Background Phacoemulsification acoenergy and shortening the phacotime can decrease this risk. Aim The aim of this work is to compare the safety and the efficiency of phacoemulsification using conventional and torsional ultrasound modalities for hard nucleus cataracts. Settings and design This was a prospective randomized interventional study. Patients and methods A total of 30 eyes of 29 patients having hard nuclear cataract (grades IV and V) were divided into two groups. Group A included 15 eyes whose cataract was operated on by conventional phacoemulsification using the Infiniti machine. Group B included 15 eyes whose cataract was operated on by torsional phacoemulsification using the OZil technology of the Infiniti machine. Intraoperative ultrasound time and cumulative dissipated energy were recorded. Postoperative central corneal thickness (CCT) was measured at days 1, 7, and 30, and specular microscopy was done at 1 month. Statistical analysis The collected data were coded, tabulated, and statistically analyzed. Results The mean ultrasound time and cumulative dissipated energy and the amount of irrigating fluid were significantly higher in group A. There was a highly significant decrease in endothelial cell count (ECC) in both groups. ECC was significantly lower in the conventional group than in the torsional group at 1 month postoperatively. CCT in both groups was significantly increased at day 1 and then decreased at 1 week and 1 month but was still significantly higher than the preoperative level. CCT became higher in the conventional group than in the torsional group at all follow-up times, but this was significant only at day 1 and week 1 and not significant at 1 month. Conclusion Both ultrasound modalities can be used in hard nucleus phacoemulsification. However, the torsional ultrasound proved to be safer. The choice between these technologies is of particular importance when operating eyes with low ECC.

Purpose To evaluate through a prospective study the efficiency and safety of triamcinolone in subconjunctival injection on macular edema (ME), in the short and medium term. Patients and methods All the patients included in the study underwent ophthalmologic examination and optic coherence tomography of the macula. The injection of 0.2–0.3 ml (8–12 mg) of triamcinolone was done in the subconjunctival space. We evaluated its efficiency by measuring the best-corrected visual acuity and the central macular thickness at 1, 3, and 6 months. Safety was evaluated by following up the intraocular pressure; the presence or absence of cataract and conjunctival complications at 1, 3, and 6 months; and the glycemic control. Results A total of 44 eyes (36 patients) were included. The overall best-corrected visual acuity and central macular thickness improved after injection. Overall, 67% of diabetic patients required reinjection at the third month. In the cases of inflammatory ME (uveitis and Irvine–Gass), the evolution has remained stable for 6 months after a single injection. No significant variation in intraocular pressure was noted after 1 month (P=0.38), after 3 months (P=0.20), or after 6 months (P=0.13). However, four patients developed ocular hypertension (10 mmHg or more above baseline), which has been well controlled with local monotherapy. Overall, 9.5% of phakic patients developed a cataract at the control of the sixth month. The change in glycated hemoglobin before and after the injection was not significant (P=0.84). Conclusion Subconjunctival triamcinolone acetonide seems to be an interesting and well-tolerated alternative therapy of ME in the short and medium term.

Settings This study was conducted in Mansoura Ophthalmic Center, Mansoura University, Egypt, during the period from January 2018 to January 2019. Purpose This study aimed to evaluate the visual outcomes, topographic features, endothelial cell densities (ECD), and complications of deep anterior lamellar keratoplasty using big-bubble technique (BB-DALK) in different corneal stromal pathologies. Patients and methods This was a prospective, interventional study that included 24 eyes of 24 patients having corneal stromal pathologies, not involving Descemet membrane (DM) and endothelium. The primary outcome measures were the clinical, visual, and topographic outcomes (uncorrected visual acuity, best-corrected visual acuity, K1, and K2) throughout the follow-up period, whereas the secondary outcome measures were the refractive outcomes, central corneal thickness, ECD, and intraoperative and postoperative complications. Results A total of 21 (87.5%) patients underwent uneventful BB-DALK, and three (12.5%) cases were complicated by intraoperative DM microperforation who developed DM detachment and double anterior chamber (AC) postoperatively. One of them resolved spontaneously and the other two cases required intracameral air injection. Uncorrected visual acuity improved from 1.55±0.26 (logarithm of minimum angle of resolution) preoperatively to 0.63±0.2 1 year postoperatively (P<0.001) and best-corrected visual acuity improved from 1.08±0.11 (logarithm of minimum angle of resolution) to 0.30±0.12 (P=0.017). Refractive cylinder improved from −7.79±1.75 to −2.85±2.01 at 12 months of follow-up (P=0.007). Average K reading changed from 60.00±7.77 preoperatively to 43.43±2.98 postoperatively (P<0.001). Total ECD was 2248.08±431.13 by the end of the first year, with a mean of 8.2% endothelial cell loss. Loosening of the sutures occurred in five (20.8%) eyes between third and sixth months postoperatively. Urrets-Zavalia syndrome occurred in one of the two cases who were complicated with postoperative double AC and required intracameral air injection. Conclusions BB-DALK is an effective and safe technique for treatment of different corneal stromal pathologies sparing endothelium and DM.

Introduction Intermittent exotropia ‘X(T)’ is a disorder of binocular eye movement control, in which one eye intermittently moves outward. It is the commonest type of exodeviation and is usually detected by the parents in early childhood. Patients with X(T) tend to manifest their deviation when they are tired, stressed, or have cold. Purpose To manifest the prevalence of different types of X(T) in exotropic children aged 6–12 years attending Ain Shams University ophthalmology outpatient clinic. Patients and methods This is a cross-sectional study including 139 exotropic children aged 6–12 years attending Ain Shams University ophthalmology outpatient clinic. All patients underwent full medical and ophthalmic history. The ophthalmic examinations included visual acuity, ocular movements, and the angles of deviation. Further ocular examinations included slit-lamp examination for anterior segment, fundus examination, and Worth 4-dot test. Results A total of 139 exotropic children (6–12 years old) attending the ophthalmology outpatient clinic of Ain Shams University were included. We found that X(T) is the commonest type of exodeviation, in 86.3%. The ‘basic type’ was the commonest subtype of X(T), in 84.2%. The true divergence excess was the second most common type, in 7.5%, pseudodivergence was seen in 5.8%, and the convergence insufficiency was the least common type seen in 2.5%. Conclusions Intermittent exotropia was the commonest type of exodeviation among children aged 6–12 years. The basic type was the commonest subtype of X(T).