Background: Infected corneal ulcers that don't show any healing within two weeks despite proper medical treatment are considered resistant and need surgical intervention [1] the amniotic membrane transplantation has been used to treat resistant corneal ulcers because it acts as a bioactive substratum that accelerates epithelial healing [2]. Aim of the Work: comparison between interrupted and running sutures for amniotic membrane fixation in cases of resistant infected corneal ulcers. Patients and Methods: This prospective, comparative, interventional randomized study was carried out on 40 eyes with resistant infected corneal ulcers. They underwent amniotic membrane transplantation as an adjunctive to the medical treatment. Divided into 2 groups: group A (interrupted suture group) and group B (running suture group). The duration of study was 12 months. Results: The duration of healing in group A ranged from 25 to 40 days with mean duration of 34.25±4.94 days, while in group B the duration of healing ranged from 20 to 40 days with mean duration of 31.0±6.61 days. UDVA didn’t improve in 65% of cases in group A and 45% of cases in group B. Conclusion: Amniotic membrane transplantation is an adjunctive surgical procedure for the management of infectious corneal ulcer by promoting wound healing and reducing inflammation. We noticed that the running suture adhered the amniotic membrane firmly to the entire corneal surface so it accelerated the corneal epithelial healing and made it less affected with eyelid movement and less annoying to patient.

Background: Microbial keratitis (MK) is caused by bacteria, fungi, and protozoa. It is very important to differentiate between these three causative microorganisms very early as they differ in their treatment, and some of these microorganisms, like Pseudomonas aeurogenosa, may result in eye perforation within 72 hours .The purpose of this study was to evaluate impression cytology smear to be used as a guide for early accurate treatment of cases. This study was conducted on 80 patients suspected of having MK. A corneal smear was taken with impression cytology paper (a non-invasive technique) and transported to the microbiology laboratory for examination. Results: The IC smear examination results were as follows: 30 (37.5%) were Aspergillus fungus, 14 (17.5%) were Acanthamoeba, 15 (18.75%) were Gram-negative bacilli, 4 (5%) were Staphylococci, 1 (1.25%) was Streptococci, 14 (17.5%) were both Gram-negative bacilli and Aspergillus fungus, and 2 (2.5%) were both Staphylococci and Aspergillus fungus. There was no significant difference between the diagnosis of MK by the culture method and the IC smear method. Conclusion: The impression cytology smear can be used as guide for early treatment of MK.

AIM:To compare argon laser photocoagulation and intrastromal injection of voriconazole as adjunctive treatment modalities in cases of resistant mycotic corneal ulcers.METHODS:Two groups each of them included 20 cases of resistant mycotic corneal ulcers. Both groups treated with local and systemic specific antimicrobial drugs guided with culture and sensitivity results. In one group argon laser photocoagulation was used as an adjunctive therapy to the specific antifungal drugs and in the other group, intrastromal injection of voriconazole was done besides the specific antifungal drugs. The 40 cases included in the study were proven according to culture and sensitivity to be 28 cases with pure fungal results and 12 cases with mixed (fungal and bacterial). In argon laser group, argon laser irradiation of the corneal ulcer was performed using argon laser 532 nm wavelength (Carl Zeiss LSL 532s AG; Meditec, Inc.) after fluorescein staining. In the other group, voriconazole solution (500 µg/mL) was prepared and injected in the corneal stroma. All cases were followed up for 3mo after healing was achieved.RESULTS:Complete healing of the epithelial defect and resolution of stromal infiltration with no adverse effects were achieved in argon laser group in duration ranged from 2-4wk in 90% of cases. In voriconazole group 4 cases needed amniotic membrane graft due to thinning and 16 cases healed in duration ranged from 2-6wk (80% of cases).CONCLUSION:Argon laser photocoagulation is superior to intrastromal voriconazole injection in treatment of resistant fungal corneal ulcers.

Purpose This is a prospective investigational study that was performed at Tanta University Eye Hospital, Tanta, Egypt to evaluate the role of ultrasound biomicroscopy (UBM) in planning secondary implantation of intra ocular lens (IOL) in aphakia. Methods Preoperative UBM was performed for the assessment of anterior segment of 30 aphakic eyes admitted for secondary IOL implantation with special attention to central corneal thickness (CCT), anterior chamber depth (ACD), ciliary sulcus (CS), anatomical changes, and posterior capsular (PC) integrity which had been assessed by measuring the remnants of PC with special attention to the 12, 3, 5, 6, 7, and 9 o'clock meridians. Results This study involved 30 eyes in 27 patients; 16 males and 11 females. The mean age was 8.39 ± 2.36 years. The causes of aphakia were: congenital cataract extraction in14 eyes (46.7 %); trauma in 14 eyes (46.7 %); and after extracapsular cataract extraction in 2 eyes (6.6 %). The mean CCT was 0.61 + 0.35 mm and the mean ACD was 3.03 + 0.41 mm. The ciliary sulcus was patent in 28 eyes (93.4 %). Posterior synechia was observed in 8 eyes (26.7 %), lens remnants in 11 eyes (36.7 %), corneal scars in 11 eyes (36.7 %), and vitreous in anterior chamber in 1 eye (3.3 %). The integrity of PC was illustrated with a diagram. Conclusions UBM is a useful device to evaluate aphakic eyes before secondary IOL implantation through good evaluation of the anterior segment with special attention to the posterior capsular integrity, ciliary sulcus, anterior chamber depth, corneal thickness, and detection of any structural changes in the anterior segment resulting from the remote cause of aphakia.

PURPOSE:To evaluate the role of argon laser as an adjunctive therapy in ten patients with resistant infected corneal ulcers with or without hypopyon.METHODS:The study included 20 patients, split into two groups of ten, with resistant infected corneal ulcers with or without hypopyon. One group was considered as the control group and treated with local and systemic specific antimicrobial drugs guided with culture and sensitivity tests. The other group started with the same specific therapy as the control group for 1 week with no obvious improvement and then was further treated with argon laser. The ten patients in the control group included five cases of fungal ulcers, three mixed (fungal and bacterial) ulcers, and two viral ulcers. The ten patients in the other group included three cases of fungal ulcers, three mixed (fungal and viral) ulcers, three viral ulcers, and one bacterial ulcer as proven with microbial culture and sensitivity tests. Eight cases of the control group and seven cases of the other group were associated with hypopyon. Before laser treatment, a drop of benoxinate hydrochloride 0.4% and a single drop of fluorescein sodium 0.25% were instilled. Argon laser irradiation of the affected cornea was performed using an argon 532 nm wavelength (Carl Zeiss LSL 532s AG; Carl Zeiss Meditec AG, Jena, Germany). A spot size of 500 μm, pulse duration of 0.2 seconds, and power of 900 mW were used. All cases were followed up for 3 months after healing was achieved.RESULTS:During the first 4 weeks after laser treatment, all patients showed complete healing of the epithelial defect and resolution of stromal infiltration with no adverse effects. In the control group, four cases needed an amniotic membrane graft due to thinning and the other six cases were healed in a duration that ranged from 3 to 7 weeks.CONCLUSION:Argon laser phototherapy is useful as an adjunctive treatment for resistant infected corneal ulcers. More cases are needed to get more reliable results and to confirm our findings.