Introduction: This study aimed to discover and document the potential of visual and ocular sequelae of computer vision syndrome (CVS) among medical students. Methods: This cross-sectional case-control study was conducted on medical students (n=4030) of five universities in Egypt. All students completed a specially designed and validated CVS questionnaire survey (CVS-F3). Students with ≥5 CVS symptoms constituted a risk group (n=352), while students with 1-4 CVS symptoms constituted a low-symptoms group (n=3067). Students from the control and risk groups were examined using objective methods, such as visual acuity, subjective refraction, dry eye disease tests, and anterior segment and fundus examinations. Students who complained of visual blur underwent multifocal electroretinography mfERG examinations (mfERG group). Results: The CVS-F3 indicated that 84.8% of students had complaints that might be related to CVS, however, our ophthalmic examination group revealed only a 56% CVS prevalence rate. The most common single screen type used by 70.4% of students was the smartphone, and the most common complaint was headache (50.2%). Multivariate logistic regression analysis revealed that CVS was significantly associated with increased screen-hours, including >2 screen-hours daily (odds ratio [OR], 2.48; P<0.0001), >2 screen-hours at night (OR, 1.79; P=0.003), and ≥3 screen-years (OR, 1.69; P=0.006). In the mfERG group, 37% demonstrated reduced amplitudes of mfERG rings and quadrants, indicating reduced foveal responses. Conclusion: CVS-questionnaires overestimate the true CVS prevalence and sequelae, which could be accurately detected by objective ophthalmic examination. Smartphones primarily caused CVS among students, with CVS severity increasing in correlation with shorter eye-to-screen distance and frequent use. Contact lens wearing doubled the risk of CVS development and augmented its severity. CVS might affect macular integrity with screen-induced foveal dysfunction. Clinical Trials Registration: PACTR201811618954630.

Purpose: To compare effective phacoemulsification time (EFX) in femtosecond laser-assisted cataract surgery (FLACS) versus traditional quick chop phacoemulsification (QCP) in senile nuclear cataracts with different densities focusing on soft and hard ones. Patients and Methods: A prospective non-randomized comparative study was carried out in Al Watany Eye Hospital and Ain Shams University Hospital, Cairo, Egypt; 250 eyes with senile nuclear cataract (NC) were included and classified into two main groups, FLACS and QCP groups. Each of them was stratified according to nuclear density into three subgroups, subgroups I (Soft NC), II (Medium NC), and III (Hard NC). Sextans-softened fragmentation pattern was performed in the FLACS group. Total EFX utilized for nucleus disassembly and removal was recorded by the completion of each surgery. Results: A total of 117 eyes were included in the FLACS group and 133 eyes in the QCP group. No significant difference in EFX was observed between the two groups (P = 0.228). Regarding subgroups, EFX showed no statistically significant difference between FLACS and QCP (P = 0.283) in soft NC. For hard NC, a trend to lower values of EFX in FLACS compared with QCP was found, but without statistically significant difference (P = 0.122). Only in medium NC were significantly lower values obtained in FLACS compared with QCP (P < 0.0001). Conclusion: When compared with QCP technique, FLACS can be used for advantages aside from EFX reduction, including astigmatic keratotomies, accurate sizing, and centration of capsulotomies especially in hard and soft nuclear cataracts. Significant reduction of total EFX with FLACS is most prominent only in medium-density nuclear cataracts.

PURPOSE:To compare ultrasound (US) energy utilized in different phases of nuclear cataract removal in femtosecond laser-assisted cataract surgery (FLACS) with conventional phacoemulsification surgery (CPS) in relation to different nuclear densities.METHODS:A prospective nonrandomized comparative study was conducted at Ain Shams University and Al Watany Eye Hospital, Cairo, Egypt on 250 eyes with senile nuclear cataracts (NCs) of different nuclear densities (1-6). Eyes were divided into two groups - FLACS and CPS - and each group was subdivided according to cataract density into subgroups A (NC 1-2), B (NC 3-4) and C (NC 5-6). sextant-softened fragmentation patterns were assessed in the FLACS group and the quick-chop technique used in the CPS group. US energy required for nucleus cracking (EFX split) and for quadrant removal (EFX quadrant) was recorded.RESULTS:Total eyes included in the FLACS and CPS groups were 117 and 133, respectively. No significant differences between the groups for EFX quadrant and EFX split groups were observed (P=0.18 and P=0.49, respectively). For subgroup A, no significant difference was found between FLACS and CPS on EFX split (P=0.08) and EFX quadrant (P=0.49). For subgroup B, significantly lower values of EFX split (P=0.0001) and EFX quadrant (P<0.0001) were obtained with FLACS than CPS. For subgroup C, no significant difference was found for EFX split (P=0.86); however, EFX quadrant was significantly lower in the FLACS group (P=0.05).CONCLUSION:FLACS lowers US energy utilized during quadrant removal at different nuclear densities, with highest significance in medium-density nuclear cataracts. Nucleus cracking by femtosecond laser is less effective in very hard cataracts. However, femtosecond-laser softening of hard nuclei is capable of of US-energy reduction during quadrant removal.

To assess the efficacy and stability of simultaneous topography-guided photorefractive keratectomy (PRK) and crosslinking (Athens protocol) followed by phakic intraocular lens (IOL) implantation for managing keratoconus. Ain-Shams University, Cairo, Egypt. Prospective non-randomized study. All patients underwent topography-guided PRK followed immediately by collagen crosslinking (Athens protocol), 2–4 months later, eyes were implanted with either an iris claw or an angle-supported phakic IOL. Statistical analysis was performed with SigmaPlot software version 11.0 (Systat Software, Inc.). This study evaluated 22 eyes of 14 patients. Follow-up interval was at least 6 months. A Veriflex phakic IOL was implanted in 14 eyes (63.6 %), and a Cachet phakic IOL was implanted in 8 eyes (36.4 %). The mean preoperative keratometric reading (45.57 ± 1.51 D) was significantly reduced at 3 months and at 6 months after treatment (43.82 ± 1.98 D, P < 0.001). The mean spherical equivalent was significantly reduced from −9.08 ± 2.5 to −0.69 ± 0.67 D, P = <0.001. The mean UCVA improved from 1.24 ± 0.49 to 0.37 ± 0.08 logMAR. The mean corrected distance visual acuity (CDVA; logMAR) improved from 0.69 ± 0.3 preoperatively to 0.35 ± 0.01 postoperatively (P = <0.001). At last follow-up, all eyes could achieve CDVA of 0.3 or better. The difference between pre- and postoperative endothelial cell counts was not statistically significant. Combining phakic IOLs and the Athens protocol improved and stabilized visual performance in patients with keratoconus. These results justify a future, large-scale study with a longer follow-up.

Purpose This paper compares and evaluates the corneal morphological changes occurring after cataract surgery through a 2.2 mm corneal incision. We use two platforms for comparison and evaluation, transversal and torsional phacoemulsification. Patients and methods This study includes 139 consecutive cataractous eyes (nuclear color 2–4, according to the Lens Opacities Classification System III [LOCSIII]) of 82 patients undergoing cataract surgery through a 2.2 mm corneal incision. Two different phacoemulsification platforms were used and assigned randomly: we used the WhiteStar Signature® system with the Ellips™ FX transversal continuous ultrasound (US) mode for group I (mean age: 65.33 ± 6.97 years), and we used the Infiniti® system with the OZil® Intelligent Phaco (IP) torsional US mode for group II (mean age: 64.02 ± 7.55 years). The corneal endothelium and pachymetry were evaluated preoperatively and at 1 month postoperatively. Incision size changes were also evaluated. Results All surgeries were uneventful. Before intraocular lens implantation, the mean incision size was 2.24 ± 0.06 mm in both groups (P = 0.75). In terms of corneal endothelial cell density, neither preoperative (I vs II: 2304.1 ± 122.5 cell/mm2 vs 2315.6 ± 83.1 cell/mm2, P = 0.80) nor postoperative (I vs II: 2264.1 ± 124.3 cell/mm2 vs 2270.3 ± 89.9 cell/mm2, P = 0.98) differences between the groups were statistically significant. The mean endothelial cell density loss was 1.7% ± 1.6% and 2.0% ± 1.4% in groups I and II, respectively. Furthermore, no significant differences between groups I and II were found preoperatively (P = 0.40) and postoperatively (P = 0.68) in central pachymetry. With surgery, the mean increase in central pachymetry was 28.1 ± 23.6 μm and 24.0 ± 24.0 μm in groups I and II, respectively (P = 0.1). Conclusion Ellips™ FX transversal and OZil® IP torsional phacoemulsification modes are safe for performing cataract surgery, inducing minimal corneal thickness and endothelial changes.

PURPOSE: To study spherical aberration, coma, and trefoil after implantation of a single-piece aspheric Tecnis intraocular lens (IOL) in cataract patients and the influence on photopic and mesopic contrast sensitivity.SETTING: Ophthalmology Department, Ain-Shams University Hospitals, Cairo, Egypt.METHODS: In this randomized prospective contralateral comparative study, patients had bilateral senile cataract Eyes with a pathological condition other than cataract that might influence postoperative visual function were excluded The aspheric IOL was compared with the Sensar AR40e spherical IOL The IOL selection was randomized. Study criteria included corrected distance visual acuity (CDVA), wavefront aberrometry, and contrast visual acuityRESULTS: Fifty-six eyes of 28 patients were enrolled All patients completed the 2-month postoperative visit There was no significant difference between the IOLs in CDVA (P> 05) Ocular spherical aberration was significantly lower with aspheric IOLs than spherical IOLs (P<.001). Two months after surgery, eyes with the aspheric IOL had better photopic contrast sensitivity and better mesopic contrast sensitivity at all cycles per degree. There was no significant difference in 3rd-order aberrations (coma and trefoil) between IOLs.CONCLUSIONS: After cataract surgery, the single-piece aspheric IOL resulted in significantly lower ocular spherical aberration and significantly better mesopic contrast sensitivity. No significant difference in 3rd-order aberrations indicates that both IOLs had satisfactory centration in the capsular bag.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.J Cataract Refract Surg 2010; 36.1536-1542 (C) 2010 ASCRS and ESCRS