Tear film assessment before and after phacoemulsification in patients with age-related cataracts.

BACKGROUND: The study aims to assess the tear film before and after phacoemulsification in patients with age-related cataracts. METHODS: A prospective observational study of 41 age-related cataract patients undergoing phacoemulsification procedure. Tear Film Break-Up Time (TBUT), Tear Film Meniscus Height (TMH), Meibomian glands (MG), and Lipid Layer Thickness (LLT) were assessed by a non-invasive Dry Eye Diagnostic System. All measurements were taken preoperatively, one week, one month, and three months postoperatively. The Marginal homogeneity and The Cochran Q tests were used in the statistical analysis. RESULTS: The value of Non-Invasive Break-Up Time (NITBUT) was statistically significantly lower at one week (7.15 ± 3.31), one month (7.61 ± 3.41), and three months (7.66 ± 3.36) postoperatively than preoperatively (10.71 ± 2.71), p < 0.001. The Non- Invasive Tear Meniscus Height (NITMH) was significantly lower at one week (0.18 ± 0.0), one month (0.20 ± 0.09), and three months (0.20 ± 0.09) postoperatively than preoperatively (0.30 ± 0.113) p < 0.001. By the first month, both (NITBUT) and (NITMH) improved significantly compared to the first post-operative week. There was no statistically significant difference between one month and three months. The (NITMH) improved to a healthy level of ≥ 0.2 mm by the first month through the third month. Both (NITBUT) and (NITMH) did not reach the baseline by the third month. The meibomian glands and the lipid layer thickness had the same preoperative grade distribution without changes. CONCLUSION: Phacoemulsification surgery can cause post-operative deterioration in the tear film, which starts within a week of the procedure, followed by gradual recovery over the next weeks and months. The phacoemulsification procedure mainly affects the tear break-up time and tear meniscus height. Both the lipid layer and meibomian glands are not affected.

Diagnostic accuracy of different keratoconus detection indices of pentacam in paediatric eyes.

OBJECTIVE: No diagnostic gold standard for keratoconus in children and adolescents exists. Our objective was investigating the diagnostic accuracy of various indices for keratoconus (KC) detection in paediatric eyes. METHODS: All retrievable data of significance from 432 normal right paediatric eyes and 48 eyes of paediatric KC and forme fruste KC (FFKC), imaged by use of a rotating Scheimpflug camera (Oculyzer II, Pentacam HR) between December 2013 and October 2018 at Watany Eye Hospitals, Cairo, Egypt, including Scheimpflug images data, were collected. The area under the receiver operating characteristic curve (AUROC) was calculated for different indices in this retrospective descriptive study. RESULTS: All 36 tested indices showed discriminative power differentiating KC and FFKC from normal corneas (AUROC P-value <0.05), except AC volume, AC angle, and horizontal decentrations of the steepest and thinnest points. The 32 indices showed variable degrees of diagnostic accuracy. The highest AUROC was that of the corneal assessment index from the relational thickness and other OCULUS values (CAIRO 8). Only 8 indices showed non-inferiority to it, namely, Ambrosio's relational thickness maximum (ART max) and avg, the pachymetric progression index maximum (PPI max) and avg, the back elevation from the best-fit toric ellipsoid (BE BFTE), the KC index (KI), the topographic KC indices (TKC), and the index of height decentration (IHD) (P > 0.05). CONCLUSIONS: The 8 most useful rotating Scheimpflug imaging indices for KC detection in paediatric eyes are CAIRO 8 followed by ART max and avg, PPI max and avg, BE BFTE, KI, TKC, and IHD.

Exfoliation Syndrome in Egypt: Prevalence and Association with Cataract in a Large Cohort.

INTRODUCTION: Exfoliation syndrome is an age-related disease leading to ocular and systemic complications. We aimed to evaluate the prevalence of exfoliation syndrome (XFS) in Egypt and its association with cataract as one of its comorbidities. METHODS: In a retrospective, hospital-based study, 155,032 Egyptians aged over 40 years from all 27 Egyptian governorates were evaluated for the prevalence of XFS and cataract in the period between January 2015 and June 2020. RESULTS: A total of 2448 (1.6%) of the studied subjects had XFS. Their mean age was 71.2 ± 9.62 years which was significantly higher than those of subjects with no XFS. Men comprised 1348 (55.1%) of those diagnosed with XFS and this association was statistically significant (OR 1.57, 95% CI 1.45-1.70). Considering the ratio between subjects in our cohort from each region and its real population, the overall corrected prevalence in Egypt was 4.49% (Territorial regions 6.89%, Upper Egypt 5.51%, Lower Egypt 4.38%, and Greater Cairo 3.29%). Among all subjects with XFS, cataract was found in 2150 subjects (87.8%) and XFS represented 6.4% of all subjects diagnosed with cataract in our cohort (n = 33,610). Among subjects with no cataract (n = 121,422), 298 subjects had XFS (OR 0.04, 95% CI 0.03-0.04). CONCLUSION: Egypt has a moderate XFS prevalence compared to other countries. There is a strong association between XFS and cataract, and XFS was more common in elderly males. The results can be explained by differences in diet, ethnicity, climate, and maybe other factors.

Exfoliation syndrome (XFS) is an age-related disease characterized by the deposition of distinctive material in many eye and systemic tissues, with resultant eye (lens opacities, chronic rise in eye pressure, and more frequent surgical complications during lens surgeries) and systemic health implications (hearing loss and cardiovascular diseases). It is a universal disease that occurs in virtually all countries and whose percentage among individuals varies from one country to another, hence the importance of studies determining its percentage. We conducted our study on a large group of individuals encompassing more than 155,000 individuals aged over 40 years in the period between January 2015 and June 2020, to determine how frequent it is in Egypt and its different regions, and determine its common associations. Overall, it had moderate frequency, most commonly found among older subjects, men, those residing in territorial areas of Egypt as well as those having cataracts and lens opacities. Given Egypt's unique geographical location being a transcontinental country (Afro-Asian), and belonging to Middle Eastern as well as Mediterranean countries, our results can be extrapolated to other neighboring countries and are not exclusive to Egypt. Studying this prevalence will give insights into risk factors for the disease that could possibly be modified, as well as determining the population at risk to help stakeholders to design effective screening programs.