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Objectives To detect the serum level of thyroid hormones, vitamin D and vitamin D receptors (VDR) polymorphism in keratoconus (KC) patients and to identify the association between vitamin D deficiency and thyroid dysfunction in KC. Methods This cross sectional study included 177 KC patients with no thyroid disorders compared to 85 healthy controls with normal corneal tomography. Measurements of thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free tetraiodothyronine (FT4) and serum 25-OH vitamin D were done using Enzyme linked immusoassay (ELISA test). VDR polymorphisms were tested including [Taq I (rs731236), Apa I (rs7975232) and Bsm I (rs1544410)] using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results An increase in frequency of thyroid disorders (P = 0.04), decrease in serum 25(OH) vitamin D level (P P P P P Conclusions Both thyroid disorders and low vitamin D are potential factors for KC development. Studying VDR at the molecular level provides interesting avenues for future research toward the identification of new KC cases.

To detect the serum level of thyroid hormones, vitamin D and vitamin D receptors (VDR) polymorphism in keratoconus (KC) patients and to identify the association between vitamin D deficiency and thyroid dysfunction in KC.This cross sectional study included 177 KC patients with no thyroid disorders compared to 85 healthy controls with normal corneal tomography. Measurements of thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free tetraiodothyronine (FT4) and serum 25-OH vitamin D were done using Enzyme linked immusoassay (ELISA test). VDR polymorphisms were tested including [Taq I (rs731236), Apa I (rs7975232) and Bsm I (rs1544410)] using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).An increase in frequency of thyroid disorders (P = 0.04), decrease in serum 25(OH) vitamin D level (P 0.001), Taq 1 and tt genotype (P 0.001) were significantly distributed in KC patients. A significantly higher serum 25(OH) vitamin D level was reported in TT genotype, while insufficient level was more common in Tt genotype (P 0.001). A deficient serum 25(OH) vitamin D level was predominant in tt genotype (P 0.001). A 95% confidence interval was in TSH (1.603, 2.946), FT4 (24.145, 77.06), hypothyroidism (1.062, 67.63), insufficient (2.936, 11.643) and deficient vitamin D (5.283, 28.704) and all were significant risk factors for KC with (P 0.05).Both thyroid disorders and low vitamin D are potential factors for KC development. Studying VDR at the molecular level provides interesting avenues for future research toward the identification of new KC cases.

The current investigation was designed to develop and optimize caffeine-loaded nanostructured lipid carriers (NLCs) for topical alopecia treatment. Screening of drug solubility in various excipients was executed. The 23 full factorial design was employed for NLCs optimization. Lipid type, surfactant type, and drug concentration were the independent variables. Entrapment efficiency (EE), particle size, polydispersity index (PDI) and % drug release were the chosen responses. Physiochemical evaluation, in vitro release, ex-vivo permeation, and stability study were achieved. The solubility of caffeine in stearic acid and glyceryl monostearate (GMS) was 47.11 ± 3.048 and 32.67 ± 2.955 mg/g, respectively. Oleic acid: garlic oil mixture at ratio 1:1 v/v was the oily phase. Tween 80 and Cremophor EL, Transcutol HP, carbonate buffer (pH 10.8 and ionic strength 200Mm) were chosen as a surfactant, co-surfactant, and aqueous phase, respectively. The optimized formula showed particle size, %EE, PDI, zeta potential of 358nm, 72.55 %, 0.912, -24.8, respectively. The % release was 92.9 ± 4.9 % after 4hours. Confocal laser scanning microscopy showed an improved permeation of caffeine-loaded NLCs to the whole skin layers. The histological examination proved the efficiency of caffeine NLCs optimized formula on promoting hair growth compared to the market formula.

AIM: To evaluate the safety and the efficacy of the ultrasound ciliary plasty (UCP) on the intraocular pressure (IOP) control in glaucomatous eyes without previous glaucoma surgery. METHODS: A retrospective study included patients with primary and secondary glaucoma who underwent UCP in Dar AlShifa Hospital, Kuwait between January 2017 to June 2018. High-intensity focused ultrasound procedures were performed under peribulbar anesthesia using the 2(nd) generation probe with 8s duration of each of the 6 shots. Complete ophthalmologic examinations were scheduled pre-treatment, and at 1d, 1wk, 1, 3, 6 and 12mo post-treatment. Primary outcomes were the IOP reduction and success rates at 12mo, while the secondary outcomes were the occurrence of vision threatening complications and visual acuity. RESULTS: The records of 62 eyes of 62 patients were analyzed with mean age of 63.8y (67.7% males). There was statistically significant reduction in the mean IOP from 35.2±8.3 mm Hg before treatment to 20.6±8.7 mm Hg at 12(th) month (P

Coenzyme Q10 (CoQ10) is an insoluble, poorly permeable antioxidant with great biological value which acts as anti-aging and anti-wrinkle agent. To improve its permeability through topical application, the current study aimed at formulating oil/water (o/w) nanoemulsion (NE) as an efficient vehicle for delivering (CoQ10) through the skin barriers. The solubility of (CoQ10) was tested for various oils, surfactants (S), and co-surfactants (CoS). The NE region was determined by constructing pseudoternary phase diagrams. NE formulae containing 1, 2, and 3% w/w drug have been subjected to thermodynamic stability test. The formulae that passed thermodynamic stability tests were characterized by physical properties as pH, viscosity, refractive index, droplet size, zeta-potential, TEM, electroconductivity, in vitro release, and ex vivo permeation. The formula 'F2' containing 10% w/w isopropyl myristate (oil phase), 60% w/w of Tween 80: Transcutol HP mixture (S/CoS

This is an interventional prospective clinical study which was conducted to evaluate the efficacy, safety, predictability, ocular aberrations, and flap thickness predictability of Visumax femtosecond laser (FSL) compared to Moria M2 microkeratome (MK) in mild to moderate myopia. This study included 60 eyes who were divided into two groups. Thirty eyes in group (I) in which the flap was created with Visumax FSL, while in group II (30 eyes) the Moria M2 MK was used. Keratometric, refractive, and aberrometric measurements were compared preoperatively and 3 months postoperatively. The intraoperative subtraction pachymetry (the SP 100 Handy pachymeter (Tomey, Nagoya, Japan) was used for preoperative pachymetry and flap thickness measurement. No significant difference was found between the two groups in regards to postoperative manifest sphere, spherical equivalent, astigmatism, safety indices nor ocular aberrations. Twenty six eyes (86.6%) in group I and 23 eyes in group II (76.6%) were within ±0.5D of the intended correction and 23 eyes (76.6%) in group I and 15 eyes in group II (50%) were within ±0.25D of the intended correction. In group I, the mean postoperative actual flap thickness was 100.12 ± 16.1 μm (81 to 122 μm), while in group II, it was 104.6 ± 20.1 μm (62 to 155 μm). The difference was statistically significant (p = 0.001). Both Visumax and Moria M2 MK are safe and effective in treating myopia with no statistically significant difference in induction of ocular aberrations but with potential advantage for Visumax regarding predictability. More accurate flap thickness is achieved with Visumax femtolasik. This study was retrospectively registered on 19/6/2017. Trial registration number NCT03193411 , clinicalTrials.gov .

BackgroundTo compare efficacy and safety of intravitreal aflibercept (IVA) injection with panretinal photocoagulation (PRP) versus early vitrectomy for diabetic vitreous hemorrhage (VH).MethodsProspective, randomized study that included 34 eyes with diabetic VH. They were divided into two groups, Group Ι (17 eyes) received three successive IVA injections followed by PRP and group ΙΙ (17 eyes) for whom early vitrectomy was done. Follow up was carried out after one, two, three, six and nine months. The primary outcome measure was change in the mean best corrected visual acuity (BCVA) after nine months, secondary outcome measures were mean duration of clearance of VH and rate of recurrent hemorrhage with any additional treatment in both groups. Complications were reported.ResultsThere was no statistically significant difference regarding initial demographic criteria between both groups. The mean final log MAR BCVA was statistically better than the initial BCVA in both groups (0.51 ± 0.20, 1.17 ± 0.48 for group I and 0.48 ± 0.18, 1.44 ± 0.44 for group II,P p ≥ 0.05), the mean duration of clearance of VH was 7.8 ± 1.8 weeks, 5 days for group I and II respectively. PRP was completely done for all eyes in group I after three months. The difference in the recurrence rate between group I (29.4%) and group II (11.8%) was statistically significant (p ConclusionBoth intravitreal injection of aflibercept followed by PRP and early vitrectomy are effective and safe modalities for treatment of diabetic vitreous hemorrhage. Early vitrectomy leads to faster vision gain with less incidence of recurrence than intravitreal injection.Trial registrationRandomized clinical trial under the number ofNCT04153253on November 6, 2019 “Retrospectively registered”.

To assess the impact of micropulsed laser (MPL) on modifying the number of aflibercept injections when used as an adjuvant therapy in diabetic macular edema (DME). A prospective randomized interventional clinical study included patients with DME attending Al Hadi Clinic, Kuwait, during the period from May 2017 to December 2018. Patients were allocated in two groups; group A received aflibercept injections alone and group B received combined aflibercept injections followed by MPL within a week. The primary outcome was the number of Aflibercept injections in each group guided by the change in central macular thickness (CMT). All the patients were followed for 18 months. Secondary outcome measures included best corrected visual acuity (BCVA), contrast sensitivity (CS), and any recorded complications. Fifty-four eyes of 51 patients were included (27 in each group). There was no statistically significant difference between the two groups in baseline characteristics except for the age that was statistically higher in group B (p = 0.001). The number of injections were significantly lower in group B (4.1 ± 1.1) than group A (7.3 ± 1.1) (p

PURPOSE This study was aimed to assess the levels of ghrelin in aqueous humor and plasma of human eyes with primary open-angle glaucoma (POAG) and to correlate their concentrations with the severity of glaucoma. DESIGN This was a case-control, prospective study. METHODS Fifty patients with POAG and 35 patients with senile nonpathologic cataract (control group) were enrolled in the study prospectively. Aqueous humor samples were obtained by paracentesis from patients with glaucoma and cataract who underwent elective surgery. Aqueous humor and corresponding plasma samples were analyzed for ghrelin concentrations by radioimmunoassay diagnostic kits assay. RESULTS Ghrelin levels were significantly lower in aqueous humor of patients with POAG with respect to the comparative group of patients with cataract (P < 0.001). There was no significant difference in the levels of ghrelin in the plasma of patients with POAG and that of patients with cataract. A positive correlation was found between plasma/aqueous humor ghrelin concentration in patients with POAG versus the control group (P < 0.001). No significant correlation was found between the levels of ghrelin and the severity of visual field loss. CONCLUSIONS Lower levels of aqueous humor ghrelin may be associated with POAG and may be a consequence of glaucomatous damage.

Objective: The object of our investigation was to develop and characterize nanoemulsion gel (NEG) as transdermal delivery systems for the poorly water soluble drug, Co-enzyme Q 10 (CoQ 10 ), to improve its solubility and skin permeability and thus improving its anti-wrinkle efficiency. Methods: An optimized nanoemulsion (NE) formula was chosen according to its particle size and stability and converted into nanoemulsion gel using different gelling agents, including; carbopol 934 (1%), xanthan gum (2%) and sodium carboxymethyl cellulose(NaCMC) (2%). Drug loaded nanoemulsion gels were characterized for particle size, zeta potential, viscosity and rheological behavior, conductivity, spreadability, drug content and permeation studies using Franz diffusion cell. Results: NEG containing 10% w/v isopropyl myristate (IPM) as oil, 60% w/v tween 80 and transcutol HP as surfactant/co-surfactant mixture (S/CoS), 30%w/v water, 2%w/v drug, and 1% w/v carbopol 934 as gelling gent was concluded as an optimized NEG formula. It exhibited pH, viscosity, drug content, particle size, zeta potential, polydispersity index(PDI) and spreadability, as 5.4±0.011, 27588±2034.34 cps,101.51±0.93%,120.5±1.19 nm,-29.8±1.46, 0.273 and 6.16±0.28 cm, respectively. Also, it showed significantly higher cumulative amount of drug permeated through dialysis membrane (281.71±0.97μg/cm 2 ) and through rat skin (20.73±2.5 μg/cm 2 ) than the other formulae and marketed formulation (P

Purpose The aim of this study was to compare the central corneal thickness (CCT) measurements by three different techniques: pentacam, noncontact specular microscopy, and ultrasound biomicroscopy (UBM) devices. Patients and methods This prospective observational cross-sectional study was performed on patients seeking medical care at the outpatient clinic of Ophthalmology Center at Mansoura University. They were consecutively recruited and selected, and measurement of CCT by pentacam, UBM, and specular microscopy was done. Thereafter, the results were compared as an evaluation study of all techniques. Results This study included 200 eyes of 100 patients. The age of the included patients in the study ranged from 20 to 50 years. The mean age was 34.56±9.94 years. The CCT ranged from 465 to 630 µm, with a mean of 532.88±34.15 µm when measured by pentacam. When measured by specular microscopy, it ranged from 456 to 601 µm, with a mean 531.92±33.64 µm, and when measured by UBM, it ranged from 463 to 602 µm, with a mean 533.97±31.10 µm, with P value of 0.824 (nonsignificant). Conclusion CCT measurements obtained by UBM tend to be thicker than those obtained by pentacam and noncontact specular microscopy, but the measurements of all three are strongly positively correlated with each other. So, any of these devices can be easily substituted by the other for the measurement of CCT.

Purpose The aim of the study was to evaluate the outcomes of intravitreal bevacizumab (IVB) monotherapy compared with conventional laser therapy in preterm infants with stage III and plus disease retinopathy of prematurity (ROP) who had zone I or II posterior disease. Patients and methods This was a prospective randomized comparative interventional pilot study. Twenty-four eyes of 12 preterm infants suffering from ROP were included. All eyes had bilateral stage III ROP with 'plus disease' affecting zone I or zone II posterior. Infants were assigned to receive conventional laser therapy in their right eyes and IVB in their left eyes. Follow-up period was 6 months following treatment. Results The study included five female infants and seven male infants. The gestational ages ranged from 26 to 33 weeks (mean 29 weeks), and the birth weights ranged from 750 to 1390 g (mean 1005 g). The postmenstrual age at which threshold ROP was detected ranged between 34 and 41 weeks (mean 36.75 weeks). All 24 eyes had stage III ROP with plus disease; 10 eyes had zone I, whereas the other 14 eyes had zone II posterior. Regression of neovascularization occurred in all 24 eyes following both treatment modalities and remained stable during follow-up. No local or systemic side effects of bevacizumab were observed, and no further treatment was necessary. Conclusion IVB injection seems to be as effective as conventional laser in treating stage III ROP. It provides the advantages of preservation of peripheral visual field and complete peripheral retinal vascularization.

Purpose The aim of this study was to assess the efficacy and safety of combined intracameral and intravitreal injection of bevacizumab followed by panretinal photocoagulation (PRP) in the treatment of neovascular glaucoma. Design This study is a prospective, interventional case series. Patients and methods This study is prospective observational case series of 23 eyes of 23 patients with different degrees of neovascular glaucoma (>22 mmHg) treated with simultaneous combined intracameral and intravitreal bevacizumab injection followed by PRP. Duration of follow-up was 3 months. The outcome measures were neovascular membrane extent, best corrected visual acuity (BCVA), and intraocular pressure (IOP) at the follow-up intervals. Results The degree of neovascular membrane extent decreased from a preoperative mean of 226.95 ± 97.34 to 58.96 ± 84.12 at 1 week postoperatively and 31.3 ± 51.54 at 1 month postoperatively. The preoperative mean IOP was 58.7 ± 16.2 mmHg; it decreased to 20.8 ± 9.99 mmHg at 1 week, 18.47 ± 5.6 mmHg at 1 month, 22.65 ± 8.7 mmHg at 2 months, and 25.34 ± 6.806 mmHg at 3 months postoperatively ( P remained ≤0.001 throughout the course of follow-up). In addition, BCVA showed noticeable improvement during the course of follow-up; the mean preoperative BCVA logarithm of minimal angle of resolution (BCVA logMAR) was 1.47 ± 0.511, which significantly improved to 1.29 ± 0.55, 1.16 ± 0.58, 1.15 ± 0.6, and 1.3 ± 0.56 at 1 week and 1, 2, and 3 months, postoperatively, respectively. Conclusion Combined intravitreal and intracameral injection with bevacizumab followed by PRP can be considered to be a very effective and safe IOP-lowering technique in the case of neovascular glaucoma.

Purpose The aim of this study was to compare the short-term outcomes of administration of intravitreal ranibizumab (IVR) and intravitreal bevacizumab (IVB) in the treatment of neovascular age-related macular degeneration (AMD). Design This study is a clinical interventional randomized comparative study. Patients and methods This randomized clinical trial was performed on 24 eyes of 24 patients with subfoveal and juxtafoveal choroidal neovascularization secondary to AMD. The eyes were randomly assigned to receive 0.5 mg IVR (group 1; 12 eyes) or 1.25 mg IVB (group 2; (12 eyes). Best-corrected visual acuity (BCVA) was assessed, optical coherence tomography was carried out at baseline and repeated at all postoperative follow-up intervals (1 week and 1, 3, and 6 months), and fluorescein angiography was performed at baseline and repeated 1 month after treatment. Results In group 1, the mean age was 62.42 ± 6.75 years (range 51-70 years) and seven of the patients were male (58.33%). In group 2, the mean age was 62.083 ± 7.96 years (range 50-75 years) and four of the patients were male (33.33%). At the sixth month postoperatively, BCVA logMAR significantly improved from 1.01 ± 0.26 (range 1.5-0.7) to 0.82 ± 0.18 (range 1.2-0.5; P = 0.001) in group 1 and from 0.98 ± 0.279 (range 1.4-0.5) to 0.81 ± 0124 (range 1.0-0.7; P = 0.004) in group 2. At 6 months postoperatively, the mean ± SD central macular thickness reduced from 363.33 ± 27.16 μm at baseline (range 319-405 μm) to 291.67 ± 25.79 μm (range 243-335 μm) in group 1 (P = 0.00), whereas in group 2, the mean ± SD central macular thickness moderately reduced from 362.5 ± 20.26 μm at baseline (range 339-400 μm) to 294.17 ± 29.62 μm (range 257-350 μm) at 6 months postoperatively (P = 0.00). There were no significant systemic or ophthalmological adverse effects in either group. Conclusion Both ranibizumab and bevacizumab are equally safe and effective treatment options as intravitreal injections in the treatment of CNVM due to AMD.