Purpose: To study the compensatory comeal epithelial changes after femtolaser-assisted intracorneal ring segment (ICRS) implantation in early and moderate cases of keratoconus (KC) using anterior ...segment optical coherence tomography (AS-OCT). Patients and Methods: A prospective observational non-randomized study of 40 eyes with mild to moderate KC received femtolaser-assisted ICRS implantation. Ferrara ICRS with different arc lengths and thicknesses were used according to the patients' tomographic pattern. Patients had a clear central cornea, keratometry reading < 60 diopters, and corneal thickness > 400 microns. ASOCT was performed preoperatively and at 1, 3, and 6 months after surgery. Corneal epithelial thickness (CET) was measured over 17 points (2 mm central and 16 points on 2-5 mm and 5-7 mm annular zones) over the pupil center. All data were collected and analyzed. Results: Comparing the preoperative and postoperative data, there was a statistically significant increase in the CET postoperatively throughout the 6-month follow-up period in all zones (p<0.001). The epithelial thickness (ET) was noticed shortly around and central to the ring ridges by the first month (5-7 mm zone). By the third month, the flattened central cornea (2 mm zone) and the 2-5 mm zone showed a significant increase in ET up to the 6th month. Conclusion: ICRS implantation in KC results in a thicker and more regular epithelium in the central corneal zone as a secondary response to the corneal stromal changes induced by the implants. Keywords: keratoconus, Ferrara rings, epithelial thickness, AS-OCT
Introduction
Benign auto-immune illnesses include Evans syndrome (ES) and auto-immune hemolytic anemia (AIHA). Despite being benign in nature, the patients’ livers are burdened by the disease’s ...chronicity and the accompanying problems beyond the course of treatment. An additional burden stems from HCV infection, of which a significant proportion of Egyptians are positive. The purpose of this study was to identify the hepatotoxicity risks and the variables that influence the prognosis and survival of patients with AIHA/ES. There are 126 AIHA patients in this observational study, which is retrospective. From June 2009 to March 2021, patients visited the Haematology Unit of the Oncology Centre in Egypt. One hundred and sixteen patients have available data.
Results
There was no significant difference between primary and secondary AIHA groups as regards baseline hemoglobin (Hb), bilirubin, LDH, or reticulocyte count. Thirty-four patients (29.31%) had HCV-positive tests and 1 patient (0.9%) had HBV. There was no difference between HCV-positive and negative cases as regards mean Hb concentration, mean platelet, or immune markers (
P
> 0.05). AIHA patients with HCV-positive showed a significantly higher relapse rate (56%) than HCV-negative patients (32%) (
P
= 0.034). HCV positivity and low platelet counts at diagnosis were poor predictors for overall survival (OS) (
P
0.022 and 0.04, respectively). Median OS was significantly better in patients with no viral hepatitis infection (1101 days, 95% CI 592–2068) than in patients with positive HCV infection (521, 95% CI 326–1325) (
P
= 0.019).
Conclusions
Azathioprine is the least hepatotoxic in AIHA patients under treatment. Viral hepatitis represents a superadded damage to the liver besides AIHA concerning clinical characteristics and outcomes.
Abstract Background The study aims to assess the tear film before and after phacoemulsification in patients with age-related cataracts. Methods A prospective observational study of 41 age-related ...cataract patients undergoing phacoemulsification procedure. Tear Film Break-Up Time (TBUT), Tear Film Meniscus Height (TMH), Meibomian glands (MG), and Lipid Layer Thickness (LLT) were assessed by a non-invasive Dry Eye Diagnostic System. All measurements were taken preoperatively, one week, one month, and three months postoperatively. The Marginal homogeneity and The Cochran Q tests were used in the statistical analysis. Results The value of Non-Invasive Break-Up Time (NITBUT) was statistically significantly lower at one week (7.15 ± 3.31), one month (7.61 ± 3.41), and three months (7.66 ± 3.36) postoperatively than preoperatively (10.71 ± 2.71), p < 0.001. The Non- Invasive Tear Meniscus Height (NITMH) was significantly lower at one week (0.18 ± 0.0), one month (0.20 ± 0.09), and three months (0.20 ± 0.09) postoperatively than preoperatively (0.30 ± 0.113) p < 0.001. By the first month, both (NITBUT) and (NITMH) improved significantly compared to the first post-operative week. There was no statistically significant difference between one month and three months. The (NITMH) improved to a healthy level of ≥ 0.2 mm by the first month through the third month. Both (NITBUT) and (NITMH) did not reach the baseline by the third month. The meibomian glands and the lipid layer thickness had the same preoperative grade distribution without changes. Conclusion Phacoemulsification surgery can cause post-operative deterioration in the tear film, which starts within a week of the procedure, followed by gradual recovery over the next weeks and months. The phacoemulsification procedure mainly affects the tear break-up time and tear meniscus height. Both the lipid layer and meibomian glands are not affected.
Background: Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia with a favorable prognosis. Hemorrhagic manifestations in APL at presentation are usually due to ...thrombocytopenia, consumptive coagulopathy, and fibrinolysis. Central nervous system (CNS) hemorrhage carries a risk for CNS relapse and early death in APL patients. Case Presentation: A 23-year-old male presented with sudden bilateral visual loss and headache. The ocular examination revealed a massive exudative retinal detachment in the right eye and bilateral dense vitreous hemorrhage. APL diagnosis was confirmed through peripheral blood and bone marrow examination, along with cytogenetic and molecular testing. The patient received 7+3 induction chemotherapy combined with All-trans-retinoic acid. After achieving complete remission, he underwent pars plana vitrectomy and silicone oil injection in the right eye. Intrathecal chemotherapy was considered for CNS prophylaxis after induction. Later, he had a medullary relapse which was managed with salvage therapy and autologous stem cell transplantation. Conclusion: Although APL has a favorable prognosis, its management can be complicated. It may present with retinal detachment or intraocular hemorrhage. Managing intraocular and intracranial hemorrhage is challenging due to the risks of hemorrhage and coagulopathy. This complexity is further heightened by poor visual prognosis, high risk of CNS infiltration, and potential for medullary relapse.
To compare the effect of three different phakic intraocular lenses (pIOLs) on the corneal endothelial cell density (ECD).
This was a prospective observational cohort study that included 60 eyes (30 ...patients) with axial myopia of -6.50 to -22.00 diopters (D). The Verisyse anterior chamber (AC) rigid iris fixated pIOL, the Veriflex (AC) flexible iris fixated pIOL, and the Visian posterior chamber (PC) implantable collamer lens (ICL) were implanted in three equal groups of patients. The effect of the three pIOLs on the ECD was compared over a follow-up period of one week, and one, three, and six months, and one, two, and three years. Specular microscopy was done to evaluate the cornea before the surgery and throughout the study. Changes were statistically analyzed and compared.
In the first three postoperative months, Verisyse and Veriflex pIOLs induced almost the same amount of endothelial cells loss of 10.3% and 10.6%, respectively, while ICLs showed endothelial cells loss of 3.5%. At the end of the three-year study, Veriflex pIOLs induced the highest rate of endothelial cell loss of 25%, while Verisyse and ICL lenses showed endothelial cells loss of 15.7% and 13.4%, respectively. The main effect of time and type of lens was statistically significant (p<0.001).
All pIOLs cause a decrease in ECD. The AC pIOLs tend to be associated with more cell loss than PC pIOLs. Surgical insult is the important factor responsible for the early endothelial cell loss, while the material from which the pIOL is made may be an important factor for the continuous corneal endothelial cell loss over a long time.
To evaluate the effect of oral contraceptive pills (OCP) on the macula, the retinal nerve fiber layer (RNFL), the ganglion cell layer (GCL), and the choroidal thickness (CT).
In this prospective ...observational cross-sectional study, 60 eyes of 30 healthy women taking monophasic OCP (0.03 mg ethinylestradiol and 0.15 mg levonorgestrel) for contraception for at least 1 year were compared with 60 eyes of a control group of 30 healthy women who were not taking any OCP. Spectral-Domain Optical Coherence Tomography (SD-OCT) was used to evaluate the macula, the RNFL, the GCL, and the CT. Measurements were taken in the follicular phase (day 3) of the last menstrual cycle in all women. The body mass index (BMI) scores of all participants were also recorded.
No disparity in terms of age and BMI between both groups was observed (p = 0.444, p = 0.074, respectively). All the macular parameters measurements were considerably lower in the OCP group compared to the control group (p < 0.001). Also, the RNFL thickness, the GCL thickness, and the CT were all significantly thinner in the OCP group (p < 0.001).
The use of OCP can cause significant changes in the retina and choroid thickness over 1 year period. The women who are using OCP for a longer duration could have some eye problems. OCT should be routinely done for follow up. Further long term studies are required, using different preparations of OCP. It is important to find out when this thickness alterations can be clinically significant or symptomatic and if these changes are reversible or not.
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.
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.
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 (
= 0.228). Regarding subgroups, EFX showed no statistically significant difference between FLACS and QCP (
= 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 (
= 0.122). Only in medium NC were significantly lower values obtained in FLACS compared with QCP (
< 0.0001).
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 evaluate the clinical and histopathological parameters of pterygium to determine significant correlations between parameters that can affect management strategies.
Methods: A total of 47 ...pterygia were clinically examined and excised for histopathological evaluation of epithelial and stromal changes. Some samples were immunostained with P53 (a protein of 53 kilodalton used as dysplastic epithelial marker), CD20 (CD/cluster of differentiation, are group of surface receptors providing targets for cellular immunophenotyping, CD20 as a B lymphocyte marker), CD 3 (as T lymphocyte marker) or vascular endothelial growth factor (VEGF/as vascular marker).
Results: Most patients were male (59.6%). Cosmetic complaints (83%), grade II redness (61.7%), grade 2 extension (63.8), and associated astigmatism of <2.5 D (83%) were observed. Histopathological features included solar elastosis (100%), squamous hyperplasia (83%), increased stromal vascularity with hemorrhage (76.6%), and lymphocytic stromal infiltration, perivascular distribution, and mild epithelial lymphocytic exocytosis in 72.3%, 74.5%, and 70.2% of cases, respectively. Other changes included goblet cell hyperplasia (31.9%), prominent epithelial pigmentation (48.9%), and, most importantly, epithelial atypia (53.2%). Clinical redness was significantly correlated with vascularity, epithelial hyperplasia, and lymphocytic stromal infiltration; lymphocytic stromal infiltration was also significantly correlated with pterygium extension and with low astigmatism.
Conclusion: The inflammatory response was mild in most cases and the density was not significantly correlated with any clinical parameter. Vascularity was related to clinical redness. Treatment with anti-VEGF may be beneficial, even for grade 1 pterygia that are not dominantly fibrotic.
To compare the effect of FS-LASIK and FS-SMILE on the corneal endothelial cell density (ECD) and morphology.
This is a prospective, cohort observational study that included 80 eyes of two equal ...groups of patients. Forty eyes were subjected to the FS-LASIK, and 40 eyes were subjected to the FS-SMILE. In both groups, patients, age ranged between 19 and 37 years with myopia ranges from -0.75 to -9.00 diopters (D) and astigmatism up to -3.00D. The ECD, coefficient of variation (CV), and hexagonality (HEX) in both groups were compared over six months. Specular microscopy was used to evaluate the corneal endothelium throughout the study.
In both groups, ECD showed a statistically significant decrease while CV showed a statistically significant increase in the first month postoperatively. The FS-SMILE had more impact on both ECD and CV until the third and six months, respectively. Hexagonality showed a significant decrease in both groups throughout the whole study. In both groups, no vision-threatening complications occurred, and no eyes developed any corneal complications over a six-month follow-up period.
Although the ECD, CV, HEX are statistically affected in both FS-LASIK and FS-SMILE groups, both procedures have no significant adverse effects on the ECD and morphology. The impact of the FS-SMILE group may be due to the deeper penetration of the femto laser in the corneal tissue compared to the FS-LASIK. The closer the femto laser to the endothelium, the more exposure to the shock waves and heat energy, although minimal but it can cause collateral damage to this layer. The effects of FS-SMILE surgery on corneal endothelial cells and morphology need further investigations.
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