Background The rising incidence of refractive errors, including myopia, hypermetropia, and astigmatism has posed a major public health challenge in the Middle East, including Oman, especially among the child and adolescent population. Aim This study aimed to evaluate the refractive status among the school student population in Al Buraimi Governorate, Oman. Patients and methods This is a quantitative, prospective, school-based study that recruited 397 student population from four randomly selected schools within Al Buraimi Governorate through stratified random sampling. An ocular examination, including refraction, was conducted to examine the participants’ refractive status. Descriptive statistics were applied to analyze the demographic variables. The Spearman correlation coefficient was used to evaluate the relationship between age and the mean spherical equivalent of both eyes of the participants. Results Out of the 397-student study population, 219 (55.16%) were males and 178 (44.84%) were females. The participants’ age ranged from 6 to 18 years with a mean of 12.11±3.30 years. Refractive errors were detected in 107 (26.95%) of the participants, with myopia prevalence being the highest (70=17.63%) followed by hypermetropia (37=9.32%). The prevalence of myopia was significantly higher among the higher secondary student population (38=33.63%) compared with the primary school student population (P<0.001). The age and mean spherical equivalent of both eyes showed a significant weak negative correlation (r=−0.206, P<0.001). Conclusion Refractive errors were detected in 26.95% of the participants. Myopia prevalence was observed to be higher (17.63%) followed by hypermetropia (9.32%). Most of the students having refractive errors had low myopia (17.38%).
Objective The aim of this study was to evaluate the accuracy of Spectralis optical coherence tomography (OCT) in detecting glaucomatous changes in the optic nerve head and retinal nerve fiber layer (RNFL) in patients with primary open-angle glaucoma (POAG). Patients and methods This prospective case–control study was conducted at the Department of Ophthalmology at Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. It included 76 participants: 38 patients with POAG and 38 healthy controls. Both eyes were evaluated using the Spectralis OCT to measure the optic disc area, rim area, cup-to-disc ratio (CDR), horizontal and vertical CDR (HCDR and VCDR), and horizontal and vertical rim thickness. Quadrant-wise RNFL assessment was also performed. The diagnostic performance of the OCT parameters was analyzed using the receiver operating characteristic curves, and the sensitivity and accuracy for glaucoma detection were calculated. Results The disc area showed no statistically significant difference between glaucomatous and normal eyes (P>0.05). In contrast, in the POAG group, the rim area was significantly reduced, while the CDR, HCDR, and VCDR were significantly higher compared to the controls (P<0.01). The horizontal and vertical rim thickness were significantly greater in the control group (P<0.01), reflecting structural thinning in the glaucomatous eyes. The RNFL abnormalities were most commonly detected in the nasal and inferotemporal quadrants. The receiver operating characteristic analysis demonstrated significant diagnostic capability for all OCT parameters, with the CDR showing the highest discriminative power (area under the curve=0.977) at a cut-off value more than 0.46. Conclusion Spectralis OCT provided a reliable and accurate assessment of optic nerve head and RNFL changes in POAG with the CDR being the best predictor.
Purpose The aim of this study was to investigate the association between genetic single nucleotide polymorphism in the promotor spot of Apurinic/Pyrimidinic Endonuclease 1 (APE1) and both senile and presenile cataract in an Egyptian population. Patients and methods This is a prospective cohort study with a random selection of patients from the Military Kobri Elkobba Eye Specialized Hospital Outpatient Clinic, Cairo, Egypt. The study included 50 patients with senile and presenile cataract (case group) and 50 age and sex matched controls (control group). Any patients with known secondary causes of cataract and pregnant females were excluded from the study. The blood samples were collected and PCR with confronting two-pair primers was done on both cases and controls to detect single nucleotide polymorphism in the promoter region of APE1-141 T/G. The PCR products were then analyzed using agarose gel electrophoresis. Results The APE1-141 G/G genotype was statistically significantly more common in the control group than in the case group (P=0.044). In cataract patients, the APE1-141 T/T genotype was higher than in controls, but the difference was not statistically significant (P>0.05). The G/G (42% in controls vs 38% in cases) and G/T genotypes (52% in controls vs. 40% in cases) were statistically significantly more prevalent in controls than in cases (P=0.021), suggesting a potential protective effect of the G allele. Conclusion The APE1-141 G/G genotype and G allele appear to be protective against cataract, whereas the T allele appears to be detrimental in the development of cataract.
Background Phacoemulsification combined with trabeculectomy (Phaco-Trab) is a standard procedure for the management of primary angle-closure glaucoma (PACG), but it carries complication risks. Phacoemulsification combined with goniosynechiolysis (Phaco-GSL) offers a potential alternative. Comparing their safety and efficacy is essential to determine the optimal intervention. Materials and methods A comprehensive literature search was conducted through PubMed, Scopus, and Google Scholar databases for the studies published between January 2000 and November 2024. Eligible studies were cohort studies or randomized controlled trials comparing Phaco-GSL with Phaco-Trab in adult PACG patients. The primary outcome measure was the intraocular pressure (IOP) reduction, while the secondary outcome measures included best-corrected visual acuity (BCVA), anterior chamber depth (ACD), and postoperative complications. The data were pooled and analyzed using random-effects models. Results Five studies with a total of 381 patients were included. The meta-analysis demonstrated no statistically significant differences between Phaco-GSL and Phaco-Trab regarding the IOP reduction at 1 month (mean difference −0.21, 95% CI: −0.84 to 0.41, P=0.067) and at 6 months (mean difference −0.61, 95% CI: −1.24 to 0.03, P=0.087), improvement in BCVA (mean difference 0.00, 95% CI: −0.10 to 0.10, P=0.99), and increase in the ACD (mean difference 0.02, 95% CI: −0.07 to 0.10, P=0.69). However, Phaco-GSL significantly reduced the postoperative complications compared to the Phaco-Trab procedure (odds ratio 0.33, 95% CI: 0.20 to 0.55, P<0.0001). Conclusion Phaco-GSL and Phaco-Trab showed comparable efficacy for reducing the IOP, enhancing the BCVA, and increasing the ACD in PACG patients. Nevertheless, Phaco-GSL had a significantly better safety profile, highlighting its potential as a preferred surgical option. Further randomized controlled trials with larger sample size and longer follow-up periods are necessary to confirm these findings.
Purpose The aim of this study was to evaluate the impact of different hypotensive anesthetic regimens on the surgical field quality, intraoperative bleeding, and postoperative outcome in the patients undergoing dacryocystorhinostomy (DCR). Patients and methods This is a prospective randomized clinical trial that included 90 patients scheduled for DCR. The patients were randomly assigned to receive dexmedetomidine (group D), fentanyl (group F), or magnesium sulfate (group M) as adjuncts to general anesthesia to achieve controlled hypotension. The primary outcome measure was the surgical field quality assessed by a standardized bleeding score by a blinded surgeon, while the secondary outcome measures included the hemodynamic stability, recovery characteristics, postoperative pain scores, analgesic requirements, and perioperative complications. Results All three regimens provided satisfactory surgical field conditions with no statistically significant difference in the bleeding scores (15.2±1.1, 14.3±2.2, and 13.3±5.2) for groups F, D, and M, respectively, (P=0.23). The recovery profiles were generally comparable between the three groups (P>0.05). However, the dexmedetomidine was associated with significantly longer extubation and anesthesia recovery times (P=0.05). The extubating time was 50.3±2.5, 55.3±5.3, and 48.4±4.2 min for groups F, D, and M, respectively, (P=0.73). The orientation time was 8±4.3, 7.3±45, and 6.3±4 min for groups F, D, and M, respectively, (P=0.83). The patients in the dexmedetomidine group demonstrated significantly lower postoperative pain scores, longer time to first analgesic request, and reduced postoperative analgesic consumption compared with the other two groups (P=0.05). The time to the first postoperative analgesic in the dexmedetomidine group was the longest among the three groups (52.37±18.76 min, P=0.05). The incidence of perioperative complications was similar across the three groups. Conclusion Dexmedetomidine, fentanyl, and magnesium sulfate were all effective agents for achieving controlled hypotension and acceptable surgical field quality during DCR. Dexmedetomidine offered superior postoperative analgesia at the expense of prolonged recovery and higher sedation levels. The selection of the hypotensive agent should be individualized based on surgical priorities and postoperative care goals.
Purpose The aim of this study was to evaluate the changes in intraocular pressure (IOP) and anterior chamber parameters induced by pars plana vitrectomy (PPV) with silicone oil (SO) 1000cs tamponade by using anterior segment optical coherence tomography (AS-OCT) before PPV, post-PPV, and post-SO evacuation. Patients and methods This prospective observational study included 30 patients with rhegmatogenous retinal detachment and proliferative vitreoretinopathy grade B or C who were treated by PPV with SO 1000cs as a tamponade. The IOP was measured and AS-OCT was done before PPV, post-PPV at 1 week and at 1 and 3 months, and post-SO evacuation at 1 week and at 1 month. The outcome measures post-PPV and post-SO evacuation included the changes in IOP, anterior chamber angle, angle opening distance at 500 µm (AOD 500), and trabecular iris space area at 500 µm (TISA 500) compared with the corresponding values before PPV. Results There were statistically significant IOP ineases at all postoperative follow up visits (P<0.001) which correlated positively with ineased central corneal thickness at 1 week and at 3-month post-PPV (r=0.28, P=0.04 and r=0.30, P=0.03, respectively). There were significant ineases in the anterior chamber angle in all quadrants at 1 week and at 1 and 3 months post-PPV (P<0.001) with no significant changes at 1 week post-SO evacuation, while there was a significant inease at 1 month post-SO evacuation except in the superior quadrant (P<0.001 and 0.09, respectively). There were significant ineases in all quadrants of the AOD 500 and the TISA 500 at 1 week and at 1-month post-PPV (P<0.05). One week post-SO evacuation, there were significant deeases in all quadrants of the AOD 500 and the TISA 500 except the temporal AOD 500 and the inferior TISA 500 (P<0.05, 0.46, and 0.40, respectively) while at 1 month post-SO evacuation, there were significant ineases of all quadrants of the AOD 500 and the TISA 500 (P<0.05). Conclusion PPV with SO 1000cs tamponade caused IOP rise maximally at 1 week which positively correlated with ineased central corneal thickness. The anterior chamber parameters by AS-OCT ineased significantly during the first month post-PPV, which reached to the preoperative values or deeased in the first week post-SO evacuation, and then all parameters were ineased 1 month post-SO evacuation.
Air pollution has been ranked as one of the leading causes accounting for global disease burden. The objectives of the current article were to ascertain the different consequences of air pollution on ocular health, identify various ocular surface diseases linked to air pollution, and to propose public health interventions to mitigate the impact of air pollution on ocular health. A wide range of air pollutants have been identified that can impact the ocular health. Their consequences are more common among urban residents, industrial workers, traffic police, street vendors, etc. The evidence from a recent review indicated that the exposure to elevated levels of particulate matter (PM) PM2.5 and PM10 correlates with raised ocular surface disease index scores. Acknowledging the wide spectrum of ocular morbidities linked to air pollution, there is an urgent need to implement targeted public health measures to minimize the impact of these pollutants. In conclusion, air pollution acts as a significant but often underestimated threat to ocular health, resulting in a spectrum of ocular diseases. There arises the need to adopt a combination of interventions, including stringent policies, community awareness, occupational protection, and lifestyle modifications.
Purpose The aim of this study was to evaluate the retinal and postretinal function in the patients with high myopia using a battery of visual electrophysiological tests. Patients and methods A retrospective cross-sectional study was conducted on 120 eyes of 120 participants, who were divided into two groups: 60 patients with high myopia [spherical equivalent more than −6.0 diopters and/or axial length (AL) of 26.5 mm or more] and 60 participants of age and sex matched emmetropic controls. Only one eye per participant in each group was included in the analysis. All participants underwent a full-field electroretinography, multifocal electroretinography (mfERG), pattern electroretinography (PERG), and visual evoked potentials (VEP) according to the International Society for Clinical Electrophysiology of Vision standards. Optical coherence tomography (OCT) was performed to correlate the structural parameters with the functional outcomes. Results All electrophysiological responses were significantly reduced in the high myopic eyes in comparison to the control group (P<0.05). The full-field electroretinography illustrated a significantly reduced scotopic combined dark-adapted 3.0 a-wave and b-wave responses in the high myopia group compared with the controls (a-wave: 242±48 vs. 280±44 μV, P=0.009, b-wave: 438±85 vs. 510±72 μV, P=0.002) and significantly reduced photopic 30 Hz flicker amplitudes (146±34 vs. 180±32 μV, P=0.002). In comparison to controls, the high myopia patients exhibited significantly reduced mfERG P1 central amplitudes (15.2±4.8 vs. 28.9±6.0 μV, P<0.001) and peripheral amplitudes (25.4±7.1 vs. 39.7±7.5 μV, P<0.001), along with a significantly delayed mfERG P1 implicit time (38.6±3.2 vs. 36.1±2.8 ms, P=0.002). In addition, the PERG P50 amplitude was significantly reduced in the high myopia group than in the controls (2.4±0.6 vs 3.2±0.5 μV, P<0.001). Similarly, the PERG N95 amplitudes were markedly reduced in the myopia group compared with the controls (3.6±1.1 vs. 6.1±1.3 μV, P<0.001) with a significant prolongation of the N95 implicit time (103.2±7.8 vs. 98.4±6.2 ms, P=0.011). The VEP results also revealed a significant delay in the P100 latency (118.7±7.9 vs. 103.2±5.6 ms, P<0.001) and reduced P100 amplitude in the high myopia group compared with the controls (7.4±2.0 vs. 9.1±2.1 μV, P=0.008). The mfERG P1 amplitude showed significant correlations with the AL (r=–0.58, P<0.001), subfoveal choroidal thickness (SFCT) (r=+0.58, P<0.001), and central macular thickness (r=+0.42, P=0.006). In addition, the PERG N95 amplitude showed significant correlations with the AL (r=–0.56, P<0.001), SFCT (r=+0.47, P=0.003), central macular thickness (r=+0.35, P=0.021), as well as the retinal nerve fiber layer (RNFL) thickness (r=+0.51, P=0.001). The VEP P100 latency showed significant correlations with the SFCT (r=–0.28, P=0.047), RNFL thickness (r=–0.39, P=0.012), and AL (r=+0.49, P=0.002). Conclusion The electrophysiological tests demonstrated a multi-layer dysfunction in high myopia, affecting the photoreceptor, macular, and ganglion cell function. The combined ERG and VEP testing provided sensitive biomarkers for the functional impairment in high myopia and complemented the structural imaging.
Aim The aim of this study was to evaluate the intravitreal injection of aflibercept alone compared to combined aflibercept with triamcinolone acetonide (TA) in the management of macular edema (ME) secondary to retinal vein occlusion (RVO). Patients and methods This is a prospective comparative study that included 40 cases with ME secondary to RVO. They were divided into two equal groups each of 20 eyes. Group 1 were managed by intravitreal injection of aflibercept (Elyea) alone, while group 2 were treated by aflibercept plus TA. All cases were examined preoperatively and during the follow-up visits of 1 day, 1 week, and 1, 3, 6, and 12 months postinjection. The outcome measures were visual acuity (VA), intraocular pressure (IOP), central macular thickness (CMT) with optical coherence tomography, number of injections, and postoperative complications. Results The mean age of groups 1 and 2 was 46.33±4.5 and 47.25±5.25 years, respectively. Both groups were matched in age and sex (P>0.05). Central RVO was observed in 11 (55%) and 12 (60%) eyes in groups 1 and 2, respectively. The difference was statistically insignificant (P=0.879). Branch RVO was observed in nine (45%) and eight (40%) eyes in groups 1 and 2, respectively, with no statistically significant difference (P=0.745). The VA was significantly improved from baseline to 3 months postinjection in both groups. However, it was more significantly improved in group 2 compared to group 1 at 3-, 6-, and 12-month postinjection (P<0.001). The IOP was elevated on the first day postinjection, especially in group 2. Then, it started to decrease by the end of the first week to reach the normal ranges by the first month. However, group 2 showed an increased IOP more than group 1 without a statistically significant difference (P>0.05). The CMT was significantly decreased from baseline to 1-month postinjection in both groups and continued to decrease till the end of the follow-up period (P<0.001). However, the effect was more marked in group 2 compared to group 1, with a statistically significant difference (P<0.05). Group 2 cases required significantly less number of injections than group 1 (P<0.05). The interval between injections was also shorter in group 1 than in group 2, with statistically significant differences at 3 and 4 weeks (P<0.001). Most eyes in group 2 had longer intervals between the injections with a statistically significant difference at 8 weeks (P<0.001). Conclusion Both aflibercept and aflibercept plus TA were efficient in the management of ME secondary to RVO. However, the outcome of combined therapy was better regarding the VA and the decrease in CMT, with a smaller number of injections. On the other hand, aflibercept showed more safety regarding the elevation of the IOP.
Objective This study aimed to assess the relationship between using digital screens in school children and adolescents and dry eye disease. Patients and methods This prospective cross-sectional observational study was conducted between January and July 2024 at the Ophthalmology Department of Menoufia University Hospital, Menoufia and Kafr El-Sheikh Ophthalmology Center, Kafr El-Sheikh, Egypt. It included 90 school children (180 eyes), aged 10–18 years (35 boys and 55 girls), who were outpatient clinic visitors and regular users of digital screens such as smartphones and tablets. The participants were assessed by the ocular surface disease index (OSDI) questionnaire, followed by clinical evaluation that included the tear break-up time (TBUT), lower tear meniscus height (LTMH), and the Schirmer’s test. The participants were grouped according to the duration of screen use into two groups: 3 h or less and more than 3 h groups. Results Most of the studied children (64.4%) spent more than 3 h daily on digital screens. The OSDI revealed a statistically significant correlation between increased screen time and higher OSDI scores (r=+0.536, P<0.001). In the group of less than or equal to 3 h of daily screen time, 78.1% had normal OSDI scores, compared to only 34.5% in the more than 3 h group. The TBUT (r=−0.421, P<0.001), Schirmer’s test (r=−0.494, P<0.001), and LTMH (r=−0.559, P<0.001) showed statistically significant reductions in the children with more than 3 h of screen time. Normal TBUT was observed in 78.1% of the low screen time group compared to 39.7% among the high screen time users. Similarly, while 90.6% of the children with less than or equal to 3 h of screen time had normal tear production, only 48.3% of those with more than 3 h had normal Schirmer’s test results. Additionally, 81.25% of the children with less than or equal to 3 h of daily screen time had an LTMH more than or equal to 300 μm, compared to only 32.8% among those with high screen use. Conclusion There was a significant association between prolonged daily digital screen use among school-aged children and adolescents and the severity of dry eye symptoms, as well as the corresponding clinical indicators. This extended screen exposure adversely affected the ocular surface health, resulting in unfavorable outcomes.
Background Uveitis is the inflammation of the uveal tissues, including the ciliary body, iris, and choroid. Vitamin D has been associated with many ocular diseases including uveitis. Purpose The objective of this study was to assess the relationship between serum vitamin D levels and the activity status of uveitis. Patients and methods This prospective cross-sectional study was conducted between October 2022 and April 2024 at the Uveitis Clinic, Ibn Al-Haitham Teaching Eye Hospital, Baghdad, Iraq. Active uveitis was defined by the presence of flare and cells in the anterior chamber, vitritis, choroiditis, retinitis, or retinal vasculitis as determined through slit-lamp biomicroscopy and fundoscopy. Blood samples were collected and vitamin D levels were checked using an enzyme-linked immunosorbent assay. Results The study included 51 patients with a mean age of 38.16±14.4 years. The mean vitamin D level was 38.8±16.2 nmol/ml. The most common type of uveitis was pars planitis followed by tuberculosis. Patients with active disease had significantly lower vitamin D levels (26.45±9.56 nmol/ml) compared to those with inactive uveitis (55.09±4.22 nmol/ml), with a mean difference of 28.64 nmol/ml (P<0.001). Regression analysis showed that no significant effects were found for any of the independent variables (sex, age, and cause of uveitis) on the dependent variable (active or inactive uveitis). Conclusions Vitamin D levels were strongly associated with uveitis activity, with lower levels linked to active disease.
Purpose This study aimed to compare the anatomical and functional outcomes of pars plana vitrectomy (PPV), intravitreal ranibizumab (IVR), and intravitreal triamcinolone acetonide (IVTA) injection in chronic persistent diabetic macular edema (DME) with nontractional epiretinal membrane (NT-ERM). Patients and methods This is a randomized prospective study that included 52 patients having chronic DME with NT-ERM who were divided into three groups: PPV with internal limiting membrane peeling group, IVR group, and IVTA group. The patients were evaluated by optical coherence tomography angiography before and 3 months after the interventions. The primary outcome measures included the changes in best-corrected visual acuity (BCVA) in LogMAR and central subfield foveal thickness (CST), while the secondary outcome measures were changes in intraocular pressure and optical coherence tomography angiography parameters. Results There was no statistically significant change in the BCVA in the PPV group (1.15±0.37 preoperatively to 1.22±0.47 postoperatively, P=0.560). On the other hand, the BCVA significantly improved in the IVR group from 1.04±0.42 preoperatively to 0.725±0.209 postoperatively (P<0.001) and in the IVTA group from 1.32±0.366 preoperatively to 0.945±0.34 postoperatively (P<0.001). The intraocular pressure increased significantly in the PPV and in the IVTA groups (from 15±1.65 to 20.33±4.22 mmHg and from 15.4±1.63 to 19.4±2.54 mmHg, respectively, P<0.001). The CST decreased significantly in all groups, with the PPV group showing the greatest reduction from 509.6±129.6 to 380.9±147.5 μm (P=0.003). The vessel density declined significantly in the PPV group from 40.5±3.5 to 35.9±4.1% (P<0.001). Conclusion PPV effectively reduced the CST and vessel density but did not improve the visual acuity. Both IVR and IVTA injections provided significant anatomical and functional benefits in chronic DME with NT-ERM.
Purpose The aim of this study was to assess the effect of the presence of epiretinal membrane (ERM) on the central macular thickness (CMT) and visual acuity in patients with diabetic macular edema (DME) treated with intravitreal aflibercept injections. Patients and methods A prospective interventional comparative study was carried out at the Department of Ophthalmology, Alexandria University, Alexandria, Egypt. It included 60 treatment-naïve patients, who were divided into two groups: 30 eyes with DME and ERM (study group) and 30 eyes with DME only (control group) that was confirmed with optical coherence tomography (OCT) with a CMT more than 300 μm. Only one eye per patient in each group was included in the analysis. All patients were subjected to full ophthalmic assessment. Then, they received three consecutive monthly intravitreal injections of 2.0 mg aflibercept and were followed up monthly for 6 months. Retreatment was performed when needed as in cases with persistent macular edema or recurrent macular edema documented by OCT. Spectral domain OCT for the assessment of the CMT was done in all patients at baseline, and at the 3 and 6-month follow up visits, and when needed in some cases during the follow-up. Results At baseline, no significant differences existed between the study group and the control group regarding age, sex, mean CMT, and mean best-corrected visual acuity (BCVA) (P>0.05). The mean CMT, in the study group, improved significantly from a baseline value of 482.1±72.83 μm (range: 375–636 μm) to 443.2±79.22 μm (range: 297–597 μm) and 422.0±73.89 μm (range: 293–585 μm) at 3 and 6 months, respectively (P<0.001). Similarly, the mean CMT, in the control group, improved significantly from a baseline value of 470.1±70.44 μm (range: 376–626 μm) to 330.0±78.12 μm (range: 246–501 μm) and 297.2±37.08 μm (range: 240.0–390 μm) at 3 and 6 months, respectively (P<0.001). In the study group, the mean baseline BCVA was 0.66±0.13 LogMAR (range: 0.50–1.0 LogMAR) and significantly improved to 0.58±0.12 LogMAR (range: 0.40–0.80 LogMAR) at 3 months and to 0.54±0.13 LogMAR (range: 0.30–0.80 LogMAR) at 6 months (P=0.002 and <0.001, respectively). The mean baseline BCVA, in control group, was 0.61±0.11 LogMAR (range: 0.50–1.0 LogMAR), that significantly improved to 0.33±0.14 LogMAR (range: 0.20–0.60 LogMAR) at 3 months, and to 0.28±0.10 LogMAR (range: 0.20–0.50 LogMAR) at 6 months (P<0.001).The control group had significantly better BCVA and superior CMT reduction compared to the study group at the 3- and 6-month follow up visits (P<0.001) with less number of injections (mean: 3.97±1.33 injections) needed than in the study group (mean: 5.77±0.57 injections) (P<0.001). Conclusion Patients with DME and ERM showed lower treatment response to intravitreal injection of aflibercept regarding both visual (BCVA) and anatomical (CMT) outcomes than the patients with DME only.
Purpose This study aimed to evaluate the outcome of argon laser therapy for nonresolving central serous chorioretinopathy (CSCR) in a Saudi patient population. Patients and methods This is a prospective case series study of 20 eyes (20 patients) having nonresolving CSCR. In all of them, no signs of spontaneous improvement were noticed in 3 months. The assessment of the patients, including history taking, visual acuity, full ocular examination using slit lamp biomicroscopy, and fundus fluorescein angiography were done at baseline. Optical coherence tomography was done before treatment and at all follow-up (FU) visits. Fundus autofluorescence was done in 16 cases. The FU was done for 6–30 months (mean=9.7±6.4 months). Results The age of the patients ranged from 24 to 73 years (mean=43.0±10.9 years). One laser session was enough in 18 (90%) eyes, while two sessions were needed in two (10%) eyes. All study eyes experienced subjective improvement in vision following treatment. The mean LogMAR visual acuity improved from 0.51±0.155 before the laser treatment to 0.23±0.23 at the last FU, with a statistically significant difference (P=0.000). The mean height of the subretinal fluid at the foveal centre decreased significantly from 196.79±116.7 µm before treatment to 11.16±14.7 µm at the last FU (P=0.000). The integrity of the inner segment ellipsoid zone and normality of the foveal AF were associated with a better visual outcome. No treatment-related complications were encountered in any case. Conclusion Although argon laser therapy is an old treatment modality for CSCR, it remains an effective one. It is easy, cheap, readily available, and safe when properly done. Foveal AF appearance and post-treatment inner segment ellipsoid zone integrity are important predictors of visual improvement in CSCR following the argon laser treatment.
A 35-year-old male patient attended our Outpatient Department with a complaint of diminution of vision in the left eye. He had a history of pterygium surgery in the left eye 20 days ago elsewhere. There was no improvement in visual acuity by best correction. Slit lamp examination showed bilateral peripheral corneal thinning with neovascularization and central macular grade corneal opacities in the left eye. Corneal topography showed ectatic areas on the anterior and posterior elevation maps and areas of high-risk corneal thinning on pachymetry in the left eye, high maximum keratometry values in both eyes despite normal corneal pachymetry in the right eye indicating progression of the disease in the right eye as well. Based on slit lamp examination, results of corneal topography, anterior segment optical coherence tomography, and lipid profile we diagnosed him as a case of bilateral Terrien’s marginal degeneration (TMD) involving the left eye more than the right eye. The patient was otherwise asymptomatic and was started on lubricants in both eyes with close follow up. We found a rare presentation of an early asymmetrical bilateral TMD associated with history of pterygium surgery. Corneal topography along with slit lamp examination and increased lipid profile levels helped in diagnosing the case as TMD while ruling out other close differentials of the disease like pellucid marginal degeneration and keratoconus.
Purpose The aim of this study was to report on the biometric characteristics of the eyes with congenital cataract (CC) and microcornea (suggesting a novel index to characterize the anterior segment of children eyes with CC) and to compare it to the equivalent values in children with CC and otherwise normal eye dimensions. Patients and methods This is a prospective case–control study that was conducted on 17 children (six males and 11 females) presenting with CC and microcornea (cases group) and 20 age-matched children (11 males and nine females) presenting with CC only (control group). Thorough history was taken from the care providers. Office examination was followed by examination under anesthesia and ultrasound biomicroscopy. The main outcome measures were the biometric characteristics of the eyes with CC and microcornea and suggesting the ratio of the lens equatorial diameter to the sulcus-to-sulcus distance (expressed as percentage) to characterize the anterior segment of eyes with CC. Results The mean age of the cases at presentation was 5.9±7.1 months (range=1.8–30.5 months) that matched that of the controls (mean=8.4±5.0 months, range=2.7–18.3 months), (P=0.225). There was a statistically significant difference between the eyes of the cases and controls in the corneal diameter (9.7±0.4 and 11.46±0.5 mm, respectively, P<0.001), central corneal thickness (588.9±72.8 and 546.0±37.5 µm, respectively, P=0.003), lens thickness (2.14±1.17 and 3.28±1.12 mm, respectively, P=0.0001), ciliary process length (1.34±0.37 and 1.20±0.23 mm, respectively, P=0.015), sulcus-to-sulcus distance (9.08±0.88 and 10.73±0.54 mm, respectively, P<0.001), nondilated pupil diameter (1.57±0.81 and 2.83±1.55 mm, respectively, P=0.0001), lens equatorial diameter (6.02±1.11 and 8.0±0.6 mm, respectively, P<0.001), lens vault (−0.01±0.43 and 0.52±0.47 mm, respectively, P<0.001), and lens equatorial diameter to sulcus-to-sulcus distance ratio (65.76±9.9 and 74.96±4.74%, respectively, P<0.001). Conclusion The whole of the anterior segment in the eyes with CC and microcornea was disproportionately smaller than the dimensions of the eyes with CC only. In eyes with microcornea, the ratio of lens equatorial diameter to the sulcus-to-sulcus distance was significantly less than in otherwise normal dimensions eyes.
Purpose The aim of this study was to build and internally validate a machine learning (ML) model that can discriminate between normal individuals and patients with different glaucoma stages using the lamina cribrosa (LC) structural parameters. Patients and methods This retrospective analysis used a dataset of 92 eyes (52 glaucomatous eyes of 28 primary open angle glaucoma patients and 40 normal eyes of 20 age-matched normal participants). Five LC parameters, specifically prelaminar neural tissue (PLNT) area, PLNT thickness, LC thickness, LC area, and anterior LC surface depth, were derived from enhanced depth imaging optical coherence tomography of the LC. These parameters were used to train a Random Forest Classifier for classifying the eyes into three groups: normal, mild to moderate glaucoma, and severe glaucoma. Internal validation was performed using a five-fold stratified cross-validation, and SHapley Additive exPlanations (SHAP) values applied to determine the model interpretability. Results The ML model average accuracy was 0.6392±0.1270, with F1-scores (the harmonic mean of precision and recall) of 0.7124 for “normal,” 0.5514 for “mild to moderate glaucoma,” and 0.5921 for “severe glaucoma.” The SHAP analysis identified PLNT area, PLNT thickness, and anterior LC surface depth as the most influential parameters for classification. Conclusion The ML model created using enhanced depth imaging optical coherence tomography LC parameters provided an objective approach in glaucoma diagnosis and staging, while offering clear explanations for its classifications. By identifying parameters such as PLNT area as highly predictive features, the model enhanced the clinical understanding of the structural changes in the LC. External validation is required for broad clinical application.
Purpose The aim of this study was to compare the efficacy of intravitreal injection of aflibercept 2 mg to oral spironolactone in acute central serous chorioretinopathy cases with subretinal fluid (SRF) of less than a 3-month duration. Patients and methods This is a prospective randomized study which included 40 eyes of 40 treatment naïve patients with acute central serous chorioretinopathy who were divided into two groups: group 1 which included 20 eyes of 20 patients who received intravitreal injection of aflibercept 2 mg based on pro-re-nata protocol and group 2 that included 20 eyes of 20 patients who received oral spironolactone 50 mg daily up to 12 months. Optical coherence tomography was performed for all cases at baseline and after 1, 3, 6, 9, and 12 months. Results In group 1, the central macular thickness (CMT) diminished significantly from 446±120.5 µm at baseline to 207.2±11.1 µm after 12 months (P<0.001), while in group 2, the CMT showed a statistically significant decline from 449±115.1 µm at baseline to 238.2±31.8 µm after 12 months (P<0.001). There was a more significant decline in the CMT in group 1 compared to group 2 throughout the whole duration of the study (P=0.001, 0.02, 0.003, 0.02, and 0.002 at 1, 3, 6, 9, and 12 months, respectively). Complete resolution of the SRF was achieved in all cases of group 1 and in 55% of the cases of group 2, with a statistically significant difference (P=0.001). There was a statistically significant improvement in best-corrected visual acuity (BCVA) (LogMAR) after 12 months in both groups (group 1 from 0.4±0.1 at baseline to 0.1±0.0 after 12 months, P<0.001 and group 2 from 0.4±0.1 to 0.16±0.06, respectively, P<0.001). Group 1 showed a more significant BCVA improvement compared to group 2 throughout the follow-up visits at 1, 6, 9, and 12 months (P=0.001, 0.006, 0.01, and 0.006, respectively). Both groups showed a significant positive correlation between the number of injections (in group 1), baseline CMT, baseline SRF height, and baseline BCVA with the CMT, SRF height, and BCVA changes after 12 months (P<0.001). Conclusion Intravitreal aflibercept 2 mg injections resulted in a faster and a more resolution of the SRF with better BCVA gain compared to oral spironolactone.
Purpose The aim of this study was to investigate the correlation between glaucoma and retinal vein occlusion (RVO) using quantitative metrics of vascular stasis on optical coherence tomography angiography (OCTA). Patients and methods This is a prospective observational, cross-sectional, case–control study that evaluated the retinal peripapillary venous tortuosity index (VTI), as a sign of vascular stasis, by using OCTA images. The study included 45 eyes of 45 patients who were equally distributed among three study groups: healthy controls (15 eyes), glaucomatous eyes with no RVO (15 eyes), and glaucomatous eyes with unilateral RVO (15 eyes). The OCTA scans were also evaluated to obtain the vessel density of the peripapillary and macular capillary plexuses for evidence of capillary nonperfusion. Results There was a statistically significant difference in the VTI among the three groups (P<0.001). The highest VTI was in the glaucoma with RVO group (1.13±0.02, 1.16±0.02) followed by the glaucoma without RVO group (1.06±0.01, 1.07±0.01) and the healthy control group (1.04±0.01, 1.05±0.01). The vessel density was significantly less (P=0.002) in the macular superficial capillary plexus in the glaucomatous eyes with RVO (39.8±5.5%), and in the eyes without RVO (40.1±4.3%) compared to the nonglaucomatous eyes (47.6±3.2%). On the other hand, the deep capillary plexus showed no statistically significant differences between the three groups. Conclusions Primary glaucomas contributed to higher peripapillary vascular stasis, manifested by increased venous tortuosity, associated with the precipitation of RVO. Larger longitudinal studies may be required to evaluate the peripapillary VTI as a prognostic marker for developing RVO in glaucoma.
