Aim of the work The aim of this study was to find out the relation between tear film function and pterygium. Patients and methods This study included 60 patients with unilateral pterygium from the outpatient clinic of October 6 University, with age ranging between 25 and 70 years. Pterygium was treated by simple excision in 20 eyes, by excision with B irradiation in 20 eyes, and with conjunctival autograft technique in the remaining 20 eyes. The results of tear break-up time (TBUT) and Schirmer-1 test were evaluated before and 6 months after surgery. We also included 25 healthy individuals as controls. Results This study included 60 patients (32 male and 28 female patients) with a mean age of 44.17 ± 9.25 years. Age and sex were not statistically different between the patients and controls (P = 0.24 and 0.96, respectively). The mean TBUT was 11.70 ± 2.16 s in control eyes (ranged from 8.5 to 16.0 s). However, in eyes with pterygium this value was markedly reduced to 5.91 ± 1.95 s. TBUT was statistically lower among patients compared with controls (P < 0.0001). The mean Schirmer-1 test result was 13.76 ± 2.06 mm (range 11-17 mm/5 min) in normal healthy eyes and 5.85 ± 1.86 mm (range 3-9.5 mm/5 min) in the eyes of patients with pterygium. The difference was statistically different between the patients and controls (P < 0.0001). Before surgery, the average TBUT was 5.90 ± 1.87 s. This was significantly prolonged to 7.95 ± 1.33 ± 6 months postoperatively (t = 9.97, P < 0.0001) in all our cases. Moreover, Schirmer-1 test was 6.29 ± 1.90 mm/5 min preoperatively and significantly prolonged to 9.67 ± 1.57 postoperatively (t = 27.23, P < 0.0001). Conclusion Ocular dryness in the presence of pterygium and its improvement after surgery favor the hypothesis that pterygium itself contributes to the phenomenon of disturbed tear film functions in such patients.

Purpose The aim of the study was to evaluate the Von Willebrand factor (vWF) as an early detector of diabetic retinopathy, correlating its levels in both serum and vitreous with the degree of retinal affection. Patients and methods The study included 90 patients who were subjected to vitreous surgery. The selected patients were 40 diabetic patients with proliferative diabetic retinopathy, 40 diabetic patients with nonproliferative diabetic retinopathy, and 10 nondiabetic individuals as control. All patients were subjected to full ophthalmological examination. Venous blood samples (5 ml venous blood) were obtained from each patient at the start of anesthesia, whereas undiluted vitreous samples were obtained at the start of surgery. Results In the diabetic group, vWF was strongly correlated with presence of retinopathy and its severity. Conclusion Diabetic patients with long duration of illness and high vWF are more susceptible to development of diabetic retinopathy and its progress of severity.

Purpose The purpose of the study was to compare the anatomical and functional outcome of the use of high-speed 23 G vitreous cutters shaving versus bimanual surgery in the management of epiretinal membranes (ERMs) in eyes with diabetic tractional retinal detachment (TRD). Design Prospective comparative double-blind study. Setting Modern Ophthalmology Center, Alexandria, Egypt. Patients and methods The study was conducted on 60 eyes with diabetic TRD, divided blindly into two equal groups. Informed consent was obtained from all patients before participation in the study. Group I was operated upon with the Twinac cutter on Oertli OS3 NovitreX using the foot-controlled peristaltic pump. Group II was operated upon with a chandelier light using twinlight on BrightStar. The ERM was operated upon using curved 23 G scissors and end-gripping forceps. All eyes were followed up for 6 months after surgery. Results Complete removal of ERM was achieved in 20 (66.7%) eyes and 30 (100%) eyes, iatrogenic breaks in 10 (33.4%) eyes and five (16.7%) eyes, postvitrectomy bleeding in five (16.7%) eyes and two (6.7%) eyes, retinal tamponade was not needed in six (20%) eyes and eight (26.7%) eyes, in groups I and II, respectively. There was significant difference between the two groups in complete removal of ERM, use of gas or air as a tamponade, and use of silicone tamponade. Conclusion Although the advent of high-speed 23 G vitreous cutter facilitates dissection of ERM in eyes with diabetic TRD, bimanual surgery is associated with statistically significant more complete removal of ERM, more use of temporary tamponade as gas or air, and less use of silicone oil.

Introduction Amblyopia is one of the most important causes of visual impairments in young children; its incidence varies between 0.14 and 4.7%. An early diagnosis can enable optimal treatment. Illiteracy and poverty play a major role in preventing individuals from seeking medical advice, and we lack data on the prevalence of amblyopia in Upper Egypt, especially Minia county. Objective This study aimed to screen for amblyopia in students attending the governmental primary schools in Minia County during the amblyogenic period. Design A prospective observational cross sectional study was carried out between March and April 2010. Patients and methods Visual acuity and pen light ophthalmic examinations were performed for 1608 students (age range 7-9 years). Overall, 864 students were from urban areas and 744 were from rural areas. Children with defective vision were subjected to a full ophthalmic examination including slit lamp, orthoptic, and fundus examination in addition to cycloplegic refraction to detect the cause of reduced vision. Results Of the total number of participants, 14.49% had defective vision; 0.75% had organic causes (5.2% of the patients with defective vision), 12.25% had refractive errors (84.5% of the patients with defective vision), and 1.49% had amblyopia (10.3% of the patients with defective vision). The main cause of amblyopia was anisometropia (54.16%), followed by strabismus (25%), ametropia (12.5%), and finally deprivation (8.33%). Conclusion The prevalence of amblyopia in our study is 1.49%, which is higher in rural areas than in urban areas.

Purpose To analyze the results of 2 years of corneal collagen cross-linking (CXL) for the treatment of keratoconus and to detect the efficiency of this procedure. Design This was a retrospective noncomparative study. Patients and methods A total of 58 eyes of 40 keratoconus patients were subjected to CXL. Epithelium-off CXL was the only procedure performed for all cases. The preoperative and postoperative measures included uncorrected visual acuity, best-corrected visual acuity (BCVA), fundus examination, slit-lamp examination, pachymetry, keratometry, refractometry, and corneal topography. All eyes included in this study were followed up at 1, 3, 6, 12, and 24 postoperative months. All preoperative and postoperative data of all eyes were collected, revised, and analyzed. Results This study showed that uncorrected visual acuity improved by at least one line in 70.7% of the eyes in the study, but remained stable in 22.4% of the eyes in the study. BCVA improved by at least one line in 53.4% of the eyes in the study, but remained stable in 36.2% of the eyes in the study. Astigmatism remained stable in 86.2% of the eyes in the study and decreased by a mean of 1.20 D in 13.8% of the eyes in the study. The average keratometry (K) decreased by more than 1 D in 74.1% of the eyes in the study, but remained stable in 13.7% of the eyes in the study. The maximum K value decreased by a mean of 2.47 D in 55.1% of the eyes in the study, but remained stable in 38% of the eyes in the study. The K value of the apex decreased by a mean of 2.73 D in 65.5% of the eyes in the study, but remained stable in 25.9% of the eyes in the study. Conclusion This study proved that corneal cross-linking is beneficial both as a visual-preserving and as a visual-improving procedure. K readings are the main indicator of the success or the failure of the procedure. Central corneal thickness can be an indicator of improvement; there is a reciprocal relationship between the central corneal thickness and the BCVA. The best chance is for patients with corneal thickness more than 400 μm. It is advised that the refractive surgeon should store the riboflavin in the refrigerator from +4°C to +8°C and discard it immediately after surgery. The use of steroid from the first postoperative day was helpful. Most postoperative visual improvements resulted from a decrease in myopia, whereas there was no remarkable improvement in astigmatism.

Purpose To evaluate the effect of the duration of symptoms on the final visual acuity improvement in patients operated for idiopathic epiretinal membrane (EMM) by the 23-G pars plana vitrectomy technique. Participants and methods A prospective cohort study including 12 eyes of 12 patients (six male and six female) operated for idiopathic EMM at a specialized vitreoretinal center between March 2012 and March 2013 was carried out. We included clinically detectable idiopathic EMM diagnosed by fundus examination or optical coherence tomography (OCT), causing a decrease in the visual acuity or metamorphopsia. Exclusion criteria included prior vitreous surgery, prior intravitreal injection of triamcinolone acetonide or antivascular endothelial growth factor, ocular inflammation, or prior trauma. Postoperatively, patients were followed up for best-corrected Snellen visual acuity (BCVA), a standard ophthalmological examination, including fundoscopy, and OCT, which was performed to assess the thickness and the morphology. The central macular thickness (CMT) was defined as the central 1 mm zone. The main outcome measures of the study were the CMT change and the visual acuity improvement in relation to the preoperative duration of symptoms, the preoperative CMT, and the preoperative BCVA. Results The study included 12 patients (male patients 50%) with a mean ± SD of age equal to 61.25 ± 6.077 years. Phacoemulsification with intraocular lens implantation was performed for the four (33.3%) phakic patients, and 23 G vitrectomy for removal of the epimacular membrane was performed for all eyes (100%). The mean preoperative BCVA was 0.12, with a range from 0.08 to 0.25, whereas the postoperative visual acuity showed a statistically significant improvement. It ranged from 0.16 to 0.66, with a mean of 0.39 (decimal). The mean postoperative CMT was 354.6 ± 73.7 μm, which was significantly thinner than the preoperative CMT of 536.25 ± 131.129 μm (P = 0.001). The mean preoperative CMT ranged from 380 to 780 μm, whereas the postoperative CMT ranged from 280 to 492 μm. None of the patients required suturing of thesclerotomy site at the end of the initial surgery.The postoperative BCVA was significantly correlated with the duration of symptoms (P = 0.029), the preoperative CMT, and also the postoperative CMT. Conclusion The shorter the duration of symptoms, the better the postoperative BCVA after surgery for an idiopathic EMM. Also, the lower the preoperative CMT measured by OCT, the better the final visual outcome. Finally, the lower the postoperative CMT reached after 9 months from vitrectomy, the better the visual acuity.

Purpose The aim of this study was to investigate the effect of chemotherapy and radiotherapy in the treatment of retinoblastoma on the conjunctiva, using the impression cytology technique. Patients and methods The study included three groups comprising 15 eyes each of children aged 1-7 years. Group I comprised patients receiving a complete course of chemotherapy alone since at least 3 months. Group II comprised patients receiving a complete course of chemotherapy and radiotherapy since at least 3 months. Group III was the control group. Impression cytology was used to take samples from the conjunctiva; the samples were fixed with ethyl alcohol 97% and then rehydrated and stained. Microscopic examination was carried out for cohesion power, cell size, nucleus/cytoplasm ratio, distribution of goblet cells, and degree of keratinization. Results As regards age distribution, there were statistically nonsignificant differences between all three groups (P = 0.73). As regards sex distribution, there were statistically nonsignificant differences between the groups (P = 0.902). Impression cytology revealed no statistically significant difference between the three groups with respect to the cohesion power, the cell size, nuclear cytoplasm ratio, goblet cell distribution, and the degree of keratinization. Conclusion There is no evident effect of either radiotherapy or systemic chemotherapy used in the treatment of retinoblastoma on the surface of the eyes of the patients, specifically the conjunctival epithelium. Further studies are needed to ascertain the exact effect of modality, or to document the nullity of effect.

Purpose The study aimed at investigating retrospectively the values of corneal and lens densitometry using the Pentacam Scheimpflug system after corneal cross-linking (CXL). Materials and methods This study included 50 eyes of 50 patients who had undergone CXL for keratoconus. The Pentacam Scheimpflug system was used before the procedure to measure objectively the corneal and lens densitometry values. The same measurements were recorded during the follow-up visits at 1, 3, 6, and 12 months using the Scheimpflug image taken at the same axis as at the baseline visit. During the same preoperative and follow-up visits, slit-lamp examination was performed by the same examiner to grade the corneal haze on a scale from 1 to 4. Results The mean Scheimpflug corneal densitometry at baseline was 16.30 ± 1.90 (measured on a scale of 100). At 1 month postoperatively, the corneal densitometry increased to 28.81 ± 4.33. Between 6 and 12 months postoperatively, there was a decrease in the corneal densitometry values by 4.78, which was statistically significant (P < 0.001). At 12 months postoperatively, the corneal densitometry did not return to baseline levels. At baseline, the mean preoperative clinical haze at slit-lamp was 0.31 ± 0.70 (grading from 0 to 4). At 1 month, there was a statistically significant increase in the clinical haze by 1.40 (P < 0.001). Regarding Scheimpflug lens densitometry values, it was 7.91 ± 2.51 at baseline and 7.93 ± 2.61 at 12 months postoperatively. Conclusion Scheimpflug corneal densitometry and the clinical corneal haze peaked at 1 month, followed by a gradual decline. They reached near baseline levels at 12 months, but at significantly higher values. Lens densitometry was not affected by CXL.

Settings The study was conducted in Faculty of Medicine, Alexandria University, Egypt. Purpose The aim of the study was to analyze the influence of various surgical factors on the postoperative corneal refractive power and astigmatism after keratoplasty in eyes with corneal diseases. Patients and Methods This was a retrospective study on 100 eyes with clear grafts 6 months following keratoplasty; the influence of different surgical factors (technique of keratoplasty, type of suturing, size of trephination) on the postoperative corneal refractive power and astigmatism was analyzed. All included patients signed informed consent. Results Around 70% of the cases of the four subgroups had keratoconus. The flattest 6 months postoperative keratometric reading was the penetrating keratoplasty (PK) with interrupted sutures subgroup with mean ± SD 43.90 ± 3.09 D. The steepest was the deep anterior lamellar keratoplasty (DALK) with double-running sutures subgroup with mean ± SD 45.30 ± 1.70 D. The highest 6 months postoperative astigmatism was the PK with interrupted sutures subgroup with mean ± SD 7.15 ± 1.95 D. The lowest was the PK with double-running sutures subgroup with mean ± SD 2.36 ± 1.15 D. Conclusion Interrupted sutures resulted in significantly higher postoperative astigmatism in both PK and DALK before suture removal. Double-running sutures resulted in acceptable postoperative astigmatism even before suture removal. DALK resulted in higher postoperative astigmatism and steeper grafts than PK.

Objectives To investigate the efficacy of the single-puncture technique for Lester Jones tube insertion. Design A noncomparative retrospective review. Participants Six patients with proximal lacrimal obstruction had seven Lester Jones tube insertion procedures. Participants and methods Patients had the single-puncture guided Lester Jones tube insertion technique over the last 2 years. The Lester Jones tube was inserted between the conjunctival sac and the nasal cavity through a tight passage created by a single puncture of a trocar and cannula. Patients were examined for symptomatic relief, tube patency, and stability. The surgical time and early postoperative complications were recorded. Results All procedures were performed successfully. The average surgical time was 12 min, with no postoperative swelling or chemosis. Two procedures out of seven had early tube block, which was cleared up by simple tube irrigation. None required a second intervention or suffered tube displacement. Conclusion The single-puncture technique for Lester Jones tube insertion is performed in a short time, avoids skin incision, achieves a high functional success, and is less likely to result in postoperative complications that would require a second intervention.

Purpose Lower eyelid ectropion is usually accompanied by a variable degree of medial and lateral eyelid laxity. This work investigates a clinical evaluation scheme and a surgical plan to repair ectropion associated with different stages of such associated laxity. Patients and methods Forty-two procedures on 30 patients with lower eyelid ectropion associated with variable degree of medial palpebral ligament laxity were performed on the basis of the ectropion classification and management protocol described in this work. Patients were followed up for at least 6 months postoperatively. Results Firm medial eyelid fixation against lateral traction and correction of ectropion were achieved in all cases. Epiphora was cured in 26 eyes. The planned cosmetic outcome was achieved in 28 cases. Conclusion Individualizing the surgical repair for involutional ectropion on the basis of the clinical findings is cosmetically and functionally rewarding.

Purpose Selective laser trabeculoplasty (SLT) is an effective procedure in lowering intraocular pressure (IOP) in patients with open angle glaucoma. The current study investigates the efficacy of SLT in lowering IOP in pseudophakic patients with open angle glaucoma. Patients and methods Records of 36 pseudophakic patients who underwent 360΀ SLT were reviewed. IOP and number of medications were recorded before and at 1, 6, 12, and 24 months after the procedure. Nine patients had undergone prior subscleral trabeculectomy (SST). Results Mean (± SD) IOP for all patients decreased from 19 ± (4.6) mmHg before SLT to 13.69 ± (4.4) mmHg at 2 years follow-up (P<0.0001). Success rate at 2 years was 76.9%. The mean number of medications used decreased from 2.11 before SLT to 1.25 at 24 months. The decrease in mean IOP for patients with prior SST (from 21.33 to 15.75 at 2 years) was comparable with patients with no prior surgery (from 18.22 to 12.78 at 2 years). Conclusion SLT is an effective method of lowering IOP in pseudophakic patients with glaucoma. Previous SST has no significance on the rate of decrease of IOP in patients undergoing laser trabeculoplasty.

Purpose The aim of the study was to evaluate the changes in central macular thickness (CMT) in the eyes of diabetic patients with primary open angle glaucoma (POAG) on topical latanoprost. Design This study was designed as a prospective, interventional, comparative trial. Place The study was conducted at Ain Shams University Hospitals and at private practices. Patients and methods Twenty eyes of 12 diabetic patients with uncontrolled POAG who required topical latanoprost either as first or as additive glaucoma medication were prospectively enrolled in this study. Twenty nonglaucomatous eyes of 10 diabetic patients were included as controls. After a complete ophthalmic examination, spectral-domain optical coherence tomography and fluorescein angiography (FA) were performed at baseline before starting latanoprost. All eyes received latanoprost for 3 months, and clinical examinations were repeated 1, 2 and 3 months later; optical coherence tomography and FA were repeated after 3 months. Outcome measures were intraocular pressure (IOP), CMT and best-corrected visual acuity (BCVA). Results The mean patient age was 49 ± 11 (range 43-56) years. The mean BCVA in logMAR was 0.1 ± 0.1 (range 6/6-6/12), IOP was 24 ± 4.2 (range 19-30) mmHg, and mean CMT was 239.7 ± 26.8 (range 157-288) μm before administration of latanoprost. At 3 months' follow-up, IOP was 14.1 ± 2.9 mmHg (P<0.001). No significant change was observed in CMT except in one eye in which CMT increased by 22 μm with no change in BCVA. However, FA did not show any leakage or abnormality. None of the patients experienced a decrease of more than one Snellen line in BCVA. There was no case of clinical or angiographic cystoid macular oedema after treatment. There were no significant differences between the study group and control group in terms of CMT or BCVA. Conclusion Topical use of latanoprost for 3 months does not seem to predispose to increased CMT in diabetic patients with POAG. However, individual variations should be considered. Close observation is recommended by spectral-domain optical coherence tomography for diabetic patients on topical latanoprost.

Aim of the study The aim of the study was to determine the efficacy and safety of deep sclerectomy (DS) compared with subscleral trabeculectomy (SST) in patients with medically uncontrolled primary open angle glaucoma (POAG) and advanced visual field (VF) loss. Design The study was designed as a prospective, interventional, comparative trial. Place The study was conducted at Ain Shams University Hospitals and in private practices. Patients and methods Forty eyes of 30 patients with medically uncontrolled POAG with advanced field loss underwent either DS or SST under topical anesthesia. Preoperative assessment included best-corrected visual acuity (BCVA) using Snellen's chart, anterior segment slit-lamp biomicroscopy, gonioscopy, applanation tonometry with the Goldmann tonometer, VF testing using Humphrey Field Analyzer, central 24°-2 and 10°-2 threshold test, and fundus examination including optic nerve head evaluation. The main outcome measures were BCVA, intraocular pressure (IOP), VF, lens status, and postoperative complications. The follow-up period was 24 months. Results Patients' mean age was 60 ± 8.6 years. Preoperatively, VF was constricted to less than central 10°, mean deviation was worse than −12 dB, cup/disc ratio was greater than 0.7, and neural rim thinness was found in all eyes. Preoperative IOP was 28.2 ± 2.5 mmHg (range 28-35 mmHg) and 27.8 ± 4.2 mmHg (range 24-36 mmHg) in groups I and II, respectively. Postoperative IOP was 17 ± 5.5 mmHg (range 12-20 mmHg) (P = 0.0066) and 18.2 ± 2.2 mmHg (range 12-22 mmHg) (P = 0.0077) at 24 months in groups I and II, respectively. The difference in mean IOP was statistically significant in comparison with baseline for both groups (P = 0.0001), but not significant between the two groups. The complete success rate was 60 and 65% and the qualitative success was 95 and 85% in groups I and II, respectively. Postoperative hyphema was reported in two eyes in group II, anterior uveitis in three eyes in group II, and self-limited shallow choroidal detachment was seen in two eyes in group I and in three eyes in group II. Long-term complication in the form of late bleb fibrosis occurred in two eyes in group II. Only one eye in group II developed more VF defects, and cortical cataract progressed in two eyes in group II. Conclusion DS appears to provide considerable control over IOP decrease with few postoperative complications and allows VF stabilization as well as preservation of BCVA. We believe that DS could be a valuable alternative to SST, especially in eyes with medically uncontrolled POAG and advanced field loss.

Purpose The aim of the study was to detect the effect of intravitreal ranibizumab injection on treatment of macular edema induced by central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) by measuring the improvement in best-corrected visual acuity (BCVA) (LogMAR) and the reduction in central retinal thickness (CRT) measured by optical coherence tomography. Patients and methods In this prospective study, 50 patients with macular edema due to retinal vein occlusion (25 with CRVO and 25 with BRVO) received intravitreal injection of ranibizumab. Results A total of 12 weeks post-treatment, 68% of patients had an improvement in BCVA, 20% of patients remained stable, and 12% of patients had a decrease in BCVA. In addition, 56% of patients had decreased CRT exceeding 200 Mm and 30% of patients had decreased CRT exceeding 100 Mm. Conclusion Intravitreal injection of ranibizumab resulted in significant vision improvement and a decreased macular edema caused by CRVO or BRVO.

Arthur Ferguson MacCallan (1872-1955)was an ophthalmic surgeon who undertook his pioneering work in Egypt between 1903 and 1923. During that time, he established the ophthalmic hospital infrastructure in Egypt consisting of both travelling (mobile) and permanent hospitals, along with the training of surgeons. He also became a world authority on trachoma; the MacCallan Classification of Trachoma, initially published in 1908, was the first grading system used to standardise the diagnosis of trachoma and was later adopted by the WHO.