The Effect of Myopia on Vessel Density in Glaucomatous Patients by Optical Coherence Tomography Angiography.

Background: Glaucoma is a degenerative optic neuropathy that causes anatomical and functional visual impairment. Aim and Objectives: This investigation's primary goal was to perform a qualitative and quantitative assessment of macular and peripapillary vessels to detect the impairment of blood flow in glaucomatous patients with or without myopia which can affect the prognosis of glaucoma and visual field. Subjects and Methods: This prospective, cross-sectional, observational research was performed for glaucomatous patients with and without myopia who attend the outpatient clinic at the ophthalmology department, at Benha University. The study was conducted on 50 subjects with glaucomatous eyes, divided into two groups: the first group consisted of (25 subjects) of glaucoma with myopia and the second group (25 subjects) of glaucoma with the same severity of mean deviation in the visual field of group 1 without myopia, using OCTA to measure retinal vessel density (superficial vessel density) and OCT thickness ILM-RPE, RNFL thickness, GCL and small vessel density (RADIAL PERI PAPILLARY PLEXUS). Results: Regarding demographic data of myopia in the studied eyes, there were (9) 18% with low myopia with no significance, (32) 64% with moderate myopia, and (9) 18% with high myopia, with open-angle glaucoma patients showed a highly significant decline in total retinal nerve fiber layer thickness, superior-nasal RNFL thickness, Inferior-nasal RNFL thickness, superior-temporal RNFL and inferior-temporal RNFL thickness compared to open-angle glaucoma patients without myopia. Conclusion: Our results show that microvascular attenuation occurs more significantly in OAG than in myopia. When both myopia and OAG are present, there is a higher reduction in microvascular attenuation than with either disease alone. The development and progression of glaucoma in individuals with high myopia are more aggressive than in low or non-myopia, so by using OCTA detection of early microvascular changes in high myopia, individuals help the early detection and management of glaucoma.

Quantitative OCT Angiography Assessment of the Effect of Peribulbar Anesthesia on Retinal Microvasculature in Primary Open-Angle Glaucoma Patients Undergoing Cataract Surgery.

Objective: To assess the effect of peribulbar anesthesia on retinal microvasculature in primary open-angle glaucoma (POAG) patients undergoing cataract surgery using OCT Angiography. Participants: Forty-nine patients undergoing cataract surgery were divided into two groups. Group I included patients with no history of glaucoma, while group II included patients previously diagnosed as POAG with controlled IOP. Each participant received 6 mL of peribulbar anesthetic injection of 4 mL lidocaine 2% containing 150 IU hyaluronidase and 2 mL bupivacaine 0.5%. They were scanned with the OCT-A 10 minutes before and 10 minutes after injection for foveal deep (DCP), superficial (SCP) capillary plexuses density and total vessel density, foveal avascular zone (FAZ) diameter, optic disc total vessel density, and radial peripapillary capillary (RPC) network density. In addition, IOP was checked before and 10 minutes after injection. Results: Median percent change in DCP post-injection was significantly greater in group II (-43%) than in group I (-2.5%) (P < 0.001). Also, DCP total density median percent change post-injection was significantly higher in group II (-21%) than in group I (-0.9%) (P < 0.001). Foveal SCP vessel density and total vessel density median percent change post-injection were -62.6% and -16.2%, respectively, in group II and were -2.6% and -1.1%, respectively, in group I, which are statistically significant (P < 0.001). The FAZ diameter median percentage change post-injection was higher in group II (40.6%) than in group I (2.5%) (P < 0.001). Optic disc total vessel density and radial peripapillary capillary (RPC) network density post-injection median percent change were significantly higher in group II (-13.6%) and (-13.1%) respectively than in group I (-1.1%) and (-1.25%) respectively (P < 0.001). Conclusion: Peribulbar anesthesia harbors a deleterious ischemic effect on the retinal vascular tree of glaucoma patients, which could harmfully affect the vision and the visual field in those vulnerable patients.

Influence of COVID­19 on the Prognosis and Medication Compliance of Glaucoma Patients in the Nile Delta Region.

OBJECTIVE: To assess the influence of the COVID-19 pandemic on the medication adherence and follow-up of glaucoma patients in the Nile Delta region. SETTING: A tertiary care center in the Nile Delta region, Egypt. STUDY DESIGN: An observational, cross-sectional study. PARTICIPANTS: Patients' records (2019-2020; group A) and (2020-2021; group B) were assessed for missed follow-up visits, medication adherence, number of trabeculectomies performed, and uncontrolled patients. In addition, a telephone-based questionnaire involving randomly chosen 200 patients from B.G.U. was carried out to clarify the potential causes of poor patients' compliance. RESULTS: There was a marked decline in the number of newly diagnosed patients and patients on regular follow-up with incidence rates 0.208 and 0.088 in group (A) and group (B), respectively (P-value < 0.0001). The number of compliant patients in group B decreased with an incidence rate difference of 0.312. The number of trabeculectomies declined in group (B) with an incidence rate in group (A) 0.131 compared to 0.081 in group (B). On the other hand, the number of uncontrolled glaucoma patients increased in group B with an incidence rate difference -0.231 between the two groups. 21.5% of patients who participated in the questionnaire identified financial issues as the leading cause of non-compliance. Comorbidities (19.5%), lockdown and transportation difficulties were also highlighted. CONCLUSION: COVID-19 had greatly hampered glaucoma care in the Nile Delta region. As a result, we need to implement new technologies like telemedicine and improve patients' awareness of glaucoma care. Training orthoptists and using mobile glaucoma care services would also be helpful ways of managing glaucoma during that pandemic.

Surgical Outcomes of Primary Congenital Glaucoma in Children Under One Year from the Nile Delta.

PURPOSE: To present outcomes of surgical management of primary congenital glaucoma (PCG) in children less than one year of age in a population based at the Nile Delta. METHODS: A retrospective review of medical records of patients with PCG less than one year of age at presentation who underwent surgical intervention in a tertiary care facility based at the Nile Delta. All patients underwent measurement of intraocular pressure (IOP), horizontal corneal diameter (HCD), cup-to-disc ratio (CDR) before and after surgery and a minimum of 6 months follow up was required. Surgical success was defined as IOP less than 22mmHg without medications and without progression of main disease parameters. RESULTS: The review revealed 44 eyes of 26 consecutive patients who underwent surgical treatment for PCG. Average age at surgery was 5.2 months and mean follow up was 18.5 months. Preoperative IOP was 28.5±4 mmHg, HCD was 13.7±0.7mm, and CDR (when visible) was 0.65±0.18. A total of 69 surgical procedures were performed with an average of 1.56 procedures per eye. Postoperative IOP was 13.3±4.8 mmHg, HCD was 12.8±0.9mm, and CDR was 0.3±0.2 (P<0.0001). Surgical success was achieved in 32 eyes (72.7%) while sight-threatening postoperative complications were reported in 3 eyes. CONCLUSION: Surgical management of PCG younger than one year of age achieved good success rate in the region of the Nile Delta with low rate of visually significant postoperative complications. However, larger studies with longer follow up are needed to fully reveal the overall characteristics of PCG in the region.

Augmented superior rectus muscle transposition in management of defective ocular abduction.

BACKGROUND: Superior rectus muscle transposition (SRT) is one of the proposed transposition techniques in the management of defective ocular abduction secondary to chronic sixth nerve palsy and esotropic Duane retraction syndrome (Eso-DRS). The aim of the current study is to report the outcomes of augmented SRT in treatment of Eso-DRS and chronic sixth nerve palsy. METHODS: a retrospective review of medical records of patients with Eso-DRS and complete chronic sixth nerve palsy who were treated by augmented full tendon SRT combined with medial rectus recession (MRc) when intraoperative forced duction test yielded a significant contracture. Effect on primary position esotropia (ET), abnormal head posture (AHP), limitation of ocular ductions as well as complications were reported and analyzed. RESULTS: a total of 21 patients were identified: 10 patients with 6th nerve palsy and 11 patients with Eso-DRS. In both groups, SRT was combined with ipsilateral MRc in 18 cases. ET, AHP and limited abduction were improved by means of 33.8PD, 26.5°, and 2.6 units in 6th nerve palsy group and by 31.1PD, 28.6°, and 2 units in Eso-DRS group respectively. Surgical success which was defined as within 10 PD of horizontal orthotropia and within 4 PD of vertical orthotropia was achieved in 15 cases (71.4%). Significant induced hypertropia of more than 4 PD was reported in 3 patients (30%) and in 2 patients (18%) in both groups, respectively. CONCLUSION: augmented SRT with or without MRc is an effective tool for management of ET, AHP and limited abduction secondary to sixth nerve palsy and Eso-DRS. However, this form of augmented superior rectus muscle transposition could result in high rates of induced vertical deviation.

Interleukin-17 haplotyping predicts hepatocellular carcinoma in sofosbuvir, pegylated interferon-alpha-2a & ribavirin treated chronic hepatitis C patients.

Suspect has been directed towards some direct acting antivirals (DAAs) due to their reported association with hepatocellular carcinoma (HCC) development in chronic hepatitis C (CHC) patients. The mechanisms behind HCC development, following CHC treatment, were not well understood and may be linked to genetic variabilities in different patients which affect several cytokine productions involved in angiogenesis and inflammation. Of these variabilities, is the genetic polymorphisms in the interleukin-17 (IL-17) A receptor gene. Being an important pleiotropic cytokine, this study aimed to investigate the association between haplotypes in IL-17A receptor rs2275913 and rs3819024 and development of HCC in CHC patients treated with either triple therapy (sofosbuvir (SOF), pegylated interferon-alpha-2a (Peg-IFNα-2a) & ribavirin(RBV)) or with dual therapy (Peg-IFNα-2a&RBV). A cohort of 100 CHC patients was recruited in this study. Samples were tested for single nucleotide polymorphism (SNPs) in IL-17A receptor (rs2275913 and rs3819024) using TaqMan Genotyping assay. Our results showed that the presence of G-G haplotype in IL-17A (rs2275913& rs3819024) is inversely associated with HCC development in patients receiving triple therapy. While, high serum AFP levels are directly associated with HCC development in patients receiving triple therapy. However, in patients receiving dual therapy, HCC development was only associated with high serum alpha fetoprotein (AFP) levels and was not correlated to any specific allele in our studied SNPs. Such results highlight the importance of IL17A receptor gene haplotyping in the prediction of HCC development in patients receiving triple therapy. These results will aid in performing tailored, personalized strategy for CHC treatment.

Management of stretched scar- induced secondary strabismus.

BACKGROUND: To determine characteristics and management of consecutive or recurrent strabismus secondary to stretched scar. METHODS: This is a retrospective review of all patients diagnosed with late secondary consecutive or recurrent strabismus due to stretched scar from 2012 to 2017. The diagnosis of stretched scar was made in any case of late (≥ 1 month) consecutive or recurrent strabismus associated with underaction of the previously operated muscle. The diagnosis was confirmed intraoperatively by negative forced duction test and the characteristic appearance of the scar tissue. Surgical correction involved excision of the scar tissue with muscle re-attachment to the sclera using non-absorbable sutures. Study parameters include improvement in secondary deviations, degree of muscle underaction and diplopia. RESULTS: 21 consecutive and 6 recurrent cases of stretched scar -induced strabismus were identified and all cases were associated with variable degrees of limited ocular duction. After surgical correction of the stretched scar, consecutive deviations in the form of consecutive esotropia and exotropia were corrected by means of 26.1PD and 65.6PD while recurrent deviations in the form recurrent exotropia and recurrent hypertropia were corrected by means of 34.3PD and 11PD respectively with significant improvement of limited ocular ductions. 21 patients had diplopia at presentation and all were improved after surgery. CONCLUSION: management of stretched scar -induced secondary strabismus by excision of the stretched scar and muscle fixation to the sclera using non-absorbable sutures significantly corrects secondary deviations and improves limitation of ocular duction.