Purpose The aim of this study was to determine the prevalence of dry eye disease (DED) in a tertiary ophthalmic outpatient hospital-based clinic in southern Egypt. Patients and methods A cross-sectional, observational, hospital-based study of 3128 patients was conducted at the Ophthalmology Outpatient Clinic of the Sohag University Hospital, Egypt, between January 2011 and August 2013. The participants comprised adult ophthalmic outpatients aged 18 years or older. DED was assessed subjectively with the Ocular Surface Disease Index (OSDI) questionnaire and objectively with Schirmer's test, tear film breakup time (TBUT), and conjunctival/corneal staining. An OSDI score of 22 or more with a TBUT of less than 10 s or Schirmer's test reading of less than 10 mm was considered diagnostic of definite DED. Descriptive and analytical statistics were performed. In all comparisons, P value less than 0.05 was considered to be statistically significant. Results Dry eye disease prevalence was 22.8% in the 3128 patients. DED was significantly more prevalent in patients 45 years or older and in females. An OSDI score more than 22 was found in 55%, TBUT less than 10 s in 44.7%, and Schirmer's test score less than 10 mm in 39.3%. DED symptoms are significantly associated with meibomian gland dysfunction, previous refractive surgery, and diabetes. Definite DED was significantly associated with previous cataract surgery, ocular allergy, pterygium, and diabetes. Conclusion This is the first observational study of DED in southern Egypt on a large sample population. The prevalence of DED among ophthalmic outpatients at Sohag University Hospital, Egypt, was 22.8% depending on both symptoms and signs. Older age patients and females were more susceptible to DED. DED is an existing entity that can compound any eye condition causing incomplete recovery, and therefore high index of suspicion is greatly advised.

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Purpose The purpose of this study was to determine the effect of unilateral large lateral rectus (LR) recession on head turn and horizontal ocular deviation in patients with unilateral exotropic Duane retraction syndrome. Patients and methods This was a prospective, interventional study of 10 consecutive patients with unilateral exotropic Duane retraction syndrome associated with contralateral head turn. All patients underwent large (8.5–10 mm) unilateral LR recession on the affected eye. All patients were followed up for at least 6 months. Preoperative and postoperative ocular deviation, angle of head turn, stereoacuity, and severity of limitation in abduction and adduction were recorded and analyzed. Results Mean head turn decreased from 30.5±9.56° (range, 15°–40°) to 6.5±4.74° (range, 0°–15°) (P<0.001). Mean exotropia decreased from 33.0±6.32 prism diopter (range, 25–45 prism diopter) to 5.7±4.9 prism diopter (range, 0–15 prism diopter) (P<0.001). Mean limitation in adduction decreased from ‒2.8±0.79 to ‒1.6±0.52 (P<0.001). Mean limitation in abduction increased from ‒3.0±1.16 to ‒3.6±0.7 (P=0.024). All patients had variable degrees of stereopsis (ranging between 100 and 800 arcsec, which remain unchanged postoperatively). Conclusion Unilateral large LR recession abolishes or ameliorates the wide scale of head turn and exotropia in unilateral exotropic Duane retraction syndrome with noticeable improvement of defective adduction.

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Purpose The purpose of this study was to compare the results of medial rectus (MR) Faden recession (FR) with MR augmented recession (AR) in the management of large distant–near disparity (DND), in convergenceexcess, partially accommodative esotropia (ET) associated with a high accommodative convergence/accommodation (AC/A) ratio. Patients and methods This is a prospective interventional study of 31 patients with convergence excess partially accommodative ET associated with a high AC/A ratio. Patients were divided into two groups. Group FR, which contains 15 patients who were treated by bimedial FR, and group AR, which contains 16 patients who underwent augmented MR recession based on the angle of near deviation. Surgical success was defined as distant and near ET≤10 prism diopter with shrinkage of high AC/A ratio and high DND. Results Surgical success was achieved in 93.3% of cases in the FR group and in 81.2% of cases in the AR group. In the FR group, mean DND decreased from 33.3±11.5 to 3.06±2.08 prism diopter. For the AR group, mean DND decreased from 25.3±7.1 prism diopter preoperatively to 5.3±2.5 prism diopter postoperatively. The difference between both groups regarding reduction of DND was statistically significant (P<0.05). The mean AC/A ratio decreased from 8.6±2.5 to 2.3±1.3 prism diopter/diopter and from 7.3±1.9 to 2.1±0.9 prism diopter/diopter in the FR and AR groups, respectively, with no statistically significant difference between both groups. Two cases in the AR group with large DND (40 and 50 prism diopter) developed consecutive exotropia. Conclusion Faden recession achieves marginal superior control of DND and high AC/A ratio in convergence excess partially accommodative ET. Augmented recession also works well with the possible development of consecutive exotropia in cases with extremely high DND. This study recommends Augmented recession for cases with mild to moderate DND and Faden recession for cases with extremely large DND.

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Aim The aim of this study was to correlate the visual field changes in the central macular area with the areas of capillary nonperfusion seen in fluorescein angiogram in patients with nonproliferative diabetic retinopathy (NPDR). Patients and methods This study included 40 eyes of 32 patients with NPDR attending the Ophthalmic Outpatient Clinic of El-Minia University Hospital during the period from January 2012 to July 2013. All patients were subjected to automated perimetry using a Topcon perimeter. A full-threshold strategy was applied for the central 10° field (program 10–2) fluorescein angiography using the IMAGE Net 2000 fundus camera. Results This study included 40 eyes of 32 patients between 50 and 70 years of age with a mean of 59.3 ± 7.6 years. Of them, there were 12 (37.5%) male and 20 (62.5%) female patients. All patients were noninsulin-dependent diabetic patients with a mean duration of 16.6 ± 5.4 years; 20 (62.5%) patients were hypertensive and 12 (37.5%) were normotensive. Twenty eyes had a rate of 0 dB corresponding to areas of capillary nonperfusion. Sixteen eyes showed a rate of 0 dB less than the areas of capillary nonperfusion. Four eyes showed relatively good retinal sensitivity (rate of 0 dB = 0) despite the presence of definite areas of capillary nonperfusion. The mean sensitivity in these areas ranged between 10.38 ± 1.47 and 12.91 ± 1.43 dB. Conclusion There is a significant correspondence between macular capillary nonperfusion and central field sensitivity in patients with NPDR.

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Free-floating intraocular cysts can be divided into those occurring in the anterior chamber, those occurring in the retrolental space, and those occurring in the vitreous cavity. The origin of vitreous cysts may be associated with remnants of the hyaloid system (congenital), or can result from trauma or ocular disease. The aim of this study was to assess the impact of free-floating vitreous cyst on the macula using optical coherence tomography, ultrasonography, and fluorescein angiography. A 58-year-old female patient presented for eye examination complaining of annoying movable floaters with glare and difficultly in close works. Ophthalmoscopic examination through the dilated fundus revealed posterior vitreous detachment, unremarkable peripheral retinal degenerations with no abnormalities at the optic disc, the macula or papillomacular bundle, and the anterior segment and pupillary reaction were free. This case report represents a case of free-floating vitreous cyst that has been advised for follow-up until it becomes visually significant, requiring interference either with argon laser cystotomy or aspiration through pars plana vitrectomy.

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Purpose The aim of the study was to assess the accuracy of optical coherence tomography (OCT) (3D OCT-2000) in diagnosing keratoconus by measuring the central corneal thickness and the central curvature radius. Patients and methods In this observational study, 50 patients with keratoconus underwent corneal topography, ultrasound pachymetry, Scheimpflug imaging, and anterior-segment optical coherence tomography (AS-OCT). Results The mean corneal power measured by AS-OCT was 51.65 ± 0.78 D, that measured with corneal topography was 50.19 ± 0.64 D, and that with the Sirius Scheimpflug camera was 50.78 ± 0.82 D. The mean central corneal thickness measured by OCT was 486 ± 73 μm, that measured by ultrasound was 475 ± 49 μm, and that using the Sirius Scheimpflug camera was 481 ± 66 μm. Conclusion 3D OCT-2000 may be a useful alternative for measuring the anterior corneal power and the central corneal thickness in keratoconic eyes.

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Purpose The purpose of this study was to evaluate the success of bicanalicular lacrimal intubation as a primary treatment in cases of epiphora caused by congenital nasolacrimal duct obstruction in children up to 6 years of age. Patients and methods A prospective surgical intervention case series study was carried out in the Ophthalmology Department of Minia University Hospital. Forty-six eyes of 43 children with epiphora (dated since birth or shortly after) were enroled in this study. A bicanalicular lacrimal silicon tube was introduced through the nasolacrimal duct to the nose. Results In this study, the primary lacrimal intubation was successful in 40 eyes out of 46 eyes (87%). For children aged 1–2 years, primary intubation was successful in 22 eyes out of 24 (91.6%), and for those aged 2–4 years it was successful in 12 eyes out of 14 (85.7%). On the other hand, for children aged between 4 and 6 years, the procedure was less successful: six eyes out of eight (75%). Improvement of symptoms occurred in two eyes out of four (50%) when the tubes were removed early, and this rate increased to 90.9% in 20 out of 22 eyes when the tubes were retained for up to 3–6 months and to 90% in 18 out of 20 eyes when the tubes were retained for up to 6–12 months. Conclusion Bicanalicular lacrimal intubation is a successful treatment for children with nasolacrimal duct obstruction, and the younger the age of the children the higher the success rate.

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Introduction Low-cost intraocular lenses (IOLs) have been used in developing countries for many years. In a recent randomized trial, they were found comparable to high-end IOLs in terms of safety, visual outcomes, and posterior capsule opacification (PCO) formation. Our team observed occasional significant refractive changes following Nd:YAG capsulotomy for patients implanted with these IOLs. We aimed to assess the changes in refraction and the anterior chamber (AC) depth induced by Nd:YAG capsulotomy for PCO following implantation of a low-cost IOL. Patients and methods This prospective study was conducted on a cohort of sequential patients with PCO following uncomplicated phacoemulsification and implant of in-the-bag low-cost IOL. Changes in refraction (spherical equivalence, cylinder power, and cylinder axis) were assessed by means of subjective verification of autorefraction. Changes in AC depth were assessed by means of ultrasound biomicroscopy. Changes in cylinder power and axis were included to assess IOL tilt. Results A total of 50 consecutive eyes were enrolled. However, five eyes of three patients were lost to follow-up. A total of 45 eyes of 36 patients completed the pre-YAG and post-YAG assessments. An overall 66.7% of patients were female. An overall 25% had bilateral capsulotomy. The mean age at capsulotomy was 62.4±7.46 years. The mean duration since cataract extraction was 13.3±17.15 months. The mean IOL power was 20.4±2.43 D. No significant changes were found in spherical equivalence, axis of cylinder, and AC depth. However, a significant change in the cylinder power (mean change: 0.36±0.93 D, P=0.039) was observed. Conclusion Our study adds further confirmation on low-cost IOLs being a suitable alternative to high-end IOLs in developing countries and in outreach settings.

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Purpose The aim of this work was to study and compare the safety and efficacy of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification cataract extraction on the corneal endothelial cell count. Design The study design was a prospective, comparative one. Participants and methods Fifty eyes underwent femtosecond laser-assisted cataract surgery and 50 eyes underwent conventional phacoemulsification between March 2014 and December 2014 at Ain-Shams University Hospitals and Magrabi Eye Institutes. In each group, 50 eyes (50 patients) underwent cataract surgery using either femtosecond laser-assisted (Alcon LenSx Laser) (the femtolaser group) or conventional phacoemulsification (the phaco group). Femtosecond laser-assisted cataract surgery involved anterior capsulotomy and lens fragmentation based on optical coherence tomography-guided treatment mapping. Conventional procedure involved manual continuous curvilinear capsulorrhexis. Both procedures were completed by means of standard phacoemulsification and insertion of an intraocular lens. Endothelial cell count was measured with a NIDEK Specular Microscopy (CEM-530) preoperatively, and at 1 day, 1 week, and 1 month postoperatively. Main outcome measures included effective phacoemulsification time, intraoperative complication rates, and corneal endothelial cell count. Results Effective phacoemulsification time was reduced by 38% in the femtolaser group (P < 0.0001). All cases treated with the femtosecond laser achieved complete capsulotomy. There was one posterior capsule rupture in the femto group and two in the phaco group (0.5%; not significant). There was no statistically significant difference as regards intraoperative complications between the two groups. Postoperatively, there was a significant decrease in central corneal endothelial cell count in both groups compared with preoperative values. The endothelial cell count was significantly higher in the femtolaser group at 1 day, 1 week, and 1 month follow-up. Conclusion Femtosecond laser-assisted cataract surgery appears to be as safe as conventional cataract surgery, with lower effective phacoemulsification time and hence less corneal endothelial cell loss.

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