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Background: Proliferative diabetic retinopathy (PDR) is a serious sight-threatening disease, and half of the patients with high-risk PDR can develop legal blindness within 5 years, if left untreated. This study was aimed at comparing panretinal photocoagulation (PRP) and intravitreal ranibizumab injections in terms of radial peripapillary capillary (RPC) density on optical coherence tomography angiography (OCTA) in patients with treatment-naive PDR. Methods: This open-label, prospective, randomized clinical trial included 50 patients with treatment-naive PDR with optic disc neovascularization and randomized them into two groups: group 1, with patients undergoing two sessions of PRP 2 weeks apart, and group 2, with patients received three intravitreal ranibizumab injections (0.5 mg) 1 month apart for 3 consecutive months. Patients underwent a full ophthalmological examination, including best-corrected distance visual acuity (BCDVA) measurement in the logarithm of minimal angle of resolution (logMAR) notation and OCTA before intervention and monthly after the last laser session or the first intravitreal ranibizumab injection for 3 months of follow-up. Visual field (VF) was tested at the beginning and end of 3 months. Results: Forty-two (84%) eyes completed the 3-month follow-up, including 22 eyes in the PRP group (88%) and 20 (80%) eyes in the ranibizumab group. The two groups were comparable in terms of demographic characteristics, diabetes duration, baseline BCDVA, glycated hemoglobin level, OCTA parameters, VF indices, and intraocular pressure (all P > 0.05). The RPC density change from baseline to the 3-month follow-up was significantly lower in the PRP group than in the ranibizumab group (mean difference in RPC density change: - 3.61%; 95% confidence interval: - 5.57% to - 1.60%; P = 0.001). The median (interquartile range) logMAR change from baseline to the 3-month follow-up (0.0 [0.2]) was significantly higher in the PRP group than in the ranibizumab group (- 0.15 [0.3]; P < 0.05). The median changes in central foveal thickness from baseline to the 3-month follow-up differed significantly between the two groups (P = 0.001). Conclusions: In eyes with PDR and neovascularization of the disc RPC density on OCTA increased in the ranibizumab group and decreased in the PRP group. Visual acuity gain was higher in the ranibizumab group than in the PRP group. Future multicenter trials addressing our limitations are required to verify the findings of this study.

Purpose To compare the measured or calculated angle Kappa using Oculus pentacam HR, Sirius and Orbscan III devices. Patients and methods A prospective randomized cohort study, conducted on 47 eyes of 47 healthy orthotropic individuals, with an age range of 18–50 years and a corrected Snellen’s distance visual acuity (CDVA) of 0.8 decimal or better. Angle Kappa is assessed directly using Orbscan® III software version 1.8.165.1. (Bausch and Lomb Rochester, New York, United States), while Pentacam® HR 1.21r.65 (Oculus Optikgeräte GmbH, Wetzlar, Germany) and Sirius device (CSO, version 3.2.1.60, Costruzione Strumenti Oftalmici, Florence, Italy) were used to calculate angle kappa indirectly. Results Least mean difference of estimated angle Kappa was between Orbscan and Pentacam devices (− 0.18° ± 1.8), and it was statistically insignificant (p value = 0.1294). Differences between both Orbscan and Sirius, and Pentacam and Sirius were statistically significant (p value = 0.0004 and Conclusion Pentacam parameters can be used as a reliable method to calculate angle kappa indirectly, without usage of any additional measurements from other machine. Sirius device parameters could also be used, but with less accurate results. A simple modification to those devices’ software to calculate it, and incorporate it in the printout is possible, and highly recommended.

Ahmed H Assaf,1,2 Mohamed G Aly,1 Rania G Zaki,1 Yasmine M Shaaban,1 Bassem F Aziz1,2 1Ain Shams University, Faculty of Medicine, Ophthalmology Department, Cairo, Egypt; 2Al Watany Eye Hospital, Cataract and Refractive Department, Cairo, EgyptCorrespondence: Ahmed H AssafAin Shams University, Cairo, Egypt Email assaf.ahmed@gmail.comPurpose: To compare effective phacoemulsification time (EFX) in femtosecond laser-assisted cataract surgery (FLACS) versus traditional quick chop phacoemulsification (QCP) in senile nuclear cataracts with different densities focusing on soft and hard ones.Patients and Methods: A prospective non-randomized comparative study was carried out in Al Watany Eye Hospital and Ain Shams University Hospital, Cairo, Egypt; 250 eyes with senile nuclear cataract (NC) were included and classified into two main groups, FLACS and QCP groups. Each of them was stratified according to nuclear density into three subgroups, subgroups I (Soft NC), II (Medium NC), and III (Hard NC). Sextans-softened fragmentation pattern was performed in the FLACS group. Total EFX utilized for nucleus disassembly and removal was recorded by the completion of each surgery.Results: A total of 117 eyes were included in the FLACS group and 133 eyes in the QCP group. No significant difference in EFX was observed between the two groups (P = 0.228). Regarding subgroups, EFX showed no statistically significant difference between FLACS and QCP (P = 0.283) in soft NC. For hard NC, a trend to lower values of EFX in FLACS compared with QCP was found, but without statistically significant difference (P = 0.122). Only in medium NC were significantly lower values obtained in FLACS compared with QCP (P < 0.0001).Conclusion: When compared with QCP technique, FLACS can be used for advantages aside from EFX reduction, including astigmatic keratotomies, accurate sizing, and centration of capsulotomies especially in hard and soft nuclear cataracts. Significant reduction of total EFX with FLACS is most prominent only in medium-density nuclear cataracts.Keywords: phacoemulsification, EFX, FLACS, quick chop, femtosecond laser, cataract surgery

Purpose To estimate the link between the thickness of retinal nerve fiber layer (RNFL); utilizing optical coherence tomography (OCT) and corresponding retinal sensitivity changes; utilizing visual field (VF) perimetry, in cases of ocular hypertension and early glaucoma. Methods Thirty patients (60 eyes) were gathered for this prospective, cross-sectional study. They were categorized into two groups. Group I comprised 30 eyes (15 patients) having ocular hypertension. Group II comprised 30 eyes (15 patients) early recognized as primary open angle glaucoma. Each patient underwent a thorough ophthalmologic examination, OCT for RNFL thickness estimation using quick RNFL thickness protocol and VF testing using automated perimetry (G2 program, central 30–2 threshold protocol). Pearson’s correlation was premediated between thickness of RNFL and VF indices. Results Significant connections between the thickness of temporal area of RNFL and mean sensitivity (MS), mean defect (MD) and loss of variance (LV) indices of VF (r = 0.533, -0.431, -0.388; P Conclusion Average RNFL thickness is certifiably not a dependable index for early determination of glaucoma or for the follow-up of ocular hypertension and POAG. Segmental RNFL thickness (especially temporal) appears to be a more dependable index. Profound structural modification with OCT test comprises an imperative sign of early utilitarian changes, regardless of whether they are not yet recognized with perimetry. The MS index of VF is by all accounts sensitive for the follow-up of ocular hypertension.

Background Phacoemulsification is one of the most common surgical interventions done worldwide; the ultrasound power used to emulsify and remove the cataractous lens is hazardous to corneal endothelium and can lead to permenant damage. Thats why ophthalmic viscoelastics have been developed and used to protect the corneal endothelium and ensure safety of intraocualr surgeries. Objective To study the effect of different concentrations of methyl cellulose on the corneal endothelium during phacoemulsification using specular microscopy. Patients and Methods Sixty patients with Immature Senile Cataract (IMSC) are equally distributed into two groups according to the concentration of Hydroxypropyl Methylcellulose (HPMC) used during phacoemulsification. In the first group HPMC 2% was used and in the second group HPMC 2.4% was used. Preoperative and one month postoperative examination was done including visual acuity testing, slit lamp examination using Topcon SL-3C, intraocular pressure measurement using Goldmann Applanation Tonometer (GAT), fundus examination, corneal edndothelium assessment by Tomey Specular Microscope EM-3000. Results Preoperatively, no significant difference was observed in age, sex, visual acuity, introcular pressure and endothelial cell count among the two groups. Postoperatively, the two groups had a significant decrease in endothelial cell count, but the decrease was less in group 2 using Methyl cellulose 2.4% (13.494%) than in group 1 using Methyl cellulose 2% (14.515%).There was an equal and significant increase in visual acuity in the two groups. Discussion Many studies have been done to compare the efficacy of different viscoelastics (OVDs) in the protection of corneal endothelium during phacoemulsification. In our study we compared the protective effect of two different concentrations of HydroxyPropyl MethylCellulose (2% &2.4%) on the corneal endothelium during phacoemulsification. We compared the demographic data as regarding age and sex of the patients in the two groups, also we compared the preoperative endothelial cell count in the two groups using Specualr Microscopy and the result showed no significant difference between the 2 groups. The endothelial cell loss was comparable in the 2 groups, in group 1 it was 362.267 ± 52.020 (14.515 % ± 1.458) and in group 2 it was 335.667 ± 21.170 (13.494% ±0.667) with slightly better protection in the second group. So these results shows that HPMC 2.4% gives better protection than HPMC 2% on corneal endothelium during phacoemulsification on terms of the postoperative endothelial cell count and the endothelial loss after phacoemulsification. Many studies have been done to compare the efficacy and the protective effect of different viscoelastics during phacoemulsification for example the studies done by Miller et al, Maar et al, Vajpayee et al and Storr-Paulsen et al, these studies showed results similar to our study as regards the protective effect of methyl cellulose with its different concentrations on the corneal endothelium during phacoemulsification, so both concentrations (2% and 2.4%) can be used safely and effectively in phacoemulsification to decrease the endothelial loss and ensure patients safety. Conclusion Methyl cellulose 2.4% and Methyl cellulose 2% were comparable in their ability to protect the corneal endothelium during phacoemulsification, in general both viscoelastics can be efficiently and safely used in performing phacoemulsification.

Background: Cataract surgery is one of the most commonly performed surgery in the world and the number of individuals with cataracts is predicted to reach 30 million by the year 20201. This number will continue to grow as the population ages. more and more patients pursue surgery at the early stage of cataract in order not to endure visual impairment. Phacoemulsification is the standard surgery procedure for cataract in the developed countries. In recent years, femtosecond laser (FSL) has been introduced into phacoemulsification cataract surgery to perform corneal incisions, capsulorhexis, and nuclear fragmentation. Numerous clinical studies have reported that using FSL to perform nuclear fragmentation before phacoemulsification significantly reduces the amount of ultrasound energy and effective phacoemulsification time (EPT) required in the surgery. Purpose: The goal of the present study is to assess the effect of FSL on effective phaco time in comparison to conventional phacoemusification procedure. Patients andMethods: a comparative study included 40 patients with senile cataract (nuclear cataract grade III or more) based on lens opacification classification system III (LOCSIII). The patients were subdivided into 2 groups; group (A) included 20 patients with senile cataract underwent Femtosecond laser-assisted phacoemulsification (CATALYS FSL system (Abbott Medical Optics)) and group (B) included 20 patients with senile cataract underwent conventional phacoemulsification ( INFINTI phacoemulsification platform (Alcon)). Effective phaco time had monitored and recorded in all patients. Results:As regarding conventional phaco group, mean EPT was 19.80±24.33 and in femto group, mean EPT was 1.05±1.28 with (p-value 0.001) which show highly significant difference between the two groups. Conclusion: Femto-second laser assisted cataract surgery reduce effective phacoemulsification time for grade 3 or more of nuclear cataract in comparison to manual procedure.

Aim This study aimed to compare the efficacy of primary intraocular lens (IOL) implantation following removal of congenital cataract in patients with aphakia younger than 2 years of age, followed by secondary implantation after the age of 2 years. Patients and methods This was a comparative prospective study that included patients with congenital cataract (28 eyes) who underwent lensectomy and anterior vitrectomy in the first year of life; 14 eyes were subjected to primary IOL implantation. Fourteen eyes with left aphakia were subjected to visual rehabilitation until the age of 2 years. Secondary implantation was performed and the two groups were followed for 2 years after implantation by a full ophthalmological examination. Results Postoperative significant uveitis occurred in 14.2% of patients in group A and 35.7% of patients in group B; the difference between the two groups was statistically insignificant. Fixation was good in 71% of patients in group A and in 57% of patients in group B; this difference was nonsignificant. Increasing intraocular pressure was noted in four cases in group B that was statistically significant and the diagnosis of glaucoma was confirmed and managed, whereas in group A, none of the cases had an intraocular pressure higher than 18 mmHg. Conclusion Primary IOL implantation was found to be safe and effective in the management of congenital cataract; it leads to lower incidence of complications and better visual outcomes compared with aphakia and secondary IOL implantation.

Comparing the clinical efficacy of Abobotulinumtoxin A (ABO) and Onabotulinumtoxin A(ONA) using a dosing ratio of 2.5U:1.0U in the treatment of crow's feet wrinkles.A single-blinded, randomized, split-face study, included 40 subjects, with moderate-to-severe crow's feet wrinkles. Patients were subjected to a dose equivalence of (ABO):(ONA); 2.5:1.0 U. Post treatment evaluation was done on 7, 30, and 120 days, comparing: Time, Duration, and Degree of Improvement; Patients Satisfaction.No significant difference was found between ABOONA regarding duration and time to improvement on static posture. While on dynamic posture, ABO showed significantly less time and longer duration. Both products produced highly significant improvement of the wrinkles' severity on both static and dynamic posture in comparison to the baseline severity. Satisfaction was more with ABO.ABO is a safe, effective alternative to ONA in treating crow's feet wrinkles.

Context Accurate intraocular lens (IOL) power calculation is mandatory to achieve satisfactory refractive outcomes. Axial length, keratometric readings, anterior chamber depth, and other measurements are utilized to estimate postoperative effective lens position. Selecting the formula of IOL calculation depends mainly on axial length (AL) and anterior chamber depth (ACD). Aims To study the correlation between AL and ACD in short, normal, and long eyes. Settings and design The study was conducted at Ain Shams University Hospitals after the approval of the research ethics committee in the Faculty of Medicine, Ain Shams University. Study period: 6 months. Patients and methods The study included 90 eyes of patients presented for IOL or phakic lens implantation. They were divided into three groups according to the AL. Group A included 30 patients with short AL of less than or equal to 22 mm. Group B included 30 patients with normal AL of more than 22 mm and less than 24.50 mm. Group C included 30 patients with long AL of more than or equal to 24.50 mm. The AL and ACD of each patient were measured using The ZEISS IOL Master 500. Statistical analysis used The Statistical Package for the Social Sciences, version 24. Results The results of our study showed that the correlation between the axial length and the anterior chamber depth among short eyes was statistically significant and they were negatively correlated, while no statistically significant correlation existed between AL and ACD in normal and long eyes. Conclusion The AL and ACD are inversely related in short eyes with an AL of less than or equal to 22 mm, while no correlation exists in normal and long eyes with an AL of more than 22 mm.

AIM: To evaluate the safety and efficacy of cellular photoablation using BCECF-AM [2’, 7’-bis-(2-carboxyethyl)-5-(and-6)-carboxyfluorescein, acetoxymethyl ester mixed isomers] as a method to control postoperative fibrosis in subscleral trabeculectomy (SST) compared to mitomycin C (MMC) in a rabbit model. METHODS: A comparative prospective case-control animal study was conducted. Fourteen rabbits were subjected to SST with intraoperative use of wound modulating agents (MMC or BCECF-AM) of the right eye (study groups I and II respectively) and SST without use of intraoperative wound modulating agents for the left eye (control group II). Two rabbits 4 eyes were considered as control group I with no surgical intervention. BCECF-AM was injected subconjunctivally 30min before surgery followed by intraoperative illumination with diffuse blue light for 10min. Antifibrotic efficacy was established by clinical response and histological examination. Clinical response was assessed by measuring intraocular pressure (IOP) at day 1, 3, 5, 7, 14, 21 postoperatively. Success was defined by ＞20.0% reduction in IOP from the preoperative values without anti-glaucoma medications. RESULTS: The mean percentage of reduction was 35.0% in the study group I with only one eye (14.3%) had 12.5% reduction. The mean percentage of reduction was 28.0 % in the study group II with two eyes (28.6%) in study group II had 14.2% reduction each. Regarding the control group II, the mean percentage of reduction was 14.3 % with 64.3% eyes had ＜20.0% reduction. There was a highly statistically significant difference between each of the study groups (right eyes) and the corresponding control group II (left eyes) as regards the mean postoperative IOP values started from day 5 in both study groups and this highly significant difference remained so till the end of the follow up period. Histologically, MMC treated blebs showed thinning of conjunctival epithelium with marked reduction of the goblet cells relative to control. Marked sub-epithelial edema was seen along with variable collagen dispersion. Mild cellularity was noted in sub-epithelial tissue. BCECF-AM treated blebs showed normal conjunctival epithelial thickness with abundant goblet cells. Mild sub-epithelial edema was noted along with moderate collagen dispersion. No histological abnormality was noted in the ciliary body or the cornea in any of the studied groups. CONCLUSION: Cellular photoablation using BCECF-AM is a safe and effective wound modulating agent to control postoperative fibrosis in trabeculectomy. However MMC considered as a more potent adjuvant to trabeculectomy than BCECF-AM in promoting IOP reduction.

Introduction During the year 2011 the Egyptian revolution arose with a change in the trend of eye trauma in Egypt. Aim of work This study aims at reviewing the epidemiology of ocular trauma presenting to Ain Shams University teaching hospital during the year 2011 and comparing it with epidemiology during the previous 5 years. Patients and methods This is a retrospective epidemiological and clinical study of patients admitted to Ain Shams University Hospital with ocular trauma from 2006 till 2011. Cases were analyzed with respect to age, sex, occupation, admission interval, type, mode, time and place of injury, causative instrument, diagnosis and examination findings, investigations, management and visual outcomes. Results Total numbers of cases presenting during the year 2011 was 237 cases. The mean age was 22.5 years. Students (47.2%) and jobless people (21.9%) constituted the majority of the sample. During the year 2011 there was a significant increase in the percentage of injuries occurring in the street. There was also a significant rise in the percentage of homicidal ocular injuries specially those caused from non-rifled weapons. Fourteen cases of endophthalmitis were associated with non-rifled fire arm missiles while 7 were associated with glass intra-ocular foreign body. This indicated that the probability of occurrence of endophthalmitis with metal intraocular foreign bodies was 2:3 i.e. 66.6% where as in glass intra ocular foreign body was 7:9 i.e. 77.7%. Conclusion The majority of ocular trauma in our population during the year 2011 was due to homicidal street injuries occurring mainly in males of young age group, which is consistent with the events occurring in Egypt in this year. The findings indicate that ocular trauma is a significant cause of visual loss in this population.