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.].

Does the scleral encircling band provide a protective effect against the progression of diabetic retinopathy?

AIM: To evaluate the effect of scleral encircling bands on the development and progression of diabetic retinopathy (DR) in diabetic patients. METHODS: The medical records of diabetic patients who underwent unilateral retinal detachment (RD) surgery using scleral buckle and encircling band were reviewed retrospectively. Both eyes of patients were included in the study: one eye in each patient had a scleral buckle with encircling band (the operated eye) and the other one is the non-operated eye. The demographic characters, duration of diabetes and period between surgery and the last recall visit were retrieved from each patient. All the cases underwent fundus photo and fluorescein angiography (when indicated) to confirm the DR staging. RESULTS: Totally 25 patients fulfilled the inclusion and the exclusion criteria were become eligible for the study. A total of 50 eyes of 25 patients were enrolled in this analysis. The mean period of time passed from surgery with encircling band and the last reassessment visit was 12.5±2y. Even though DR could develop in the operated eyes, it was at a less degree of severity compared to the non-operated eyes of same patients (P=0.027). CONCLUSION: Scleral encircling bands have protective effects against the development and progression of DR.

Treatment of presumed trematode-induced granulomatous anterior uveitis among children in rural areas of Egypt.

PURPOSE: The purpose of this study is to evaluate the efficacy of systemic antiparasitic medications alone or in combination with surgical aspiration in management of presumed trematode-induced anterior uveitis in children. PATIENTS AND METHODS: Prospective case series. Children who presented with anterior chamber (AC) granuloma were included in the study. All patients received antiparasitic treatment and after 2 weeks; patients were divided based on their clinical improvement in terms of the baseline granuloma area into two groups: group A (<2.5 mm2) who continued on antiparasitic medications only (n = 15) and group B (≥2.5 mm2) who underwent surgical aspiration (n = 15). Basic demographics data, visual acuity (VA), corneal thickness, granuloma area and AC activity (cells and flare) were recorded and analysed. Systemic work-up including stool and urine analysis, full blood count, chest X-ray and schistosomiasis titre were performed. RESULTS: Thirty eyes of 30 patients were included in the study with a mean age of 13.4 ± 2.42 years. All patients were male. Patients were examined and followed at Mansoura Ophthalmic Center, Mansoura University. Both groups showed statistically significant improvement in VA, AC activity, corneal thickness and granuloma area (p-value < 0.001), which was achieved with medical treatment only in group A. However, in group B granuloma required aspiration and did not recur after that. CONCLUSION: Presumed trematode-induced AC granuloma is common among children living in the rural areas of Egypt. Antiparasitic medication alone was found to be effective for small-sized granulomas. Surgical aspiration is an effective adjuvant procedure to treat large-sized ones.

Functional and anatomical evaluation of the effect of nepafenac in prevention of macular edema after phacoemulsification in diabetic patients.

AIM: To evaluate the effect of prophylactic administration of nepafenac in prevention of macular edema occurring in diabetic patients after phacoemulsification and to investigate the correlation between optical coherence tomography (OCT) foveal thickness and multifocal electroretinogram (MF-ERG) parameters. METHODS: The study included two groups. Group 1 included 50 diabetic patients with senile cataract (50 eyes, 30 females, 20 males, aged 55±7y) received nepafenac 0.1% eye drop. Group 2 included another 50 diabetic patients with senile cataract (50 eyes, 22 female, 28 males, aged 53.8±8y) did not receive nepafenac. All patients were followed up for 3mo postoperatively. OCT and MF-ERG were done preoperative and at 1wk, 1, 2 and 3mo. RESULTS: The mean foveal thickness was statistically significantly lower in Group 1. Five eyes in Group 2 developed clinical cystoid macular oedema (CMO) (10%), and no patients in Group 1 developed central macular thickening more than 50 µm. There were insignificant differences in MF-ERG amplitudes and latencies between the two groups except in the five eyes that developed CMO, there statistically significant reduction of MF-ERG amplitude with increase in foveal thickness. CONCLUSION: Perioperative nepafenac reduces the incidence of CMO following uncomplicated phacoemulsification significantly. Nepafenac has no side effects.

Long-term results of Ahmed glaucoma valve implantation in Egyptian population.

AIM: To evaluate the long-term results and complications of Ahmed glaucoma valve (AGV) implantation in a cohort of Egyptian patients. METHODS: A retrospective study of 124 eyes of 99 patients with refractory glaucoma who underwent AGV implantation and had a minimum follow-up of 5y was performed. All patients underwent complete ophthalmic examination and intraocular pressure (IOP) measurement before surgery and at 1d, weekly for the 1st month, 3, 6mo, and 1y after surgery and yearly afterward for 5y. IOP was measured by Goldmann applanation tonometry and/or Tono-Pen. Complications and the number of anti-glaucoma medications needed were recorded. Success was defined as IOP less than 21 mm Hg with or without anti-glaucoma medication and without additional glaucoma surgery. RESULTS: Mean age was 23.1±19.9y. All eyes had at least one prior glaucoma surgery. IOP was reduced from a mean of 37.2±6.8 to 19.2±5.2 mm Hg after 5y follow-up with a reduced number of medications from 2.64±0.59 to 1.81±0.4. Complete and qualified success rates were 31.5% and 46.0% respectively at the end of follow-up. The most common complications were encapsulated cyst formation in 51 eyes (41.1%), complicated cataract in 9 eyes (7.25%), recessed tube in 8 eyes (6.45%), tube exposure in 6 eyes (4.8%) and corneal touch in 6 eyes (4.8%). Other complications included extruded AGV, endophthalmitis and persistent hypotony. Each of them was recorded in only 2 eyes (1.6%). CONCLUSION: Although refractory glaucoma is a difficult problem to manage, AGV is effective and relatively safe procedure in treating refractory glaucoma in Egyptian patients with long-term follow-up. Encapsulated cyst formation was the most common complication, which limits successful IOP control after AGV implantation. However, effective complications management can improve the rate of success.

Clinical Performance of a Spherical Hybrid Lens Design in High Regular Astigmatism.

OBJECTIVES: To evaluate safety, efficacy, and comfort of a spherical hybrid contact lens design in management of the regular astigmatic cornea. METHODS: This prospective study included 18 eyes from 18 subjects with regular corneal astigmatism greater than -3.00 diopters. All patients were fitted with optimal hybrid contact lenses. Demographic data and fitting parameters were recorded. Patient refraction, visual outcomes, contrast sensitivity, and glare levels were measured 2 weeks, 3 months, and 6 months after the start of lens use. Duration of lens use, comfort grades, causes of lens discontinuation, and any noticed complications were recorded. RESULTS: An average of 1.8 lenses (range 1-3) was required to achieve the optimal fit. Average logMAR visual acuity had improved significantly from 0.92±0.03 to 0.03±0.04 (P<0.001) at the last follow-up. Contrast sensitivity and glare tests were also significantly improved. Statistical analysis of the subjective responses indicated a strong acceptance of the lens by most of the patients. Mean wearing time of lenses was 10.1±3.2 hr/d. Causes of discontinuation were discomfort (2 patients), high lens price (2 patients), and handling problems (1 patient). Minimal complications were demonstrated in wearers of the lenses during follow-up visits. CONCLUSION: Spherical hybrid contact lenses provide a good option for patients with regular astigmatic corneas. They provide optimal visual function with high comfort and patient satisfaction, especially when surgery is undesirable or contraindicated.

Correlation Between En Face Optical Coherence Tomography Defects of the Inner Retinal Layers and Ganglion Cell Inner Plexiform Layer Analysis After Internal Limiting Membrane Peeling for Idiopathic Full-Thickness Macular Hole.

PURPOSE: The purpose of this study was to report en face optical coherence tomography (OCT) inner retinal changes after internal limiting membrane (ILM) peeling for idiopathic full-thickness macular hole (IFTMH) and to correlate these findings with macular ganglion cell inner plexiform layer (GC-IPL) analysis. METHODS: This prospective study included 20 patients with IFTMH treated using pars plana vitrectomy with ILM peeling. All patients were analyzed using en face OCT at 6 months after surgery to determinate the effect of ILM peeling on the inner retinal layers. Correlation between the GC-IPL en face OCT findings and that obtained by three-dimensional volumetric OCT scanning also was performed. RESULTS: Seven patients (35%) showed defects in the retinal nerve fiber layer (RNFL) that appeared as multiple dark dots with no visible defects at the GC-IPL, either with en face OCT or 3D volumetric OCT scanning. Thirteen patients (65%) showed a similar combination of RNFL defects and well-circumscribed defects in the underlying GC-IPL. These defects could be visualized on en face OCT display, and they correlated with areas of GC-IPL thinning detected in the 3D volumetric OCT scanning. CONCLUSIONS: With ILM peeling, en face OCT scanning showed two forms of inner retinal layers changes. The first form was the concentric macular dark spots (CMDS) with intact GC-IPL. The second form appeared in the CMDS with evident localized defects in the underlying GC-IPL. These defects correlate with the areas of GC-IPL thinning detected using 3D volumetric OCT scanning.

Evaluation of rigid gas permeable lens fitting in keratoconic patients with optical coherence tomography.

PURPOSE: To assess fitting of rigid gas permeable (RGP) lenses in patients with keratoconus, using spectral domain optical coherence tomography (SD-OCT). METHODS: The study was conducted on 30 eyes of 30 keratoconic patients fitted with RGP lenses, namely Rose K2 lens. Biomicroscopic examination with and without RGP lens was done. Fluorescein pattern was examined to determine the fitting, if ideal (three-point light touch), steep (central fluorescein pooling) or flat (central heavy bearing touch). Post-lens tear film thickness was measured centrally and at the lens edges using SD-OCT. Patient's comfort was assessed and graded. RESULTS: Mean central post-lens tear film thickness was 35.1 ± 7.3 µ in patients with ideal fitting. Mean post-lens tear film thickness of 50.4 ± 8.2 µ and 25.3 ± 6.1 µ was noted in patients with steep and flat fitting, respectively. Mean post-lens tear film thickness of 102.5 ± 12.1 µ, 85.4 ± 11.4 µ, 135.6 ± 13.3 µ was demonstrated in eyes with ideal, steep and flat edge lift, respectively. Tear film thickness under the edges was significantly (p=0.04) lower in patients unsatisfied with their contact lenses. CONCLUSION: SD-OCT can image and measure the tear film thickness in keratoconic patients with different fitting patterns of RGP lenses. OCT- guided fitting can be used to evaluate and modify the lens parameters to increase patient satisfaction. Lens intolerance may be related to edge lift rather than central fitting.