A novel surgical correction technique of involutional entropion by combined triangular tarsectomy, orbicularis muscle tightening and inferior retractor plication.

PURPOSE: Describing a novel collective technique for treatment of involutional entropion of the lower eyelids in patients aged 55 years old or more. METHODS: A prospective comparative study included 56 patients (69 eyelids), recruited from the outpatient clinic of Tanta University Eye Hospital, presented with involutional lower eyelid entropion either primary or secondary. They were divided into: 1- Group A 42 eyelids with excessive horizontal lid laxity (pinch test > 8.0 mm), who underwent Combined tarsectomy of a triangle with base down and horizontal tightening of orbicularis muscle. 2- Group B: 27 eyelids with excessive horizontal lid laxity (pinch test < 8.0 mm) who underwent vertical tightening of orbicularis muscle. Follow up of the patients up to 12 month and satisfaction recording were done. RESULTS: The mean age of Group A was 60.08 ± 8.38 and of Group B was 55.10 ± 7.40. An overall high success rate (91.07%) and a low recurrence rate (8.92%) with a high post-operative satisfaction, both functionally and cosmetically (96.42%), were reported. CONCLUSION: Combined procedures with addressing the horizontal tightening was associated with a higher success rate and a lower recurrence rate.

A Proposed Diagnostic Algorithm for Fungal Orbital Infections after 20 Years of Experience in a Tertiary Eye Care Center- Egypt.

METHOD: Medical Records of cases with orbital fungal infection from January 2000 to December 2019 were reviewed. RESULTS: The study included 45 patients. Mucormycosis was proven in 32 (71.1%) and aspergillosis in 13 (28.9%) patients. Thirty-five (77.8%) patients had predisposing factors mainly uncontrolled diabetes. Twenty-seven (60%) patients presented with orbital apex syndrome, 10 (22.2%) with orbital cellulitis and 8 (17.7%) with proptosis. The prognosis was generally poor (31.1% mortality, 8.88% exenteration and 11.1% self-evisceration). The proposed algorithm composed of six atypical clinical presentations mainly acute orbital apex and fulminating orbital cellulitis plus any radiological or microbiological findings. CONCLUSION: The proposed algorithm markedly reduced the complications after 5 years of the study. Once fungal orbital infection is suspected, treatment should start immediately.

Unilateral surgery for pediatric sensory exotropia: clinical characteristics and surgical results.

BACKGROUND: To delineate the clinical characteristics and surgical outcomes of large angle sensory exotropia in pediatric patients. METHODS: The medical records of 54 large angle exotropia ≥40 PD patients aged from 1 to 18 years who were operated on between 2018 and 2021 and were followed up for 1 year were reviewed and contacted. Clinical characteristics and surgical outcomes were analyzed retrospectively. Patients were divided into two groups, group S patients had supermaximum recession resection and group E had augmented recession by lateral rectus muscle elongation with an autograft from the resected medial rectus muscle in the same eye. The clinical characteristics and results of both groups were compared. RESULTS: The mean age of the studied patients with sensory exodeviation at the time of surgery was 8.3 ± 4.2 years. Mean of the duration of exotropia was 6.9 ± 2.2 years, and the mean of postoperative follow-up was 14.3 ± 4.2 months. Surgical success was achieved in 73.07% of group S and 82.14% of group E. Recurrence was more common with anterior segment pathology. Larger post-operative distant angles were strongly related to poorer visual acuities P = 0.001 and not related to the age of onset or the duration. Narrowing of the palpebral fissure improved in both groups at the last follow up P = 0.336. The limitation of abduction in both groups improved in the last follow up P = 0.145. CONCLUSION: The outcome of monocular surgery for sensory exotropia in children is satisfactory with no significant differences in results between lateral rectus muscle tendon autograft elongation technique and supermaximum recession resection. Recurrence is more common with anterior segment pathology. Larger post-operative distant angle of deviation is strongly related to poorer visual acuity. CLINICAL TRIAL REGISTRATION: This study was retrospectively registered at clinicaltrials.gov (ID: NCT04286945) on 25-2-2020.

Exenterate or Not: A Simple Proposed Management Algorithm for Mucormycosis During the Era of COVID-19 in a Tertiary Eye Care Center in Egypt.

Purpose: To construct a simple management algorithm for cases with orbital mucormycosis during the COVID-19 era. Methods: Retrospective study included records of 30 Egyptian patients with post COVID-19 orbital mucormycosis. They underwent full clinical examination, laboratory investigations, Computed tomography (CT)/magnetic resonance imaging (MRI) of the paranasal sinuses and pathological specimen examination. The proposed algorithm was based on all the available data of the included patients. Results: The mean age of the studied patients was 62.47±11.13 years; 56.6% were females and 63.3% had uncontrolled diabetes mellitus. The main presentation was Orbital apex syndrome (OAS) in 43.3% of the cases. Twenty-six patients (86.6%) received systemic liposomal amphotericin B, while 4 patients (13.3%) received posaconazole. Orbital exenteration was done in 6 patients (20.0%), 4 of them died (66.7%). Twenty-four patients (80%) survived with clinical but not with visual improvement. Conclusion: Systemic antifungal treatment and functional endoscopic sinus surgery (FESS) with extensive debridement of involved necrotic tissues were the main steps to control ROCM. Orbital exenteration should be kept for cases with periorbital tissue affection as it did not increase the final cure rate. The proposed management algorithm is supposed to be simple and easy to follow.

Concurrent and Post COVID-19 Ophthalmological Implications.

BACKGROUND AND AIM: COVID-19 infection is a respiratory disease but it can have ophthalmological manifestations as well. This study aimed to investigate the ophthalmological implications of COVID-19 either during the course of the disease or after recovery. METHODS: A retrospective study included the records of 425 COVID-19 patients, proved by positive PCR swabs. The records were collected from three isolation hospitals in Gharbeya Governorate, Egypt. RESULTS: The mean age of the studied group was 41.73 ± 13.59, and 216 (50.8%) of them were males. One hundred and thirty one (30.8%) patients had ophthalmological manifestations. Among the entire patients, the most common ophthalmological presentation was conjunctivitis in 111 patients (26.1%), followed by neuro-retinal affection in 9 (2.1%), secondary fungal orbital cellulitis in 6 (1.4%), episcleritis in 3 (0.7%) and keratitis in 2 (0.5%) patients. All of the observed ophthalmological implications occurred either during the course of the disease (concurrent) or after recovery, except for the fungal orbital cellulitis which occurred only after recovery. CONCLUSION: COVID-19 could cause different eye manifestations. Recovery from the main disease does not guarantee eye safety, especially in high-risk patients.

Pattern electroretinogram changes in patients with primary open-angle glaucoma in correlation with visual field and optical coherence tomography changes.

PURPOSE: To study the pattern electroretinogram changes in primary open-angle glaucoma patients in correlation with visual field changes and optical coherence tomography measurements of retinal nerve fiber layer thickness in the peripapillary region in an attempt to evaluate the clinical value of pattern electroretinogram as an objective test of functional deficit in glaucoma. PATIENTS AND METHODS: The study included 81 eyes of 81 participants: 50 primary open-angle glaucoma patients, 16 primary open-angle glaucoma suspects, and 15 controls. All subjects underwent visual field testing using 24-2 Humphrey standard automated perimetry, peripapillary retinal nerve fiber layer average thickness using the 3.4-mm circular scan of the Heidelberg OCT spectralis and pattern electroretinogram using CSO RetiMax device in accordance with the International Society for Clinical Electrophysiology of Vision guidelines. RESULTS: We had three main groups: normal, glaucoma suspect, and primary open-angle glaucoma patients, and the last group included three subgroups: mild, moderate, and severe. There was significant difference in the visual field mean deviation, peripapillary retinal nerve fiber layer average thickness, and most pattern electroretinogram measured parameters between the three main groups and in between primary open-angle glaucoma subgroups. There was significant positive correlation between visual field mean deviation and the peripapillary retinal nerve fiber layer average thickness, P50 amplitude, and P50-N95 amplitude (p < 0.001, p = 0.018, and p < 0.001, respectively). Significant negative correlation was also found between peripapillary retinal nerve fiber layer average thickness and N95 amplitude (p < 0.001). Significant positive correlation was found between retinal nerve fiber layer average thickness and P50-N95 amplitude (p = 0.001). Significant negative correlation was found between peripapillary retinal nerve fiber layer average thickness and N95 amplitude (p = 0.001) and significant positive correlation of retinal nerve fiber layer average thickness with P50-N95 amplitude (p = 0.017) in primary open-angle glaucoma patients. CONCLUSION: Peripapillary retinal nerve fiber layer average thickness shows significant negative correlation with pattern electroretinogram N95 amplitude and a significant positive correlation with P50-N95 amplitude. In combination with optical coherence tomography, pattern electroretinogram can be used to objectively assess functional loss in glaucoma.

Prevalence and topographical characteristics of keratoconus in patients with refractive errors in the Egyptian delta.

PURPOSE: To study the prevalence of keratoconus (KC) and the topographical characteristics of the affected corneas in patients with refractive errors who were seeking refractive surgery in the Egyptian delta. METHODS: A retrospective study covering four and half years (Jan 2012-June 2016) where the topographical data of 8124 participants were obtained from the records of a refractive center in the Nile delta region, Egypt. The diagnosis of KC was based on the Holladay criteria in one or both eyes, using the Pentacam scans, whereas grading of KC was based on the Amsler-Krumeich classification. RESULTS: The prevalence of KC was 1.12% (91/8124 participants) with 95% confidence interval 0.91-1.3. Of all the affected cases, 5 cases (5.5%) had unilateral, and the other 86 cases (94.5%) had bilateral KC. The affected and unaffected subjects did not show any significant difference regarding gender. Sixty-eight (38.4%) eyes had stage 1 KC, 53 eyes (29.9%) had stage 2, 27 eyes (15.3%) had stage 3, and 29 eyes (16.4%) had stage 4 KC. It was most prevalent (1.2%) among cases with astigmatism (P < 0.001). CONCLUSION: Keratoconus was found in 1.12% of patients seeking refractive surgery, with no gender preference. Most cases had bilateral affection. Astigmatism was the most common refractive error to be associated with keratoconus.