Argon laser photocoagulation for treatment of presumed trematode-induced granulomatous anterior uveitis in children.

BACKGROUND/AIMS: To assess the safety and efficacy of argon laser photocoagulation as a new modality for the treatment of presumed trematode-induced granulomatous anterior uveitis (PTGAU) in children. METHODS: Forty-eight eyes of 48 children with PTGAU with pearl-like nodule(s) in the anterior chamber were included in this prospective non-randomised controlled clinical trial. The patients were divided into two groups: those in Group A (23 eyes) were treated with one session of argon laser applied to the anterior chamber nodules and those in Group B (25 eyes) received medical treatment in the form of topical steroid and cycloplegic eye drops with trans-septal triamcinolone injections. All cases were followed up for 3 months with measurement of visual acuity (VA), assessment of the anterior chamber reaction and measurement of the pearl-like nodule size. RESULTS: In Group A, 22 eyes (95.65%) showed regression of the pearl-like nodules with resolution of the anterior chamber reaction (flare and cells) and improvement in visual acuity from 0.52±0.12 to 0.06±0.08 logMAR (p<0.001). Such improvement was maintained within the 3-month follow-up period. In Group B, 23 eyes (92%) showed initial regression of the granulomas, which was maintained in only 14 eyes (56%),with nine eyes experiencing recurrence after 3 months of follow-up. CONCLUSION: Argon laser photocoagulation is a safe and effective novel treatment for PTGAU with pearl-like nodules in the anterior chamber in children. Larger studies with longer follow-up periods are needed to confirm these results.

Clinical outcomes of transepithelial photorefractive keratectomy versus femtosecond laser assisted keratomileusis for correction of high myopia in South Egyptian population.

AIM: To evaluate the safety and efficacy of transepithelial photorefractive keratectomy (t-PRK) with adjuvant mitomycin C (MMC) versus femtosecond laser assisted keratomileusis (Femto-LASIK) in correction of high myopia. METHODS: Prospective randomized comparative study including 156 eyes of 156 patients with high myopia and a spherical equivalent refraction (SER) <-6.00 D. They were divided randomly into two groups: Group A included 72 eyes treated with t-PRK with adjuvant MMC and Group B included 84 eyes treated with Femto-LASIK. Visual acuity, SER, corneal topography, pachymetry and keratometry were assessed for 12mo postoperatively. RESULTS: The preoperative mean SER was -8.86±1.81 and -9.25±1.70 D in t-PRK MMC group and Femto-LASIK respectively (P=0.99) which improved to -0.65±0.43 D and -0.69±0.50 D at 12mo follow up. Mean SER remained stable during the 12mo of follow-up, with no statistically significant difference between the two groups (P=0.64). In t-PRK MMC group, only six eyes needed retreatment after six months of follow up. And two eyes showed haze (one reversible haze grade 2, while the other had dense irreversible haze grade 4). CONCLUSION: t-PRK MMC provides safe and satisfactory visual outcomes and acceptable risk as Femto-LASIK in patients with high myopia.

Analysis of Bimatoprost-Induced changes on Rabbits eyelash Follicle: Clinical and Electron microscopic study.

OBJECTIVE: To analyze ultrastructural changes of rabbits' eyelash follicles treated with bimatoprost eye drops to increase our knowledge of how this drug works. METHODS: The study included 15 clinically healthy male rabbits. All rabbits were treated with bimatoprost 0.03% daily for 4 weeks with one drop of the topical eye drops applied to the conjunctival fornix of the right eyes; left eyes were used as controls. Eyelash lengths were measured before and after treatment. The eyelid of each animal was dissected for light and electron microscopic analysis. RESULTS: Both control and treated rabbit eyes matched regarding eyelash length before treatment (9.80±0.388mm vs 9.88±0.24mm) (P=0.108). There was a significant increase in eyelash length between control (9.75±0.33 mm) and treated rabbit eyes (11.60±0.46 mm) (P=0.369). Light and electron microscopy revealed, bimatoprost treated eyes had thick epidermis. The dermis contained two hairs growing out of the same hair follicle. Heavily keratinized Henle's layer, the cortical cells (Cx) have prominent nucleolus and cytoplasm is studded with melanin granules. CONCLUSION: Bimatoprost-induced eyelash changes were not restricted to increased eyelash length, thickness, and pigmentation but also showed increased number of eyelashes within the same hair follicle which were stronger and could resist pulling from the skin without any evidence of inflammatory cells within the specimens. These changes occurred as early as 1 month of treatment, giving rise to thoughts about the possibility of using bimatoprost eye drops as a prophylaxis against madarosis associated with chemotherapy if it is started 1 month before chemotherapy and continued afterwards, making eyelashes stronger and resistant to falling out.

Nd:YAG laser for epithelial ingrowth after laser in situ keratomileusis.

PURPOSE: To evaluate the efficacy of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser for treatment of epithelial ingrowth after laser in situ keratomileusis (LASIK). PATIENTS AND METHODS: Fifty-eight patients with epithelial ingrowth presented to Sohag refractive center, Sohag, Egypt, between January 2015 and March 2017. Only 41 patients (18 females and 23 males, mean age: 33.4 years) involving 41 eyes were indicated for treatment by Nd:YAG laser as the rest of the eyes were only under observation. Patients with epithelial ingrowth were recognized at a mean of 6 months after primary LASIK procedure (range: 2-16 months). Four eyes had undergone previous LASIK enhancements. Four eyes had the epithelial ingrowth removed by flap lift and scrapping. The mean intensity of the spots used was 0.8 mJ with variable number of shots depending on the size and density of the epithelial ingrowth area. Twenty-eight eyes showed complete regression after one session, while the rest necessitated 2-3 sessions for complete resolution. Mean follow-up period was 8 months (range 5-12 months). RESULTS: Epithelial ingrowth was treated successfully in all 41 eyes. The uncorrected visual acuities were 20/20, and there was no evidence of recurrent epithelial ingrowth after 6 months with no complications reported. CONCLUSION: YAG laser is a simple, effective outpatient procedure for the management of epithelial ingrowth after LASIK.

Combined Argon Laser and Low Dose Acetylsalicylic acid in Treatment of Acute Central Serous Chorioretinopathy.

This study was designed to evaluate the efficacy of low-dose of oral acetylsalicylic acid (aspirin) with focal argon laser for the treatment of acute central serous chorioretinopathy (CSCR). In this prospective case-control study, 40 Patients with acute CSCR were classified randomly to two groups; group A with no treatment as the control group and group B with argon Laser in focal treatment once, followed by aspirin, 100 mg per day orally, with follow up period of 12 months by evaluation of visual acuity, and by Optical Coherence Tomography (OCT), every three months for one year. Patients in the second group treated with argon Laser and aspirin showed more clinically significant improvement in both visual acuity and OCT macular thickness by the end of the follow-up period when compared with the observational group. It was concluded that argon Laser with low-dose oral aspirin results in improvement of visual acuity and OCT macular thickness.

Effect of Reformation of the Anterior Chamber by Air or by a Balanced Salt Solution (BSS) on Corneal Endothelium after Phacoemulsification: A Comparative Study.

AIM: To study the effect of reformation of the anterior chamber by air or by a balanced salt solution, after smooth phacoemulsification on the corneal endothelial count and morphology. METHODS: A prospective interventional nonrandomized comparative study included 500 eyes of 500 patients with age range between 50 and 60 years, prepared for cataract surgery and presented to the Ophthalmology department of Sohag University Hospital in the period from October 2016 to May 2017. Corneal endothelial morphology and count were examined, and the results were recorded for all cases before the surgery. Patients were divided into two groups, and both groups were diagnosed with grade 2 cataract and underwent uncomplicated phacoemulsification performed by well-trained surgeons. At the end of the surgery, group 1 was subjected to a reformation of the anterior chamber via a balanced salt solution (BSS) injection while group 2 was subjected to a reformation of the anterior chamber via air injection. Corneal endothelial morphology and count were evaluated in the first and 3rd month postoperatively. RESULTS: The study included 500 patients (250 in each group), 220 males (44%) and 280 females (56%) with no significant statistical age differences. Both preoperative and postoperative (3 months after the operation) recorded parameters of the corneal endothelium did not show any significant statistical differences. The cumulative dissipated energy was recorded, for all cases of both groups, during phacoemulsification with no significant statistical differences (P = 0.7). CONCLUSION: There is no difference between the effect of reformation of the anterior chamber after phacoemulsification, using air or using a BSS injection, on the corneal endothelial count and morphology.

Air Bubble Technique for Fundus Visualization during Vitrectomy in Aphakia.

PURPOSE: To evaluate the efficacy and safety of air bubble technique for vitrectomy in aphakia. STUDY DESIGN: Prospective interventional uncontrolled case series. METHODS: This study included 53 eyes of 53 patients who are phakic and indicated for phacovitrectomy (7 eyes, group 1), aphakic and indicated for vitrectomy (22 eyes, group 2), or underwent unplanned vitrectomy for immediate management of a phacoemulsification surgery complicated by rupture posterior capsule with dropped nucleus, fragments, or IOL (24 eyes, group 3). Cases with complicated vitreoretinal pathology were not included in this study. All vitrectomy surgeries were conducted by the air bubble technique in the anterior chamber. Main outcomes included anatomical success, visual acuity, and intraoperative and postoperative complications. RESULTS: The surgical success was achieved in 50 eyes (94.3%). Conversion to BIOM viewing system was needed in the retinal detachment cases of groups 1 and 2. The mean overall LogMAR visual acuity was significantly improved from 1.29 ± 0.58 preoperatively to 0.56 ± 0.19 at the final visit, 6 months postoperatively (P < 0.001). CONCLUSION: The air bubble technique as visualization method for vitrectomy in aphakia is an effective and cheap technique for immediate management of complications of phacoemulsification surgery. This trial is registered with Pan African Clinical Trial Registry PACTR201709002466296.

Preoperative subconjunctival combined injection of bevacizumab and mitomycin C before the surgical excision of primary pterygium: clinical and histological results.

PURPOSE: The aim of this study was to detect the clinical and histological effects of preoperative subconjunctival injection of both bevacizumab and mitomycin C (MMC) 1 month before the surgical excision of primary pterygium using a bare sclera technique. PATIENTS AND METHODS: A total of 20 patients with primary pterygium underwent subconjunctival combined injection of 0.1 mL of MMC (0.1 mg/mL) and 0.1 mL of bevacizumab (1.25 mg/0.1 mL) 1 month before bare sclera excision of the pterygium. The excised pterygium tissues were examined histologically and immunohistologically by CD31 staining, and the patients were followed up clinically for at least 2 years. The excised pterygia of two patients without preoperative injection were used for histological comparison. RESULTS: Clinically, there were no intraoperative or postoperative complications. No recurrence was noted during the follow-up period. Histologically, the previously injected pterygia showed a decreased number of epithelial cells and stromal fibroblasts. The latter were rounded or oval and swollen rather than spindle shaped, and some were degenerating or apoptotic. Collagen and elastic fibers were degenerated, distorted, and decreased in density, while blood capillaries were obliterated. There was a significant decrease in CD31-positive cells in previously injected pterygia. CONCLUSION: Preoperative subpterygium combined injection of bevacizumab and MMC is safe and effective in reducing the postoperative recurrence of primary pterygium. Histological and immunohistological changes in the form of decreased fibrovascular activity and degeneration of the extracellular matrix and nerve axons were noted.