Angiopoietin-2 as a Marker of Retinopathy in Children and Adolescents With Sickle Cell Disease: Relation to Subclinical Atherosclerosis.

OBJECTIVES: Angiopoietin-2 (Ang-2) is a multifaceted cytokine that functions in both angiogenesis and inflammation. A proangiogenic state has been found in adults with sickle cell disease (SCD), mainly because of elevated Ang-2 levels. We determined Ang-2 level in 40 children and adolescents with SCD compared with 40 healthy controls and assessed its relation to retinopathy as well as carotid intimamedia thickness (CIMT). METHODS: Hematologic profile, serum ferritin, and serum Ang-2 were measured. CIMT was assessed using high-resolution ultrasound. Fundus examination was performed followed by fundus fluorescein angiography. Optical coherence tomography angiography (OCTA) was used to find small vascular changes not clinically manifested. RESULTS: Ang-2 levels and CIMT were significantly higher in SCD patients compared with controls. The incidence of nonproliferative retinopathy was 45%. SCD patients with retinopathy were older in age with a history of sickling crisis of >3 attacks per year and had a higher incidence of sickle cell anemia than sickle ß-thalassemia. Ang-2 cutoff value 9000 pg/mL could significantly detect the presence of retinopathy among SCD patients with 100% sensitivity and specificity. Serum Ang-2 levels were positively correlated with HbS and CIMT. Logistic regression analysis revealed that Ang-2 and HbS significantly contribute to retinopathy among patients with SCD. CONCLUSIONS: Elevated Ang-2 highlights the role of angiogenesis in the pathophysiology of SCD and may be considered a promising marker for screening of patients at risk of sickle retinopathy and vascular dysfunction.

Cap-preserving SMILE Enhancement Surgery.

BACKGROUND: Different enhancement procedures have been suggested for reduction of residual refractive errors after SMILE. The aim of this study is to evaluate an improved cap-preserving technique for enhancement after SMILE (Re-SMILE). METHODS: A retrospective case series was conducted at Eye subspecialty center, Cairo, Egypt on 9 eyes with myopia or myopic astigmatism (spherical equivalent - 8.0 and - 12.0D). undergoing SMILE procedure and needed second interference. This was either because the more myopic meridian was more than - 10.0 D and therefore planned to have two-steps procedure (six eyes) or because of under correction needing enhancement (three eyes). Assessment after the primary SMILE procedure was conducted at 1 day, 1 week, 1 month and 3 months postoperatively. Assessment after Re-SMILE was conducted at 1 day, 1 week, 1 month, 3 months, 6 months and 1 year postoperatively. The assessments included full ophthalmic examination, objective and subjective refraction, and rotating Scheimpflug camera imaging. RESULTS: Preoperatively, the mean refractive spherical equivalent (MRSE) values were: - 9.36 ± 0. 89. After primary SMILE it was - 2.18 ± 0.71. After Re-SMILE it was - 0.13 ± 0.68. MRSE was significantly improved after both procedures (P < 0.01). The safety index of primary SMILE cases was 1.65 ± 0.62 and for Re-SMILE 1.13 ± 0.34 and the efficacy index was 1.14 ± 0.24 after primary SMILE and 1.11 ± 0.26 after Re-SMILE. CONCLUSION: Centered cap-preserving Re-SMILE is an effective procedure in reducing residual refractive errors after primary SMILE in high myopes.

New corneal assessment index from the relational thickness and other OCULUS values (CAIRO Index).

PURPOSE: The aim of this study was to find indices for keratoconus (KC) detection with higher sensitivity and specificity than the currently available ones with the rotating Scheimpflug imaging (Oculyzer I, Pentacam) software. PATIENTS AND METHODS: Data of 103 normal and 73 KC eyes imaged by Oculyzer I, including slit-lamp examination, refraction, Scheimpflug images, and follow-up data were collected. Logistic regression was done to find new indices with higher area under receiver operating characteristic curves using the currently available ones. RESULTS: The Corneal Assessment Index from Relational thickness and other OCULUS Values 9 (CAIRO 9) index, deduced from the Ambrosio relational thickness-maximum and the anterior elevation at thinnest point from 9 mm best-fit sphere, and the CAIRO 8, deduced from Ambrosio relational thickness-maximum and anterior elevation at thinnest point from 8 mm best-fit sphere, have a very high area under receiver operating characteristic curves for KC detection (0.997 and 0.995, respectively). CONCLUSION: New corneal assessment index is deduced with better sensitivity and specificity for KC detection.

Topographic Asymmetry Indices: Correlation between Inferior Minus Superior Value and Index of Height Decentration.

PURPOSE: To investigate the correlation between decentration index (index of height decentration, IHD) automatically calculated by the Pentacam HR software and the manually calculated inferior minus superior (I-S) value. SETTING: Al Watany Eye Hospital, Cairo, Egypt. METHODS: In a retrospective study, history taking, clinical examination, and rotating Scheimpflug camera scanning (by Oculyzer II equivalent to Pentacam HR) were done to 128 eyes: 82 normal, 24 forme fruste keratoconus FFKC (apparently normal cornea with evident keratoconus in the fellow eye), and 22 keratoconus (KC). All cases of corneal scars or previous corneal surgeries were excluded. The (I-S) value was calculated manually from 10 points astride the horizontal meridian. The IHD is calculated automatically by the device software 1.17r119. RESULTS: The mean (±SD) of (I-S) value in normal, FFKC, and KC eyes were 0.30 ± 0.93, 0.11 ± 2.03, and 4.62 ± 3.89, respectively, and those of IHD were 0.008 ± 0.004, 0.011 ± 0.005, 0.066 ± 0.067, respectively. The two indices were highly correlated (p < 0.0001) with a correlation coefficient (r 2 = 0.874). Deduced regression formulae linking the two indices were calculated. CONCLUSIONS: The two topographic decentration indices are highly correlated. Deduced formulae were proposed linking them.

Dellen formation as a complication of subconjunctival silicone oil following microincision vitrectomy.

PURPOSE: To study the subconjunctival silicone oil (SCSO) parameters associated with dellen formation following microincision vitrectomy (MIV). PATIENTS AND METHODS: This was a case-control study of 20 eyes with SCSO following MIV. Ten of them suffered postoperative dellen formation. Dellen occurrence, their sizes, number of loci, and distance between SCSO and the limbus were recorded. The outcome after silicone-oil removal was evaluated. RESULTS: The SCSO was at 3.1±1.2 mm from the limbus. All cases with dellen had SCSO within 2 mm of the limbus (P<0.001). No other factors were found to be associated with dellen formation (age, P=0.414; sex, P=0.656; laterality, P=1; indication for pars plana vitrectomy, P=0.655; instrument gauge, P=0.211; circumference involved by SCSO, P=0.252). All the dellen healed after surgical evacuation of SCSO (P<0.001), leaving scars. CONCLUSION: Dellen can be associated with MIV secondary to SCSO near the limbus. Resolution with scarring occurred following SCSO evacuation. Therefore, SCSO should be evacuated as early as possible to avoid long-term peripheral corneal morbidity.

Rotating Scheimpflug Imaging Indices in Different Grades of Keratoconus.

Purpose. To evaluate accuracy of various Keratoconus (KC) screening indices, in relation to Topographic Keratoconus (TKC) grading. Setting. Al Watany Eye Hospital, Cairo, Egypt. Methods. Data of 103 normal (group 1) and 73 KC eyes (group 2), imaged by Pentacam (branded as Allegro Oculyzer), were analysed. Group 2 was divided into 2a: 14 eyes (TKC = 1, early KC), 2b: 25 eyes (TKC = 1 to 2 or 2, moderate KC), and 2c: 34 eyes (TKC = 2 to 3 up to 4, severe KC). Participants were followed up for six years to confirm diagnosis. Area under the receiver operating characteristic curve (AUROC) was calculated for evaluated curvature, elevation, and pachymetry indices with various reference shapes at different diameters. Results. When comparing normal to KC eyes, ten indices had significantly higher AUROC. Only five of them had significantly higher AUROC in early KC compared to normal corneas: Pachymetry Progression Index- (PPI-) Maximum (Max), Ambrósio's Relational Thickness- (ART-) Max, PPI-Max minus PPI-Minimum (Min), central corneal thickness (CCT), and diagonal decentration of thinnest point from the apex (AUROC = 0.690, 0.690, 0.687, 0.683, and 0.674, resp.). Conclusion. Generally, ten pachymetry and elevation-based indices had significantly higher AUROC. Five indices had statistically significant high AUROC when comparing early KC to normal corneas.

Effect of a single-piece aspheric hydrophobic acrylic intraocular lens design on centration and rotation.

PURPOSE: To assess the rotation and centration stability of the new design features of a 1-piece aspheric hydrophobic acrylic intraocular lens (IOL). SETTING: National Eye Hospital, Cairo, Egypt. DESIGN: Randomized clinical trial. METHODS: Patients in this study had implantation of a 1-piece Tecnis 1 ZCB00 IOL or a 3-piece Sensar AR40e IOL. Decentration and rotation were recorded immediately postoperatively, and 2 to 3 days and 8 weeks postoperatively. This was done using 2 slitlamp eyepieces and referring to constant corneal landmarks (ie, the limbus and the phaco incision). RESULTS: Thirty-two 1-piece IOLs and 30 3-piece IOLs were implanted. Although the 1-piece IOLs moved toward the corneal center more than the 3-piece IOLs between 3 days and 8 weeks postoperatively (P=.054), the difference was not statistically significant between 0 day and 3 days or during the entire follow-up (P=.546 and P=.367, respectively). There were no statistically significant differences in the horizontal or vertical components of this movement between the 2 groups (P=.883 and P=.636, respectively). The mean rotation was 2.5 degrees ± 9.1 (SD) in the 1-piece IOL group and 0 ± 6.5 degrees in the 3-piece IOL group, with no statistically significant difference between the groups (P=.521). CONCLUSION: The new 1-piece design showed relatively good centration and stability in the horizontal, vertical, and rotational aspects.

Agreement and relationship between ultrasonic and partial coherence interferometry measurements of axial length and anterior chamber depth.

PURPOSE: To find the relationship between axial length (AL) and anterior chamber depth (ACD) measurements, using partial coherence interferometry (PCI) and A-scan ultrasonography (US). SETTING: National Eye Hospital, Cairo, Egypt. METHOD: Retrieving and comparing biometric data from the files of 163 consecutive patients seeking cataract extraction by PCI (IOLMaster) and US (Sonomed). RESULTS: AL measured using US range from 20.93 to 33.17 mm (mean ± SD = 24.45 ± 2.73 mm). AL measured by PCI range from 20.90 to 33.27 mm (24.05 ± 2.76 mm). The range of ACD measured by US was 2.09 to 4.48 mm (3.32 ± 0.46 mm). The range of ACD measured by PCI was 2.15 to 4.29 mm (3.31 ± 0.45 mm). There is very high agreement between both methods; the intraclass correlation coefficient = 0.999 for AL, and 0.966 for ACD measurements. A linear regression model of two formulae fits the AL values (one for eyes longer than 29 mm, and the other for the shorter eyes), with no significant departure from linearity (P > 0.1). One formula fits the ACD values with significant departure from linearity (P < 0.05). CONCLUSION: Both US and PCI methods for measurements of AL and ACD are highly correlated. Therefore, the value of AL measured by one method can be predicted, with high accuracy, from the other method.

Visual performance of the Tecnis one-piece lens ZCB00.

SYNOPSIS: The aspheric, one-piece design of the Tecnis® ZCB00 intraocular lens provided higher mesopic contrast sensitivity and relatively constant refraction at different pupil sizes compared to the Sensar® AR40e. PURPOSE: Comparing the impact on functional vision of the aspheric Tecnis® ZCB00 one-piece lens compared to the spherical Sensar® AR40e three-piece lens. SETTING: National Eye Hospital, Cairo, Egypt. METHODS: In this prospective study, we implanted 32 Tecnis ZCB00 (Abbott Medical Optics, Santa Ana, CA) and 30 Sensar AR40e (Pharamacia and Upjohn LLC, North Peapack, NJ) lenses. Twenty-three patients in the ZCB00 group and 13 patients in the AR40e group provided reliable, reproducible data, and were therefore included in the statistical analysis. After 8 weeks, we measured photopic contrast sensitivity (PCS) at 85 cd/m(2) and mesopic contrast sensitivity (MCS) at 5 cd/m(2). Uncorrected and best-corrected visual acuity were measured. Myopic shift was analyzed by comparing the manifest refraction spherical equivalent at 3 days and 8 weeks after surgery in the normal and dilated pupil. RESULTS: The Tecnis ZCB00 group showed significantly better MCS than the Sensar AR40e group at a spatial frequency of six cycles per degree (cpd) (P = 0.037), but not at 3, 12, or 18 cpd (P = 0.299, P = 0.226, and P = 0.396, respectively). There were no significant differences between groups in corrected distance visual acuity (P = 0.175) or PCS at 3, 6, 12, or 18 cpd spatial frequencies (P = 0.440, P = 0.176, P = 0.365, and P = 0.251, respectively). The ZCB00 group showed less myopic shift in normal and dilated pupils between 3 days and 8 weeks after surgery compared to the AR40e group, but this difference was not significant. CONCLUSION: The Tecnis one-piece ZCB00 provided higher MCS at moderate spatial frequency than the three-piece Sensar AR40e, and was associated with relatively constant refraction at different pupil sizes.