Background Accelerated photoactivated chromophore for keratitis–corneal collagen cross-linking (PACK-CXL) was investigated to be effective in the treatment of fungal keratitis in many studies. High-fluence CXL was used effectively in the treatment of progressive keratoconus but not tested in PACK-CXL for fungal infection. Aim To evaluate the antifungal efficacy of high-fluence CXL in the treatment of induced fusarium corneal ulcer in rabbits. Design This is an experimental interventional study. Patients and methods This is an experimental interventional study conducted on 16 eyes of eight rabbits for which fusarium corneal infection was induced by intrastromal corneal injection. The rabbits were divided into two groups: group A received no treatment and was left as a control group. Group B received a single high-fluence PACK-CXL session. All rabbits were followed up for 6 days and then the eyes were enucleated. Culture was performed for seven corneas and histopathology for the remaining cornea. Results There was statistically significant deterioration in group A (P=0.003), while a statistically significant clinical improvement was seen in group B (P<0.001). The median colony-forming units was more in group A (4×10⁴) than in group B (2×10²). Histopathological examination also revealed less inflammatory signs in high-fluence PACK-CXL-treated group. Conclusions High-fluence PACK-CXL total ultraviolet A fluence of 7.2 J/cm² is effective in the treatment of mycotic keratitis.

Background Intracorneal ring segment (ICRS) implantation in combination with corneal collagen cross-linking (CXL) has shown promising results in improving the visual acuity and reducing refractive errors, but long-term results are lacking. Aim To evaluate the long-term outcomes (>5 years) of simultaneous CXL and femtosecond laser-assisted intracorneal stromal ring segment implantation for management of keratoconus. Design This was a noncomparative, noncontrolled retrospective single-center study. Patients and methods The study included 50 eyes of 37 patients with keratoconus who underwent simultaneous CXL and ICRS implantation and were followed up for at least 5 years regarding visual acuity, refraction, and corneal imaging. Results Best-corrected visual acuity showed statistically significant improvement, with mean changed from 1.07±0.41 to 0.40±0.30 LogMAR. The results showed significant improvement also after 5 years. The spherical equivalent also was significantly improved from a mean of −4.61±4.37 D to a mean of −1.41±−1.49 D. Keratometric readings also showed improvement of both K1 and K2. The mean K1 improved from a mean of 49.6±6.76–47.78±6.17 D, and the mean K2 improved from 55.04±7.34 to 52.67±7.38. The results were stable, with no statistically significant change after 5 years. Conclusions Simultaneous CXL and femtosecond laser-assisted ICRS is effective and stable for both visual outcome and refraction in patients with keratoconus.

Purpose To determine the role of the intraoperative triamcinolone acetonide application after pterygium excision using bare-sclera technique and mitomycin C (MMC). Patients and methods This prospective randomized clinical study included 80 patients (80 eyes) who had primary pterygium and was done at the Alpha Center of Ophthalmology. In total, 40 eyes were treated by excision with bare-sclera technique with MMC combined with intraoperative subconjunctival triamcinolone-acetonide injection (group I) (steroid group), and the other 40 eyes were treated by excision with bare-sclera technique with MMC alone (group II) (control group). All patients were subjected to complete ophthalmic evaluation preoperatively and were followed up for 6 months postoperatively. The postoperative conjunctival inflammation rate at 1 week was the primary outcome measure, while the rate of pterygium recurrence 6 months postoperatively and intraocular pressure (IOP) was the secondary outcome measure. No complications developed intraoperatively or postoperatively. Results The postoperative conjunctival inflammation was significantly higher in group II (45%) than group I (12.5%) (P=0.001). The recurrence rate of pterygium 6 months postoperative in group I was 7.5%, while in group II was 17.5%, which was statistically insignificant (P=0.176). The mean IOP 6 months postoperative in group I was 14.2±1.9, and in group II was 13.6±1.7, which was statistically insignificant (P=0.172). Pyogenic granuloma developed in one (2.5%) eye in group I and two (5%) eyes in group II. Conclusion After pterygium excision using the technique of bare sclera and MMC, the intraoperative subconjunctival injection of triamcinolone acetonide at the surgical site was found to be beneficial in reducing the incidence of postoperative conjunctival inflammation without elevation of the IOP and decreasing the recurrence rate of the pterygium.

Purpose To evaluate the outcomes of early pars-plana vitrectomy (PPV) in the management of acute onset endophthalmitis after cataract surgery. Study design Retrospective observational study. Patients and methods We collected data from 11 patients who were diagnosed as acute infectious endophthalmitis within 6 weeks after cataract surgery, from January 2015 to December 2020 and had undergone early 23-G PPV and were followed up for 3 months. We analyzed factors that may affect prognosis and final visual outcomes. Results The mean age was 58±5 years, there was male predominance (72.7%). The mean axial length was 24.76±1.58 mm. The baseline best-corrected visual acuity was 2.3 logMAR and was improved to 1.2 logMAR at the third month (P<0.001). Mixed air/fluid intraocular tamponade was used in 63.6% of patients. About half of the cases had positive cultures (54.5%), and the most frequent organism was Staphylococcus aureus (66.7%). Retinal detachment was reported in 36.4% of patients. The preoperative factors correlated with final best-corrected visual acuity were posterior vitreous detachment and intraocular tamponade. Conclusions Early PPV for acute-onset endophthalmitis after cataract surgery aided in improving final visual outcome and preserving structural and functional integrity of the globe, thus preventing late complications that could affect patients’ quality of life. Factors that influence the final visual outcome were intraocular tamponade and posterior vitreous detachment.

Aim The aim of this study was to compare two surgical techniques of inferior oblique muscle weakening in the management of inferior oblique overaction whether primary or secondary, that is, inferior oblique myectomy and graded inferior oblique muscle recession. Patients and methods This is a randomized prospective study, performed in Alexandria, Egypt, that included cases of inferior oblique muscle overaction, whether primary or secondary, starting on May 2020. It included 40 patients, divided into two groups: group I included 20 patients who were managed by inferior oblique myectomy, and group II included 20 patients who were managed by graded inferior oblique muscle recession, according to the clinical grading of overaction. Results The results of the two groups were compared, and it was found that the results were comparable as the final outcomes of correction of hypertropia were satisfactory in both groups. Conclusion As the results in both techniques have no significant difference, it is recommended that each surgeon should perform his/her preferred technique.

Purpose To study the morphological changes in the foveal avascular zone (FAZ) in children diagnosed with sickle cell disease (SCD) via the optical coherence tomography angiography (OCTA). Patients and methods This was a prospective case–control study that was done in a tertiary hospital. A total of 15 children with SCD (confirmed with electrophoresis) and 15 matched healthy children were included. Ophthalmological assessment was done. RTVue XR Avanti was employed to obtain 6×6 macular OCTA scans. Foveal parameters including FAZ area (mm²), perimeter (mm) (PERIM), acircularity index (AI), and foveal density were analyzed. Pediatric assessment including the disease variant, sickling crisis, and current treatment was done. Results A total of 15 eyes of 15 children with SCD and 15 eyes of healthy children were included. Six eyes showed stage 1 retinopathy. Children with SCD had wider FAZ area (P=0.001) with larger PERIM (P=0.00) and higher AI (P=0.030) in comparison with the control children. No significant changes in the FAZ parameters between patients with SCD with stage 1 retinopathy and patients without retinopathy were found. Conclusion Children with SCD have a wide FAZ area with large PERIM and high AI in comparison with normal controls. OCTA macular changes might be an early predictor of sickle cell retinopathy. Further follow-up studies are recommended to understand the effect of early macular changes on the future development of retinopathy.

Clinical relevance Early detection of keratoconus (KC) progression and timing for retreatment. Background Q value (coefficient of corneal asphericity) reflects the shape of the cornea, its refractive power, and spherical aberration. In this study, we aimed to analyze the correlation between changes in Q value and progression of KC in children. Patients and methods In this retrospective cross-sectional study, clinical data of 18 eyes of nine children that were diagnosed as bilateral progressive KC (four boys, five girls: mean age of 11.3±1.6 years) were extracted from a Scheimpflug camera (Pentacam) for analysis before (baseline) and annually after bilateral transepithelial corneal collagen cross-linking (TE-CXL) up to 5 years of follow-up. Results At all follow-up visits up to 5 years, Kmax improved significantly (mean change at 5 years was 1.6 D) (P<0.001); uncorrected visual acuity and best-corrected visual acuity showed significant changes at all follow-up visits (P<0.001). In seven (38.8%) eyes, KC had progressed by more than 1.0 D by the last follow-up visit, despite corneal cross-linking. In the last visit, there was a significant negative correlation between mean Q value and Kmax in both 6 and 8 mm anterior corneal zones (Pearson correlation coefficient, r=−0.847, P<0.001, r=−0.605, P<0.001, respectively). Conclusion There is significant negative correlations between changes in corneal asphericity and progression of KC in children, which could be considered with other parameters in early detection of disease progression and timing for retreatment after transepithelial corneal collagen cross-linking.