Purpose The aim of this study is to compare small incision levator and conventional transcutaneous levator resection in the management of cases of ptosis with good and excellent levator action. Patients and methods This is a prospective comparative study that included 30 patients with unilateral ptosis, 16 cases with congenital, and 14 cases with aponeurotic ptosis. Levator action was good (>10 mm levator excurtion) in 20 cases and excellent (>15 mm levator excurtion) in 10 cases. Fifteen cases (group B) were operated through a small (8 mm) upper lid crease incision through which sutures were passed from the tarsal border to the levator muscle at the target distance and 15 cases (group A) were operated through a conventional transcutaneous levator resection. Results This study included 30 cases of unilateral ptosis. They were divided into two groups: group A was operated by a conventional technique and group B was operated by a small incision technique. In group A, 80% of cases were fully corrected, 13.3% were undercorrected, and 6.7% were over corrected; however, in group B, 86.7% were fully corrected and 13.3% were undercorrected. The mean surgical time in group A was 49.5 ± 5.9 and that in group B was 28.1 ± 5.2. Conclusion This study shows that small incision levator muscle resection is equally effective as the conventional transcutaneous levator resection for the management of ptosis, with good and excellent levator action, with better lid contour and quicker time.

Aim of the work The aim of this study was to evaluate the effectiveness of a new permanent lacrimal silicone stent - maintaining a patent passage from the medial wall of the lacrimal sac to the nasal cavity through a bony ostium - in the management of chronic dacryocystitis and epiphora as a simple, quick, and effective procedure. Design This was an interventional study. Patients and methods Thirty-two eyes of 28 patients attending Research Institute of Ophthalmology (RIO), complaining of epiphora due to chronic dacryocystitis or previously failed conventional dacryocystorhinostomy (DCR) surgery, are operated upon using this new modification. All patients underwent surgery in the operating theatre. The selection criterion included patients with chronic dacryocystitis, failed previous DCR, or with chronic epiphora having nasolacrimal duct obstruction with patent canalicular system. All cases were destined for classic DCR. There was no sex choice, race preference or age limitation. The only exclusion criterion was young children below the age of 3 years. Results The majority of the patients (71.4%) were women, with a male to female ratio of 2: 5. The mean age of the patients was 38 years ranging between 19 and 61 years. They were 13 right and 19 left eyes. There were four bilateral cases. The mean postoperative follow-up period to determine the success and failure was 9.5 months with a range between 7 and 14 months. In all, 15.6% of patients needed syringing once, whereas 3.1% of patients needed syringing twice after the surgery. The overall success rate of the surgery with complete resolution of epiphora was 96.9% and failure of the procedure in 3.1% of cases. It was also noticed that the failure in surgery as well as the patients who needed syringing were cases that underwent surgery as a secondary procedure as compared with cases where the procedure was done as a primary procedure. Conclusion Modified DCR with the new lacrimal silicone stent is technically quick and easy to perform and can be done for all age groups with a high success rate and could be considered as a good alternative to classic DCR surgery.

Botulinum toxin blocks acetylcholine release at the neuromuscular junction causing paralysis that is reversed within 4 months. The toxin was well known for its lethal effect when ingested with food (botulism); however, it was found to be highly effective in various disorders, both cosmetic and noncosmetic. The therapeutic uses in ophthalmology include treatment of strabismus, spastic focal facial dystonias, induction of temporary ptosis in cases of lagophthalmos (chemotarsorrhaphy), temporary correction of dysthyroid upper eyelid retraction, suppression of lacrimal gland secretion to temporarily control gustatory lacrimation, some cases of obstructive epiphora and primary hyperlacrimation, and temporary correction of lower lid entropion. In this prospective study, we evaluate the results of using botulinum toxin A (botox) injection in some periorbital pathologies namely, focal facial dystonias, lower lid entropion, lagophthalmos, and epiphora. Fifty patients were treated with botox (20 patients with focal facial dystonias, nine with lagophthalmos, eight with lower lid entropion, and 13 with epiphora), different techniques were used according to the pre-existing pathology, and the following data were recorded: age and sex, total dose for each injection, onset and duration of effect, degree of improvement, and the occurrence of any adverse effects. The study results supported the high efficacy of botulinum toxin for treatment of blepharospasm, hemifacial spasm, lagophthalmos, lower lid entropion, and epiphora, with marked to moderate improvement in 99, 87.5, 55.5, 75, and 92.3% of patients, respectively. Few side effects occurred but they resolved spontaneously without residues. We concluded that botulinum toxin A is a safe and effective treatment with a temporary outcome that may be desirable in certain situations.

Purpose The aim of the study was to evaluate and compare the advantages and disadvantages of iris fixation with scleral fixation of posterior chamber foldable intraocular lenses (IOLs) in eyes without adequate capsular support. Patients and methods Aphakic eyes without adequate capsular support and planned to be corrected with posterior chamber foldable IOL implantation were randomly distributed between two groups. Group A included eyes treated with the scleral fixation technique and group B included eyes treated with the iris suture fixation technique. Preoperative, intraoperative, and postoperative data included uncorrected and best-corrected visual acuity, refraction, intraocular pressure, signs of anterior segment inflammation, areas of capsular remnants, vitreous prolapse, surgical time, intraoperative difficulties, IOL malposition, and postoperative complications. Patients were followed up for at least 6 months. Results Eighty eyes were randomly distributed between two groups; each included 40 eyes. The mean duration of surgery was 48.3 ± 12.6 min in group A and 38.9 ± 7.8 min in group B (P < 0.05). The grades of anterior chamber cells and flare were higher in group B than in group A, and the differences were statistically significant (P < 0.05) until the first week only. IOL tilt was found in seven (17.5%) eyes in group A and in two (5%) eyes in group B (P < 0.05). After 6 months, the mean best-corrected visual acuity was 0.82 ± 0.28 in group A and 0.77 ± 0.22 in group B (P > 0.05). Macular edema was found in two (5%) eyes in group A and in five (12.5%) eyes in group B (P < 0.05). Except for two eyes in group B, none of the eyes in either group required antiglaucoma treatment. Conclusion In the absence of adequate capsular support, fixation of posterior chamber foldable IOL by iris suturing is associated with significantly less IOL malposition and consumes a shorter operative time compared with scleral fixation. However, iris suture fixation is associated with a higher incidence of postoperative iridocyclitis in the early postoperative period.

Background/aim The present study aims to compare postoperative endothelial outcome after cataract surgery performed with longitudinal phacoemulsification with that performed with torsional phacoemulsification in patients with senile cataract. Patients and methods In this prospective observational study, 20 eyes with senile cataract of different grades of nuclear hardness underwent phacoemulsification by means of a 2.8-mm clear corneal incision using Ozil IP, 10 of which underwent torsional phacoemulsification and 10 underwent longitudinal phacoemulsification. Central endothelial cell counts were taken in all patients preoperatively, at 1 week, 1 month, and 3 months postoperatively. Results The study included 20 patients with age-related cataract whose ages ranged from 55 to 64 years. There was highly statistically significant endothelial cell loss throughout the study in the two groups and also significant endothelial cell loss between the two groups by the third month (P = 0.02). Conclusion Both torsional and longitudinal phacoemulsification techniques were efficient in removing noncomplicated cataract; however, statistically significant endothelial cell loss was noted, especially with longitudinal phacoemulsification.

Purpose The aim of the present study was to compare the efficacy of full-dose, half-dose photodynamic therapy (PDT) and intravitreal bevacizumab (IVB) injection in treatment of chronic central serous chorioretinopathy (CCSC). Design The current study was retrospective, observational, and comparative in nature. Materials and methods We retrospectively reviewed the medical records of 80 eyes with CCSC in the form of four groups of 20 eyes each: group 1, in which the eyes were treated with full-dose verteporfin PDT (6 mg/m ² ); group 2, in which the eyes were treated with half-dose verteporfin PDT (3 mg/m ² ); group 3, in which the eyes were treated with IVB injection 1.25 mg/0.05 ml; and group 4, in which the eyes were only observed without treatment and therefore served as the control group. The primary outcome was the proportion of eyes with complete resolution of subretinal fluid on the last follow-up. The secondary outcomes included the mean changes in the best-corrected visual acuity, central retinal thickness in optical coherence tomography, and absent leakage in fundus fluorescein angiography from baseline to 12 months. Results Overall, complete resolution of subretinal fluid at 12-month follow-up was achieved in 18 eyes (90.0%) in group 1, 17 eyes (85%) in group 2, nine eyes (45%) in group 3, and five eyes (25%) in group 4. The improvement in best-corrected visual acuity was statistically significant in groups 1 and 2 (P < 0.05), although the difference between them was not statistically significant (P = 0.58). The mean change in central retinal thickness over 12 months from baseline was 122, 118, 70, and 40 μm in group 1, 2, 3 and, 4, respectively. Retreatment were given if persistence or recurrence was noted, with an average of 1.5, 1.4, and 6 retreatment in groups 1, 2, and 3, respectively. Conclusion Half-dose PDT is an alternative treatment in patients with CCSC. It has more efficacy than IVB and observation, and is safer than full-dose PDT. Larger multicenter prospective randomized control study of longer duration of follow-up is recommended.

Aim The aim of this study was to evaluate the efficacy of intravitreal injection of ranibizumab for patients with chronic central serous chorioretinopathy (CCSC). Materials and methods A prospective interventional noncomparative study was conducted on nine patients with CCSC who were treated with an intravitreal injection of ranibizumab once. Visual acuity with Snellen's chart and the foveal thickness were studied before and after the injection. Results The mean age of the patients was 44.3 ± 5.7 years. After 1 month of intravitreal injection, visual acuity improved from 20/120 to 20/30 (P < 0.001). Central retinal thickness improved from 493 ± 76 μm (before injection) to 216 ± 36 μm (1 month after injection) (P < 0.001). None of the cases exhibited relapses. Conclusion Intravitreal injection of ranibizumab can be an optional treatment in patients with CCSC as it leads to an anatomic and functional improvement.

Purpose The aim of this study was to compare the results as regards efficacy, safety, and patient satisfaction between two combined procedures. The first is combined femtosecond laser myoring implantation with cross-linking (CXL) and the second is combined femtosecond laser keraring implantation with CXL for the treatment of keratoconus. Setting The study was conducted in Sohag University Hospital, Sohag University, Egypt. Design This was a prospective nonrandomized clinical comparative study. Patients and methods A total of 46 eyes of 30 patients with keratoconus were included in this study. Group A included 27 eyes of 17 patients that were subjected to combined cross-linking with femtosecond laser myoring implantation, whereas group B included 19 eyes of 13 patients that were subjected to combined cross-linking with femtosecond laser keraring implantation. All eyes were subjected to preoperative and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest refraction, slit-lamp examination of the anterior segment, intraocular pressure, fundus examination, and keratometry and pachymetry assessed with Pentacam corneal topographies at 3 and 6 months of follow-up period. Results In group A, the preoperative mean UCVA was 1.30 ± 0.28 (logMAR ± SD), whereas the postoperative mean UCVA was 0.90 ± 0.12. The preoperative mean BCVA was 0.70 ± 0.23, whereas the postoperative mean BCVA was 0.30 ± 0.17. The preoperative K average was 53.27 ± 0.62 (D ± SD), whereas the postoperative K average was 45.83 ± 0.64. The postoperative astigmatic correction was 1.51 ± 0.42 (D ± SD). In group B, the preoperative mean UCVA was 1.30 ± 0.33, whereas the postoperative mean UCVA was 1 ± 0.16. The preoperative mean BCVA was 0.90 ± 0.46, whereas the postoperative mean BCVA was 0.60 ± 0.32. The preoperative K average was 50.97 ± 0.48, whereas the postoperative K average was 49.01 ± 0.32. The postoperative astigmatic correction was 3.07 ± 0.15. Conclusion This study proved that combined CXL with myoring implantation is effective in the correction of the myopic component of keratoconus. Combined CXL with keraring implantation is effective in the correction of the astigmatic component in keratoconus. The type and the site of keratoconus cone together with the K readings can help in the preoperative decision as to which type of ring is best in each keratoconus case. This study proved that there is a synergistic action when CXL is combined with intracorneal rings (myoring of keraring).

Purpose The aim of the study was to compare the success rates between external and endoscopic dacryocystorhinostomy (DCR) surgery performed for congenital nasolacrimal duct obstruction. Materials and methods Fifty patients with congenital nasolacrimal duct obstruction were recruited and divided into two groups. Group 1 underwent external DCR and group 2 underwent endoscopic DCR. Results Relief from symptoms and endoscopic visualization of the patent stoma were considered indexes of success: 23 patients in group 1 (92%) and 22 patients in group 2 (90%) fulfilled these criteria after 6 months of follow-up. Conclusion Both approaches of pediatric DCR - that is, external and endoscopic - have comparable success rates, although the endoscopic approach has the advantages of avoidance of skin incision, preservation of the pump mechanism, and the ability to address other nasal pathologies at the time of surgery.

Aim of work This work aimed to diagnose any abnormalities in contrast sensitivity and retinal functions in β-thalassemic patients. Patients and methods Thirty patients diagnosed with b-thalassemia were included in this study. Detailed assessment of history and full ophthalmological examination were performed for all our cases. Contrast sensitivity and electroretinogram were performed for all our cases. Results Thirty β-thalassemic patients were included in this study. The mean age of the patients was 37 years; most of our patients were women. The main presenting symptoms were discomfort in night vision. Contrast sensitivity was significantly low in all our cases and electroretinogram showed low scotopic visual sensitivity in 23 cases. Conclusion Ophthalmic follow-up in β-thalassemic patients is mandatory.