Background Psoriasis is an immune-mediated systemic inflammatory disease in which corneal affection takes various forms such as dry eye disease (DED), punctate epithelial keratitis, and sterile corneal infiltrates. Purpose The aim of this study was to evaluate the corneal epithelial profile of psoriasis patients using anterior segment optical coherence tomography (AS-OCT). Patients and methods This is a cross-sectional analytic study that included 81 eyes: 39 eyes of 20 psoriasis patients and 42 eyes of 21 healthy age-matched and sex-matched controls. They were divided into three groups: psoriasis patients with dry eye disease (PDED), psoriasis patients without DED (PS), and healthy subjects (HS). AS-OCT was done to study the epithelial profile data of each eye and to correlate any finding with the disease activity evaluated by the Psoriasis Area and Severity Index score and disease extent. Results The PDED patients showed significantly lower central corneal thickness (CCT), higher central epithelial thickness (CET), and thicker inferior epithelium (P=0.004, 0.002, and 0.005, respectively). A significantly thinner superior epithelium was detected in the PS group compared with the PDED and HS groups (P=0.001 and 0.010, respectively). In addition, the topographic thickness variability (SD) and minimim–maximum were significantly higher in both the PDED and PS groups compared with the HS group (P<0.001). The CCT showed a significantly positive correlation with the tear breakup time (r=0.373, P=0.020), while the CET showed a significantly negative correlation with it (r=−0.331, P=0.040). The CET also had a significant positive correlation with disease duration (r=0.390, P=0.014) and disease extent (r=0.323, P=0.045). Conclusion AS-OCT has proved to be a valuable method for screening and detecting the corneal whole thickness and epithelial thickness abnormalities in psoriasis patients in the presence or absence of DED. The presence of thicker epithelium and thinner CCT were significant findings in the PDED, while in psoriasis patients without DED, superior epithelial thinning was the significant finding. A statistically significant high topographic thickness variability was detected in both groups compared with the controls.

Purpose The aim of this study was to evaluate the corneal changes after corneal collagen cross-linking (CXL) in progressive keratoconus using anterior segment optical coherence tomography. Patients and methods This prospective interventional noncomparative case-series study was conducted on 30 eyes of 18 patients of both sexes with a mean age of 23.11±4.06 years diagnosed as progressive keratoconus patients with clear central cornea. All eyes underwent epithelium-off accelerated CXL. Anterior segment optical coherence tomography and Scheimpflug camera imaging were done to all cases preoperatively and at 1, 3, and 6 months, postoperatively. Results The demarcation line (DL) was detected in all eyes 1 month postoperatively, and was still detected at 3 and 6 months, postoperatively. However, it was accurately measured until 3 months postoperatively. At 6 months, it was barely visible, so measuring its depth was difficult to be done. There was a statistically significant positive correlation between the thinnest corneal thickness and the central corneal DL depth (r=0.480, P=0.006). There was no statistically significant correlation between the maximum keratometric reading (K-max) and the depth of central corneal DL (r=−0.253, P=0.17). In addition, there was no statistically significant correlation between corneal densitometry and the depth of central corneal DL (r=−0.68, P=0.715). Conclusions The DL is a direct clinical sign of corneal CXL and can be found within 6 months after the treatment, being most clearly visible at 1 month after CXL. However, the line starts to be less visible after 3 months and becomes barely visible after 6 months postoperatively, making it difficult to measure its depth at that time.

Purpose The aim of this study was to evaluate the safety and efficacy of double stromal lenticules, extracted by femtolaser small incision lenticule extraction (SMILE) surgery, as a surgical adjuvant for sealing of impending corneal perforation. Patients and methods The study included 20 eyes of 20 patients with impending corneal perforation. Double corneal stromal lenticules obtained through SMILE surgery, with a central thickness of 65 μm for each lenticule, were fixed over the corneal impending perforation site by 10-0 nylon interrupted stitches. The patients were monitored for a minimum of 6 months and were assessed using slit-lamp biomicroscopy, fluorescein stain, tonometry, and best spectacle-corrected visual acuity measurements. Postoperative complications were recorded throughout the follow-up period. Results The mean age of the patients was 51.25±1.49 years. The mean thickness of the used double SMILE lenticules was 108.85±10.77 μm (range, 90–120 μm). The preoperative best spectacle-corrected visual acuity was counting fingers at 30 cm in four patients, whereas the other 16 patients had a visual acuity of hand movement. Postoperatively, the corneal perforations were successfully sealed in 16 (80%) patients, and 15 (75%) patients exhibited a statistically significant improvement in visual acuity (P=0.02). During the follow-up period of 6 months, there was evidence of one case of infection and two cases of sliding graft. There was no significant association between the patients’ data and the reported complications except the association between complications and hand movement visual acuity. Conclusion The use of double corneal lenticules was a safe and effective surgical adjuvant for corneal perforation closure. It is a simple and inexpensive temporary measure to improve the corneal condition for further definitive interventions.

Purpose The aim of this study was to investigate the ultrastructure of corneal incisions after phacoemulsification by anterior segment optical coherence tomography (AS-OCT). Patients and methods This is a prospective interventional study of 50 eyes of 50 patients with senile cataract attending the Outpatient Clinic of the Ophthalmology Department, Qena University Hospital, Qena, Egypt, for whom clear corneal-incision phacoemulsification was performed from July 2020 to July 2021. The patients had preoperative and postoperative AS-OCT, and were followed up at 1 week, 2 weeks, 1 month, and 3 months, postoperatively. The four AS-OCT features that were studied were corneal thickness at the site of the main incision, epithelial and endothelial changes at the wound, and Descemet’s membrane detachment. Results The mean age of the patients was 62.16±7.71 years. The mean corneal thickness was 768.06±102.03, 883.24±96.59, 841.98±100.70, 797.68±98.12, and 782.26±101.66 μm preoperatively, at 1 week, 2 weeks, 1 month, and 3 months postoperatively, respectively (P<0.001). Descemet’s membrane detachment was observed in nine (18%) and seven (14%) patients at 1 and 2 weeks postoperatively, respectively. Epithelial gaping was observed in five (10%) patients at 1 week and in two (4%) patients at 2 weeks. It was not observed after 1 month, postoperatively. Endothelial gaping was observed in 36 (72%) patients at 1 week, in 30 (60%) patients at 2 weeks, and in four (8%) patients at 1 month, and was not present after 3 months. Conclusion AS-OCT is an excellent tool to assess the integrity and structure of the corneal wound after phacoemulsification sensitively and quantitatively. So, it could play an important role in the early detection and management of endophthalmitis.

Purpose The aim of this study was to evaluate the accuracy of intraocular lens (IOL) power calculation using Scheimpflug tomography and OKULIX ray-tracing software in cases of paracentral corneal scarring. Patients and methods The study was conducted on 40 consecutive eyes: 20 with corneal scarring and coexisting cataract and 20 controls with clear cornea, for whom uneventful phacoemulsification and IOL implantation was performed. Preoperatively, Scheimpflug tomography and OKULIX ray-tracing software and third-generation IOL power calculation formulas were used for IOL power calculation. Accuracy of IOL power calculation was evaluated by subtracting the expected and achieved spherical refraction, 3 months postoperatively and was recorded as the mean absolute error (MAE). The distance uncorrected visual acuity for each eye was measured preoperatively and 3 months postoperatively; the visual acuity was scored and converted to the logarithm of the minimum angle of resolution (LogMar) for statistical analysis. Results In cases of corneal scarring, all eyes (100%) yielded a postoperative spherical refraction which differed by less than 1 D from the predicted. In 16 (80%) eyes, the postoperative spherical refraction was within 0.50 D from the expected. The MAE was 0.2 D in cases of corneal scarring, which did not differ significantly from the controls (MAE=0.1 D), P=0.142. In corneal scarring cases, the distance uncorrected visual acuity showed significant improvement from 1.3 LogMar (Snellen’s equivalent 20/400), preoperatively, to 0.5 LogMar (Snellen’s equivalent 20/60), 3 months postoperatively. Conclusion Scheimpflug tomography combined with OKULIX ray-tracing software for the calculation of IOL power provided accurate results in cases of corneal scarring.

Purpose The aim of this study was to investigate the role of sex on retinal nerve fiber layer (RNFL) thickness and macular thickness measurement by spectral domain optical coherence tomography (SD-OCT). Patients and methods In this prospective observational study, 200 participants who fulfilled the inclusion and exclusion criteria were scanned three times as per predefined guidelines at 0, 30, and 60 min on the same day, by the same investigator using SD-OCT for measurement of RNFL and macular thickness. The observations were statistically analyzed and correlated. Results The RNFL thickness was greatest in the superior quadrant and thinnest in the temporal quadrant. The mean value of average RNFL thickness was 87.90±6.12 μm in females and 93.18±4.04 μm in males (range=74.33–99.67 μm). A statistically significant difference was found between males and females in all quadrants and in average RNFL thickness (P<0.0005). The macular thickness was thinnest at the central zone (innermost 1-mm ring), thickest within the inner 3-mm ring, and diminished peripherally. The mean macular thickness was 272.95±8.40 μm in females and 289.42±12.32 μm in males. A statistically significant difference was found between males and females in all macular zones and in the mean macular thickness (P<0.0005). Conclusion RNFL thickness and macular thickness were significantly thicker in males compared with females in healthy eyes. Sex should be used as an additional parameter in commercially available OCT machines, in addition to age, because of its potential in improving the existing RNFL thickness and macular thickness norms.

Background Age related macular degeneration (AMD) is the most common cause of irreversible visual loss in elderly individuals. Purpose The aim of this study was to identify the potential role of serum pro-inflammatory cytokines, including interleukin-13 (IL-13), IL-17, tumor necrosis factor-α (TNF-α), transforming growth factor β (TGF-β), and vascular endothelial growth factor (VEGF), in patients with AMD. Patients and methods The patients were divided into three groups: 20 patients with dry AMD, 20 patients with wet AMD before treatment with anti-VEGF injections, and 20 patients with wet AMD after anti-VEGF injections. Serum samples from patients with AMD and 20 age-matched controls were examined for the aforementioned cytokines using the ELISA technique. Results Serum levels of IL-13, IL-17, and TGF-β were significantly elevated in all patients with AMD compared with the controls (P=0.045, 0.047, and 0.042, respectively). There was a positive correlation (r=0.6, P=0.045) between the levels of IL-13 and TGF-β in these patients. In addition, the serum levels of TNF-α were significantly decreased in patients with AMD compared with the controls (P=0.037). The serum levels of IL-17 of the patients treated with anti-VEGF were significantly decreased compared with the untreated patients (P=0.032). In addition, the serum levels of TNF-α were significantly elevated in the treated patients compared with the untreated patients (P=0.024). There was no significant difference in the levels of IL-13, TGF-β, and VEGF in the treated patients compared with the untreated patients (P=0.07). Conclusion The study demonstrated that AMD is an inflammatory disease as patients with AMD had elevated levels of IL-13, IL-17, and TGF-β. In addition, serum IL-17 and TNF-α level could be significant predictors of the efficiency of anti-VEGF therapy. These findings may help in improvement of AMD diagnosis and may lead to the development of new therapeutic agents targeting these cytokines.

Purpose The aim of this study was to evaluate the changes in retinal vascular plexuses and choriocapillaris in type-2 diabetes mellitus (DM) patients without clinical diabetic retinopathy (DR) and to compare them with healthy controls and to identify early preclinical biomarkers for DR using optical coherence tomography angiography (OCTA). Patients and methods This is a prospective cross-sectional study that included 68 eyes (34 eyes of type-2 diabetic patients without DR and 34 eyes of healthy controls). Using OCTA, the vessel density (VD) in the superficial and deep capillary plexuses, macular thickness, foveal avascular zone (FAZ) area, and choriocapillaris flow area were measured. The OCTA morphological findings in diabetic patients were noted. In addition, the correlations between OCTA and glycosylated hemoglobin and diabetes duration were evaluated. Results There was a statistically significant decrease in the parafoveal macular thickness in the diabetic group compared with the control group (the superior–hemi parafoveal thickness was 310.94±10.84 vs. 321.71±11.2 μm, respectively, P=0.001, while the inferior–hemi parafoveal thickness was 304.71±11.04 vs. 320.82±11.25 μm, respectively, P=0.001). There was no statistically significant difference in the parafoveal and perifoveal superficial capillary plexus and DCP VD in the diabetic patients compared with the controls. In addition, there was no change in the FAZ area between the two groups, but there was a significant difference regarding the FAZ irregularity (P=0.00). Microaneurysms (100%), capillary nonperfusion (94%), capillary loop (17.6%), enlarged perifoveal intercapillary spaces (17.6%), punched-out FAZ (12%), lost spider web (6%), and capillary blind end (6%) were detected in the diabetic patients. A negative significant correlation was found between the parafoveal thickness and glycosylated hemoglobin in the DM group in the inferior–hemi thickness (r=−0.61, P=0.01), and between DM duration and VD in the DCP in the parafoveal and perifoveal areas (r=−0.55, P=0.06 and r=0.62, P=0.018, respectively). Conclusion OCTA can be used to diagnose preclinical maculopathy/retinopathy in diabetic patients using the parafoveal retinal thickness, DCP VD, FAZ irregularities, quantification of microaneurysms, and choriocapillaris flow area as biomarkers.

Background Schizophrenia is associated with visual perception and early processing deficits. Retinal optical coherence tomography (OCT) parameters can be biomarkers of neural pathology and disease progression by detecting neurodegenerative changes. Purpose The aim of this study was to detect neurodegenerative changes in schizophrenic patients by OCT and to correlate them to the severity and duration of schizophrenia. Patients and methods This is a comparative case–control study that included 60 participants: 30 male schizophrenics compared with 30 age-matched and sex-matched healthy persons. Both groups were subjected to ophthalmic examination, including visual assessment, anterior-segment examination using slit lamp, and posterior-segment examination by indirect ophthalmoscopy. Schizophrenic patients were subjected to psychometric evaluation using Positive and Negative Syndrome Scale. Then, OCT imaging was done for all participants. Results The schizophrenic group showed thinning of the retinal nerve fiber layer (RNFL) compared with the controls. The difference was statistically significant regarding the average, superior, and nasal quadrants (P=0.002, P<0.001, and P<0.001, respectively), but it was insignificant in the inferior and temporal quadrants (P=0.187 and 0.074, respectively). The average ganglion cell complex thickness showed insignificant difference between the two groups regarding the average, superior, and inferior sectors (P=0.650, 0.624, and 0.694, respectively). There was a significant negative correlation between schizophrenia duration and RNFL average, superior, and inferior thickness (r=−0.566, P=0.001, r=−0.555, P=0.001, and r=−0.479, P=0.007, respectively). Conclusion Schizophrenics were found to have a significantly reduced peripapillary RNFL thickness, especially in the superior and nasal quadrants. This reduction became more obvious with disease chronicity.

Background Following surgery to address intermittent exodeviation, consecutive esotropia (ET), in which postoperative ET continues for more than 6 months, may arise. Both lateral rectus advancement (LRA) and medial rectus recession (MRR) are effective in correction of consecutive ET. Purpose The aim of this study was to compare the results of LRA and MRR in correction of consecutive ET (within 40 PD) following bilateral lateral rectus recession for treatment of intermittent exotropia. Patients and methods This was a randomized double-blind controlled trial that included 30 patients who were divided into two groups: group 1 (LRA group, 15 patients) and group 2 (MRR group, 15 patients). Unilateral or bilateral LRA or MRR was done according to the preoperative angle of deviation. All patients had preoperative ocular examination, which included history taking, visual acuity testing, slit-lamp examination, fundus examination, preoperative angle of deviation at near and far using the Krimsky method, stereopsis using the Titmus test, and suppression using the Worth 4-dot test. The patients were followed up at 1, 3, and 6 months after surgery. Results There was no statistically significant difference between the two groups in the preoperative angle of deviation (P=0.213). In group 1, the mean preoperative angle of consecutive ET was 29.0±6.14 PD, which improved to 0.87±3.56 PD 6 months after surgery, with a statistically significant difference (P<0.001). In group 2, the mean preoperative angle of consecutive ET was 25.47±8.81 PD and improved to 1.67±4.58 PD 6 months after surgery, with a statistically significant difference (P<0.001). However, there was no statistically significant difference between the two groups in the postoperative angle of deviation (P=0.562). Six months postoperatively, there were two (13.3%) undercorrected cases and one (6.7%) overcorrected case, with a success rate of 80% in group 1, whereas in group 2, there were two (13.3%) undercorrected cases and two (13.3%) overcorrected cases, with a success rate of 73.4%, with no statistically significant difference between the two groups in the success rate (P=0.66). In group 1, the mean preoperative stereoacuity value was 291.7±206.5, which improved significantly postoperatively to 140±35.71 (P=0.005). Similarly, in group 2, the mean preoperative stereoacuity value was 506.7±810.5 and improved significantly postoperatively to 150±46.41, (P=0.003). Conclusion Both LRA and MRR were effective in the correction of consecutive ET.

Background Mucormycosis is an opportunistic fungal infection with high morbidity and mortality. Purpose The aim of this study was to determine the risk factors, clinical presentation, management, and outcome of management of orbital mucormycosis during the coronavirus disease 2019 (COVID-19) pandemic. Patients and methods This is a prospective hospital-based observational study that was conducted on cases of rhino-orbital cerebral mucormycosis (ROCM) presented to a tertiary health-care center in North-West Rajasthan, India, during the second wave of COVID-19 over a period of 1 month (May 26, 2021 to June 25, 2021). The patients were followed up for 3 months. A total of 40 cases fulfilling the clinical, radiological, and pathological or microbiological criteria for the diagnosis of ROCM were included in the study. Results Out of a total of 126 mucormycosis patients, 40 had ocular manifestations ranging from lid edema, chemosis, and ptosis to severe manifestations such s ophthalmoplegia, optic neuritis, and cavernous sinus thrombosis. Rare presentations of corneal eschar and corneal ulcer were also reported. Among the 40 patients of orbital mucormycosis, 57.5% were in the age group of 51–65 years, 65% were males, 62.5% were COVID positive, 37.5% had a history of oxygen therapy during the COVID-19 illness, and 85% were not vaccinated against COVID-19. All patients with orbital involvement had rhinitis at presentation. Intravenous Amphotericin B was given to all patients. Functional endoscopic sinus surgery was done in 92.5% of the cases and orbital exenteration was done in 35% of the patients to prevent the spread of mucor and to reduce mortality. In 32.5% of the patients, retrobulbar Amphotericin B was given. The mean length of hospital stay was 24.62±11.70 days and 70% of the patients were discharged from the hospital on oral antifungal therapy. A total of 30% of the patients with cerebral involvement passed away. During the follow-up of 3 months, three (7.5%) more patients who discontinued treatment progressed to advanced disease and died, while 62.5% (25 out of 40) patients were alive with stable/regressed disease. The survival rate with retrobulbar Amphotericin B was 92.30% and with exenteration was 92.85%, which was statistically significant compared with the 5% survival rate in the cases in whom no such intervention was done. Conclusion Early diagnosis and treatment of ROCM reduced morbidity and mortality in mucormycosis patients.