Background Diabetic maculopathy is a serious consequence of diabetic retinopathy (DR) that greatly affects the visual acuity. Diabetic macular edema (DME) and diabetic macular ischemia (DMI) are major causes of vision affection in diabetic patients. Purpose The aim of this study was to compare fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) in evaluation of diabetic maculopathy. Patients and methods This comparative cross-sectional study was performed on 87 eyes of 54 patients with type I or type II diabetes, older than 18 years old with any diabetic retinal changes, and 108 eyes of 54 control subjects. An ocular examination was performed as well as color fundus photography, FA, and OCTA. Investigations were done on the same day. FA and OCTA findings were summarized and compared. Results The mean age of the patients was 59.4±8.5 years. OCTA was statistically significantly superior to FA in diagnosing DMI. The foveal avascular zone (FAZ) was ischemic (enlarged) in 74 (85.06%) eyes by OCTA compared with only 46 (52.87%) eyes by FA, with a statistically significant difference (P = 0.001). In addition, OCTA detected microaneurysms significantly more than FA (P = 0.001). The mean FAZ area of the control eyes by OCTA was significantly less than in the ischemic eyes (U = 56.602, P < 0.001), while the superficial capillary plexus (SCP) vascular density (VD) and the deep capillary plexus (DCP) VD in the control eyes was statistically significantly higher than in the ischemic eyes (U = 36.984, P < 0.001, and U = 35.955, P < 0.001, respectively). FA showed diffuse leakage (edema) at the macula as the most common pattern of DME that was detected in 37.9% of the eyes followed by focal macular leakage in 18.4% of the eyes and cystoid leakage in 8% of the eyes while 35.5% of the eyes showed no macular edema. Conclusion OCTA is a cornerstone in DMI diagnosis both qualitatively and quantitatively. In addition, it is essential in evaluating the deep retinal vasculature, while FA is essential in diabetic retinopathy grading and in the diagnosis of DME in a qualitative manner. Both investigations are complementary to each other in diabetic maculopathy evaluation.

BackgroundDiabetic retinopathy (DR), nephropathy, and peripheral neuropathy are the common complications of diabetes mellitus. DR is one of the causes of blindness worldwide. Although diabetic-eye disease is often thought to refer merely to the retina, the anterior segment of the eye has also been shown to be affected in diabetes.ObjectiveTo compare the anterior ocular-segment biometry among type-2 diabetes mellitus with no DR, nonproliferative diabetic retinopathy (NPDR), and evaluate the correlation of anterior ocular-segment biometry with glycosylated hemoglobin (HbA1c) level.Patients and methodsA cross-sectional study was conducted on 48 patients. The patients were randomly selected from the Ophthalmology Outpatient Clinic of Menoufia University Hospital. Also, they were divided into group I that included 16 diabetic patients with no DR group, group II included 16 diabetic patients with NPDR group, and group III included 16 healthy participants of comparable age and sex. The results were collected, tabulated, and statistically analyzed. Descriptive statistics included percentage (%), mean, SD, range, and median, and analytic statistics included χ2 test, Student's t test, Spearman correlation, Mann–Whitney test, and analysis of variance (F).ResultsNumbers of angle-opening distance and anterior-chamber angle were significantly increased among diabetic patients with no DR group (524.69 ± 41.92, 29.75 ± 3.28) than diabetic patients with NPDR group (491.06 ± 40.80, 27.50 ± 2.53) and control group (479.00 ± 49.55, 26.94 ± 2.08). Also, central corneal thickness (CCT) was significantly increased among diabetic patients with the NPDR group (561.50 ± 14.93) than diabetic patients with no DR group (505.31 ± 46.15) and control groups (452.06 ± 32.14) (P > 0.05). There were significant positive correlations between HbA1c with age, HbA1c%, CCT, and number of angle-opening distance.ConclusionDiabetic patients appear to have significantly thicker CCT, regardless of retinopathy status, whereas anterior-chamber width was significantly narrower in diabetics with the NPDR group compared with a diabetic with no DR. Development of new noninvasive diagnostic technologies has provided a better understanding of corneal-tissue changes related to diabetes.

ObjectivesTo evaluate and compare the outcomes of bicanalicular self-retaining stent (SRS) versus rectangular 3-snip punctoplasty in the treatment of acquired lower punctal stenosis.BackgroundPunctal stenosis is a common disorder and one of the most commonly encountered diseases that cause tearing. Visual disturbance occurs because of constant epiphora.Patients and methodsThis prospective randomized comparative study was carried on 65 eyes of 39 patients with acquired lower punctal stenosis. Patients were categorized into two groups based on the intervention, such as insertion of bicanalicular SRS (group A) and rectangular 3-snip punctoplasty (group B). Assessment of epiphora, punctal stenosis grading, and fluorescein dye disappearance test were performed preoperatively and postoperatively. Patients were followed up for 6 months postoperatively.ResultsGroup A, which included 34 eyes of 20 patients, showed anatomical success in 31 (91.2%) eyes and functional success in 32 (94.1%) eyes, whereas group B, which included 31 eyes of 19 patients, showed anatomical success in 26 (83.9%) eyes and functional success in 22 (71.0%) eyes. The difference in the functional success rate was clinically significant (P = 0.013).ConclusionBicanalicular SRS achieves better results than rectangular 3-snip punctoplasty in the treatment of acquired lower punctal stenosis.

BackgroundThe tear film is a complex mix of electrolytes, proteins (lipocalins, lactoferrin, transferrin, defensin, and lysozyme), phospholipids, oligopeptides, glycopeptides, and immunoglobulins.ObjectiveThe aim was to investigate the efficacy of topical carbomer-based lipid-containing artificial tears and hyaluronate in patients with dry-eye disease (DED) based on serum 25-hydroxy vitamin D (25HD) levels and cholecalciferol (vitamin D) supplementation.Patients and methodsA nonrandomized clinical trial study was conducted on 42 patients with DED by Schirmer tear-secretion test (mm) who were examined by Ophthalmology Department, Menoufia University Hospital, Egypt, during the study period from March 2020 to March 2021.ResultsSerum 25HD levels were significantly decreased among vitamin D deficiency (VDD) group than non-VDD group at baseline and after 2 weeks of treatment. International Ocular Surface Disease Index grade was significantly increased among the VDD group after 2 weeks and 4 months of treatment as compare with non-VDD group (P < 0.05). Tear break-up time was significantly decreased among VDD group than non-VDD group after 4 months of treatment (P = 0.015). Lid hyperemia was significantly increased among the VDD group (2.00 ± 0.853) than non-VDD group (1.29 ± 0.659) after 4 months of treatment (P = 0.029). While Schirmer tear-secretion test was significantly decreased among the VDD group (5.75 ± 1.603) than non-VDD group (7.18 ± 1.188) after 2 weeks of treatment (P = 0.009). While Schirmer tear-secretion test did not show any significant difference between the VDD group (6.50 ± 1.567) and non-VDD group (7.75 ± 2.066) after 4 months of treatment.ConclusionThe effect of topical topical carbomer-based lipid-containing artificial tears and hyaluronate was dependent on serum 25HD levels. Cholecalciferol supplementation enhanced the efficacy of topical treatment and may be a useful adjuvant therapy for patients with DED refractory to topical lubricants.

Background: Trabeculectomy is commonly performed in patients with chronic open angle glaucoma when medical therapy fails to control intraocular pressure (IOP). Objective: The aim of the current work was to evaluate choroidal thickness (C.T) changes with Enhanced Depth Imaging-Optical Coherence Tomography (EDI-OCT) & axial length (AXL) with ophthalmic A-Scan ultrasound after reduction of intraocular pressure (IOP) following trabeculectomy. Patients and Methods: The study was included 20 patients with open-angle glaucoma. The choroidal thickness was measured using enhanced depth imaging spectral domain optical coherence tomography (EDI-SD-OCT) and AXL of eye was measured using A-scan ultrasound before trabeculectomy and 1 month, 3 and 6 months postoperatively. Results: The changes of choroidal thickness before and after 1, 3 and 6 months of the operation found to have high statistically significant increase in SFCT-V, SFCT-V, NCT, TCT, SCT and ICT in 1st month postoperative with mean (217.65±27.03, 218±21.09, 216.9±28.86, 190.35±34.3, 223.1±24.82 and 244.8 ± 23.77) respectively, then they decreased in the 3rd month with mean (198.85 ±27.8, 197.8±23.3, 200.15±27.5, 178.35 ±31.9, 208.75±23.3 and 233.5±21.05) respectively, but it was not less than preoperative, and continued in decreasing in the 6th month with mean (187.3 ± 29.02, 186.95 ± 25.82, 188.95±27.47, 166.45±26.38, 197.7± 23.05 and 223.5±22.66) respectively, but it was not also less than preoperative. Conclusion: It could be concluded that intraocular pressure (IOP) reduction after trabeculectomy caused an increase in choroidal thickness (CT) this reduction of IOP was negatively correlated only with the increase in nasal, temporal, inferior and superior CT 3 mm away from the fovea.

Objectives To evaluate the outcome of the corneal cross-linking procedure regarding their effect on morphological and optical properties of the cornea. Background Cross-linking using ultraviolet A light and riboflavin is a method to stop the progression of keratoconus. The orbscan system has the ability to yield corneal thickness, curvature, and elevation data. Patients and methods The study was carried out on 40 eyes of 30 patients, with a mean age 22.55 ± 3.15 years. All underwent corneal cross-linking.Uncorrected visual acuity and best-corrected visual acuity were assessed. Orbscan's Kmax, thickness at thinnest corneal point and at the center of the cornea, irregularity at 3 and at 5 mm optical zone and topographic astigmatism, were all determined before cross-linking and 6 months after. Results There was improvement of uncorrected visual acuity from 0.21 ± 0.09 to 0.23 ± 0.08 and best-corrected visual acuity from 0.62 ± 0.13 to 0.72 ± 0.10 after 6 months (P Conclusion Patients with progressive keratoconus appear to have improvements in most of the anterior surface topographic measures.

Purpose The aim of this study was to evaluate the efficacy and safety of Botulinum toxin injection in the palpebral lobe of the lacrimal gland for treatment of epiphora. Patients and methods A total of 20 patients with epiphora (crocodile tears syndrome, lower lid laxity, malposition of the lower lid, and obstruction of lacrimal drainage system in which lacrimal surgery was impossible) received intralacrimal gland injection of Botulinum toxin (2.5 IU/0.1 ml). Follow-up was performed on the first day, first week, first month, third month, and sixth month after injection to evaluate the efficacy, safety, and occurrence of any complications and to record the rate of recurrence. Results Cure was successfully achieved in 60% of the patients after the first injection and in 90% of patients after the second injection. There were 15% of recurrent cases after the first injection, and there were no recurrent cases after the second injection. Temporary ptosis occurred in 10% of this study group after the first injection and in 5% after the second injection. There was a highly significant decrease in Schirmer’s test and tear meniscus height among the study group regarding the pre-injection and follow-up values (P<0.01). In addition, there was a highly significant decrease in Munk scale and time of dye disappearance test among the study group regarding the pre-injection and follow-up values (P<0.01). Conclusion The injection of Botulinum toxin in the palpebral lobe of the lacrimal gland was effective and safe as a temporary measure to reduce excessive tearing until a more permanent measure can be taken.

Objective This study aimed to evaluate the role of ultrasound biomicroscopy (UBM) in assessing uneventful trabeculectomy parameters. Background The recent development of the UBM device has made it possible to observe the detailed structure of the anterior segment of the eye with a noninvasive procedure. Patients and methods In this prospective cohort study, an analysis of UBM scanning of 30 glaucomatous eyes of 30 patients, any age, both sexes, after 1 month from uneventful subscleral trabeculectomy operation was done. Results There was a negative significant correlation between bleb size (r = 0.905, P < 0.001) and intraocular pressure (IOP). There was an insignificant correlation at anterior chamber depth and IOP (P = 0.193). There was a positive significant correlation at bleb reflectivity and IOP (r = 0.836, P < 0.001). Multiple regression analysis showed that both bleb size and reflectivity affect IOP, but anterior chamber depth does not. Conclusion UBM is a good predictor of the anatomical patency of surgically created passage in post-trabeculectomy patients and well correlated with IOP.

Objectives The purpose of this study was to evaluate the changes in retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT) in idiopathic intracranial hypertension or pseudotumor cerebri (PTC). Patients and methods This cross-sectional comparative study involved 50 patients with PTC (group I) and 50 age-matched and sex-matched normal persons as controls (group II). Retinal nerve fiber thickness is measured using OCT for all studied population and then recorded and collected to be statistically analyzed. Results Visual acuity and best-corrected visual acuity were measured in both groups. Comparison between both groups shows a statistically highly significant difference (P Conclusion RNFL thickness measurements can provide important information regarding retinal axonal loss in patients with papilledema from PTC. Although axonal loss was documented in the chronic phase of papilledema, our findings, to be confirmed in future prospective studies, suggest a possible use of OCT during the treatment of PTC syndrome.

Objectives To compare between the successes of probing using soft cannula (a 22 G) versus conventional probing in children with congenital nasolacrimal duct obstruction. Background Congenital obstruction of the nasolacrimal duct is a common problem in the early years of life. Obstruction can occur in 6–20% of neonates. The usual cause is failure of canalization of the epithelial cells that form the nasolacrimal duct as it enters the valve of Hasner. Patients and methods This prospective, randomized study was conducted on 36 children (48 eyes) having congenital nasolacrimal duct obstruction presented to the outpatient clinic of Menoufia University Hospital and Kafer El-Sheikh Ophthalmology Center from November 2016 to July 2018. The children were divided into two groups: group A, 18 children (24 eyes) operated by conventional probing and group B, 18 children (24 eyes) operated by probing using soft cannula. The patients were monitored for 6 months postoperatively. Results Clinically successful results were achieved in 20 eyes (83.4%) for conventional probing group and 19 eyes (79.2%) for soft cannula group. No significant complication occurred intraoperatively or postoperatively. Conclusion Soft cannula probing is an effective and simple method with no significant complication for the treatment of congenital nasolacrimal duct obstruction. This method allows probing in a more controlled way. However, there was no statistical difference between it and conventional probing.

Objective The aim of the study is to evaluate choroidal thickness alteration in women with preeclampsia and compare with healthy pregnant and nonpregnant controls by using optical coherence tomography (OCT). Background Pregnancy is a predisposing factor for central serous chorioretinopathy. Choroidal thickness (CT) increases in central serous chorioretinopathy and this study evaluates changes in computed tomography (CT) during pregnancy and preeclampsia. Patients and methods This was a cross-sectional study conducted at Menoufia University Hospital Ophthalmology Department during the period from April 2018 to March 2019 on 66 eyes of 33 patients divided into groups. Each group had 22 eyes. Group 1 is the pregnant group and group 2 is the preeclampsia. Group 3 included healthy nonpregnant controls. Each of the patients underwent full ophthalmologic examination followed by OCT assessment and the procedure was achieved without pupillary dilatation. Macular thickness was determined automatically and was analyzed by OCT. Results The choroid thickness increases in both healthy pregnant women and preeclampsia women. Choroidal thickness in healthy pregnant women was significantly thicker than preeclampsia. The most likely mechanism for this increase is pregnancy-related fluid retention in the choroid layer. The choroidal thickness in preeclampsia was lower than healthy pregnant women. This lower rise in choroidal thickness can be generally attributed to the markedly increased systemic vascular vasospasm secondary to preeclampsia. Conclusion This study has shown that CT measured using OCT increased in women with preeclampsia and healthy pregnant women but the increase of CT in preeclampsia was lower than healthy pregnant controls.

Background To assess and compare corneal hysteresis (CH) and corneal resistance factor (CRF) in normal thin (NT) healthy corneas with central corneal thickness (CCT) 470-500 µm with matched thickness in keratoconus (KC) and keratoconus suspect (KCS) eyes. Methods A total of 66 eyes in three groups were included prospectively: NT, KCS and KC groups based on clinical examination and topography. Corneal hysteresis (CH) and corneal resistance factor (CRF) were measured by the ocular response analyzer. CH and CRF were compared between the three groups and statistically analyzed by variances test. Results The three groups consisted of 32 NT, 19 KCS, and 15 KC. The mean CH measured was 8.55± 1.77, 9.03± 1.119 and 8.06 ± 0.85 mm Hg in NT, KCS and KC eyes, respectively. The mean CRF was 8.39 ± 1.47, 8.27 ± 1.09 and 7.24 ± 1.27 mm Hg in NT, KCS and KC eyes, respectively. Within range of central corneal thickness (470 – 500 µm), only mean CRF was statistically significantly different between the NT and KC (P < 0.05); there was no statistically significant difference between NT and KCS, nor the mean CH between each groups (P > 0.05). Conclusions CRF only can be helpful in differentiating KC from NT eyes; however, it’s not valuable for detecting KCS which is the main concern for refractive surgery. No benefit from CH in differentiating between the study groups. Further investigations & work focusing on more accurate tests for identifying KCS are still needed.

Background Corneal cross-linking (CXL) is an important modality for keratoconus therapy. Lens and corneal density are reported to change in keratoconus and with CXL. However, these changes are not well studied. Aim The aim of this study was to evaluate the changes in corneal and lens density in patients with keratoconus after corneal CXL. Patients and methods This is a prospective case series study that was conducted in a private Eye Laser Center, Menoufia Governorate, Egypt. The study consisted of patients with bilateral clinical keratoconus whose age ranging between 15 and 40 years with clear lenses. Bilateral minimum corneal thickness of 400 µm, measured with Pentacam, was essential. All study patients were examined preoperatively and 1, 3, and 6 months postoperatively. Ophthalmic examination included uncorrected distance visual acuity, corrected distance visual acuity, and manifest refraction as well as corneal thickness, thinnest location, maximal keratometric reading (Kmax), and corneal and lens densitometry measured by Pentacam. Results The preoperative mean corneal density on the axis 0–180 was 17.3±1.8, which changed to 20.7±2.01 after 6 months postoperatively (P=0.001). Although the preoperative mean corneal density on the axis of 90–270 was 17.4±2.06, it changed to 19.9±2.4 after 6 months postoperatively (P=0.04). No significant changes were encountered in lens density after CXL. Conclusion Corneal CXL significantly increased the corneal but not the lens density. This increase was maximal after 1 month and gradually returned toward the baseline. CXL is considered as a safe procedure for the lens.

Background: A loss of glenohumeral internal rotation has been associated with altered kinematics of the glenohumeral and the scapulothoracic joint. Aim of Study:To evaluate the association between Acromio-humeral distance (AHD), gleno-humeral internal rotation deficit GIRD).Methods: 40 impingement patients (from 25 to 45 years old), participated in this study,They were evaluated by ultrasonography for acromio-humeral distance(AHD), digital goniometer for gleno-humeral internal rotation deficit (GIRD).Results: This study showed a positive significant relation between gleno-humeral internal rotation difict (GIRD) and acromio-humeral distance (AHD), GIRD increase, AHD decrease. Conclusion:Glenohumeral internal rotation deficit, decrease acromiohumeral distance and lead to compression of the rotator cuff and subacromial bursa in this limited space in patients with shoulder impingement syndrome.

Background Duane retraction syndrome (DRS) is a congenital ocular motility disorder most commonly characterized by the inability of the eye to abduct, sometimes limitation of adduction, and globe retraction with palpebral fissure narrowing on adduction. Aim To study the clinical features, management, and outcome of DRS. Patients and methods A prospective, nonrandomized study was carried out on patients attending the Outpatient Clinic of Ophthalmology in Menoufia University Hospital during the period of study from June 2017 to July 2019. This study was conducted on 51 patients with DRS. Ocular and systemic features were studied. Surgery was done when indicated to eliminate upshoot or downshoot, face turn with a horizontal deviation, and globe retraction. Preoperative and postoperative ocular deviation, angle of head turn, and severity of limitation in abduction and adduction were detected and analyzed. Results Type I DRS was more common (70.6%), with female preponderance (52.9%) and a predilection for the left eye (70.6%). Twenty-one (41.2%) cases were operated, by recessing MR and/or lateral rectus (LR) muscles and/or Y-splitting and acceptable improvement was detected. Mean esotropic DRS improved from 18±4.02 to 3±2.8 (P<0.001) and mean exotropic DRS improved from 14±2 to 5±1.4 (P<0.01). Upshooting/downshooting and narrowing of the palpebral fissure showed significant improvement (P<0.001 and <0.03, respectively). Conclusion Proper diagnosis of patients with DRS and proper plan for surgical management can reduce several complications with satisfactory postoperative outcomes.

ObjectiveThe aim was to evaluate corneal changes after topography-guided partial photorefractive keratectomy (PRK) combined with accelerated corneal collagen cross-linking (CXL) (the Athens protocol) in progressive keratoconus with Pentacam Scheimpflug imaging.BackgroundKeratoconus is a bilateral noninflammatory progressive corneal thinning that results in irregular astigmatism and progressive myopia. Topography-guided partial PRK combined with CXL (The Athens Protocol) has been developed not only to arrest progression of keratoconus but also to offer the patients functional vision.Patients and methodsThis prospective study included 20 eyes that underwent topography-guided partial PRK combined with accelerated CXL (The Athens Protocol). Preoperative and postoperative assessments included visual acuity, slit lamp evaluation, and Pentacam. All investigation and examination were done during the period from June 2017 to June 2018.ResultsAll study parameters demonstrated a statistically significant improvement with uncorrected distance visual acuity of 0.55 ± 0.29 Snellen line postoperatively vs. 0.33 ± 0.24 Snellen line preoperatively and best-corrected visual acuity of 0.73 ± 0.25 Snellen line postoperatively vs. 0.61 ± 0.27 Snellen line preoperatively, with a P value of 0.005; flat keratometry of 44.76 ± 1.64 D postoperatively vs. 45.29 ± 2.01 D preoperatively and steep keratometry of 46.55 ± 2.09 D vs. 47.68 ± 2.42 D, preoperatively, with a P value of less than 0.001; mean postoperative index of surface variance of 50.70 ± 18.34 postoperatively vs. 65.25 ± 29.29 preoperatively, with P value less than 0.001; and mean postoperative index of height decentration of 0.053 ± 0.033 postoperatively vs. 0.091 ± 0.052 preoperatively, with P value less than 0.001.ConclusionTopography-guided partial PRK combined with accelerated CXL (The Athens Protocol) is a relatively new and revolutionary procedure aimed at stabilization of corneal ectatic disorders and achieving a good visual quality. Longer duration of follow-up and a larger sample may further provide more reliable results.

PURPOSE To evaluate the safety and efficacy of combined oral and topical beta blockers for the treatment of superficial periocular infantile hemangioma at the early proliferative stage. METHODS This was a randomized, controlled comparison trial involving 25 patients. Patients were randomly enrolled into two groups: the topical and systemic treatment and systemic treatment only groups. The topical and systemic treatment group was treated with oral propranolol (1 mg/kg per day initially, increased to 2 mg/kg per day gradually in 2 weeks) and timolol maleate 0.5% gel. The systemic treatment only group received oral propranolol (1 mg/kg per day initially, increased to 2 mg/kg per day gradually in 2 weeks) and simple eye ointment to be applied to the lesion. The Hemangioma Activity Score was used to record the proliferative activity of the hemangioma. The main outcomes of the study were the change in the hemangioma size, the proliferative activity, and the treatment side effects. RESULTS At the end of the treatment period, the Hemangioma Activity Score was significantly improved in both groups from their values before treatment. However, the score obtained after treatment was significantly better in the topical and systemic treatment group (P < .05). Regarding the response to treatment, 10 and 3 cases in the topical and systemic treatment and systemic treatment only groups, respectively, showed a good response, with a significant difference between the two groups (P < .50). There were no recorded serious local or systemic complications during treatment in either group. CONCLUSIONS The results from combining topical with oral beta blockers showed that topical beta blockers are of additive value in treating superficial periocular infantile hemangioma in the early proliferative stage. [J Pediatr Ophthalmol Strabismus. 2018;55(1):37-42.].

To introduce and evaluate the application of Ologen implants in external Dacryocystorhinostomy (DCR) Surgeries.

Objectives The aims of the present study were to estimate the prevalence of undetected refractive errors among primary school students in Menoufia governorate and to assess possible risk factors such as family history, prolonged near work, etc. Background Early detection of refractive errors in children provides the best opportunity for effective treatment, whereas failure to detect such problems early can have permanent, deleterious effects on long-term visual outcomes, educational achievement, and self-esteem. Patients and methods This was a cross-sectional analytical study that was carried out from the beginning of January 2015 to the end of January 2016 in children between the ages of 6 and 15 years (mean age: 8.39 ± 1.85 years). After obtaining consent from parents and the school authority, students underwent manifest refraction, vision, best-corrected visual acuity, ocular motility, and cycloplegic refraction tests. Results This study was conducted on 276 students (48.6% of males and 51.4% of females); 83 of them had an occult refractive error, with an estimated incidence of 30.1%. Among the studied group, 37.3% had a family history of using glasses. In addition, 28.6% of the studied group had a history of headache. The most common type of refractive errors was astigmatism (45.8%), myopia (40.4%), and hypermetropia (13.9%) among the studied group. Conclusion The present study concluded that uncorrected refractive error is a common cause of visual impairment among schoolchildren in Menoufia governorate. Therefore, it is recommended that the education authority, together with the health authority, should provide appropriate measures to make eye examination for students in Egypt compulsory.

Background: Correction of vision using Photorefractive Keratectomy (PRK) or Laser In Situ Keratomileusis (LASIK) flap creation associated with ablation produces profound changes in the corneal structure and biomechanical properties secondary to central thinning and disruption of collagen lamellar continuity. Aim of Work:This study aims to compare the changes in corneal biomechanical properties after PRK and LASIK in the treatment of low and moderate myopia by Ocular Response Analyzer. Subjects and Methods: This study included 42 adult eyes divided into two groups: (1) Contain 21 eyes referred for Lasik surgery.(2) Contain 21 eyes referred for PRK surgery.Ocular Response Analyzer (ORA) was applied to each group to measure Corneal Hysteresis (CH) and Corneal Resistance Factor (CRF).Results: There was no statistically significant difference in CH and CRF, and between CCT and RSB between the two studied groups.There was statistically significant decrease in CH after both LASIK and PRK.There was statistically significant decrease in CRF after both LASIK and PRK.There was statistically significant difference in SE after LASIK and PRK.There was statistically significant difference between LASIK and PRK in CH and CRF change with more decrease after LASIK. Conclusion:PRK and LASIK substantially weaken the biomechanical strength of the cornea, depending on the amount of archived myopic correction, and that the changes in corneal biomechanics were larger after LASIK than after PRK.