Aim The aim of this study was to assess the prevalence of refractive errors in students enrolled in the first year in Assiut University, Assiut, Egypt. Patients and methods A total of 3442 students attending the pre-enrollment fitness clinic in Assiut University Hospital for routine medical examination before university enrollment underwent visual screening including uncorrected visual acuity, color vision, in addition to a slit-lamp examination. Students with a visual acuity of 6/9 or less in either eye undergo objective refraction and subjective verification to determine the best-corrected visual acuity. Results A total of 3442 students were enrolled in this study; refractive error was found in 360 (10.46%) students, 193 males and 167 females. Among these 360 students, the mean uncorrected visual acuity in the right and left eye was 0.19 ± 0.18 and 0.20 ± 0.18, respectively, whereas the best-corrected visual acuity in the right and left eye was 0.80 ± 0.26 and 0.80 ± 0.26, respectively. The mean spherical equivalent in the right and left eye was −2.71 ± 2.76 and −2.97 ± 2.83, respectively. Conclusion Refractive error is a common cause of visual impairment among the group of adolescents admitted for university education in Upper Egypt. Myopia is particularly more prevalent than that reported in other regions of Egypt and other countries. Early detection and correction is essential to avoid ametropic amblyopia.

Purpose To compare the results in terms of the efficacy and safety of collagen matrix implant [Ologen (OLO) implant] versus mitomycin C (MMC) in trabeculectomy for the surgical treatment of primary congenital glaucoma. Materials and methods Twenty eyes of 15 patients with primary congenital glaucoma were divided into two groups. The first group (MMC group) included 10 eyes that were subjected to trabeculectomy with MMC. The second group (OLO group) included 10 eyes that were subjected to trabeculectomy with a collagen matrix implant (OLO implant). All procedures were performed in Sohag University Hospital. Postoperative evaluation included intraocular pressure (IOP) level, bleb evaluation, complications, and the need for further medication or surgical intervention. The postoperative IOP level was classified into four groups (>21, >17-21, 15-17, and <15 mmHg). Results At the end of the sixth postoperative follow-up month, in the MMC group, only 10% of eyes achieved the target IOP, 10% of eyes had failed surgery, and 80% of eyes had IOP ranging from 15 to 21 mmHg. However, in the OLO group, 40% of eyes achieved the target IOP, 60% of eyes had IOP ranging from 15 to 21 mmHg, and there were no failed surgeries. In terms of complications, the MMC group had a higher rate of complications than the OLO group in the form of early hyphema, bleb leakage, hypotony, and choroidal detachment. Conclusion This study proved that the use of a collagen matrix implant yields more effective results than MMC when combined with trabeculectomy for the treatment of primary congenital glaucoma. Furthermore, OLO implantation is safe and has low incidences of complications. Because of the small sample size in this study, which limits the statistical comparison between the groups, further larger studies are required to investigate the long-term efficacy and safety of this new device.

Aim of the work To assess the safety and the effectiveness of a new approach for sutureless 20-G pars plana vitrectomy using N-butyl-2-cyanoacrylate 'Histoacryl' glue, aiming for the conversion of the conventional 20-G vitrectomy to a sutureless technique. Design An interventional study. Patients and methods About 40 eyes of 40 patients attending the surgical retina clinics of the Research Institute of Ophthalmology were subjected to the new technique. The selection criterion included patients with diabetic and nondiabetic vitreous hemorrhage, rhegmatogenous retinal detachment (RD), recurrent RD, pseudophakic RD, giant retinal breaks, macular hole, proliferative diabetic retinopathy, complications of anterior segment surgery, posterior dislocated IOL, vitreomacular traction syndrome, macular pucker, idiopathic epiretinal membrane, and dropped nucleus. Patients were selected randomly. There was no age limitation, sex choice, or race preference. All the patients underwent a modified 20-G sutureless vitrectomy surgery. Periotomy was performed in the upper part of the eye, and the sclera was exposed, three 1/2-thickness scleral flaps were fashioned using a crescent knife for a length of 2 mm, and a 20-G self-retaining infusion cannula was introduced at the 12 O'clock position. At the end of the surgery, Histoacryl tissue glue was applied to close the scleral flaps and the conjunctiva. Different vitreal substitutes and tamponades were used according to the case. All the patients had undergone ultrasonic biomicroscopy at the sclerotomy sites 6 weeks postoperatively. Our main concern was to assess the success and the effectiveness of the procedure, wound integrity, intraoperative and postoperative complications, the efficacy of the N-butyl-2-cyanoacrylate to hold the tissues, tissue reaction related to cyanoacrylate, patients' satisfaction, and the final surgical outcome. The postoperative intraocular pressure (IOP) and the Snellen visual acuity relative to the preoperative values were recorded. Patients were evaluated postoperatively on the first day, the first week, and then weekly for 1 month and monthly for 6 months or till the time of removal of silicone oil, which was also removed by the same aforementioned technique. Results The proportion of male patients was 47.5% (19 patients) and that of female patients 52.5% (21 patients). The mean age of the male patients was 49 ΁ 12.5 years, whereas the mean age of the female patients was 44 ΁ 15.5 years. Different vitreous substitutes/tamponades were used, including air, SF6, ringer lactate, and silicon oil 5000 cSt. The mean operative time was 61.75 ΁ 13.8 min and the mean time fashioning and closing the sclerotomies and the conjunctiva was 7 ΁ 1.8 min. No sclerotomy-related intraoperative difficulties or complications were seen and none of the patients required stitching of the sclerotomies at the end of the surgery. All patients were discharged from the hospital immediately after the surgery. Ultrasonic biomicroscopy (UBM) revealed complete wound closure in 36 patients (90%), partial internal wound dehiscence in four patients (7.5%), and three patients (10%) showed microcyst formation under the conjunctiva. Postoperative hypotony was not seen in any of the patients.There was no single case of endophthalmitis or chemical uveitis. The visual acuity was improving along the follow-up period, except for one uncontrolled diabetic patient, who developed rubeosis iridis and the condition deteriorated. Most patients presented with an initial increase in the IOP followed by stabilization of the IOP thereafter. Conclusion The new approach of 20-G sutureless vitrectomy utilizing N-butyl-2-cyanoacrylate is a safe and effective technique for the surgical treatment of a variety of vitreoretinal pathologies. Conversion to this technique is very simple. A very short learning curve is required, with no need for new expensive instrumentation. It combines all the advantages of 20-G vitrectomy, adding to it the sutureless advantage of the technique.

Objective The aim of this study was to evaluate the outcome of pterygium excision with conjunctival limbal autografting from the lower bulbar conjunctiva for the treatment of primary pterygium. Patients and methods This prospective analysis study included 60 eyes of 60 patients with primary pterygium treated by means of pterygium excision with conjunctival limbal autograft from the lower bulbar conjunctiva in El-Minia University Hospital. Patients were examined on the first day, the first week, at 2 weeks, and every month until the 12th month postoperatively. Outcomes were evaluated in terms of complications and recurrence. Results During the 12 months of follow-up, postoperative complications occurred in 18 (30%) patients. Recurrence occurred in one (1.7%) eye during the follow-up period. Conclusion In patients with primary pterygium, conjunctival limbal autografting from the lower bulbar conjunctiva is an effective technique with a low recurrence rate. It can be a suitable treatment for glaucomatous patients with pterygium to leave the upper bulbar conjunctiva untouched.

Purpose The aim of this work is to evaluate the influence of time elapsed between the occurrence of orbital floor fracture and management on improvement of complications. Patients and methods This is a prospective comparative interventional study that including 17 patients with pure orbital floor fracture (without involvement of the orbital rim) who presented to Mansoura Ophthalmic Center from January 2012 to September 2012; they presented with diplopia with or without enophthalmos. For all cases, computed tomography-coronal cuts were performed. For all cases, repair of the orbital floor fracture was performed using a titanium mesh. For cases that had persistent diplopia after repair because of restrictive myopathy, adjustable inferior rectus recession was performed. Those who did not achieve correction after recession were corrected by prisms. Cases were followed for 6 months after surgery. Results This study included 17 cases with pure orbital floor fracture. They were divided into two groups according to the time of presentation after trauma: group A included seven (41.2%) patients who were operated within 3 weeks of trauma and group B included 10 (58.8%) patients who were operated after 3 weeks up to 6 months of trauma. In group A, all cases presented with diplopia in up gaze; however, one (14.3%) case presented with enophthalmos more than 2 mm. In group B, all cases presented with diplopia in up gaze and three (30%) of them presented with enophthalmos more than 2 mm. In group A, diplopia and enophthalmos were completely resolved after surgical repair of orbital floor fracture; however, in group B, diplopia improved only in two (20%) cases, but cases of enophthalmos were completely resolved. Among the remaining eight (80%) patients with persistent diplopia who underwent adjustable inferior rectus recession, seven (70%) patients improved and only one (10%) patient had persistent diplopia that was corrected with prisms. Conclusion Early repair of orbital floor fracture (within 3 weeks) leads to complete improvement in diplopia; however, late repair in most of the cases needs inferior rectus recession and sometimes prism correction. However, enophthalmos is not affected by the time of repair.

Introduction Although malignant eyelid tumors are rare, their incidence appears to be increasing. The recognition and treatment of malignant eyelid tumors pose a challenge. Moreover, late diagnosis of the tumors, although is rarely lethal, requires more invasive surgery and consequently will have adverse aesthetic effects. Objective The aim of this study was to evaluate histopathologically confirmed eyelid malignant lesions as regards pathological types and degree of tissue invasion at the time of presentation in patients admitted to the Oculoplastic Unit in Minia University Hospital during the 5-year period. Design This is a retrospective case series study that was carried out in the Oculoplastic Unit in Minia University Hospital during the 5-year period (from January 2009 to December 2013). Patients and methods Five years' medical records of all patients admitted to the Oculoplastic Unit at the Ophthalmology Department, Minia University Hospital, for the diagnosis and management of suspected eyelid lesions were reviewed. Data such as age and sex of the patients, laterality of the lesion, upper or lower lid lesion, site of the lesion, histopathological type of the lesion, grade of tissue invasion at the time of presentation, the procedure performed for each case, the recurrence if any and the follow-up period were evaluated. Results An overall 65% of eyelid malignancies were basal cell carcinoma (BCC), 23% were squamous cell carcinoma (SCC) and only 12% were sebaceous gland carcinoma (SGC). An overall 0.62% of the cases were confined to the lower eyelids and 38% were confined to the upper eyelids. An overall 88% of BCCs were confined to the eyelids and only 12% were extended deeper to the underlying periosteum. An overall 33% of cases with SCC and SGC extended deeper in the tissues or to the regional lymph nodes. Local recurrence after resection was nil in BCC, 16% in SCC and 33% in SGC. Conclusion In our locality, BCC represented two-thirds of the malignant eyelid lesions, whereas SCC was responsible for one-fourth of the lesions. Most of the malignant lesions were confined to the eyelid only. Although SGC was less frequent, it was aggressive and invasive; moreover, it had a higher rate of local recurrence.

Introduction Management of epiphora in children is a stepwise process, starting with probing after age of 1 year and it provides a high cure rate. Nasolacrimal intubation is recommended when symptoms persist after two probings. For persistent epiphora following probing and intubation, more invasive procedure is required like balloon dacryocystoplasty, or external and endonasal dacryocystorhinostomy. Objective This study was designed to evaluate the indications and surgical outcome of external dacryocystorhinostomy in the paediatric age group. Design A retrospective case series study that was carried out in the oculoplastic unit in Minia University Hospital including children undergoing external dacryocystorhinostomy (DCR) in a 5-year period (from June 2008 to June 2013). Patients and methods Data of all patients who underwent external DCR with silicone intubation in a 5-year period were retrospectively reviewed. Patients aged 15 years or less were chosen for the study and data collected were age and sex of the patients, side of the obstruction, indication for surgery, follow-up period and postoperative results and complications. Criteria of success were disappearance of epiphora, discharge and/or the mucocele in addition to negative fluorescein dye disappearance test and patent lacrimal passages on syringing and probing. The follow-up period was at least 6 months. Data of 29 patients were retrieved and the patients were categorized into two subgroups according to the cause of obstruction: congenital group (17 patients) and acquired group (12 patients) and the collected data were statistically analysed. Results Seventeen (58.6%) out of the 29 patients had congenital causes of epiphora, whereas 12 (41.4%) patients had acquired causes. Age of the patients ranged from 6 to 180 months with a mean of 78 months. Males were slightly more (53%) in the congenital subgroup, whereas 58% of the patients in the acquired subgroup were females and the overall male to female ratio in all patients was nearly 1 : 1. The overall success rate in all patients was 89%, which was higher in the congenital subgroup (94%) than in the acquired subgroup (83%). Conclusion External DCR yielded good results with minimal complications regarding epiphora in children. The results were better in patients with congenital causes than acquired causes.

Purpose The aim of this study was to report the findings of optical coherence tomography measurement of retinal nerve fiber layer (RNFL) thickness and ganglion cell complex (GCC) in idiopathic intracranial hypertension (IIH) patients and to assess whether the RNFL and GCC correlate with retinal sensitivity determined by automated perimetry in the form of mean deviation (MD) and pattern standard deviation. Patients and methods A prospective observational study was carried out for 30 patients with confirmed IIH (age ≥18 years), BMI below 25, intracranial pressure (ICP) of at least 20 cmH ₂ O, and normal neurological examination (except for papilloedema and horizontal diplopia). All patients received a complete neurological examination and most recent lumbar puncture opening pressure (latest ICP) was recorded. Complete ophthalmic evaluation including best-corrected visual acuity, perimetry, RNFL, and GCC thickness within 24 h of performing lumber puncture. Results In IIH patients the initial RNFL thickness was significantly higher, whereas GCC was significantly lower than controls (P = 0.045 and 0.004, respectively). The value of ICP measured was found to be positively correlated with the stage of papilloedema (r = 0.494, P = 0.000). The final recordings showed a significant decrease in GCC and RNFL values (P = 0.000 and 0.002, respectively), and improvement in MD (P = 0.003). Regression analysis showed that for every 10 μm increase in mean RNFL thickness, there was worsening in MD of 0.56 dB, whereas for every 10 μm decrease in mean GCC thickness, there was worsening in MD of 0.9 dB at the last follow-up. Conclusion GCC and RNFL thickness abnormalities assessed by optical coherence tomography in IIH patients were quantitatively correlated with visual field sensitivity losses and can be definitively useful to quantify optic nerve damage.

Purpose The aim of this study was to compare the effect of phacoemulsification on the corneal endothelium using Ringer's and Ringer's lactate as the intraocular irrigating solution. Setting Mansoura Ophthalmic Centre, Faculty of Medicine, Mansoura University, Egypt. Design Prospective randomized comparative study. Materials and methods A total of 102 eyes of 102 patients with senile cataract were randomized to have phacoemulsification with foldable intraocular lens implantation performed using Ringer's (group 1) or Ringer's lactate (group 2) as the intraocular irrigating solution. Specular microscopy was done preoperatively, 1 week and 3 months postoperatively to evaluate endothelial cell density (ECD), coefficient of variation (CV), and central corneal thickness. Data were analyzed using the t-test, the Mann-Whitney U-test, and the Pearson correlation coefficient. Results Mean ECD was 2532 cells/mm ² preoperatively, 2345 cells/mm ² 1 week, and 2284 cells/mm ² 3 months postoperatively in group 1, and 2526, 2374, and 2322 cells/mm ² , respectively, in group 2. There was a statistically significant difference between preoperative ECD and each of 1 week and 3 months postoperative ECD in each group. No significant difference was found between 1-week mean ECD reduction in group 1 (7.35%) and group 2 (6.05%) or between 3-month mean ECD reduction in group 1 (9.69%) and group 2 (8.07%). Conclusion Ringer's and Ringer's lactate solutions are associated with minimal changes in corneal ECD, morphology, and function during uncomplicated phacoemulsification with foldable intraocular lens implantation in patients with normal endothelial cell counts. There is no clinically significant difference in endothelial cell preservation and polymegathism and corneal swelling between Ringer's and Ringer's lactate solutions.

Settings The Faculty of Medicine, Alexandria University, Egypt. Purpose The aim of this work was to study the contribution of posterior corneal astigmatism to total corneal astigmatism. Patients and methods A descriptive prospective observational study that included 100 eyes of 100 patients aged 18 years and above. Scheimpflug camera imaging was performed using a Pentacam. The following data were recorded: anterior corneal radii of curvature, posterior corneal radii of curvature and astigmatism, simulated keratometry (sim K) and astigmatism, the true net power and astigmatism, and central corneal pachymetry. All included participants signed a written informed consent. Results The mean age was 38.11 ± 12.69 years. The orientation of the steep axis of the anterior corneal surface was vertical in 70% of the cases, resulting in with-the-rule astigmatism. For the posterior corneal surface, the steep axis orientation was vertical in 94% of the cases, resulting in against-the-rule (ATR) astigmatism. The mean sim K astigmatism was higher than that of the true net K astigmatism by 0.12 ± 0.18 D (range -0.3-0.4 D) at 4 ± 5° (range 0-21°). Conclusion Anterior corneal with-the-rule astigmatism tends to change to ATR astigmatism with age. The posterior corneal surface showed ATR astigmatism regardless of the age. Using data from the anterior corneal surface only resulted in a higher astigmatism of 0.12 D compared with using data from both the anterior and the posterior surfaces. Also, data from the anterior corneal surface alone resulted in a difference in the axis of more than 10° in 11% of the cases.

Purpose The aim of the study was to investigate the differences in corneal endothelium between patients with and those without diabetes before and after phacoemulsification with intraocular lens implantation. Design The study was designed as an interventional prospective comparative investigation. Setting The study was conducted at Mansoura Ophthalmic Centre, Faculty of Medicine, Mansoura University, Egypt. Patients and methods A total of 100 eyes of 99 patients (49 with and 50 without type 2 diabetes) with senile cataract underwent phacoemulsification with foldable intraocular lens implantation. Specular microscopy was performed preoperatively, at 1 week, and at 3 months postoperatively to evaluate endothelial cell density (ECD), endothelial cell size variability [coefficient of variation (CV)], and central corneal thickness (CCT). Data were analyzed using the t-test, the Mann-Whitney U-test, and Pearson's correlation coefficient. Results Preoperatively, the mean ECD was 2558.20 cells/mm ² , the mean CV was 39.84%, and the mean CCT was 512.56 μm in diabetic patients. In controls, the mean ECD was 2484.31 cells/mm ² , mean CV was 41.03%, and mean CCT was 507.20 μm. There were no significant differences between the two groups (P = 0.145, 0.338, and 0.450 respectively). At 3 months postoperatively, the mean endothelial cell loss (ECL) was 8.09%, mean CV increase was 2.38%, and mean CCT increase was 3.00 μm in diabetic patients, whereas in controls the mean ECL was 8.36%, mean CV increase was 1.06%, and mean CCT increase was 1.30 μm. No significant difference was found in ECL between the two groups (P = 0.850), whereas the increases in CV and CCT were significantly more in diabetic patients than in controls (P = 0.001 and 0.031, respectively). Conclusion There was no significant difference in the corneal endothelium preoperatively between diabetic and nondiabetic patients. Although no significant difference was found in ECL following phacoemulsification between the two groups, diabetic patients had a significantly greater increase in CV (polymegathism) and CCT compared with nondiabetic patients.

Purpose The aim of the study was to evaluate the intraoperative complications and clinical outcome of descemet membrane endothelial keratoplasty (DMEK) in eyes with endothelial diseases. Design The study was designed as a prospective noncomparative interventional trial. Patients and methods In 13 eyes with visually significant endothelial diseases, the diseased endothelium and descemet's membrane were stripped and replaced with a donor graft consisting of endothelium and descemet's membrane. Intraoperative and postoperative complications were evaluated. Best spectacle corrected visual acuity, subjective and objective refraction, keratometric readings, endothelial cell density, and central corneal thickness at 3 months were documented. Results Seventeen DMEK procedures were performed. Reinjection of air into the anterior chamber was needed in nine eyes and the procedure failed in five eyes, requiring a repeat DMEK. Three months postoperatively all eyes showed a mean best spectacle corrected visual acuity of 0.36 ± 0.28 log MAR, a mean keratometric reading of 44.7 ± 1.7 D, a mean astigmatism of 2.16 ± 1.04 D, a mean endothelial cell density of 1881.71 ± 213.39 cells/mm ² , and a mean central corneal thickness of 501 ± 27.52 μm. Conclusion Although many challenges exist when performing DMEK, this technique allows a quick and complete restoration of the visual potential in patients with corneal endothelial disorders.

Purpose The aim of this study was to investigate the sensorineural hearing loss (SNHL) in patients with pseudoexfoliation (PXF) syndrome and its correlation with clinical ophthalmological findings. Methods A total of 25 patients with PXF and 15 age-matched and sex-matched normal controls were subjected to complete ophthalmological and audiological evaluation. The degree of hearing loss was compared between the two groups and correlated with the clinical findings including glaucoma, cataract, and laterality of PXS. The independent-sample Mann-Whitney U-test, the Kruskal-Wallis one-way analysis of variance, the related-sample McNemar test and Pearson's correlation were used for statistical analysis. Results A total of 22 patients had bilateral symmetrical SNHL. Overall, three ears (6%) had normal hearing sensitivity, 29 ears (58%) had mild SNHL, 15 ears (30%) had moderate SNHL, and three ears (6%) had moderately severe SNHL. On an average, patients had mild degree of SNHL in the frequencies 250-2000 Hz, moderate degree of SNHL in the frequency 4000 Hz, and moderately severe SNHL in the frequency 8000 Hz. SNHL was not affected by the association of cataract or glaucoma. A total of 28 ears of the controls had mild degree of hearing loss and two ears had normal hearing sensitivity. Conclusion The prevalence and severity of SNHL increases in cases of PXF compared with age-matched controls. This is not affected by the laterality of ocular involvement, or the presence or absence of cataract or glaucoma. This confirms the systemic nature of the disease and may add to difficulties during ophthalmic surgery when performed under local anesthesia due to difficulty in communication.