomography. Patients and methods This case–control study included one case group of 40 eyes of 20 diabetic patients and one control group of 40 eyes of 20 nondiabetic age-matched and sex-matched patients. All participants were subjected to full ophthalmological examination, including best-corrected visual acuity testing, BMI calculation, glycosylated hemoglobin (HbA1c), serum Lp (a), and CMT measurement by three-dimensional optical coherence tomography. Results There was no significant difference between the two groups regarding age or sex. Cases group had significantly higher BMI, HbA1c, Lp (a), and CMT than the control group (P<0.001 for all). In addition, cases had significantly lower best-corrected visual acuity than the controls (P<0.001). A significant positive correlation was found between CMT (μm) and each of HbA1c, Lp (a), and BMI (P<0.001, P<0.001, and P=0.002, respectively). Lp (a) level of 11.34 ng/ml or more was found to have a 95% sensitivity, 95% specificity, and 95% overall accuracy in predicting central macular edema (CME). On univariate logistic regression analysis, both of the BMI and Lp (a) were independent significant predictors for CME (P<0.001 and P=0.05, respectively), with odds ratio of 1.569 and 14.482, respectively. Conclusion Lp (a) was significantly correlated with CMT. It had an excellent sensitivity and specificity in predicting CME and can be used as a potential marker for its detection.

Aim The aim of this study was to correlate the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness with glycosylated hemoglobin (HbA1c) in diabetic patients. Setting and design This is a comparative case series study that was conducted on 58 eyes of 30 diabetic patients attending the Outpatient Clinics of the Ophthalmology Department, Beni-Suef University Hospital, Beni-Suef, Egypt, between June and August 2019. Patients and methods The 30 cases were divided into two equal groups: uncontrolled diabetic group (group 1), with HbA1c more than or equal to 7%, and controlled group (group 2), with HbA1c less than 7%. Both eyes in each patient were scanned using optical coherence tomography, ‘Optovue.’ Blood samples for HbA1c testing were collected as well. Results There was a significant negative correlation between average, superior, inferior, and nasal RNFL quadrant thickness and HbA1c in group 1, which was found with HbA1c level more than 9%. In group 2, there was no statistically significant correlation of HbA1c and all RNFL parameters in both eyes. In addition, in group 1, there was a significant negative correlation of average, superior, and inferior GCC quadrant thickness and a positive correlation of focal loss volume with Hb1Ac level more than 9%. In group 2, the average and inferior GCC thickness showed a positive correlation with HbA1c. Furthermore, focal loss volume and global loss volume were negatively correlated with HbA1c. Conclusion There was a statistically significant correlation between thinning of most of RNFL and GCC quadrants and uncontrolled HbA1c more than 9%.

Background Diabetic macular ischemia (DMI) has a known effect on visual loss in diabetics. Optical coherence tomography angiography (OCTA) allows identification of the vascular abnormalities of diabetic maculopathy. Aim This study aimed to detect the quantitative and qualitative OCTA features of foveal and macular areas in diabetic patients with unexplained visual loss. Settings and design This was a cross-sectional study. Patients and methods This cross-sectional study enrolled 15 diabetic patients with unexplained visual loss. They underwent comprehensive ophthalmological assessment, including measurement of best-corrected visual acuity (BCVA) converted to LogMAR for statistical analysis and macular OCTA imaging (AngioVue OCTA). Quantitative data analyzed were foveal avascular zone (FAZ) area, FAZ perimeter, and acircularity index (AI). Vessel density (VD) parameters included full-retinal VD in a 300-µm circle around the FAZ (FD-300) plus foveal and parafoveal VD in superficial and deep capillary plexuses. Results A positive significant correlation was found between LogMAR BCVA and FAZ area (r=0.701, P=0.004), FAZ perimeter (r=0.732, P=0.002), and AI (r=0.540, P=0.038). However, there was no significant correlation between BCVA and either FD-300 (P=0.144), or superficial and deep parafoveal VD (P=0.187 and 0.764, respectively), or superficial and deep foveal VD (P=0.34 and 0.187, respectively). In addition, DMI grade showed a significant positive correlation with LogMAR BCVA (P=0.011). Conclusion FAZ parameters (perimeter, area, and AI) measured by OCTA macula can precisely depict DMI in diabetic patients with unexplained visual loss and are closely correlated to BCVA. It is recommended to perform OCTA macula for those patients before making treatment decisions.

Background Retinal vein occlusion is one of the most common vascular disorders that can cause visual loss. It is classified into central retinal vein occlusion (CRVO) and branch retinal vein occlusion. The most common cause of visual loss in CRVO is cystoid macular edema. Intravitreal injection of many antivascular endothelial growth factor agents can treat cystoid macular edema that occur owing to CRVO. Purpose The aim of the present study was to evaluate the efficacy of a new drug (Ziv-aflibercept) in the management of patients with CRVO. Patients and methods This is a prospective interventional study that was conducted on 15 eyes of 15 patients of recently diagnosed nonischemic CRVO of less than 2-month duration. Three loading doses of 1.25 mg of Ziv-aflibercept were given 1 month apart for each patient and then continued as needed in a pro re nata regimen. Complete ophthalmic evaluation was done at the Ophthalmology Department of Tanta University, including best-corrected visual acuity (BCVA), fundus examination, intraocular pressure measurement, and anterior segment examination. Optical coherence tomography (TOPCON 3D optical coherence tomography machine) was done for all patients at presentation and 1 month after each injection and then monthly during the follow-up period, which persisted for 6 months. Results The intraocular pressure did not show a statistically significant increase after intravitreal injection of Ziv-aflibercept. The BCVA improved significantly from 0.87±0.10 to 0.32±0.12 LogMAR after injection (P=0.001). The central macular thickness decreased significantly from a baseline value of 771±141.87 μm before injection to 306.67±91.51 μm after the three loading doses and to 208.07±12.97 μm after 6 months (P=0.001). There was no statistically significant correlation between the final BCVA and the final central macular thickness after 6 months (r=0.054, P=0.848). No serious complications were reported, such as endophthalmitis, vitreous hemorrhage, retinal detachment, or stroke. Conclusion Ziv-aflibercept is a highly effective drug in cases of nonischemic CRVO with a high safety profile and a relatively low cost.

Purpose This prospective study aimed to identify the incidence of retinopathy of prematurity (ROP) in premature infants in a neonatal ICU in a tertiary care hospital and to evaluate the risk factors predisposing to it. Patients and methods All preterm babies admitted to the neonatal ICU, during the study period, with gestational age (GA) less than 37 weeks and low birth weight (LBW) of less than or equal to 2.00 kg, were included in this study. Examination and follow-up of patients were done by binocular indirect ophthalmoscopy using a 28 D lens with a speculum and scleral depressor to examine the retinal periphery after efficient pupillary dilatation. Results Of 216 screened neonates, 66 (30.6%) developed ROP. Of these, 27 (40.9%) had stage 1, 35 (53.0%) had stage 2, and four (6.1%) had stage 3 ROP. The incidence was high in the GA group less than 28 (86.7%) weeks and in LBW neonates (100.0%). ROP was associated with LBW (1280±435 g, P<0.001), GA (30.4±1.9 weeks, P=0.005), sepsis (P=0.006), anemia (P=0.007), blood transfusion (P=0.018), bronchopulmonary dysplasia (P=0.001), and O₂ therapy (P=0.006) as well as its duration (P<0.0001) by multiple logistic regression analysis. Conclusion ROP incidence in our tertiary care hospital was 30.6%. The main risk factors for ROP development were low GA, LBW, anemia, blood transfusion, sepsis, bronchopulmonary dysplasia, and O₂ therapy and its duration. Prevention of prematurity, control of infection, reduction of blood sampling to prevent occurrence of anemia with subsequent blood transfusion, and judicious use of O₂ therapy may be promising factors that may decrease the incidence and severity of ROP.

Aim The aim of this study was to evaluate the safety and efficacy of low-dose (0.01%) topical atropine eye drops for slowing down the progression of myopia in children and adolescents. Patients and methods A total of 600 eyes of 300 patients aged from 8 to 14 years were included in the study. They were divided into two groups: group A, which included 300 myopic eyes with a spherical equivalent (SE) between −3.00 and −6.00 D that received low-dose (0.01%) topical atropine eye drops once daily for 1 year, and group B as a control group, which consisted of 300 myopic eyes (with SE between −3.00 and −6.00 D) that did not receive the topical atropine eye drops. Posttherapy follow-up for myopia progression was done at 6 months, 1, 1.5, 2, 2.5, and 3 years. Results By the end of 3 years, the mean SE was −5.1±1.75 D in group A in comparison with −6.15±3.15 D in group B. The progression of myopia was significantly more in group B than in group A after 1 year of follow-up and continued with statistically significant difference till the end of the follow-up period. No significant changes in topography or pachymetry were reported in the present study. In addition, no complications related to the low-dose topical atropine drops (0.01%) were reported. Conclusion The use of low-dose (0.01%) topical atropine eye drops was safe and effective in decreasing the progression of myopia in children and adolescents.

Purpose The aim of this study was to evaluate the efficacy of combining mitomycin-C (MMC) with modified rectangular 3-snip punctoplasty and mini-Monoka stent to treat punctal stenosis. Design This is a prospective interventional case series. Patients and methods The study included 62 eyes of 31 patients diagnosed with epiphora secondary to punctal stenosis who received modified rectangular 3-snip punctoplasty with mini-Monoka stent and MMC in their right eyes (Rt eye group) and modified rectangular 3-snip punctoplasty with mini-Monoka stent only in their left eyes (Lt eye group). Epiphora, punctal opening, and tear meniscus height (TMH) were evaluated and compared with the preoperative data in both groups. The main outcome measures were epiphora, punctal opening, and TMH. Results A total of 17 (54.8%) patients were females, with a mean age of 58.4±5.1 years. No surgical complications were reported. Epiphora and TMH were improved, with a functional success of 90.3% in the Rt eye group and 87.1% in the Lt eye group, as compared with the preoperative status (P<0.001). The punctum remained open, with anatomical success achieved in 29 (93.5%) eyes in the Rt eye group and in 28 (90.3%) eyes in the Lt eye group (P<0.03). Moreover, the TMH and punctal grading were significantly better in the Rt eye group compared with Lt eye group during the 12th and 24th postoperative week follow-up visits (P<0.05). Conclusion MMC proved to be an efficient and safe therapeutic adjuvant in the armamentarium of oculoplastic surgeons to treat punctal stenosis.