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 objective of this study was to assess the effect of diabetic retinopathy (DR) on the retinal nerve fiber layer (RNFL) thickness. Patients and methods This study included 30 diabetic patients having nonproliferative diabetic retinopathy (NPDR) without macular edema, 20 diabetic patients without DR, and 20 healthy nondiabetic age-matched individuals as a control group. In each patient one eye was included. Patients were evaluated for RNFL thickness by Heidelberg Spectralis optical coherence tomography. Results The global (G), the superior, and the temporal RNFL thickness in the diabetic patients without DR was significantly less than that of the control group and that of the patients with NPDR. However, there was no statistically significant difference between the patients with NPDR and the control group. It was noted that there was no statistically significant difference in the RNFL thickness of the inferior and nasal quadrants between the three studied groups. Conclusion Early retinal neurodegeneration can occur before retinal microvascular diabetic changes can be observed.

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Purpose The aim of this study was to compare the safety and efficacy of simultaneous topography-guided photorefractive keratectomy (PRK) and corneal collagen cross-linking (CXL) with consecutive topography-guided PRK and CXL. Patients and methods A total of 34 eyes with early keratoconus were enrolled in this clinical study and assigned into two groups. Group A (n=17 eyes) underwent topography-guided PRK with CXL on the same day (the simultaneous group), and group B (n=17 eyes) underwent topography-guided PRK followed by CXL after 6 months (the sequential group). Changes in uncorrected and best-corrected visual acuity, spherical equivalent, keratometry (K), topography, and central corneal thickness were recorded. Follow-up was 12 months. Results The mean uncorrected visual acuity improved from 0.2±0.02 to 0.5±0.06 postoperatively in the simultaneous group at 12 months, whereas in the sequential group it improved from 0.25±0.03 to 0.5±0.08 (P=0.3). Best-corrected visual acuity improved from 0.4±0.25 to 0.8±0.3 postoperatively in the simultaneous group, whereas it improved from 0.5±0.12 to 0.7±0.2 in the sequential group (P=0.25). The mean spherical equivalent in the simultaneous group improved from –3.25±0.25 to –1.25±0.35 D with a mean reduction by 2.12±0.15 D, whereas in the sequential group it improved from –3.75±0.28 to –1.5±0.21 D with a reduction of 2.25±0.27 D (P=0.24). The mean reduction in K reading was 3.18±0.99 D in group A and 3.25±1.2 D in group B. Conclusion The same results have been obtained in both groups as regards the visual outcome in early cases with keratoconus.

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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 identify the duration of surgery, the incidence of Descemet’s membrane (DM) perforation during deep anterior lamellar keratoplasty (DALK), and the incidence of conversion to a penetrating keratoplasty (PKP) surgery when the procedure are performed by a single corneal surgeon during his learning curve. Setting This study was conducted in a specialized eye hospital from March 2013 to April 2014. Design This was a retrospective noncomparative case series study. Patients and methods We conducted a retrospective analysis of the first 52 cases of planned DALK that used the big-bubble (BB) technique, focusing on the 10 cases that were converted to PKP (19.23%). The cases were subdivided into four groups, categorized chronologically from A to D, comprising 13 patients each. Results DM perforation occurred during initial trephination in one case (10% of converted cases), during BB (over) injection with escape through (iatrogenic) DM break in one case (10% of converted cases), and during air injection with escape through a pre-existing big DM break in one case (10% of converted cases). During initial stab/deroofing of the BB using a superblade, perforation occurred in two cases (20% of converted cases). Perforation was most commonly encountered during supradescematic cleavage plane dissection, which happened in five cases (50% of converted cases). However, microperforations that occurred during dissection into the bare DM in six cases (11.53% of total cases) were managed successfully without conversion to PKP. Of the successful DALK cases, five were converted to manual DALK with complete baring of DM. Conclusion Despite a learning period needed to successfully perform DALK with the BB technique, complications related to this technique and total surgery duration decrease significantly after the first 10 cases.

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Aim The aim of this study was to report the prevalence and possible systemic associations of pseudoexfoliation syndrome (PXF) in patients with age-related cataract scheduled for surgery in Najran District, South Saudi Arabia. Patients and methods In this retrospective study, the medical records of 681 consecutive patients scheduled for routine cataract surgeries were reviewed. All patients were 60 years old or more. A comprehensive ophthalmic examination was performed for all patients, including visual acuity assessment, refraction, Goldmann applanation tonometry, gonioscopy, assessment of type of cataract, as well as fundus examination. Systemic conditions were reported, and a possible relation with PXF was assessed and analyzed. Results Pseudoexfoliation was diagnosed in 192 patients, with an overall incidence of 28.19%. The occurrence of pseudoexfoliation was found to be higher in older age groups. Possible associations with several systemic conditions were documented and discussed. Conclusion PXF is a common age-related disorder in patients with age-related cataract in Najran area, South Saudi Arabia, with an overall incidence of 28.19%. More research is needed before using PXF as an indicator for the presence of systemic diseases.

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Purpose The purpose of this study was to evaluate the difference in the effect of two speeds of intraocular lens (IOL) insertion on the clear corneal wound structure of two sizes: 2.4 and 2.2 mm. Setting This study was conducted in the Department of Ophthalmology, Faculty of Medicine, Alexandria University, Egypt. Design This is a prospective randomized clinical trial. Patients and methods Eyes that had phacoemulsification and Acrysof IQ IOL implantation using a screw-plunger-type injector were randomly divided into two equal-sized groups as follows. Group A included 40 eyes in which an incision of 2.4 mm size was used. These eyes were randomly divided into two equally sized subgroups: group AF with fast IOL insertion [1 revolution per second (rps)] plunger speed, and group AS with slow IOL insertion (1/4 rps). Group B included 40 eyes in which an incision size of 2.2 mm was used. These eyes were randomly divided into two equally sized subgroups: BF with fast IOL insertion (1 rps) and BS with slow IOL insertion (1/4 rps). The change in wound size before IOL insertion and after IOL insertion, need for corneal hydration, and surgically induced astigmatism were compared. Results The change in wound size was significantly larger in groups AS and BS than in groups AF and BF (P=0.002 and 0.008, respectively). Corneal hydration was required in 35% of cases in group AF and in 65.0% of cases in group AS. In group B, wound hydration was required in 30.0% of cases in group BF and 60% of cases in group BS. The differences were statistically not significant (P=0.057 and 0.736, respectively). Conclusion With an injector system, slow IOL insertion affected clear corneal wound size to a greater extent than fast insertion in the two wound sizes: 2.4 and 2.2 mm.

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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 aim of the study was to measure subfoveal choroidal thickness (SFCT) in eyes with central serous chorioretinopathy (CSCR), to compare it with that of contralateral clinically unaffected eyes and with that of other healthy persons, and to study its correlation with central macular thickness (CMT). Patients and methods Fifty-four eyes of 36 (23 male and 13 female patients) patients were included in this study under three groups: 18 eyes with recent unilateral CSCR, 18 free fellow eyes of patients with unilateral CSCR, and 18 healthy eyes of age-matched normal controls. Spectral-domain optical coherence tomography was performed to measure SFCT in all eyes and CMT in eyes with CSCR. Results The mean patient age was 37.4 years, whereas that of normal controls was 38.0 years. The mean SFCT was 332.0 μm in eyes with CSCR, 247.25 μm in the unaffected fellow eyes, and 248.74 μm in normal control eyes. SFCT in eyes with CSCR was significantly greater than that in each of the unaffected fellow eyes and normal control eyes, whereas there was no significant difference between fellow eyes and control eyes. The mean CMT in eyes with CSCR was 477.62 μm with a significant positive correlation with SFCT. Conclusion Subfoveal choroid in eyes with acute unilateral CSCR was significantly thicker than that in contralateral clinically unaffected eyes and that in healthy eyes of age-matched normal controls, whereas it was not significantly different between contralateral unaffected eyes and normal eyes. CMT was positively correlated with SFCT in eyes with CSCR.

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Purpose The purpose of this study was to evaluate the changes in subfoveal choroidal thickness (SFCT) in eyes with diabetic macular edema (DME) after intravitreal bevacizumab (IVB) injection. Patients and methods Thirty eyes diagnosed as nonproliferative diabetic retinopathy with DME were included in this prospective study. All eyes received an intravitreal injection of 1.25 mg/0.05 ml bevacizumab. Best-corrected visual acuity, SFCT, and central macular thickness were measured and recorded before the IVB injection and 1 month after the injection. The choroidal thickness was measured using enhanced depth imaging technique of Heidelberg Spectralis-optical coherence tomography. Results The mean age of the patients was 55.63±4.6 years, with a mean duration of diabetes of 8.26±1.96 years. The mean preinjection SFCT was 214.3±7.9 μm. The mean SFCT after 1 month of IVB injection was 215.5±6.8 μm, with no significant difference from the preinjection value (P=0.56). The mean change in the SFCT 1 month after intravitreal injection was 1.1±9.5 μm, with 0.5% change ratio. The correlation between change in SFCT and changes in central macular thickness and best-corrected visual acuity were 0.24 and −0.3, respectively, which were insignificant (P=0.2 and 0.09, respectively). Conclusion The IVB injection has no effect on the SFCT in eyes with DME.

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