Fungal Keratitis in the Egyptian Delta: Epidemiology, Risk Factors, and Microbiological Diagnosis.

PURPOSE: The current study evaluates the epidemiological characteristics, risk factors, and microbiological diagnosis of fungal keratitis among patients living in the Egyptian Delta. METHODS: This is a prospective hospital-based study that included patients who were clinically diagnosed and confirmed by culture test to have fungal keratitis. Patients were examined at baseline and risk factors were identified and collected. Patients were followed over 6 months and the outcomes were documented. RESULTS: A total of 171 (67%) of 252 microbial keratitis patients was proved fungal by microbial culture test. Rural residence and agricultural activity were reported in 139 (81.3%) and 85 (49.7%) patients, respectively. Patients presented within 1 week from the start of symptoms were 120 (70.2%). A total of 54 (31.6%) patients reported ocular trauma. Forty patients (23.4%) had prior ocular surgery and 43 (25.1%) patients had a history of previous ocular disorders. Aspergillus species was the most common organism found in 120 (70.17%) patients, followed by Dematiceous fungi that were found in 25 (14.6%) patients. The main outcome was corneal opacity in 132 (77.2%) patients following medical treatment. CONCLUSION: Filamentary fungal predominance in Mansoura is influenced by the rural residence of its population. Therefore, more efforts in spreading awareness about microbial keratitis among villagers are important to reduce blindness caused by corneal opacity in rural areas.

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.

Posterior Surgical Revision of Failed Fornix-based Trabeculectomy.

PURPOSE: To evaluate outcomes after revision of failed fornix-based trabeculectomy using a posterior conjunctival incision and mitomycin C. METHODS: Cases were identified using Current Procedural Terminology codes. Information from clinical records was analyzed retrospectively. Complete success was defined as intraocular pressure (IOP) ≤16 mm Hg with no glaucoma medications and IOP reduction of >20% from preoperative levels. Qualified success was defined as IOP≤16 with or without medications and IOP reduction of >20%. Secondary outcomes included IOP, number of glaucoma medications used, visual acuity, and complications. RESULTS: Sixty eyes of 56 patients underwent surgical revision of failed trabeculectomy. The complete success rate at 1 year was 43.7%, declining to 41.7% at 2 years and all time points up to 5 years; qualified success rates were 68.9% at 1 year and at all subsequent time points. Mean IOP declined from 21.2±7.7 (SD) mm Hg preoperatively to 10.9±4.3 mm Hg at 1 year, to 10.5±3.8 mm Hg at 2 years, and to 9.9±4.6 mm Hg at 3 years. The mean number of glaucoma medications used fell from 2.5±0.5 preoperatively to 1.0±0.4 at 1 year, 0.9±0.4 at 2 years, and 0.9±0.4 at 3 years. Complications included bleb leak in 3 eyes (5.0%), hypotony with choroidal detachment in 3 eyes (5.0%) and hyphema in 1 eye (1.7%). Eight eyes required additional glaucoma surgery. CONCLUSIONS: Surgical bleb revision with mitomycin C using a posterior incision in cases of failed fornix-based trabeculectomy can provide effective control of IOP. This conjunctiva-sparing procedure should be considered as a viable alternative to a tube shunt or repeat trabeculectomy.

Facilitating Glaucoma Diagnosis With Intereye Retinal Nerve Fiber Layer Asymmetry Using Spectral-Domain Optical Coherence Tomography.

PURPOSE: To test whether increased intereye retinal nerve fiber layer (RNFL) asymmetry may be indicative of glaucoma. To determine the best statistical methods and intereye RNFL cutoffs for differentiating between normal and glaucoma subjects to better alert clinicians to early glaucomatous damage. METHODS: Sixty-six primary open-angle glaucoma (OAG) and 40 age-matched normal subjects had both eyes imaged at the Massachusetts Eye and Ear Infirmary with a commercially available spectral-domain optical coherence tomography (OCT) machine. Statistical methodologies were used to find cutoffs that achieved the best sensitivities and specificities for differentiating OAG from normal subjects. RESULTS: Intereye RNFL asymmetry for global average, all quadrants, and all sectors was significantly greater in OAG than normal subjects. Intereye RNFL asymmetry for global average showed the greatest statistical difference (P<0.001) between OAG (23.64 ± 14.90 µm) and normal eyes (3.58 ± 3.96 µm), with 6.60 times greater asymmetry in OAG eyes. The inferior quadrant showed the second greatest difference, with 3.91 times greater asymmetry in OAG eyes. Using a statistically determined cutoff of 6.0 µm as abnormal, intereye RNFL asymmetry for global average achieved a sensitivity of 74.24% and specificity of 90% in differentiating between normal and OAG subjects, achieving a better combination of sensitivity and specificity than intereye RNFL asymmetry of any quadrant or sector. CONCLUSIONS: Intereye RNFL asymmetry may be a useful clinical OCT measurement to provide quantitative assessment of early glaucomatous damage. Newly developed algorithms for intereye RNFL asymmetry may improve the ability to detect glaucoma.

Deletion of SPARC Enhances Retinal Vaso-Obliteration in Mouse Model of Oxygen-Induced Retinopathy.

BACKGROUND: Secreted Protein Acidic and Rich in Cysteine (SPARC) is a matricellular protein which is implicated in regulation of angiogenesis. PURPOSE: To characterize the changes in SPARC expression and effect of its deletion in a mouse model Oxygen Induced Retinopathy (OIR). MATERIALS AND METHODS: Wild type (wt) and SPARC-deficient mice were subjected to high oxygen (75%) for 5 days (p7-p12) before room air for additional 5 days (p12-p17). Retinas from both groups were flat mounted and retinal vessels were labeled with Isolectin-B4. Areas of Retinal Neovascularization (RNV) and vaso-obliteration were measured by Image-J and normalized to total retinal areas. SPARC expression was analyzed in both groups at p14 and p17 in retinal homogenates and sections by Western Blotting (WB) and immunofluorescence respectively. Human Retinal Endothelial Cells (HRECs) were exposed to hypoxia (1% O2) for 6 hours then SPARC was measured in cell lysate and condition medium by WB and ELISA. Moreover, HRECs were treated with VEGF or SPARC to study their mutual regulatory effect. RESULTS: SPARC-deficient mice demonstrated significant increase in the vaso-obliteration (p=0.03) and modest increase in RNV compared to the wt control. Retinal levels of SPARC was significantly decreased during OIR at p14 (p=0.01) and partially restored to normal level by p17. Moreover, hypoxia significantly reduced SPARC expression and secretion in HRECs (p=0.001). We noticed a mutual positive regulatory feedback between SPARC and VEGF. CONCLUSION: SPARC deletion enhances ischemic retinopathy, thus modulation of SPARC expression could be a novel therapeutic approach to prevent pathological RNV.