Efficacy of 5-fluorouracil (5-FU) and low molecular weight heparin (LMWH) in high-risk pediatric retinal detachment; randomized clinical trial.

BACKGROUND: Pediatric rhegmatogenous retinal detachments (PRRDs) are complex, rare occurrences and are often related to trauma or congenital abnormalities. Children often do not recognize or report symptoms of retinal detachment. Thus at presentation, PRRD is typically advanced often with macular involvement, proliferative vitreoretinopathy (PVR), chronic duration, and poor visual acuity. Because 5-FU and LMWH are effective in different aspects in the PVR process, it was believed that a syngergistic approach to the prevention of PVR would be advantageous. METHODS: After informed consent, children under 14 years of age with high-risk PRRD underwent pars plana vitrectomy and silicone oil injection with scleral buckle divided into 2 groups in prospective randomized trial. Group A received intraoperative infusion of 5-FU (200 µg/ml) and LMWH (5 IU/ml), group B received infusion of normal saline. Primary outcome was occurrence of recurrent PRRD within 12 weeks, secondary outcomes were occurrence of PVR, best corrected visual acuity (BCVA), number and timing of secondary procedures within 12 weeks. RESULTS: The study included 42 eyes of 41 patients, 21 in group A and 21 in group B, the duration of PRRD ranged from 0.5 to 7 months in group A and 0.25-5 months in group B.The rate of recurrent PRRD was higher in group B 33% compared to 19% in group A (p = 0.292). The mean timing of occurrence of recurrent PRRD was 9.5 ± 5 weeks in group A compared to 2.86 ± 2.41 weeks in group B (p = 0.042), more patients in group B ended up with more advanced PVR (p = 0.038), BCVA was hand movement (HM) only in all cases preoperatively and improved to HM-0.3 Snellen in group A compared to light perception (PL)-0.1Snellen in group B (p = 0.035), there was no difference in any of secondary procedures but with later timing in group A 9.71 ± 3.73 weeks than in group B 4.0 ± 2.83 weeks (p = 0.042). CONCLUSION: This study concluded that the use of the 5-FU and LMWH combination in high risk PRRD resulted in lower rate of postoperative PVR, later recurrence of PRRD and better final BCVA. TRIAL REGISTRATION NUMBER: Registry: clinicaltrials.gov PRS NCT06166914 date of initial release 4/12/2023. Unique Protocol ID: 9,163,209 date 21/10/2021. Retrospectively registered.

Corneal biomechanics in different age groups.

PURPOSE: To report on the corneal biomechanical characteristics, namely the corneal hysteresis (CH), corneal resistance factor (CRF), as well as the intraocular pressure (IOP) goldman compensated (IOPg), and the cornea compensated (IOPcc), using the ocular response analyzer (ORA) in different age groups in a cohort of normal individuals from the second decade to the seventh decade and beyond. PATIENTS AND METHODS: The study was a cross-sectional survey conducted on 997 eyes of 508 normal individuals presenting for a routine ophthalmic examination at Alexandria Main University Hospital in Alexandria University, Alexandria, Egypt. The study subjects were age stratified into decades (10-20, 21-30, 31-40, 41-50, > 50) and the ORA parameters (CH, CRF, IOPg, IOPcc) reported and stratified. Correlations were sought between the ORA parameters and the age, gender, and laterality. RESULTS: The study was conducted on 997 (502 right) eyes of 508 (234 males) normal individuals. The mean ± SD ages of the study groups were 14.7 ± 3.2, 25.9 ± 3.0, 35.3 ± 2.8, 44.6 ± 2.9, and 61.1 ± 7.7 years. The mean ± SD of the CH in the study groups were 10.9 ± 2.4, 9.8 ± 1.5, 9.8 ± 1.4, 9.7 ± 1.7, and 9.5 ± 1.6 mmHg and of the CRF were 10.9 ± 2.4, 9.5 ± 1.7, 9.4 ± 1.8, 9.6 ± 1.9, and 9.6 ± 1.8 mmHg. A statistically significant negative correlation was found between age and each of CH and CRF. IOPcc demonstrated a fairly constant trend in the different age groups whereas IOPg demonstrated an initial decline followed by a gradual rise over time. CONCLUSION: The corneal biomechanical properties CH and CRF decrease with age. IOPg and IOPcc change minimally with age.

Grading of macular perfusion in retinal vein occlusion using en-face swept-source optical coherence tomography angiography: a retrospective observational case series.

BACKGROUND: To evaluate the efficacy of swept -source optical coherence tomography angiography (SS-OCTA) in grading macular perfusion in retinal vein occlusion. METHODS: Retrospective observational case series including patients with different types of retinal vein occlusion (RVO). SS-OCTA utilizes OCTARA algorithm to examine the retinal vascular plexuses for the presence of morphological signs of ischemia according to a predetermined grading scheme. The findings were compared with fundus fluorescein angiography (FFA), and swept-source optical coherence tomography (SS-OCT) features. Bivariate correlation, coefficient of determination, and crosstabs procedures were used to calculate inter-variable linear correlation, relative contribution of the tested variables, and multivariate association, respectively. RESULTS: The study included 144 eyes of 138 patients. The most common type of RVO was branch retinal vein occlusion (BRVO) (53%). The superficial capillary plexus (SCP) and the deep capillary plexus (DCP) did not correlate with each other in all parameters tested. Increased central macular thickness (CMT) and disrupted retinal outer layers (DROL) were associated with increased severity of ischemia in DCP. Disorganized retinal inner layers (DRIL) correlated significantly with the presence of perifoveal capillary ischemia in the SCP and the DCP. Macular ischemia on FFA correlated with ischemia in the SCP layer only. Increased CMT, DROL and DRIL on SS-OCT, and SCP and DCP ischemia on SS-OCTA contributed significantly to diminished best-corrected visual acuity (BCVA). CONCLUSION: SS-OCTA is more precise in defining the extent and location of maximum ischemic insult following RVO compared to FFA, hence represents a more efficient grader for ischemic damage in the posterior pole. Increased CMT, DRIL, and DROL on SS-OCT, and SCP and DCP ischemia on SS-OCTA are significant predictors of poor visual outcome.

Expression levels of aldose reductase enzyme, vascular endothelial growth factor, and intercellular adhesion molecule-1 in the anterior lens capsule of diabetic cataract patients.

PURPOSE: To compare the levels of aldose reductase (ALR) enzyme, intercellular adhesion molecule-1 (ICAM-1), and vascular endothelial growth factor (VEGF) in the anterior lens capsule of diabetic versus nondiabetic patients. SETTING: Alexandria Main University Hospital, Alexandria, Egypt. DESIGN: Prospective case-control study. METHODS: The study enrolled patients undergoing cataract extraction and divided them into 3 groups: eyes that had proliferative diabetic retinopathy (PDR), eyes that had nonproliferative diabetic retinopathy (NPDR), and nondiabetic eyes. The anterior lens capsules were obtained by performing femtosecond laser-assisted capsulorhexis. Concentrations of ALR, ICAM-1, and VEGF in the lens capsule specimens were measured using human enzyme-linked immunosorbent assay. RESULTS: This study comprised 200 patients (200 eyes); 51 eyes had PDR, 49 eyes had NPDR, and 100 eyes were nondiabetic. The mean ALR, ICAM-1, and VEGF levels in the anterior capsule of diabetic group were 2.84 nanogram (ng)/mL ± 0.51 (SD), 87.73 ± 22.84 picogram (pg)/mL, and 75.53 ± 14.95 pg/mL, respectively; whereas, in the nondiabetic group, they were 1.44 ± 0.17 ng/mL, 35.45 ± 2.8 pg/mL, and 33.55 ± 5.47 pg/mL, respectively. In comparing the concentrations of these mediators, both the PDR and NPDR groups had significantly higher levels compared with the nondiabetic eyes (P < .001). In addition, eyes with PDR had significantly higher levels of these mediators than eyes with NPDR (P < .001). CONCLUSION: The concentrations of ALR, ICAM-1, and VEGF in the anterior lens capsule of diabetic patients are significantly higher than those of nondiabetics. A significantly higher level of 3 mediators in eyes with PDR compared with those with NPDR might allow the use of them as a biomarker for severity of diabetic retinopathy.

Decompression retinopathy after glaucoma surgery in children.

Of 170 children who underwent 248 glaucoma procedures at a single center between 2005 and 2012, 13 eyes of 12 children (5.24%) developed decompression retinopathy, which resolved spontaneously, leaving no visible structural damage to the fundus structures. The mean age of children with hemorrhages was 39.2 ± 63.5 months; of those without, 8.0 ± 9.7 months. The fundus hemorrhages were peripapillary, subfoveal, dot-and-blot, and diffuse. Combined angle and filtering surgery with antimetabolite was the most common procedure performed in all eyes. There were no statistically significant differences between eyes with and without hemorrhages with respect to demographics or preoperative and operative characteristics. No definite ocular risk factor was identified for the occurrence of decompression retinopathy.

Ocular response analyzer and goldmann applanation tonometry: a comparative study of findings.

PURPOSE: Correlation of findings of the Reichert Ocular Response Analyzer (ORA) with Goldmann applanation tonometry (GAT). DESIGN: Observational, cross-sectional study. METHODS: The study was conducted on 103 eyes of 56 patients, aged 41 to 78 years; average (±SD) 58.9 (±9.8) years attending the outpatient clinic of the Department of Ophthalmology, Alexandria University, for a routine refraction. Full ophthalmic examination including slit lamp biomicroscopy and GAT, then Reichert ORA utilization to obtain the intraocular pressure cornea corrected (IOPcc), the IOP Goldmann (IOPg), the corneal resistance factor (CRF), the corneal hysteresis (CH), and the central corneal thickness (CCT). Exclusion criteria included previous ophthalmic surgery and any corneal pathology. RESULTS: The mean (±SD) IOP GAT was 14.1 mm Hg (±3.0) (range: 8 to 22 mm Hg). The mean (±SD) IOPg, IOPcc, CRF, CH, and CCT was 15.5 (±4.0), 16.9 (±3.7), 9.6 (±2.0), 9.4 mm Hg (±1.7) and 540.8 (±32.6) µm, respectively. There was a significant correlation (P<0.0001) between IOP GAT and each of IOPg, IOPcc, and CRF; between IOPg and each of IOPcc, CRF, and CCT; between IOPcc and each of CRF and CH; and between CCT and each of CRF and CH at 0.01 level. The average (±SD) difference between IOP GAT and IOPg and IOPcc was -1.33 (±2.38) mm Hg and -2.81 (±2.66) mm Hg, respectively, and was statistically significant (paired t test in a 95% confidence interval). CONCLUSIONS: The ORA is valuable for the evaluation of IOP and corneal biomechanics. However its results are not to be used interchangeably with the GAT findings.

Intraoperative sclerotomy-related retinal breaks for macular surgery, 20- vs 25-gauge vitrectomy systems.

PURPOSE: To compare the rate of intraoperative sclerotomy-related retinal breaks (SRRB) between 20- and 25-gauge vitrectomy systems for the correction of macular pucker (MP) and macular hole (MH). DESIGN: Retrospective interventional case series. METHODS: Single institution review of 347 consecutive eyes of 333 patients between August 2003 and May 2005 receiving pars plana vitrectomy (PPV) for MP or MH repair. Eyes were excluded if they had any form of proliferative retinopathy, or if there was an intraoperative conversion of any sclerotomy from 25- to 20- gauge. RESULTS: Fourteen (6.4%) of 219 eyes in the 20-gauge group had SRRB vs 4 (3.1%) of 128 eyes in the 25-gauge group (Fisher exact test, P value = .22). CONCLUSIONS: There was a trend for slightly lower rates of intraoperative sclerotomy-related retinal breaks, single or multiple, with 25-gauge PPV compared with 20-gauge PPV, but the differences were not statistically significant.