Clinical outcome following reinjection of Ranibizumab for reactivation of retinopathy of prematurity.

BACKGROUND: To assess reactivation after initial intravitreal injection of ranibizumab (IVR) for type 1 retinopathy of prematurity (ROP) or worse and the outcome following reinjection of ranibizumab for this reactivation. METHODS: This retrospective study was performed on infants screened for ROP between March 2013 and February 2020 in Mansoura University Children Hospital, Mansoura, Egypt. Infants treated with ranibizumab 0.25 mg/0.025 mL were identified for review of their clinical outcomes. Data of infants with reactivation and IVR re-injection were analysed. RESULTS: A total of 2318 infants were screened for ROP, 115 (5%) infants (216 eyes) with a mean gestational age of 30 ± 2.5 weeks and mean birth weight of 1290 ± 355.2 g received IVR at mean postmenstrual age (PMA) of 38 ± 3.1 weeks. All treated eyes demonstrated initial regression of ROP. However, ROP reactivation occurred in 5 (2.3%) eyes of 3 patients, at an average of 9.6 ± 2.9 weeks after treatment. None of these eyes had retinal detachment. A second dose IVR was administered and all five eyes showed regression with complete retinal vascularisation, at a mean PMA of 60 ± 5.1 weeks. CONCLUSIONS: IVR is beneficial as an initial and subsequent treatment for type 1 ROP or APROP. A long-term follow-up until complete retinal vascularisation is recommended to avoid disease reactivation.

Corneal Tomographic Analysis Among Patients With Thyroid Gland Dysfunction.

PURPOSE: To analyze the corneal tomographic parameters of patients with thyroid gland dysfunction. METHODS: This case-control study included 100 eyes of 50 patients with thyroid gland dysfunction and 100 eyes of 50 healthy controls. All eyes were examined by Pentacam (Oculus Optikgeräte GmbH). Pentacam parameters were compared between patients with thyroid gland dysfunction and controls. Spearman's correlation coefficient between different Pentacam parameters and the serum level of free thyroxin (T4) and thyroid-stimulating hormone (TSH) was calculated. RESULTS: Patients with hypothyroidism had significantly higher median values of steep and maximum simulated keratometric readings, central corneal thickness (CCT), and thinnest pachymetry (CTmin) than both patients with hyperthyroidism and controls (P⩽ .05). The median values of the average and maximum pachymetric progression index (PPI), posterior elevation, and back difference elevation were significantly higher in patients with hyperthyroidism than in patients with hypothyroidism and controls (P ⩽ .05). The Ambrósio Relational Thickness (ARTmax) was significantly reduced in patients with hyperthyroidism (P ⩽ .001). Both CCT and CTmin showed a moderately positive correlation with serum TSH level and a moderately negative correlation with serum free T4 level. Patients with non-autoimmune thyroid gland dysfunction had significantly thinner CCT, CTmin, and inferior vertical deviation than the autoimmune group (P ⩽ .05). CONCLUSIONS: Thyroid gland dysfunction is associated with significant corneal tomographic changes. Patients with hyperthyroidism tend to have thinner corneas and more abnormal tomographic parameters correlating with keratoconus. No significant tomographic changes were found in association with autoimmune thyroid gland dysfunction. The authors recommend screening and regular follow-up of patients with thyroid gland dysfunction for early detection and management of keratoconus. [J Refract Surg. 2021;37(3):192-197.].

Collagen crosslinking with photoactivated riboflavin in advanced infectious keratitis with corneal melting: Electrophysiological Study.

AIM: To assess the effect of photoactivated chromophore for keratitis crosslinking (PACK-CXL) in case of severe keratitis with melting on the electrophysiological function of the retina and the optic nerve. METHODS: The study included 32 eyes of 32 patients with smear positive severe infectious keratitis with corneal melting. The patients were randomly divided into two groups. Group I (control group) included 16 eyes received systemic and topical antimicrobial drugs guarded by culture and sensitivity test. Group II underwent CXL and then continued their antimicrobial treatment. Full field electroretinogram (ERG) and flash visual evoked potential (VEP) were done for each patient in both groups basically and then 1wk, 1 and 3mo post-treatment to assess the changes in the electrophysiological function of the retina and optic nerve. RESULTS: Healing of 10 eyes in group I in comparison to 14 eyes in group II was recorded. The mean duration of healing was 36.56±5.21d in group I vs 20.2±4.4d in group II (P<0.005). In group II, ERG showed an insignificant reduction of all parameters of ERG and VEP after CXL. The amplitude of scotopic rod response, oscillatory potential amplitude, flicker amplitude and photopic cone response were insignificantly decreased (P=0.4, 0.8, 0.1, and 0.3 respectively). There were insignificant prolongation of latencies of scotopic rod, oscillatory potential, flicker and photopic cone response (P=0.2, 0.7, 0.5 and 0.1). There was slight delay in latency of VEP without a significant reduction in amplitude. CONCLUSION: CXL is an effective technique in treatment of severe infectious keratitis with melting as it halts the melting process with acceptable safety on the retinal and optic nerve function.

Pentacam changes in primary angle-closure glaucoma after different lines of treatment.

AIM: To assess the changes in the anterior chamber parameters using Pentacam following four different lines of treatment of primary angle-closure glaucoma (PACG). METHODS: A retrospective comparative study included 126 patients (126 eye) presented within 24-48h after acute angle-closure glaucoma (AACG). Patients were divided into 2 groups: group A (68 eyes) with controlled intraocular pressure (IOP) ≤21 mm Hg, which included subgroup A1 (34 eyes) with clear lens underwent Nd:YAG laser peripheral iridotomy (LPI) and subgroup A2 (34 eyes) with cataract underwent standard phacoemulsification; and group B (58 eyes) with uncontrolled IOP, which included subgroup B1 (30 eyes) with clear lens underwent trabeculectomy and subgroup B2 (28 eyes) with cataract underwent combined phacoemulsification and trabeculectomy. Patients were followed up for at least 3mo. Primary outcomes were Pentacam anterior segment measurements [anterior chamber angle (ACA) and depth (ACD)]. Secondary outcomes were changes in IOP, visual acuity (VA) and recorded complications. RESULTS: At the 3rd month, there was significant increase in the ACA values in all studied groups compared to preoperative values (P<0.001). The highest percent of increase in ACA was recorded in phacotrabeculectomy group B2 (128.40%). There was significant increase in ACD values at 3rd month compared with baseline values (P<0.001) for groups A1, A2, and B2; without change in B1 trabeculectomy group. The maximum deepening of ACD was noticed in group B2 with 94.27% increase. Significant decrease in postoperative IOP in groups A2, B1 and B2 (P<0.001, P=0.014, and P<0.001 respectively). In group A1 there was significant increase in 3rd month postoperative IOP from baseline values (P<0.001). The maximum decrease in IOP was noticed in group B2 with 59.54% decrease. VA improvement in 3rd month postoperative was recorded in all studied groups, maximum VA improvement was observed in group B2 up to 0.2 logMAR. CONCLUSION: Pentacam can be a helpful tool in studying and comparing the effect of the different lines of management of PACG on the anterior chamber measures. Phacotrabeculectomy was proved to be an effective line for managing PACG with resultant significant increase in the anterior chamber parameters, IOP reduction as well as maximum VA improvement. LPI has only temporary effect on IOP with significant changes in ACA and ACD. Phacoemuslification alone can be an option in treating PACG. Trabeculectomy resulted in temporary increase in the anterior chamber parameter which subsequently returned to baseline values.

Micropulsed diode laser cyclophotocoagulation in recurrent pediatric glaucoma.

PURPOSE: To evaluate the intermediate-term efficacy and safety of micropulsed diode laser cyclophotocoagulation in recurrent pediatric glaucoma. PATIENTS AND METHODS: A prospective interventional study included children <16 years old diagnosed with recurrent glaucoma, attending Mansoura University, during the period from July 2017 to November 2017. Micropulsed diode laser sessions were performed in all the cases. The main outcome was the intraocular pressure reduction with monitoring of complications as secondary outcome. The mean follow-up period was 15.08 ± 1.1 (mean: 12-16) months. RESULTS: A total of 36 eyes of 29 patients were included (62% males) with median age of 24 months. Primary congenital glaucoma represented 47.2% of the initial diagnoses. At the 15th month, the mean intraocular pressure dropped significantly from 37.5 ± 11.3 mmHg at baseline to 20.03 ± 2.7 mmHg (p < 0.001) with 37.15% reduction. The mean number of glaucoma medications decreased significantly from 2.6 ± 0.5 pretreatment to 1.7 ± 0.6 at the 15th month (p < 0.001). A total of 24 eyes (66.7%) required second session of treatment with mean number of 1.7 ± 0.5 sessions per eye. The cumulative probability of qualified success was 69.4%, 58.3%, 52.8%, 47.2%, and 41.7% at 1, 3, 6, 12, and 15 months after treatment. Qualified success was achieved in 61% at 15 months without statistically significant difference between the initial diagnoses (p = 0.61). None of the eyes developed any major ocular complications throughout the follow-up period. CONCLUSION: Micropulsed diode laser was proved to be a safe approach with relative effectiveness in controlling intraocular pressure in children with recurrent glaucoma.

Launching a paradigm for first and redo-surgery in primary congenital glaucoma: institutional experience.

AIM: To evaluate the outcome of the initial and the redo-surgeries for primary congenital glaucoma (PCG) correlated to its degree of severity. METHODS: A retrospective study involved patients with PCG presented between 2010 and 2018. Medical records were reviewed to assess the degree of the preoperative severity according to the intraocular pressure (IOP), corneal diameter and corneal edema. Success and failure rates were calculated for both first and redo-surgeries at 6 and 12mo respectively then correlated to the severity of the cases. RESULTS: Complete records were retrieved for 272 eyes (153 patients) with PCG: 43 eyes were mild, 136 moderate and 93 severe. Combined trabeculotomy and trabeculectomy (CTT) had the highest success rate in moderate (96.4%) and severe cases (59.3%) while trabeculotomy had the highest success rate in mild cases (96.3%). Medical records of 88 eyes (63 patients) with recurrent PCG were analyzed, most with severe presentation (59 eyes). Ahmed glaucoma valve (AGV) was used in 67 (76%) eyes and augmented trabeculectomy in 21 (24%) eyes. At 12mo, there was no statistically significant difference between both surgeries in total success rate (P=0.256). For mild cases, success rate was 100% for both surgeries. Severe cases had higher success rates following AGV (87%) than augmented trabeculectomy (20%). Preoperative severity of the disease was an independent factor affecting the failure rate in secondary trabeculectomy but not in AGV. Patients younger than 24mo had higher probabilities of failure following both redo-surgeries with hazard ratio=1.325 and 0.37 for augmented trabeculectomy and AGV respectively. CONCLUSION: Preoperative assessment of the severity of eyes with PCG helps in the selecting the optimal primary and secondary surgery. For first surgery, trabeculotomy is more effective in mild cases whereas; CTT and augmented subscleral trabeculectomy (SST) are appropriate for moderate and severe cases. AGV proved to be superior to augmented SST in severe recurrent cases.

Outcome of pediatric cataract surgery with intraocular injection of triamcinolone acetonide: Randomized controlled trial.

PURPOSE:: To evaluate the use of intraocular injection of triamcinolone acetonide in pediatric cataract surgery with or without intraocular lens implantation as a vitreous dye to ensure a complete anterior vitrectomy and evaluate its effect on postoperative ocular inflammation, infection, posterior capsule opacification, and intraocular pressure. METHODS:: Randomized controlled trial included children diagnosed with bilateral congenital cataract in both eyes. Their eyes were randomly assigned into two groups: group A underwent aspiration, posterior capsulotomy, and anterior vitrectomy with intraocular injection of triamcinolone acetonide, while group B underwent the same surgical procedure without intraocular injection of triamcinolone acetonide. Intraocular pressure, postoperative inflammation, infection, and posterior capsule opacification were followed up till 6 months. RESULTS:: The study comprised 44 eyes of 22 children. The mean age was 2.4 ± 2.1 years including 10 males and 12 females. The mean postoperative intraocular pressure was within normal range in both groups. No case of infection in both groups. No eyes in group A showed reaction, while in group B, three eyes showed exudate on the first day, which improved at 2 weeks. Posterior synechiae was recorded in four eyes in group A and in five eyes in group B. Posterior capsule opacification was noted in one eye in group A at 3 month, while it was noted in nine eyes in group B. The difference was statistically significant ( p = 0.004). CONCLUSION:: Triamcinolone acetonide was found to be useful in better visualization of vitreous in pediatric cataract surgery and has good effect in decreasing postoperative inflammation and posterior capsule opacification.

Intra-ocular lens power calculation in patients with high axial myopia before cataract surgery.

PURPOSE: To evaluate the accuracy of different formulas used for IOL power calculation in patients with high axial myopia undergoing cataract surgery. METHODS: A prospective clinical study was carried out on 53 eyes of 51 patients with an axial length from 25.5 to 31.4 mm including 21 males (41.2%) and 30 females (58.8%). Calculation of the IOL power to be implanted was done by three available IOL power formulas; Haigis formula, SRK/T formula, and Holladay I formula. The mean error (ME) was calculated from the difference between the formula predicted refractive error and the actual post operative refractive error. RESULTS: There was no statistically significant difference between the mean error of the three formulas used in the overall performance or in the axial length subcategories. SRK/T formula caused the smallest mean error, (+0.17 D). Haigis formula showed a higher ME (+0.21 D) and Holladay formula caused a myopic postoperative refractive error (-0.20 D). CONCLUSION: The calculation of IOL power in patients with high axial myopia using the third or the fourth generation formulas help in improvement of the accuracy of the calculation and decreasing the post operative refractive error. SRK/T formula showed the lowest mean error, however, there was not statistically significant difference between the three formulas used, neither in the overall performance, nor in axial length subcategories.