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Ibrahim Abdelkalek Elsaadani, Abdelmonem Mahmoud Hamed, Ahmed Elshahat, Mohamed Amin Heikal Ophthalmology Department, Benha College of Medicine, Benha University, Benha, Qalyopia, EgyptCorrespondence: Abdelmonem Mahmoud HamedOphthalmology Department, Benha College of Medicine, Benha University, Alansar Tower, Science of College St, Benha, Qalopia, Egypt, Tel +201221640288, Email abdelmonem.abdelmonem@fmed.bu.edu.egPurpose: To retrospectively compare the refractive outcomes between two groups of small-incision lenticule extraction (SMILE), one with a single incision and the second one with dual-incisions.Setting: Ebsar Eye Center, Benha, Qalyopia, Egypt.Design: A retrospective cohort study.Methods: This study was made up of two groups (162 eyes each): all eyes in group 1 had one SMILE cut at 120°, and all eyes in group 2 had double SMILE incisions, the first incision at 120° and the second one at 270°. Refractive outcomes between the two groups were compared at 3, 6, and 12 months after surgery.Results: The mean preoperative refractive spherical equivalent (MRSE) was − 5.75 ± 2.59 D and − 6.38 ± 2.18 D in group 1 and 2, respectively (P = 0.73), and a cylinder of 1.25 ± 0.83 D and 0.75 ± 0.81 D, respectively (P = 0.85). At 12 months postoperatively, in group 1, 162 eyes (100%) achieved a UCVA of 20/25, 154 eyes (95.06%) achieved a UCVA of 20/20, and 110 eyes (67.90%) achieved 20/16. In group 2, 162 eyes (100%) achieved a UCVA of 20/25, 156 eyes (96.29%) achieved a UCVA of 20/20, and 113 eyes (69.75%) achieved 20/16. The mean MRSE at 12 months postoperatively was − 0.25 ± 0.33 D in group 1 and − 0.5 ± 0.33 D in group 2 (P = 0.62).Conclusion: Dual-incision SMILE is safe and effective as single-incision SMILE, with a predictable and stable effect in correcting myopia and myopic astigmatism.Keywords: ReSMILE, ReLEX, SMILE, SMILE technique, kerato-refractive, LASER vision correction, small incision lenticule extraction

Hammouda Hamdy Ghoraba,1,2 Mahmoud Leila,3 Adel Galal Zaky,4 Sameh Mohamed Elgouhary,4 Amin Faisal Ellakwa,4 Hosam Othman Mansour,5 Mohamed Amin Heikal2,6,7 1Faculty of Medicine, Tanta University, Tanta, Egypt; 2Magrabi Eye Hospital, Tanta, Egypt; 3Retina Department, Research Institute of Ophthalmology, Giza, Egypt; 4Ophthalmology Department, Faculty of Medicine, Menoufia University, Shebin ElKom, Menoufia, Egypt; 5Ophthalmology Department, Faculty of Medicine, Al Azhar University - Damietta Branch, New Damietta, Egypt; 6Ophthalmology Department, Faculty of Medicine, Benha University, Benha, Egypt; 7Vitreoretinal Department, Magrabi Eye Hospital, Eastern province, Khober, KSACorrespondence: Mahmoud Leila 146 Street 3, 2nd Floor, Flat#8, Hadabet Al-Ahram, Giza, 12572, EgyptTel +201286644025Email mahmoudleila@yahoo.comPurpose: To report the long-term outcome of pars plana vitrectomy (PPV) for management of retained posterior segment intraocular foreign body (IOFB) secondary to gunshot injury.Methods: This is a retrospective interventional case series including consecutive patients who had PPV for retained posterior segment IOFB secondary to gunshot injury. Main outcome measures were final best-corrected visual acuity (BCVA), long-term globe survival and detection of complications. Spearman correlation analyzed relationships between numerical data. Kruskal–Wallis test compared differences in initial BCVA and final BCVA across variables. Categorical variables were tested using Chi square or Fisher’s exact test. P value is significant at 0.05.Results: The study included 103 eyes of 103 patients. Mean baseline BCVA was 0.01 decimal unit (2 logMAR). Mean duration from primary repair to PPV was 3 weeks. Mean duration of post-operative follow-up was 60 months. Mean final BCVA was 0.04 decimal unit (1.3 logMAR), p 0.001. Post-operatively, BCVA improved in 58.2% of patients. Nineteen patients (18%) gained ≥ 2 lines of vision, and 15 patients (14.5%) achieved final BCVA of 0.4 decimal unit (logMAR 0.4). All complications were related to the original injury. These included macular scar (19%), macular pucker (6%), recurrent retinal detachment (4%), subretinal fibrosis (3%), consecutive optic atrophy (3%), and PVR (3%). Phthisis bulbi or sympathetic ophthalmia did not develop in any case.Conclusion: PPV for removal of IOFB caused by gunshot injury yielded long-term favorable functional outcome with excellent globe survival. Poor initial BCVA, location of IOFB in the posterior pole, associated lens injury and retinal detachment are significant adverse prognostic factors for final BCVA but not for globe survival.Keywords: Intraocular foreign body; IOFB, ocular gunshot injury, penetrating ocular trauma, IOFB-associated endophthalmitis, pars plana vitrectomy for intraocular foreign body, PPV for IOFB

Hammouda Hamdy Ghoraba,1,2 Mahmoud Leila,3 Adel Galal Zaky,4 Tamer Wasfy,1 Haithem Maamoun Abdelfattah,2,5 Emad Mohamed Elgemai,2,6 Sameh Mohamed El Gouhary,4 Hosam Osman Mansour,7 Hashem Hammouda Ghoraba,1,2 Mohamed Amin Heikal8,9 1Ophthalmology Department, Tanta University, Tanta City, Gharbia, Egypt; 2Ophthalmology Department, Magrabi Eye Hospital, Tanta City, Gharbia, Egypt; 3Retina Department, Research Institute of Ophthalmology, Cairo, Egypt; 4Ophthalmology Department, Menoufia University, Shebein Elkoom City, Menoufia, Egypt; 5Ophthalmology Department, Benha Teaching Hospital, Benha City, Qualuopia, Egypt; 6Ophthalmology Department, Damanhour Teaching Hospital, Dmanhour City, Albehaira, Egypt; 7Alazahr University, Damietta City, Damietta, Egypt; 8Ophthalmology Department, Benha University, Benha City, Qualuopia, Egypt; 9Vitreoretinal Department, Magrabi Eye Hospital, Khober City, Eastern Province, Kingdom of Saudi ArabiaCorrespondence: Mohamed Amin HeikalOphthalmology Department, Benha University, Benha City, Qualuopia, 13511, EgyptTel +00201007131431Email mohammedheikel@gmail.comPurpose: To compare different types of macular holes regarding the anatomic and functional success following pars plana vitrectomy (PPV) and internal limiting membrane (ILM) removal.Methods: A retrospective review of all patients with macular holes treated by PPV, ILM removal with gas tamponade from January 2014 to July 2017 in Magrabi Eye Hospital.Results: One hundred fifty-seven eyes of 153 patients were analyzed. The eyes were classified according to the etiology of macular hole into four groups: 79 eyes with idiopathic macular hole (IMH), 51 eyes with traumatic macular hole (TMH), 16 eyes with macular hole in diabetic patients (DMH) and 11 eyes with myopic macular hole (MMH). We classified the IMH group based on the International Vitreomacular Traction Study Classification according to size into 3 subgroups; subgroup 1: ≤ 250μ, subgroup 2: > 250 to 400μ and subgroup 3: ≥ 400 μ. All types of macular hole showed statistically significant postoperative improvement in BCVA compared to the baseline except cases with MMH. Anatomic postoperative hole closure was achieved in 86.1%, 60.7%, 43.65%, an 45.46% of eyes with IMH, TMH, DMH and MMH, respectively. In eyes with IMH, closure rate in subgroup 1 was significantly higher than in subgroups 2, and 3.Conclusion: PPV, ILM peel and C2F6 technique yielded variable anatomic and functional outcomes in different types of macular holes. Anatomic results were most favorable in IMH and least favorable in MMH. The smaller the diameter of the hole the better the results. The underlying pathogenetic mechanisms that lead to different types of macular holes are pivotal in determining the final outcome.Keywords: ILM peeling, macular holes, pars plana vitrectomy

Hammouda Hamdy Ghoraba,1,2 Hosam Othman Mansour,1,3 Mohamed Ahmed Abdelhafez,1 Sameh Mohamed El Gouhary,4 Adel Galal Zaky,4 Mohamed Amin Heikal,5 Ali Ahmed Ali Ghali3 1Magrabi Eye Hospital, Tanta, Egypt; 2Tanta University, Tanta, Egypt; 3Al Azhar University, Damietta Branch, New Damietta, Egypt; 4Meunofia University, Meunofia, Egypt; 5Benha University, Benha, EgyptCorrespondence: Hosam Othman MansourAl Azhar University, Damietta Branch, New Damietta, EgyptTel +201001559282Email drhmansor@yahoo.comBackground and Objectives: To compare anatomical and visual results of pars plana vitrectomy (PPV) with or without additional encircling band in the management of pediatric traumatic rhegmatogenous retinal detachment (RD) in a tertiary referral center.Methods: A retrospective review of children diagnosed with traumatic rhegmatogenous retinal detachment treated by pars plana vitrectomy with or without encircling band.Results: One hundred thirty-nine eyes of 139 children diagnosed with traumatic rhegmatogenous retinal detachment. Surgeries were performed between May 2011 and November 2016. Patients were followed up for at least 18 months after last intervention. The included eyes were categorized into two groups. Group A (vitrectomy with additional encircling band) included 72 eyes of 72 children; 58 boys and 14 girls. Group B (vitrectomy without encircling band) included 67 eyes of 67 children; 58 boys and 9 girls. In group A, the mean age was 9.21± 3.24. Attached retina was achieved in 61% (44 out of 72 eyes), of which 34 eyes remained attached after silicon oil removal, and 10 eyes remained attached under silicon oil tamponade. Recurrent RD under oil was present in 28 eyes (38.9%). In group B, the mean age was 11.06± 3.64. Attached retina was present in 61.2% (41 out of 67 eyes), of which 30 eyes remained attached after oil removal, and 11 eyes remained attached under silicon oil tamponade. Recurrent RD was present in 26 eyes (38.8%). In group A, the final visual acuity (VA) ranged from NLP to 0.5; 58.7% of patients achieved VA more than counting fingers at 1 meter, and 34.6% of patients achieved VA of 0.05 or more. In group B, the final postoperative VA ranged from NLP to 0.9; 16% of patients achieved VA from counting fingers at 1 meter to 0.05, and 29.2% achieved VA of 0.05 or more.Conclusion: Although no statistically significant difference between the two groups (combined vitrectomy and encircling band versus vitrectomy alone in pediatric traumatic retinal detachment), it is wise to consider adding encircling band in severe trauma cases.Keywords: trauma, pediatric retinal detachment, encircling band, pars plana vitrectomy, silicon oil

Hammouda Hamdy Ghoraba,1 Mahmoud Leila,2 Hashem Ghoraba,3 Mohamed Amin Heikal,4 Hosam Othman Mansour5 1Faculty of Medicine, Tanta University, Tanta, Egypt and Medical Director, Magrabi Eye Hospital, Tanta, Egypt; 2Retina Department, Research Institute of Ophthalmology, Giza, Egypt; 3Magrabi Eye Hospital, Tanta, Egypt; 4Faculty of Medicine, Benha University, Benha, Egypt; 5Faculty of Medicine, Al Azhar University, New Damietta City, EgyptCorrespondence: Mahmoud LeilaRetina Department, Research Institute of Ophthalmology, 2, Al-Ahram Street, Giza, EgyptTel +201286644025Email mahmoudleila@yahoo.comObjective: To describe the optical coherence tomography (OCT) findings in terms of macular hole closure and ellipsoid zone (EZ) recovery following modified internal limiting membrane (ILM) surgical technique in traumatic macular holes (TMH).Methods: The study was a retrospective case series that recruited 16 consecutive patients with TMH. Following vitrectomy (PPV), we performed modified ILM surgical technique (IFT) in which ILM peel was stopped at the edges of the hole forming a floating ILM flap. Primary outcome measures were pattern of TMH closure and recovery of EZ. Student’s T-test and Pearson’s correlation coefficient were used for statistical analysis.Results: The study had 16 eyes of 16 patients. Mean baseline minimum linear diameter (MLD) was 562μ. Mean baseline best-corrected visual acuity (BCVA) was 1.4 logMAR. U-pattern closure occurred in 50% of eyes, V-pattern closure occurred in 31.2% of eyes, whereas W-pattern closure occurred in 18.7% of eyes. Mean BCVA improvement was 5 lines (p 0.02). Failure of recovery of EZ was detected in 75% of eyes. In the present series, neither pre-operative MLD nor time lapse prior to surgery were significant factors in determining the closure pattern of TMH, the grade of EZ recovery or final BCVA.Conclusion: Modified IFT is effective in promoting macular hole closure and improving visual acuity in patients with TMH. The technique does not promote recovery of EZ.Keywords: modified ILM surgical technique, traumatic FTMH, ILM peel adjuvants, ILM blue-assisted ILM peel, ellipsoid zone recovery

Hammouda Hamdy Ghoraba,1,2 Mahmoud Leila,3 Sameh Mohamed Elgouhary,4 Emad Eldin Mohamed Elgemai,2,5 Haithem Mamon Abdelfattah,2,6 Hashem Hammouda Ghoraba,2 Mohamed Amin Heikal7 1Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt; 2Department of Retina, Magrabi Eye Hospital, Tanta, Egypt; 3Retina Department, Research Institute of Ophthalmology, Giza, Egypt; 4Department of Ophthalmology, Faculty of Medicine, Menoufia University, Menoufia, Egypt; 5Department of Ophthalmology, Damanhour Teaching Hospital, Damanhour, Egypt; 6Department of Ophthalmology, Banha Teaching Hospital, Banha, Egypt; 7Department of Ophthalmology, Faculty of Medicine, Benha University, Benha, Egypt Purpose: The purpose of this study was to evaluate the safety of high-dose intravitreal triamcinolone acetonide (IVTA) as affordable low-cost alternative to anti-vascular endothelial growth factor (anti-vascular endothelial growth factor [anti-VEGF] agents) in lower-middle-income countries.Patients and methods: This was a retrospective interventional non-comparative case series. The study recruited patients who received 20 mg IVTA for treating various retinal and optic nerve diseases over the past 5 years. Main outcome measure was assessment of complications secondary to high-dose IVTA. The crosstabs procedure was used to display the interaction between the variables tested. The ANOVA test was used to analyze the differences among group means.Results: The study included 207 eyes of 168 patients. The main indication for high-dose IVTA were diabetic macular edema 64%, and macular edema secondary to retinal vein occlusion 19%. The mean follow-up period post-injection was 22 months. Mean number of injections was 1.3. Cataract developed in 54% of eyes. Glaucoma developed in 18.5% of eyes. Glaucoma surgery for intractable glaucoma attributed to high-dose IVTA was needed in 1% of eyes. Endophthalmitis and retinal detachment developed in one patient each.Conclusion: High-dose IVTA is a safe and cost-effective alternative to anti-VEGF agents. Cataract formation and intraocular pressure rise do not pose major adverse effects when weighed against the risk of vision loss due to inability to afford anti-VEGF treatment. Keywords: high-dose IVTA, cost-effectiveness of anti-VEGF, ICER of anti-VEGF per QALY

Mohamed A Heikal, Tarek Tawfik Soliman, Ayser Fayed, Abdelmonem M Hamed Department of Ophthalmology, Benha University, Benha, Egypt Purpose: To evaluate the efficacy of transepithelial corneal collagen crosslinking (TE-CXL) in patients with progressive keratoconus. Patients and methods: This is a prospective interventional consecutive study carried out on 30 eyes of 18 patients with progressive keratoconus who underwent TE-CLX using both ParaCel™ (riboflavin 0.25%, hydroxy propyl methyl cellulose, NaCl, ethylenediaminetetraacetic acid [EDTA], Tris, and benzalkonium chloride) and vibeX-Xtra (riboflavin 0.22%, phosphate-buffered saline solution). The procedure was carried out at Ebsar Eye Center in Egypt in the period from 2012 to 2014. The follow-up visits were scheduled on days 1, 3, 6, and 12 months after treatment. Results: There were statistically significant improvements (P

Mohamed A Heikal, Marwa Abdelshafy, Tarek T Soliman, Abdelmonem M Hamed Department of Ophthalmology, Benha University, Banha, Egypt Purpose: We attempted to evaluate the efficacy of femtosecond laser-assisted intrastromal corneal ring segment implantation in patients with keratoconus (KC). Patients and methods: A retrospective interventional consecutive clinical study was conducted on patients with KC who were treated with femtosecond laser Keraring implantation. All procedures were performed at Ebsar Eye Center in the period from January 5, 2015, to February 28, 2016. Results: Thirty eyes of 20 patients were included in this study. The mean age of patients was 27.43±3.57 years. Eleven patients (55%) were female and nine patients (45%) were male. Keraring segments were successfully implanted in all eyes. There were no complications or need for ring repositioning. The follow-up period was 6 months postoperatively. There was a significant improvement in the mean logarithm of the minimum angle of resolution (LogMAR) of uncorrected visual acuity (UCVA) after Keraring segment implantation from 1.5±0.23 preoperatively to 0.54±0.16 at 6 months postoperatively (P=0.001). The preoperative mean LogMAR of best-corrected visual acuity (BCVA) was 0.85±0.17. At 1 month postoperatively, it was 0.35±0.15; at 3 months postoperatively, it was 0.26±0.11, and at 6 months postoperatively, it was 0.14±0.07 (P=0.001). The mean preoperative maximum keratometric value for 3 mm pupil in diopters (K max) significantly decreased from 55.85±5.44 preoperatively (N=30) to 44.05±1.64 D at 6 months postoperatively (P=0.001). There was a statistically significant reduction in the mean preoperative spherical equivalent from –5.43±1.76 D preoperatively to –2.43±0.95 D at 6 months postoperatively. No statistically significant differences were detected between 1 and 3 months of follow-up regarding the visual and refractive outcomes. Conclusion: Analysis of the outcomes after Keraring ICRS implantation showed a significant postoperative corneal flattening with a subsequent increase in UCVA and BCVA. Using the femtosecond laser for tunnel creation made the procedure easy and fast with an accurate precise depth of implantation and reduced the risk of operative and postoperative complications. Keywords: femtosecond laser, K astigmatism Keraring, spherical error

Purpose: To compare the effects of ciclosporine A (2%) eye drop and tacrolimus (0.03%) eye ointment on children with vernal keratoconjunctivitis (VKC) who were not responding to corticosteroid eye drops., Methods: A prospective comparative study was carried out on children who were diagnosed with refractory VKC at the ophthalmology clinic in Benha University, Delta area, Egypt, during the period from October 2019 to February 2020., Results: Fifty-nine patients completed this study. Regarding the individual symptom score, redness, burning, photophobia, and foreign body sensation were significantly reduced in the tacrolimus group compared to those in the ciclosporine A group during the 1st week (p < 0.05). Moreover, the tacrolimus group showed a statistically significant reduction in burning and foreign body sensation at the 4th week (both p = 0.032), and in redness and burning sensation at the 12th week compared to those in the ciclosporine A group (p = 0.005 and 0.048, respectively). The tacrolimus group showed significantly lower mean scores for tarsal conjunctival papillary hypertrophy at the 1st week and 12th week (p = 0.037 and 0.046, respectively), and for punctate erosion and cobblestone papillae at the 1st week (p = 0.029 and 0.037, respectively) than the ciclosporine group. Failure of treatment was observed in 6 patients (19.35%) in the ciclosporine A group and in 5 patients (17.85%) in the tacrolimus group. No serious side effects were detected in any group., Conclusion: A higher reduction in inflammatory symptoms and signs as well as compliance with tacrolimus 0.03% eye ointment than with ciclosporine A 2% eye drops was observed. Moreover, long-term medication for refractory cases is needed to control inflammation. Overall, our finding suggested that ciclosporine A eye drops and tacrolimus eye ointment could be considered as corticosteroid-sparing drugs in the management of children with refractory VKC., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To evaluate the effects of femtosecond laser small incision lenticule extraction (SMILE) on treating unilateral myopic anisometropia in children with spectacles or contact lens intolerance., Methods: This was a retrospective study that included children with unilateral myopic anisometropic amblyopia who underwent a SMILE procedure at Alpha Vision Center, Zagazig, Egypt, from January 2014 to December 2016., Results: One hundred twenty-four eyes of 124 patients were included in this study. The postoperative corrected distance visual acuity (CDVA) at the 3-month and 1-, 2-, 3-, and 4-year follow-up visits improved significantly ( P < .05) compared to the preoperative CDVA, indicating the safety of the procedure. At the 3-month postoperative visit, 23% of cases showed improvement of one or more lines of CDVA, whereas only 2% of cases showed a decline of only one line. Moreover, the postoperative uncorrected distance visual acuity compared favorably to the preoperative CDVA, denoting the efficacy of the refractive correction. The spherical equivalent was within ±0.50 diopters of the intended correction in 75% of the cases and within ±1.00 diopters in 89% of the cases. The intraoperative complications were scarce and relatively innocuous., Conclusions: SMILE is a safe and effective alternative method for correcting myopic anisometropic amblyopia in children with spectacles or contact lens intolerance with good refractive results. A larger study with longer follow-up periods is necessary to determine the long-term effects of SMILE. [ J Refract Surg . 2021;37(8):510-515.] .

Background: To evaluate the results of pars plana vitrectomy (PPV) and silicone oil (SO) tamponade with or without encircling scleral band for repair of rhegmatogenous retinal detachment (RRD) in children with buphthalmos., Patients and Methods: Retrospective comparative nonrandomized interventional case series including consecutive patients who underwent PPV with or without encircling band and SO tamponade for RRD associated with buphthalmos., Results: The study included 19 eyes of 19 children. Mean age was 8 years, range 3-16 years. Mean follow-up period was 28 months, range 19-63 months. Globe survival has been achieved in 15 out of 19 eyes (79%). Phthisis bulbi was reported in four cases (22%). Eight patients (42%) achieved ambulatory vision. Most eyes initially achieved anatomical success., Conclusion: Despite the poor visual and anatomical results of RRD repair in eyes with buphthalmos, globe survival might be the rationale for surgery in such cases. Globe preservation could avoid the psychological and social consequences of phthisis bulbi in non-operated children.

Objective: To evaluate the risks that might be associated with recurrent macular hole retinal detachment (MHRD) after silicone oil (S.O) removal in myopic patients with open flat macular hole (MH)., Methods: In this retrospective series, we assessed the different factors that might be associated with recurrent MHRD after S.O removal in 48 eyes with open flat MH that underwent S.O removal after successful MHRD repair. We divided the enrolled eyes into 2 groups: group 1 included 38 eyes with flat open MH and flat retina after S.O removal, and group 2 included 10 eyes with flat open MH and recurrent MHRD after S.O removal., Results: Ten of 48 eyes (20.8%) with open flat MH developed recurrent MHRD after S.O removal. Univariate logistic regression analysis revealed that MH at the apex of PS, MH minimum diameter, hole form factor (HFF), and MH index (MHI) were significant risk factors for recurrent MHRD after S.O removal in myopic patients with open flat MH., Conclusions: If there is a "flat open" MH that is large, located at the apex of PS, or with an HHF or MHI <0.9-0.5, there is a high chance of recurrent MHRD after S.O removal., (© 2021 S. Karger AG, Basel.)

Purpose: To report the long-term follow-up of patients with inadvertent retained submacular perfluorocarbon liquid (PFCL) bubbles after vitrectomy surgery., Background: PFCL has unique chemical and physical features which facilitate displacement of subretinal fluid from central toward periphery allowing intraoperative reattachment of the mobile retina and manipulation of the anterior part of the detached retina without performing drainage retinotomy. Despite these advantages, PFCL droplets may be inadvertently retained in the submacular space., Methods: A retrospective case series study was conducted. We reviewed 1224 consecutive patients who had undergone primary pars plana vitrectomy at one vitreoretinal center operated by single surgeon (Hammouda Ghoraba). Chart review was performed to identify patients and procedural factors that could predispose to retained submacular PFCL with anatomical and functional outcomes with follow-up at least 18 months., Results: The retina was completely attached in 97% of eyes where PFCL was used after one or two vitrectomy surgeries. Submacular PFCL was found in 12 (0.98%) eyes. There was no statistical difference between perfluorodecalin and perfluoro-n-octane as regards retention rate. The possible risk factors associated with submacular retention of PFCL phenomenon are the presence of post-equatorial retinal breaks in six patients (50%) and large retinal break (2-3 clock hours) in three patients (25%)., Conclusions: Submacular PFC migration occurs in nearly 1% of cases when it is used. It occurred in cases of RRD with post-equatorial or large breaks. Using perfluoro-n-octane or perfluorodecalin had no statistical difference. Different behaviors of submacular PFC droplets occurred. Some cases of small submacular PFC droplets maintained fair VA for a long period.

Purpose: To compare the efficacy of PPV and ILM peel versus PPV and IFT in patients with traumatic FTMH., Methods: Retrospective interventional comparative case series including two groups of patients with traumatic FTMH. Patients were divided into group I (ILM peel) and group II (IFT). The main outcome measure was closure of the macular hole and restoration of the foveal microstructure. The independent-samples T -test and ANOVA test were used to study the mean between 2 groups and calculate the P value, whereas the bivariate correlation procedure studied the interaction between the variables tested., Results: Group I included 28 patients. Mean preoperative MLD was 757 µ m. Mean preoperative BCVA was approximately 20/320. Group II included 12 patients. Mean preoperative MLD was 529.5 µ m. Mean preoperative BCVA was 20/320. Group I had a macular hole closure rate of 75% versus 92% in group II P =0.05. Mean BCVA improvement was 2.5 lines in group I versus 5 lines in group II P =0.02. Disrupted ELM and IS/OS was the most salient finding in both groups., Conclusion: IFT has a significantly superior anatomic and functional outcome compared to ILM peel in traumatic FTMH.

Aim: To report the intraoperative complications associated with small incision lenticule extraction (SMILE) and their management., Methods: This was a retrospective consecutive interventional clinical study, carried out on patients with myopia and myopic astigmatism, who underwent SMILE procedure. Type of intraoperative complications and their management were recorded., Results: Our study comprised 282 eyes of 141 patients who were enrolled for SMILE surgeries. The intraoperative complications included lost vacuum (18 eyes, 6.38%), treatment decentration (6 eyes, 2.12%), wound bleeding (21 eyes, 7.45%), incomplete bubble separation (black islands) (3 eyes, 1.06%), the epithelial defects (15 eyes, 5.32%). Incision tear (27 eyes, 9.57%), lenticule adherence to the cap (6 eyes, 2.12%), and cap perforation occurred in 2 eyes (0.7%)., Conclusion: Although SMILE is a promising technique for the correction of myopia and myopic astigmatism with predictable, efficient, safe refractive and visual outcomes, complications can occur. However, most of them are related to inexperience and are included in the learning curve of the technique. More studies with a bigger number of eyes are required to efficiently evaluate the intraoperative complications and standardize their management strategies.

Objective: To report and analyze the phenomenon of sticky silicone oil on the retina at the time of its removal., Background: Silicone oil has been used for more than 25 years as a long-term retinal tamponade in the surgical management of patients with complex retinal detachments. When a decision to remove silicone oil was made at the end of the tamponade period, the system involved a number of different materials: silicone oil, aqueous solution with or without remnants of perfluorocarbon liquid plus the material of the cannula used to aspirate Silicone oil. This, in effect, may lead to an abnormal adherence of large bubbles of residual silicone oil to the posterior pole of the retina., Patients and Methods: A retrospective, interventional case study was performed. We consecutively reviewed 796 patients of silicone oil removal (5,000 or 5,500 centistokes) after primary pars plana vitrectomy at one vitreoretinal center operated by a single surgeon (HG). Chart review was performed to identify potential patients or procedural factors that could predispose to sticky silicone oil formation at the macular area., Results: Large silicone oil bubbles were sticky to the macula in eight out of 796 silicone oil removal procedures between January 2014 and August 2015. The use of perfluorooctane was related to the occurrence of the phenomenon (P < 0.001)., Conclusion: The sticky silicone oil bubble at the macular region was not related to internal limiting membrane peeling, epiretinal membrane, viscosity, duration, or brand of silicone oil used, but to the use of perfluorooctane.

Background and Objective: To evaluate the feasibility and safety of silicone oil (SO) removal in cases of gunshot perforating eye injuries (PEI)., Patients and Methods: A retrospective, consecutive, interventional study from medical records regarding cases of gunshot PEI during the periods of Egyptian political instability (January 2011 until December 2013). The main outcomes were to evaluate the feasibility of SO removal in cases of gunshot PEI and management of retinal detachment (RD) after SO removal in such cases., Results: One hundred ninety-six eyes of 193 patients were reviewed. SO was removed in 72 eyes of 70 patients (36.7%). After SO removal, five eyes (6.9%) developed RD. One case refused any other intervention. RD in the remaining four cases was treated with revision surgery and SO reinjection. The retina remained stable throughout follow-up. None of the eyes developed phthisis bulbi after SO removal. Mean follow-up after SO removal was 10.86 months (range: 3 months to 30 months). Mean follow-up after management of RD after SO removal was 17.7 months (range: 13 months to 21 months)., Conclusions: Patients aged younger than 20 years were associated with extensive fibrous proliferation, which might affect the safety profile of SO removal in cases of gunshot PEI. Rate of RD after SO removal in cases of apparent retinal stability and localized fibrous proliferation was 6.9%. Retinal detachment after SO removal in such cases can be treated with revision surgery and SO reinjection. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:242-250.]., (Copyright 2017, SLACK Incorporated.)

Purpose: To report the results of pars plana vitrectomy with adjuvant intravitreal amphotericin B and systemic fluconazole in the management of endogenous endophthalmitis after the urinary tract procedures., Methods: Retrospective study of 10 eyes of 7 patients diagnosed as endogenous fungal endophthalmitis. Pars planavitrectomy with adjuvant intravitreal amphotericin B and oral fluconazole was conducted once the general condition is suitable. The final anatomical and functional results were evaluated., Results: Ten eyes of seven patients, five men and two women had pars plana vitrectomy. Control of infection was achieved in all cases. Visual acuity improved in 7 eyes (70%), remained the same in 2 eyes (20%), and worsened in 1 eye (10%). The retina was flat in all cases. No eye developed phthisis bulbi., Conclusion: In cases of fungal endophthalmitis, after urinary tract procedures, the prevention of phthisis bulbi can be achieved in all cases. Improvement of vision can be achieved in most of the cases. The final visual status depends on visual acuity at presentation, macular affection, and the presence of retinal detachment at presentation.

Background: Silicone oil (SO) is used as an intravitreal tamponade agent in vitreoretinal surgery for rhegmatogenous retinal detachment (RRD) complicated by proliferative vitreoretinopathy or with large, multiple retinal tears. Usually, SO is left in the eye for at least 3 months. Although its use can lead to well-known complications, intraocular SO is generally well tolerated. Some studies have reported unexpected central vision loss after SO use or removal., Objective: To investigate and analyze the reason for visual loss after the use or removal of intraocular SO in patients who underwent vitrectomy surgeries for RRD., Patients and Methods: A retrospective observational case series of 12 patients with macula-on RRD who reported visual loss after the use or removal of SO was reviewed. Investigations carried out included fundus fluorescein angiography, optical coherence tomography (OCT) of the macula and optic disc, perimetry, and electrophysiological study. Electrolyte levels were measured in retro-oil fluid and compared with their levels in the vitreous humor of patients who underwent vitrectomy for macular holes, floaters, dropped intraocular lenses, or dropped crystalline lens fragments., Results: Visual acuity levels dropped by at least 2 Snellen chart lines. None of the 12 cases had macular detachment at any stage. Fundus fluorescein angiography and OCT results were unremarkable in most of the cases. Mean levels of electrolytes in retro-oil fluids and vitreous humor were similar., Conclusion: Visual loss is a possible complication after SO use or removal. This still remains a mysterious issue which needs further research and investigation., (© 2017 S. Karger AG, Basel.)

Purpose: To evaluate whether omitting the use of the 360° episcleral band in combination with pars plana vitrectomy and silicone oil tamponade had an effect on either anatomical or functional success in cases of perforating eye injury due to gunshot., Methods: A retrospective consecutive interventional study from medical records. Surgeries were performed in the period from January 2011 until the end of December 2013. Patients with perforating eye injury due to gunshots were treated with pars plana vitrectomy and silicone oil tamponade with or without the addition of a 360° scleral band., Results: Two hundred and thirteen eyes of 210 patients were reviewed of which 17 patients were excluded, 5 patients because the vision had no light perception and 12 patients because of the short follow-up period (less than 6 months). The remaining 196 eyes of 193 patients were analyzed. All surgeries were performed by 1 surgeon. The included eyes have been classified into 2 groups; 101 eyes in the first group (360° band was used), and 95 eyes in the second group (without 360° band). The included patients were followed up at least 6 months after the last surgery. By first surgery, anatomical success was achieved in 93 eyes (92.08%) in Group 1, and retinal detachment developed in 8 eyes (7.92%). In Group 2 anatomical success was achieved in 91 eyes (95.78%), and retinal detachment developed in 4 eyes (4.21%). All cases with retinal detachment were reattached by second surgery. In the first group, visual acuity improved in 80 eyes (79.2%), unchanged in 14 eyes (13.86%), and was less than that of preoperative value in 7 eyes (6.93%). In the second group visual acuity improved in 78 eyes (82.1%), unchanged in 13 eyes (13.68%) and less than that of preoperative value in 4 eyes (4.21%). No statistically significant difference was found between the two groups (P = 0.943) in anatomical or functional results. None of the operated eyes developed phthisis bulbi., Conclusion: The abundant use of the 360° scleral band in combination with pars plana vitrectomy and silicone oil tamponade did not change the anatomical or the functional outcomes in the management of perforating eye injury due to gunshots.

The aim of this study is to report the difference in either anatomical or functional outcome of vitreoretinal intervention in cases of gunshot perforating eye injury if done 2-4 weeks or after the 4th week after the original trauma. Patients were treated with pars plana vitrectomy and silicon oil. Surgeries were performed in the period from February 2011 until the end of December 2014. 253 eyes of 237 patients were reviewed. 46 eyes were excluded. 207 eyes of 197 patients were analyzed. The included eyes were classified based on the timing of vitrectomy in relation to the initial trauma into two groups: 149 eyes (the first group) operated on between the 3rd and the 4th week and 58 eyes (the second group) operated on after the 4th week after the trauma. Following one surgical intervention, in the first group, attached retina was achieved in 93.28% of patients. In the second group, attached retina was achieved in 96.55% of patients. All RD cases could be attached by a second surgery. Visual acuity improved in 81.21% of patients, did not change in 15.43% of patients, and declined in 3.35% of patients. In the second group, visual acuity improved in 81.03% of patients, did not change in 12.06% of patients, and worsened in 6.89% of patients. There was no statistically significant difference between the two groups in either anatomical or functional results. We recommend interfering before the 5th week after the trauma as retinal detachment is encountered more in cases operated on after the 4th week. The visual outcome depends on the site of entry and exit (the route of gunshot).