Purpose The purpose of this paper is to evaluate differences between IOL master and A-scan regarding axial length (AXL) and predicted IOL power in different types of cataract. Patients and methods Forty eyes of 40 patients underwent examination by IOL master and A-scan, where average K-reading, AXL and predicted IOL power were compared. Results Forty eyes of 40 patients were included. The mean AXL measured by IOL master was higher (26.18±2.92 mm) than that with A-scan (26.02±2.99 mm) with a mean difference of 0.2±0.44 mm (P=0.07). The mean predicted IOL power was 11.61±8.33 D with IOL master versus 12.01±8.23 D with A-scan (P=0.03). However, no statistically significant difference was found regarding average K-readings and predicted postoperative refraction (P=0.4 and 0.7, respectively). Bland–Altman plots showed almost perfect agreement between both methods regarding AXL and predicted IOL power. Further subgroup analysis revealed a statistically significant difference in AXL between both devices only in nuclear cataract with no significant difference in cases with complicated cataract to myopia or silicone oil (P=0.013, 0.2 and 0.1, respectively). No statistically significant difference was found between the three groups regarding the calculated IOL power (P=0.34, 0.13 and 0.15, respectively). Bland–Altman analysis showed almost perfect agreement for the mean difference of AXL and IOL power in the three subgroups. Conclusion There is no significant difference between IOL master and A-scan biometry, with the noncontact IOL master being preferred by patients; however, there exists certain situations where A-scan is still mandatory.

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Purpose The aim of this study was to evaluate the safety of trabeculectomy in advanced glaucoma patients in the Egyptian population, and to detect postoperative wipe-out syndrome in high-risk patients. Patients and methods Thirty-six eyes of 33 patients with advanced glaucoma were included in the study. All patients underwent subscleral trabeculectomy. The patients were followed up for 3 months during which intraocular pressure (IOP), best-corrected visual acuity (BCVA), slit lamp biomicroscopy, fundus examination, and perimetry were done. Results The mean age of the study group was 51.17±2.64 years. The study included 24 males and nine females. The mean preoperative BCVA was 0.36±0.33. the mean IOP was 31±8.75 mmHg and the mean number of medications was 3.08±0.1. In all cases, complete success was achieved except for two cases with qualified success. The BCVA at day 90 showed no change in 21 eyes, visual decline in three eyes and visual gain in 12 eyes. A negative linear correlation was noticed between the percent reduction in IOP and the reduction in BCVA in the first postoperative day (r=−0.239) which was not statistically significant (P=0.162). The color of the neuroretinal rim was not a significant determinant for the final BCVA (P=0.48). Visual field changes showed no statistically significant differences. Conclusion Wipe-out phenomenon is not an ultimate postoperative outcome for filtering surgery in patients with advanced glaucoma. Pale neuroretinal rim and postoperative hypotony are risk factors for postoperative visual deterioration.

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Purpose The aim of this work was to study the effectiveness and potential complications of adjunctive intraoperative mitomycin-C (MMC) application combined with limbal-conjunctival autografting after primary pterygium excision. Patients and methods Fifty-seven eyes of 43 patients with primary pterygia were randomized to receive pterygium excision, followed by either a free conjunctival autograft (control group, n = 27) or an adjunctive intraoperative MMC 0.02% application for 2 min and limbal-conjunctival autograft (triple procedure group, n = 30). All patients were followed for 12 months. Results After 1 year, the recurrence rate was 14.81 and 0% in the control and the triple procedure groups, respectively (P < 0.05). Most complications were transient and mild. The duration of surgery was significantly shorter in the control group (P < 0.01). The surgery did not significantly alter the corrected distance visual acuity or the average absolute astigmatism in either group. Conclusion Simple excision of pterygium combined with adjunctive intraoperative MMC 0.02% application for 2 min and limbal-conjunctival autografting is a safe and effective way of treating primary pterygia.

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Purpose The purpose of this study was to present different topographic presentations of keratectasia following laser in-situ keratomileusis (LASIK), and their management strategies. Settings The study was carried out in specialized eye hospital − Cornea and Refractive Unit. Design This is a retrospective case series. Patients and methods The study enrolled 44 eyes of 29 patients who presented with post-LASIK ectasia, between 2011 and 2014. Eight eyes (18.18%) had previous LASIK surgery at our center and 36 eyes (81.81%) had LASIK procedure by surgeons outside our hospital. Results Although 29 eyes (65.90%) presented early with crab-claw/pellucid-like pattern, only six eyes (13.63%) first presented with asymmetric bow tie with inferior steepening. Isolated inferior steep cone was the pattern in six eyes (13.63%), whereas three eyes (6.81%) presented early with superior steepness. Twenty-five eyes (56.81%) were managed by corneal collagen cross-linking (CXL) with riboflavin, followed 6 months later by toric implantable collamer lens in three eyes and implantable collamer lens in a single eye. Intracorneal ring segment implantation procedure was implemented in nine eyes (20.45%), whereas seven eyes (15.90%) had deep anterior lamellar keratoplasty done. Three patients − three eyes − (6.81%) refused treatment by cross-linking on early diagnosis, and they presented with progressive features of ectasia over 3 years, which finally required deep anterior lamellar keratoplasty. Conclusion Post-LASIK ectasia can manifest with various topographic patterns, at different onset points following LASIK, and unpredictable course of progression. Early diagnosis, proper discussion of the pros and cons of treatment modalities with the patient, and early intervention with the suitable corrective procedure is crucial.

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Purpose The aim of this study was to evaluate the surface quality of corneal lenticules at variable corneal depths in cases of small incision lenticule extraction using scanning electron microscopy. Patients and methods Forty eyes of 20 myopic patients were included. One eye was randomly assigned for lenticules at 100 µm depth (group I), whereas the other eye was assigned for lenticules at 160 µm depth (group II). The VisuMax femtosecond laser system was used for the procedure. An established scoring system and a new scoring system at higher magnification levels for surface regularity were used. Results The mean overall diameter of the lenticules as seen on electron microscopy was 6.54±0.17 and 6.73±0.20 mm in group I and group II, respectively (P=0.003). In both groups, around 50% of cases showed a smooth surface at ×10 magnification. The mean score was 14.90+1.74 and 13.25+2.77 in group I and group II, respectively (P=0.031). Conclusion The VisuMax femtosecond laser system creates predictable good-quality surface refractive corneal lenticules at superficial depth. Deeper corneal lenticules showed more irregular surfaces, especially at higher magnification levels. Energy settings still need further adjustment to be able to create deeper predictable lenticules in small incision lenticule extraction cases.

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Purpose The aim of the study was to investigate visual outcome in patients with traumatic cataract after cataract surgery and to study the various etiological factors. Patients and methods A prospective study was carried out on all patients with traumatic cataract who underwent cataract extraction with primary intraocular lens implantation at a tertiary eye hospital between January 2012 and December 2014. Data were collected on age, sex, preoperative vision, postoperative vision at 3–6 months, and postoperative complications responsible for decreased visual acuity. Results Fifty eyes in 50 patients were studied. The study population comprised 36 male and 14 female patients. The preoperative visual acuity was less than 6/60 in all 50 eyes. The postoperative visual acuity in 28 eyes was 6/6–6/12, whereas 20 eyes had visual acuity of 6/18–6/36 and two eyes had visual acuity less than 6/60. The cause of poor visual acuity was mainly corneal opacity and posterior capsular opacity. Conclusion Our study shows that good visual results can be achieved with traumatic cataract surgery if the posterior segment is not involved and the corneal scar does not block the optical axis.

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Purpose The aim of this study was to compare the surgical efficacy and aesthetic outcome of using tissue adhesive N-butyl-2-cyanoacrylate 'Histoacryl' with subcuticular suture closure of skin incision in external dacryocystorhinostomy (DCR). Design The present study was conducted as an interventional study. Patients and methods A total of 60 chronic dacryocystitis patients undergoing DCR procedures at the Research Institute of Ophthalmology were included. The patients were randomly selected, irrespective of age, sex or race, and were divided into two groups of 30 patients each. A classic external DCR was done for all the patients. At the completion of the surgery, the skin incisions in group 'A' were closed with vicryl 6/0 subcuticular suture, whereas in group 'B' N-butyl-2-cyanoacrylate 'Histoacryl' (FDA approved) tissue adhesive was used to close the skin incisions. No subcutaneous sutures were placed to approximate the wound edges. After 20 s of drying time the adhesive was applied for the second time. All the patients were followed up on the first day, fourth day, first week, second week, first month, and then monthly thereafter for 6 months. The time of suturing the wound and the time of application of the tissue adhesive was recorded for all the patients in both groups. During follow-up the wound was examined for evidence of infection, pain and discharge, and an inquiry was carried out for patient satisfaction. Photographs of the wounds were taken at every visit. The photographs were then shown to a senior surgeon, who was oblivious of the method of closing the wound, and rated the quality of skin incision according to 'WES scale'. Results No intraoperative wound complications were encountered in any patient. Statistical analysis of the data available, at 1 month, showed no statistically significant differences between the two groups as regards duration of healing, inflammation or final incision appearance as rated by the senior surgeon. Skin closure time averaged 61 s in subcuticular suture and 52 s in N-butyl-2-cyanoacrylate skin glue, which was statistically insignificant. Conclusion Using N-butyl-2-cyanoacrylate glue is an effective and a reliable method for skin closure, yielding similar aesthetic results as skin closure with subcuticular sutures in clean incision for external DCR surgery. It is safe, quick, does not compromise wound integrity, is adequately tolerated by the patients and could be considered an excellent alternative and an improvement on the traditional method of wound closure, providing high level of satisfaction for both patient and surgeon.

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Purpose The aim of this study was to evaluate the efficacy NSAID eye drops in comparison with topical steroids following phacoemulsification cataract surgery. Patients and methods This prospective study included 120 patients with senile cataract who were subjected to phacoemulsification cataract extraction with foldable posterior chamber intraocular lens implantation. Postoperatively, patients were assigned to two groups: NSAIDs group and steroids group. All patients were subjected to preoperative and postoperative investigations including autorefractometer, slit-lamp examination, indirect ophthalmoscopy, tonometry, and Nassar color plates. Optical coherence tomography was performed for all patients in the last visit. Results No statistically significant differences were found between both groups in visual acuity (0.20±0.15 in the NSAIDs group and 0.20±0.13 in the steroidal group), corneal edema, or anterior chamber reaction (P>0.05). The mean macular thickness for the steroidal patient group was significantly higher than their counterparts in the NSAIDs group (P<0.05). However, both medications proved their efficacy in preventing complications throughout the study. Intraocular pressure showed spikes in the steroidal group patients from the third week till the end of the study. Conclusion Both topical NSAIDs and steroids have the same efficacy in preventing inflammation and corneal edema. However, patients subjected to topical steroids were more likely to develop intraocular hypertension and cystoid macular edema.

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Purpose The aim of this study was to compare between sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT) in the treatment of pollen-induced vernal keratoconjunctivitis (VKC) in children. Patients and methods This was a prospective randomized case series. Forty-six patients with grass pollen-induced VKC were enrolled in this study. The cases were divided randomly into two groups: group A included 23 children treated by SLIT and group B included 23 children treated by SCIT. All cases were assessed for improvement by measurement of the level of specific immunoglobulin E (IgE)/6 months and by clinical scoring system/3 months. This system comprises the total subjective symptom scores (TSSS) and the total ocular sign score (TOSS). Data were collected, compared, and analyzed. Results Both routes, SLIT and SCIT, led to a statistically significant effect (P˂0.001) in the improvement of these cases of pollen-induced VKC, and this was evident from all of the follow-up variables including specific IgE test, TSSS, and TOSS. There was no statistically significant difference between the two routes of administration of immunotherapy in the specific IgE test, TSSS, and TOSS at all the follow-up visits (P<0.05). Conclusion SLIT had the same efficacy as SCIT in the treatment of children with grass pollen-induced VKC, but with less pain and a shorter and a more convenient schedule compared with that of SCIT.

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Purpose The aim of this study was to determine the normative data of macular thickness in the Egyptian population and to assess the effect of different demographic data and ocular parameters on it using spectral-domain optical coherence tomography (SD-OCT). Patients and methods This cross-sectional study included 105 healthy Egyptian patients who underwent a comprehensive ophthalmic examination, including Spectralis SD-OCT scanning, at Alexandria Main University Hospital. One eye from each patient was chosen randomly to be included in the study. Macular thickness was calculated based on center thickness and nine areas that corresponded to the Early Treatment Diabetes Retinopathy Study map using OCT mapping software. The relationships between macular thickness and sex, age, axial length (AL), spherical equivalent, keratometry readings, intraocular pressure, BMI, parity, and use of oral contraceptive pills were analyzed. Results The study included 49 male and 56 female patients. The mean age of the patients was 40.41±14.17 years. The mean central subfield thickness was 262.70±19.64 μm. The mean macular thickness values in all areas of the Early Treatment Diabetes Retinopathy Study map were significantly greater in men than in women. As age increased, outer macular thickness decreased significantly in the overall group and in female but not in male patients (partial correlation). The AL correlated negatively with inner and outer macular thickness (partial correlation). However, spherical equivalent had no significant influence on multiple linear regression analysis. Central subfield thickness did not correlate significantly with keratometry readings, intraocular pressure, BMI, parity, or use of oral contraceptive pill. Conclusion The mean macular thickness values in the Egyptian population were found to be less than those seen in the Spectralis SD-OCT studies published previously on Caucasians but more than those seen in Blacks. Sex had the most significant effect on macular thickness in all regions. Age and AL showed a significant negative correlation with outer macular thickness.

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Purpose The purpose of this study was to evaluate the relationship between smoking and dry eye in the adult population. Patients and methods A total of 500 male patients, 250 smokers and 250 nonsmokers, were recruited for this study in the period between May 2015 and April 2016. In addition to history taking and general examination, all participants were asked about eye irritation symptoms and were subjected to slit lamp and fundus examination. Schirmer 2 test, using topical anesthesia, tear break-up time (TBUT), and rose bengal staining were done for all study participants. Results There was no statistically significant difference between the age of patients in both groups. The mean age of smokers was 41.44±7.55 years, whereas in nonsmokers it was 39.97±7.59 years. Schirmer 2 test values were significantly lower in smokers compared with nonsmokers (P=0.017). In smokers, the mean value of Schirmer 2 test was 13.91±6.81 mm, whereas in nonsmokers it was 16.58±7.41 mm. TBUT values of the smokers were significantly lower in smokers than in nonsmokers (P=0.035). It averaged 11.9±5.8 s in smokers and 14.9±5.5 s in nonsmokers. The rose bengal staining scores did not differ between the two groups (P=0.467). Additionally, a linear negative correlation was detected between smoking index of smokers and their Schirmer 2 test and TBUT values. The eye irritation indices of the smokers were statistically higher than those of the nonsmokers (P=0.0007). Conclusion The findings of this study suggest that smoking affects the tear film secretion and stability. In addition, it causes eye irritation symptoms, and so smokers are more likely to have dry eyes and severity of dry eye is more in smokers than in nonsmokers.

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Purpose The aim of this study was to compare the clinical outcomes of phacoemulsification with that of manual small incision cataract surgery (MSICS) in cases of hard nuclear cataract. Patients and methods Eighty eyes of 80 patients with gradual painless diminution of vision, diagnosed as senile nuclear cataract grade 4 or higher according to Lens Opacities Classification System III (brown cataract), were studied. These eyes were divided randomly into two groups: group A included 40 eyes treated by phacoemulsification by the vertical chopping technique and group B included 40 eyes treated by MSICS by the viscoexpression technique. Results One day postoperatively, the corrected distance visual acuity was at least 6/18 in 21 (52.5%) patients in the MSICS group and in nine (22.5%) patients in the phacoemulsification group. The difference was statistically significant (P=0.01). A postoperative increase in intraocular pressure was recorded in one (2.5%) case in the phacoemulsification group. On the first postoperative day, 11 (27.5%) cases in the MSICS group and 13 (32.5%) cases in the phacoemulsification group developed postoperative iritis, with no statistically significant difference between both the groups. Conclusion Both phacoemulsification and MSICS achieved comparable and excellent visual outcomes for treatment of hard brown cataract, with lower complications rates and earlier postoperative visual rehabilitation in small incision cataract surgery.

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Purpose The aim of this study was to investigate the correlation and validity of tear film allergen-specific immunoglobulin E (IgE) in relation to the skin prick test in diagnosing different types of allergic conjunctivitis. Design The study design was a prospective randomized case series. Patients and methods One hundred and twenty patients with allergic conjunctivitis were included in this study and were classified into four groups according to the type of allergy. Group 1 included 48 patients with perennial allergic conjunctivitis. Group 2 included 35 patients with seasonal allergic conjunctivitis. Group 3 included 30 patients with vernal keratoconjunctivitis (VKC), and group 4 included seven patients with atopic keratoconjunctivitis. All patients were subjected to the skin prick test, which was performed with aeroallergen panel using kits containing different inhalant allergens, positive control (histamine 1 mg/ml), and negative control (saline 0.9%). Tear samples were collected using the microcapillary method for the quantitative determination of specific IgE using immune blot assay. Data were evaluated and statistically analyzed. Results In this study, the skin prick test and specific IgE were performed to 11 different allergens and the results revealed that the most common mixed allergens were mixed pollen, mixed mould, and mixed mite. Validity of tear film-specific IgE in the detection of allergens was assessed against the skin prick test (gold standard). There was IgE specificity of 100%, whereas the sensitivity ranged from 50 to 100% to the three common allergens in the four groups. There was a statistically significant correlation between specific IgE and the skin prick test for the most common allergens in patients with perennial allergic conjunctivitis, seasonal allergic conjunctivitis, and VKC (except for mould allergens in the VKC group). There was only a statistically significant correlation between specific IgE and the skin prick test for mite allergen in patients with atopic keratoconjunctivitis. Conclusion Tear film-specific IgE has a statistically significant correlation and validity when compared with the skin prick test in diagnosing the causative allergen in different types of allergic conjunctivitis. It could be a good alternative to the skin prick test in the diagnosis of allergic conjunctivitis with high sensitivity and specificity and fewer complications and limitations.

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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.

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Recently, there has been an increase in the use of targeted therapies for cancer treatments. Nevertheless, the ocular side effects of the commonly used targeted agents are generally under-reported and not well studied in the literature. The aim of this study was to review common targeted therapies leading to ocular side effects and their management. A database search was conducted on Google scholar, PubMed and Medline using phrase words, ‘targeted therapy’, ‘ocular toxicity’, ‘antineoplastic agent’ and ‘management’. Ocular toxicity has been described with numerous approved targeted agents and also seems to be associated with several classes of agents currently being tested in early-phase clinical trials. It is important for oncologists to be aware of the potential for ocular toxicity, with prompt recognition of symptoms that require referral to an ophthalmologist. The ocular side effects of targeted therapy are clinically relevant and can be present in up to 70% of patients depending on the medication used. Because no screening protocol is recommended, ophthalmologists and oncologists should be vigilant; however, a dose reduction or cessation of therapy is only rarely necessary.

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Purpose The aim of this study was to evaluate the use of perforated punctal plugs with punctotomy for the management of canaliculitis with preservation of punctal and canalicular patency. Patients and methods This was a prospective interventional case series including 12 consecutive patients with unilateral canaliculitis. Punctotomy was performed for all cases with curettage of canalicular contents followed by application of a perforated punctal plug. Plugs were removed after 3 months and all patients were followed up for 6 months. Results This study included 12 cases of canaliculitis, eight female (66.7%) and four male (33.3%), with a mean age of 60.33 ± 4.6 years (ranging from 48 to 73 years). The lower canaliculus was affected in 83.33% of cases, whereas the upper canaliculus was affected in 16.67% of cases. Sulfur granules were present in six cases (50%) and six cases (50%) were negative. Gram staining of the expressed contents revealed the following: 50% Actinomyces israelii, 30% Staphylococcus aureus, and 20% mixed infection. Improvement in inflammation and epiphora occurred in 11 cases (91.67%), whereas persistence of epiphora occurred in one case (8.33%). One case (8.33%) showed inflammatory granuloma at the site of punctotomy and one case (8.33%) showed extrusion of the plug after 1 month of surgery. Conclusion This study showed that punctotomy combined with implantation of perforated punctal plug is an effective technique for the management of canaliculitis, with improvement in manifestations and preservation of punctal and canalicular patency.

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Introduction Femtosecond laser flap creation exerts less intraocular pressure (IOP) fluctuation but requires more procedural time compared with microkeratome flap creation. This IOP elevation during suction may affect the macular and retinal nerve fiber layer thickness that can be assessed with optical coherence tomography. Purpose The aim of this study was to compare the influence of the transient elevation of IOP during suction on the macular and retinal nerve fiber layer thickness after small-incision lenticule extraction (SMILE) and femtosecond laser-assisted in-situ keratomileusis (femto-LASIK). Patients and methods A total of 80 and 75 eyes that received SMILE and femto-LASIK procedures for myopia and myopic astigmatism, respectively, were enrolled in this study. Spectral-domain optical coherence tomography was used to measure macular and peripapillary retinal nerve fiber layer thickness preoperatively, at 1 week, and 1, 3, and 6 months postoperatively. Results The study included 155 eyes. In both the SMILE group and the femto-LASIK group, the mean foveal, parafoveal, and perifoveal retinal thickness did not change significantly from the preoperative to any postoperative timepoint (P > 0.05). The mean foveal retinal thickness was significantly greater in the femto-LASIK group than in the SMILE group (P<0.05). The retinal nerve fiber layer thickness did not change significantly from the preoperative to any postoperative timepoint in either group (P > 0.05). The differences in the retinal nerve fiber layer between the SMILE group and the femto-LASIK group were not statistically significant at any follow-up visit (P > 0.05). Conclusion Both SMILE and femto-LASIK procedures had no significant effects on the macular and retinal nerve fiber layer thickness postoperatively.

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Aim The aim was to identify if the type of surgical procedure has any bearing on dry eye syndrome and to find out the duration of postsurgical recovery of dryness in small-incision cataract surgery and phacoemulsification. Patients and methods A prospective randomized study was conducted on 100 patients of cataract. Group A had 50 patients who underwent small-incision cataract surgery, and group B included 50 patients who underwent phacoemulsification. Patients with pre-existing ocular surface disease, for example, known case of glaucoma; taking topical antiglaucoma drugs; lid disorders; and grade 5 cataract (hard cataract in which it is difficult to do phacoemulsification) were excluded. Dry eye workup included Schirmer’s I, basic secretion test, tear film breakup time, and corneal sensation. The workup was done preoperatively and then on seventh, 21st, and 90th day postoperatively. The values were compared in the group itself and in-between the two groups. Results In groups A and B, there was significant difference in the preoperative values of Schirmer’s I test, basic secretion test, and tear breakup time (TBUT) as compared with day 7 and day 21 postoperative values (P<0.05). However, the day 90 postoperative values were comparable to preoperative values, and there was no significant difference (P>0.05). There was significant difference in the Schirmer’s I test and basic secretion test values after 21 days of surgery between the groups (P<0.05), whereas there was no significant difference in TBUT and presence of corneal sensation values between the groups (P>0.05). Conclusion Cataract surgery can cause or aggravate dry eye and affect the dry eye test values in the postoperative period up to 3 months. This holds true for both manual small-incision cataract surgery and phacoemulsification surgery. Therefore before surgery, patients must be informed about the possible aggravation of dry eye symptoms, and artificial tears should be prescribed for attenuating corneal damage and dry eye symptoms.

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Purpose The aim of the present study was to investigate the correlation between different features of optical coherence tomography, macular thickness, and visual acuity (VA) in patients with diabetic macular edema. Patients and methods In total, 168 eyes with clinically significant diabetic macular edema were included in the study. Best-corrected VA was measured and converted to the logarithm of the minimum angle of resolution (logMAR). Optical coherence tomography was carried out and morphology at the presumed fovea was used to classify eyes into four groups: group I, in which the eyes had only noncystoid sponge-like diffuse retinal thickening (DRT); group II, in which the eyes had DRT with cystoid macular edema (CME); group III, in which the eyes had DRT with serous retinal detachment (SRD); and group IV, in which the eyes had DRT with CME and SRD in the same eye. Retinal thickness at the central fovea [center point thickness (CPT)], average macular thickness (AMT), and the height of the cystoid space and the SRD at the fovea were measured. Results DRT was found alone in 65% of the eyes, CME in 16%, SRD in 13%, and CME and SRD in 6%. Mean logMAR was 0.68 with DRT, 1.16 with CME, 0.89 with SRD, and 1.05 with CME and SRD. Mean CPT was 299 μm in DRT, 573 μm in CME, 354 μm in SRD, and 483 μm in CME and SRD, whereas mean AMT was 309 μm with DRT, 374 μm with CME, 344 μm with SRD, and 390 μm with CME and SRD. There was a positive significant correlation between logMAR and CPT in DRT (0.357, P = 0.001), whereas the correlation was less in CME, SRD, and CME and SRD (0.373, P = 0.087; 0.463, P = 0.053; and 0.082, P = 0.847; respectively). The positive correlation between logMAR and AMT was significant in DRT, CME, and SRD but not in CME and SRD (0.314, P = 0.002; 0.605, P = 0.003; 0.646, P = 0.004; and 0.327, P = 0.429, respectively). The height of the SRD was positively correlated with logMAR (0.516, P = 0.028), whereas the correlation between the height of the cystoid space in CME and logMAR was less (0.360, P = 0.099). Conclusion DRT was the most common feature. CME had worst visual outcome and greatest CPT and AMT. In DRT, worse VA correlated more with CPT than with AMT, whereas in CME and SRD, correlation of VA was more with AMT than with CPT. VA correlated with height of lesion in eyes with SRD but not with CME. The height of cystoid space correlated with CPT but not with AMT, whereas the height of SRD correlated with both CPT and AMT.

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Purpose The aim of the present study was to assess visual acuity, measure the degree of visual impairment, and examine fundus changes in Egyptian children with Bardet-Biedl syndrome (BBS), and to correlate these findings with the results of flash electroretinography (ERG). Materials and methods A cross-sectional study was conducted on infants and children with BBS. Diagnosis was carried out by a specialized pediatrician. Full ophthalmological examination, including slit-lamp examination, refraction, and indirect ophthalmoscopy, was carried out. Best-corrected visual acuity was measured and full-field flash ERG was performed. Results This study included 20 patients with BBS. The median age was 9 years (ranged from 1 day to 18 years). The mean age of onset of symptoms in the whole group was 6.5 ± 4.3 years. Visual impairment, defined as a best-corrected visual acuity in the better seeing eye of 20/60 (6/18) or less, was present in 11 patients (55% of the cases), and night blindness as a symptom was present in nine patients (45%); pigmentary retinopathy was clinically detected in 35% of the patients and retinal dystrophy as an ERG finding was detected in 60% of the patients. Conclusion Visual impairment in BBS is mainly caused by rod-cone dystrophy, which is one of the major criterion of diagnosis, which manifests with age. Before the age of 6, children rarely present with ocular manifestations, and usually have normal fundus examination; on the other hand, retinitis pigmentosa-like picture is usually seen in children older than 6. However, the electrophysiological changes may precede the fundus changes.

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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'.

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Purpose The aim of this study was to study the prevalence and risk factors of vernal keratoconjunctivitis (VKC) among children aged 12–15 years in Menoufia Governorate. Patients and methods This was a cross-sectional study that was carried out on 768 children (405 males and 363 females) aged from 12 to 15 years in Menoufia Governorate during the period from September 2016 to the end of August 2017. All participants were asked to answer a questionnaire and were subjected to full ophthalmological examination. Results The mean age of the participants was 13.02±1.00 years. The prevalence of VKC among the studied children was 3.9% (95% confidence interval, 2.6–5.3). Exposure to dust and family history of allergy were the major risk factors (odds ratio, 16.04 and 45.25, respectively). Itching and burning sensation were the most prominent symptoms, whereas hyperemia was the most prominent sign. Conclusion VKC is fairly common among children in Menoufia Governorate as part of the North African region. Exposure to dust and family history were the major risk factors. VKC was associated with other types of allergy like asthma or allergic rhinitis.

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Background Rheumatoid arthritis (RA) is a systemic inflammatory disease associated with a number of extra-articular organ manifestations. Ocular manifestations involved with RA are keratoconjunctivitis sicca (KCS), episcleritis, scleritis, keratitis, and retinal vasculitis. The etiopathogenesis of this autoimmune disorder is still debated. The aim of the current study was to present different ocular manifestations of RA and their frequency. Patients and methods A total of 180 patients with RA participated in this cross-sectional survey. All patients were subjected to general and specific examinations, ophthalmological examinations, and rheumatologic examinations in addition to blood investigations for rheumatoid factor and anti-cyclic citrullinated peptide. Results Of the 180 examined patients, 61 (33.9%) patients had ocular manifestations. There were 52 (85.3%) patients with KCS, three (4.9%) patients with episcleritis, three (4.9%) patients with scleritis, and three (4.9%) patients with keratitis. Patients with longer disease duration were much more likely to have ocular manifestations (odds ratio=7.13, P<0.001). In addition, patients with positive history of steroid intake were more likely to have ocular manifestations (odds ratio=1.88, P<0.001). Conclusion Ocular manifestations involved with RA are significant. The most common manifestation of ocular involvement was KCS. Ocular manifestations were more common among patients with longer disease duration.

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Aim The aim of this study was to evaluate the effects of subthreshold micropulse yellow 577-nm laser photocoagulation on eyes with diabetic macular edema (DME). Patients and methods In this prospective interventional case series, 20 eyes of 20 patients with previously treated centre involving DME received one single session of yellow micropulse 577-nm laser photocoagulation. Treatment was delivered using the IQ 577-nm laser system. Fixed treatment parameters were used in all cases: 200-µm spot size, 200-ms exposure duration, 400-mW powers, and a 5% duty cycle. Confluent applications with no spacing were administered over the entire edematous area including the fovea. Results The baseline best-corrected visual acuity was 0.42±0.15 logMAR, which improved to 0.3±0.26 logMAR at the final follow-up (P<0.043). The central subfield thickness was 354.3±32.96 μm at baseline and the final central subfield thickness was 310.7±52.62 μm (P<0.002). Conclusion Subthreshold micropulse yellow 577-nm laser photocoagulation is effective in treating DME.

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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.

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