Purpose The aim of this study was to assess and compare minimally invasive pterygium surgery with air-assisted dissection technique for excision of primary pterygium. Patients and methods This prospective randomized comparative study was carried out on 20 eyes of 16 patients with primary pterygium. The cases were randomly divided into two equal groups: group I included 10 eyes in which pterygia were excised with minimally invasive pterygium surgery, and group II included 10 eyes in which pterygia were excised with air-assisted dissection technique. Postoperative examination and follow-up for 3 months were carried out. Results The mean age of the patients was 46.1±3.8 years. Successful dissection was recorded in 80% of cases in group I and in 70% of cases in group II. Recurrence occurred in 10% of cases in each group, with a follow-up duration of 3 months. Conclusion The minimally invasive pterygium surgery is superior to air-assisted dissection of pterygium as it keeps the tenon capsule intact.

Purpose The aim of the study was to evaluate the efficacy and safety of using corneal collagen cross-linking as a refractive procedure to correct corneal astigmatism. Setting This study was conducted in Sohag University Hospital (Egypt). Design This is a prospective, nonrandomized, clinical trial study. Patients and methods Fifteen eyes of 11 patients complaining of astigmatism were treated with refractive meridional cross-linking (RMCXL). Group A included eight eyes that had undergone previous cross-linking and implantation of intracorneal rings that failed to correct the astigmatic component of keratoconus. Group B included seven eyes with astigmatism without corneal ectasia. All eyes were subjected to examination of the preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and manifest refraction, as well as slit lamp examination of the anterior segment, keratometry, and pachymetry by corneal topographies at 1 week and at 1, 3, and 6 months' follow-up. Results In group A, the preoperative mean UDVA was 0.90 ± 0.33 (log MAR ± SD), whereas the postoperative mean UDVA was 0.78 ± 0.27. The preoperative mean CDVA was 0.60 ± 0.38, whereas the postoperative mean CDVA was 0.48 ± 0.26. The mean postoperative astigmatic correction was 1.8 ± 0.36. In group B, the preoperative mean UDVA was 0.78 ± 0.53, whereas the postoperative mean UDVA was 0.52 ± 0.23. The preoperative mean CDVA was 0.52 ± 0.26, whereas the postoperative mean CDVA was 0.30 ± 0.15. The mean postoperative astigmatic correction was 0.90 ± 0.29. Conclusion RMCXL showed good refractive correction for astigmatism in both ectatic and nonectatic corneas. RMCXL proved to be a promising new simple, effective, and safe procedure for the treatment of corneal astigmatism with reasonable patient satisfaction.

Purpose The aim of the study was to evaluate the accuracy of corneal power measurements for intraocular lens (IOL) power calculation after myopic laser in-situ keratomileusis (LASIK). Setting The study was conducted at the Faculty of Medicine, Alexandria University, Egypt. Patients and methods The study was conducted on 45 eyes that had undergone myopic LASIK previously. Corneal power was measured using manual keratometry, automated keratometry, IOLMaster, and Pentacam. Different hypothetical IOL power calculation formulas were used in each case. Results The steepest mean K value with manual keratometry (37.48 ± 2.86 D) followed by automated keratometry (37.31 ± 2.83 D) and the IOLMaster mean K value (37.06 ± 2.98 D) were steeper than any other mean K value measured by Pentacam. Using 4 mm Holladay equivalent K reading (EKR) with the double-K SRK/T formula, the refractive outcome was good, with 97.8% of cases within ± 2 D, 80.0% of cases within ± 1 D, and 42.2% of cases within ± 0.5 D. The best combination of formulas was 'Shammas-PL+double-K SRK/T using EKR 4 mm'. Conclusion Pentacam Scheimpflug imaging using EKR at 4 mm improved the accuracy of IOL power calculation in post-LASIK eyes. The best option is a combination of formulas. It is recommended to use the mean of the combination of 'Shammas-PL+double-K SRK/T with EKR 4 mm'.

Purpose This study aimed to evaluate the efficacy and safety of the fibrin glue use with Ahmed glaucoma valve (AGV) implantation in refractory glaucoma. Patients and methods Twenty-two eyes of 22 patients diagnosed with refractory glaucoma were scheduled to receive an AGV and were grouped into two groups: group I included 12 eyes in which fibrin glue was used to secure the scleral flap and conjunctiva over the valve tube. Group II included 10 eyes in which sutures were used as the standard technique for valve implantation. Results The mean age of the patients was 29.5 ± 13.4 and 27.1 ± 10.3 years in groups I and II, respectively, and there was no statistically significant difference between the two groups (P > 0.5). Congenital glaucoma was the most common preoperative diagnosis in each group. The surgical outcome of both groups showed a statistically significant reduction in the mean operation time in group I (37 ± 6 min) than in group II (43 ± 5 min) (P < 0.05). In addition, upper limbal inflammation was less in group I than in group II (17 and 40%, respectively), which was statistically significant (P < 0.05). Complete success was achieved in nine cases (75%) and qualified success was achieved in two cases (17%) in group I; in group II, complete success was achieved in eight cases (80%) and qualified success was achieved in one case (10%). There was no statistically significant difference between both groups in complete success and failure (P > 0.05). There was no statistically significant difference in the mean final intraocular pressure between the two groups (18.1 ± 2.2 and 17.4 ± 3.5 mmHg) in groups I and II, respectively (P > 0.05). The operative complications were hyphema, which occurred in one case in group I (8%) and in two cases in group II (20%). Suprachoroidal hemorrhage occurred in one case in group II. Shallow anterior chamber occurred in two cases (17%) in group I and in two cases (20%) in group II. One case in group I developed choroidal detachment. Tube exposure occurred in three cases, two cases in group I (17%), and one case (10%) in group II. Encysted valve occurred in three cases, two of which belonged to group I (17%) and one case belonged to group II (10%). Conclusion The use of fibrin glue with AGV implantation in refractory glaucoma makes its implantation easier, with a shorter operation time and less postoperative pain and inflammation, but its added cost usually limits its use. However, larger multicenter studies with longer-term follow-up are needed before the widespread use of this surgical technique.

Purpose The aim of the study was to evaluate the efficacy and safety of decapsulation of the fibrous capsule around the valve body versus valve reimplantation in another site in refractory glaucoma cases. Patients and methods We studied 25 cases with refractory glaucoma that had been implanted with an Ahmed glaucoma valve; their intraocular pressure (IOP) was greater than 21 mmHg and had undergone additional maximum topical antiglaucoma therapy. Patients were divided into two groups according to the surgical treatment that had been performed: group I included 12 eyes that had been treated by surgical decapsulation of the cyst around the valve body without removal of the valve and group II included 13 eyes treated by removal of the valve and reimplantation in another quadrant of the eye. Results Of the 25 patients included in the study, 15 were male and 10 were female, with a mean age of 19.2 ± 9.2 years in group I and 22.1 ± 10.3 years in group II. Recurrent congenital glaucoma was the most common preoperative diagnosis in both groups (50 and 53.8% in groups I and II, respectively). There was no statistically significant difference between the two groups regarding preoperative patient demographic characteristics (P < 0.05). The surgical results revealed that the mean operation time was significantly lower in group I than in group II (30 ± 12 and 45 ± 13.5 min, respectively; P = 0.023). However, there were no statistically significant differences in the success (complete and partial) and failure rates between the two groups (P < 0.05). There was marked reduction in IOP from preoperative values in both groups but there were no significant differences in IOP levels between the two groups over the follow-up visits. Tube-related complications occurred in group II only and included corneal tube touch in one (7.7%) case and erosion of the tube covering in two (15.4%) cases. One of them developed endophthalmitis and then lost the perception of light (PL) and ended in phthisis bulbi. Recurrence of encapsulation occurred more in group I (three cases, 25%) than in group II (two cases, 15.4%), after a mean postoperative time of 23 ± 2 weeks. The incidence of valve re-encapsulation was statistically insignificant between the two groups (P = 0.09). Conclusion Both surgical techniques were effective in controlling IOP in cases with encapsulated Ahmed valve; however, the decapsulation technique was simpler with shorter operation time and no probability for tube-related complications. Although the other technique of valve reimplantation had a longer operation time and more tube-related complications, it was associated with less incidence of re-encapsulation. However, larger multicenter studies with longer follow-up are needed for validation of these treatment strategies.

Purpose The aim of this study was to investigate electroretinogram changes after intravitreal injection of bevacizumab with or without adjuvant intravitreal corticosteroids for diabetic macular edema. Patients and methods This prospective randomized study evaluated multifocal electroretinogram (MFERG) changes in 60 eyes of 45 diabetic patients who had clinically significant macular edema after treatment with intravitreal bevacizumab (IVB) with or without corticosteroids. Preoperative and postoperative clinical examination, fluorescein angiography, optical coherence tomography, and MFERG were carried out for all cases. The patients were divided into three groups and each group included 20 eyes. The first group was treated with IVB injection alone, the second group was treated with IVB and triamcinolon injection, and the third group was treated with IVB and dexamathosone. The follow-up was carried out up to 3 months. Results The mean visual acuity improved in the three groups, and the mean foveal thickness was reduced in the three groups. As regards MFERG-C, P1 amplitudes increased and P1 peak time (ms) was shortened in the three groups. Intraocular pressure rise occurred in 10% of cases in the second group and in 5% of cases of the third group. Conclusion Diabetic macular edema can be treated with bevacizumab alone, as the use of adjuvant corticosteroids has many complications.

Purpose The aim of the study was to investigate the efficiency, advantages, and disadvantages of posterior approach advancement of the levator aponeurosis in the repair of aponeurotic ptosis. Patients and methods This is a prospective interventional study, which included 27 eyelids of 20 patients with aponeurotic ptosis. The study included only cases with good levator function of 11 mm or more. Patients with significant dermatochalasis were excluded from the study. All patients were treated by posterior approach levator aponeurosis advancement under local anesthesia. Patients were evaluated 1 week, 1 month, 3 months, and 6 months postoperatively for margin reflex distance 1 (MRD1), eyelid symmetry, and eyelid crease and contour. Results The study included 27 eyelids of 20 patients with aponeurotic ptosis. The patients' mean age was 44.36 ± 14.47 years. The mean preoperative MRD1 was 1.6 ± 0.5 mm, whereas the mean levator function was 12.6 ± 1.1 mm. The mean operative time was 32.6 ± 5.4 min. The postoperative MRD1 showed significant improvement to 3.7 ± 0.6 mm (P < 0.001). Eighty-five percent showed successful outcome with postoperative MRD1 within 1 mm symmetry with the other eye in unilateral cases or 3.5-4.5 mm in bilateral cases. All cases showed postoperative good natural-looking eyelid crease and contour. Success of the procedure showed no correlation to the results of the phenylephrine test (P = 0.762). Conjunctival granuloma was recorded in 3.7% of patients. Conclusion Posterior approach aponeurotic advancement is an effective procedure for correction of aponeurotic ptosis. It has the advantages of high success rate, good natural-looking eyelid contour, and short operative time, and the results are independent of the response to phenylephrine.

Purpose The aim of this study was to evaluate the use of the blind disfiguring eye as a natural implant for artificial eyes instead of evisceration or enucleation with synthetic implants. Patients and methods Ten eyes, which were painless and blind with disfiguring appearance, were included in this study. All eyes were subjected to a new simple surgical technique by simply converting the eye into a natural implant. The main outcome measure was the cosmetic appearance, patient satisfaction, and psychological impact. All patients were followed up at 1 and 2 weeks and 1, 3, and 6 months postoperatively. Results Ten eyes of 10 patients were included in this study with a male-to-female ratio of 1 : 4. Two (20%) eyes developed lid edema and ecchymosis, one (10%) eye complicated with conjunctival hematoma, and another eye (10%) had postoperative shallow fornices. Seven (70%) patients had good postoperative cosmetic appearance with good prosthesis motility and patient satisfaction. Two (20%) patients were not satisfied, as they had poor cosmetic appearance with restricted prosthesis motility. One (10%) patient had failed surgery. Conclusion The use of the painless blind disfiguring eye as a natural implant for artificial eye proved to be an efficient and cheap procedure with excellent cosmesis. Great patient satisfaction was noted as regards the prosthesis movements and final new look.