Efficacy and Safety of Sutureless Deep Sclerectomy in Juvenile and Adult Open Angle Glaucoma: 2-Year Outcomes.

PRCIS: Sutureless deep sclerectomy (SDS) achieved significant reduction in primary open angle glaucoma (POAG) and juvenile open angle glaucoma (JOAG). PURPOSE: To assess long-term results of SDS in cases with POAG and JOAG. PATIENTS AND METHODS: A prospective interventional study included 84 eyes of 54 patients underwent SDS with the superficial scleral flap left un-sutured. Changes in intraocular pressure (IOP) were recorded over 2 years. Success was defined according to the world glaucoma association criteria: Criterion A: IOP ≤18 mmHg and IOP reduction ≥30% from the preoperative status without medications [complete success (A1)], with and without medications [qualified success (A2)]. Criterion B: IOP ≤15 mmHg and IOP reduction ≥40% from the preoperative status without medications [complete success (B1)], with and without medications [qualified success (B2)]. RESULTS: There was statistically significant reduction in IOP compared with the preoperative IOP (mean IOP = 26.21± 10.46 mmHg) starting from 1 st postoperative day (mean IOP = 7.18 ± 1.8 mmHg) till the end of follow-up period at 2 years (mean IOP = 15.85± 4.46) ( P < 0.001). Also, number of medications dropped significantly from 3.27 ± 1.14 to 0.82 ± 0.97 at the end of follow up period. At 2 years complete success (A1) was achieved in 57.1% and qualified success (A2) was achieved in 91.6% of cases. Subgroup analysis into males and females, POAG and JOAG showed no statistically significant difference between subgroups regarding IOP reduction. CONCLUSION: SDS is an effective and safe modification to deep sclerectomy in cases with POAG and JOAG.

Corneal Hysteresis, Central Corneal Thickness, and Intraocular Pressure in Rheumatoid Arthritis, and Their Relation to Disease Activity.

PURPOSE: To evaluate biomechanical properties, corneal thickness, and intraocular pressure (IOP) in patients with rheumatoid arthritis (RA) and correlate them with rheumatoid activity. PATIENTS AND METHODS: Forty RA eyes were enrolled in a cross-sectional study. Clinical Disease Activity Index (CDAI) was used to assess the rheumatoid activity by a rheumatologist. Corneal hysteresis (CH), corneal resistance factor (CRF), and IOP corneal compensated, IOP Goldmann corrected were assessed using ocular response analyzer (ORA), Corneal thickness was measured using optical coherence tomography, and IOP using Goldman applanation tonometer (IOP GAT). RESULTS: There was a positive correlation between CH and CRF (P < 0.001 and r = 0.818) and (P < 0.001 and r = 0.714) in the active and inactive groups respectively, also between CRF and central corneal thickness (CCT) (P value 0.05 and r = 0.0435) in Inactive Group only. No correlation was found between CDAI score and ORA parameters. There was a negative correlation between CDAI and CCT in Active Group only (P < 0.001 and r = -0.823). CONCLUSION: Corneal biomechanical properties could be affected in rheumatoid patients in both active and remission phases, which may indicate that any corneal changes may be irreversible. These changes are of important significance regarding IOP measurement in rheumatoid patients. CCT may be a new parameter in the follow up of disease activity.

Peripapillary capillary density in acute angle closure crisis and angle closure suspect: A structure, flow and function correlation study.

PURPOSE: to describe peripapillary vascular changes using Optical Coherence Tomography Angiography (OCT-A) in patients with acute angle closure crisis (AACC) and primary-angle closure-suspects (PACS) in comparison to normal controls. METHODS: This cross-sectional/case-control/non-randomized study was conducted at Cairo University Hospitals. It included 21 eyes following AACC, 21 eyes of PACS and 32 eyes of age-matched-controls. Participants underwent visual field (VF) examination, retinal nerve fiber layer (RNFL) assessment using spectral-domain-OCT (SD-OCT), and radial peripapillary capillary density (RPC%) using OCT-A. RESULTS: There was a statistically significant difference in MD and PSD among the three groups (p ⩽ 0.001). There was a significant difference in mean RNFL among the three groups (p ⩽ 0.001), this decrease was still present when comparing the AACC group to controls p = 0.032. There was a significant decrease in the peripapillary RPC% in all groups p ⩽ 0.001. The correlation between structure, function and flow was studied for all groups. Peripapillary RPC% in AACC was positively correlated to MD and peripapillary RNFL (p ⩽ 0.001). In PACS, RPC% was positively correlated to RNFL (p = 0.012). In controls, RPC% was positively correlated to PSD and peripapillary RNFL (p ⩽ 0.001). AUC was 0.8 for the MD, 0.56 for the RPC and 0.38 for the RNFL. CONCLUSIONS: Peripapillary vessel density was lower in AACC eyes than in suspects and control eyes. OCT-A parameters could be a more sensitive marker than OCT parameters after an AACC attack as evident on ROC analysis. PACS remains a clinical diagnosis as we could not find any significant differences in OCT or OCT-A parameters between suspects and normal healthy controls.

Vascular Endothelial Growth Factor Gene Polymorphism is not Associated with Diabetic Retinopathy in Egyptian Patients.

PURPOSE: Vascular endothelial growth factor (VEGF) was implicated as a major contributor to the development of diabetic retinopathy (DR). This study investigated whether single nucleotide polymorphisms of A allele of rs699947 or G allele of rs10434 in the VEGF gene were associated with DR in Egyptian patients with type 2 diabetes mellitus (DM). METHODS: This is a case-controlled study which was performed at Cairo University Hospital in 2012 on Egyptian patients with type 2 DM with and without DR. Healthy adults without diabetes comprised the comparison group. Patients underwent an ophthalmological examination and fundus photography. Genotyping was performed for the A allele of rs699947 and the G allele of rs10434 polymorphisms using real-time polymerase chain reaction. RESULTS: A total of 128 patients were enrolled in this study and divided into three groups: Group A included 46 patients with type 2 DM and DR; Group B included 41 patients with type 2 DM without DR; and Group C included 41 healthy controls. There was no significant association between rs699947 or rs10434 and any of the three groups (P = 0.5, P = 0.7, respectively). Allelic frequency in the three groups was not statistically significant for rs699947 or rs10434 (P = 0.6, P = 0.6, respectively). CONCLUSION: Rs699947 or rs10434 polymorphism was not associated with the presence of DR in Egyptian patients. Further studies are required before genetic testing for polymorphism can be used clinically to correlate with DR.