Background. Diabetic macular edema (DME) is a major cause of vision loss in diabetics that is cur... more Background. Diabetic macular edema (DME) is a major cause of vision loss in diabetics that is currently mainly treated by antivascular endothelial growth factor (VEGF) agents. The effect of these agents on macular perfusion (MP) is a current concern. Optical coherence tomography angiography (OCTA) is an imaging modality that allows noninvasive high-resolution retinal microvasculature imaging. Several recent studies evaluated the effect of anti-VEGF agents on the MP of DME patients using OCTA. Our aim is to provide a systematic review of these studies. Methods. Multiple databases were searched including PubMed, Ovid Medline, EMBASE, and Google Scholar for relevant studies published between January 2016 and November 2020 which were included in this review. Studies were compared regarding their design, the number of included patients, the machine and scanning protocol used, the inclusion and exclusion criteria, the number of injections given, the type of anti-VEGF agent used, the outco...
We read with great interest a recent article published by Raina et al. in your journal regarding ... more We read with great interest a recent article published by Raina et al. in your journal regarding the occurrence of 5-fluorouracil associated optic neuropathy in the context of treatment of a case of metastatic colorectal cancer. I too (the first author) have recently reported a similar case of optic neuropathy associated with 5fluorouracil therapy. In the beginning, we would like to congratulate the authors on their diagnosis and management of this difficult case; however, we have several comments regarding their article. First, the authors’ provisional diagnosis for the case was right optic neuritis although the patient presented with severe generalized constriction of his right visual field rather than a central or centrocecal scotoma which would have been more characteristic of an optic neuritis. Second, since the fundus examination was normal, a more accurate diagnosis would have been a retrobulbar or posterior optic neuritis. The magnetic resonance imaging (MRI) of the patient’s orbit with gadolinium, however, as the authors have indicated, did not reveal any enhancement of the optic nerve which was also against the diagnosis of retrobulbar optic neuritis, and should have prompted the authors to seek an alternative explanation for the patient’s presentation since MRI with gadolinium shows the intrinsic optic neuritis lesion in 95% of the cases. A fundus fluorescein angiography, for example, could have probably helped in the differential diagnosis of the condition by demonstrating either leakage in case of optic neuritis, or hypoperfusion in case of ischemic optic neuropathy which the authors later mentioned in the article as another possible cause of the neuropathy in this case. Third, the dramatic improvement of the field defect following corticosteroid therapy may have been the result of resolution of the vasospasm of the posterior ciliary arteries following the cessation of 5-fluorouracil therapy rather than due to an effect of treatment. Finally, the authors concluded that the possible cause of optic neuropathy in their case is probably related to ischemia caused by vasospasm from the 5-fluorouracil which indicates a diagnosis of either anterior or posterior ischemic optic neuropathy and not optic neuritis.
Harlequin syndrome is a condition characterized by autonomic dysfunction leading to hemifacial fl... more Harlequin syndrome is a condition characterized by autonomic dysfunction leading to hemifacial flushing on one side with pallor and impaired sweating on the other side. It is a rare condition that can be both congenital and acquired, with congenital cases being rarer, comprising ∼6% of all Harlequin syndrome cases. Harlequin syndrome is usually associated with other autonomic disturbances including Horner syndrome especially when presenting as a congenital condition. We reported the findings of a rare case of concomitant congenital Horner and Harlequin syndromes in an otherwise healthy 4-month-old male infant patient and provided a review of the current literature.
ABSTRACT A 61-year-old male presents with diplopia of acute onset and progressive course. He has ... more ABSTRACT A 61-year-old male presents with diplopia of acute onset and progressive course. He has a history of previous intracranial haemorrhage that was surgically evacuated 7 years ago and was also associated with diplopia. Examination revealed left complete oculomotor nerve paralysis with a fixed and dilated left pupil. Computed tomography (CT) revealed encephalomalacia, evidence of previous craniotomy, and an incidental left parietal convexity meningioma. CT angiography of the brain revealed a left tortuous duplicate middle cerebral artery with fenestration of its proximal part, an anterior communicating artery aneurysm, and a characteristic capillary blush of the meningioma. Possible mechanisms of oculomotor nerve involvement are discussed.
ABSTRACT A 43-year-old female is referred to our clinic for evaluation of an incidentally discove... more ABSTRACT A 43-year-old female is referred to our clinic for evaluation of an incidentally discovered unilateral papilledema in her right eye of unknown cause. She had no past ocular or medical history. Examination revealed a corrected-distance visual acuity of 20/20 in both eyes. Posterior segment examination showed an elevated right optic nerve head with blurred edges. Ultrasonography failed to reveal optic disc drusen. Visual field testing showed enlargement of the blind spot in the right eye. Magnetic resonance imaging of the brain and orbit was done and revealed enlargement of the intracanalicular and prechiasmatic part of the right optic nerve and a diagnosis of a presumed right intracanalicular optic nerve sheath meningioma was made. She was managed conservatively and several years later remains asymptomatic.
A 22-year-old female presented with gradually progressive blurring of vision for 3 weeks. She als... more A 22-year-old female presented with gradually progressive blurring of vision for 3 weeks. She also complained of continuous headaches and nausea that preceded the diminution of vision. The headaches were present all day and increased with straining and leaning forwards. She had no past ocular or medical history and was only taking acetaminophen for the headaches which provided minimal relief. Examination revealed a corrected distance visual acuity (CDVA) of 20/40 bilaterally. External ocular examination and pupillary exam were normal. Color vision testing was 16/20 in the right eye and 17/20 in the left using Ishihara plates. Anterior segment exam was unremarkable while posterior segment exam revealed bilateral grade IV papilledema (Frisén scale). Visual field testing showed enlargement of the blind spot with generalized field depression in both eyes. Magnetic resonance (MR) imaging of the brain and orbit revealed distended optic nerve sheaths while MR venography was normal. Lumbar puncture revealed a cerebrospinal fluid (CSF) opening pressure of 36 cm H2O with normal composition. The patient was diagnosed with idiopathic intracranial hypertension (IIH). She had a body mass index of 32 and so was strongly advised to lose weight. She also received medical treatment in the form of oral acetazolamide tablets for 1 month but did not tolerate its systemic side effects and so consented to perform optic nerve sheath fenestration (ONSF) in the right eye to prevent further vision loss in both eyes. Before the operation, optical coherence tomography (OCT) (Optos OCT SLO, Optos, Scotland, UK) of the optic nerve head (ONH) was done bilaterally and showed swelling of the peripapillary retinal nerve fiber layer (RNFL) compared to age-matched normative data with enlargement of the optic disc area (Fig. 1a, b). Right ONSF was performed through the medial transconjunctival orbital approach. Briefly, following a localized medial periotomy, the medial rectus muscle was disinserted on 6-0 Vicryl sutures and retracted, then the optic nerve sheath was exposed and multiple longitudinal slits were successfully done in the optic nerve sheath which was accompanied by a CSF gush and collapse of the dural sheath. The rectus muscle was then reinserted, and the conjunctiva closed. Postoperatively, the patient was prescribed topical antibiotic and steroid eye drops as well as an oral antibiotic. One month following the procedure, CDVA improved to 20/20 in the right eye and 20/30 in the left, color vision improved to 17/20 in the right eye and 18/20 in the left, and OCT showed a decrease of the peripapillary RNFL thickness to within normal limits in both eyes with decreased optic disc area (Fig. 1c, d). A follow-up after 3 months revealed continued stabilization of the condition. IIH is a condition characterized by increased intracranial tension without the presence of an intracranial mass lesion and with normal CSF composition [1]. It is more common in young obese females who frequently complain of transient visual obscurations, headaches, and tinnitus [2]. Papilledema is the main sign of IIH, and patients are at risk of developing optic atrophy if left untreated [3]. Treatment can be either medical or surgical depending on several factors including the severity and extent of the disease. The diagnosis and evaluation of papilledema has been mainly subjective and qualitative using clinical examination; however, OCT is a non-invasive imaging modality with very high axial resolution (up to 5 μm) which can obtain optical sections resembling histological sections using interferometry that has been successfully used to provide reliable objective and quantitative assessment of the severity of papilledema [4–6]. This is done by measuring the thickness of the peripapillary RNFL by comparing, interferometrically, the light reflected from the RNFL with light that traveled a known reference path * Ayman G. Elnahry ayman_elnahri@hotmail.com
Background: Diabetic macular edema (DME) is a major cause of vision loss in diabetics worldwide. ... more Background: Diabetic macular edema (DME) is a major cause of vision loss in diabetics worldwide. Anti-vascular endothelial growth factor (anti-VEGF) agents have become the mainstay of treatment of vision loss due to DME. Long-term effects of these agents on the macular perfusion (MP) are a current concern. Objective: To review recently published studies that evaluated the effect of intravitreal injection of anti-VEGF agents on the MP of diabetics with DME. Methods: Different databases were searched including PubMed, Medline, Ovid, Science Direct, and Google Scholar for relevant studies published between 2010 and 2019. All studies found were compared regarding methodology and results and included in this review. Some studies relating to retinal perfusion in general and not strictly MP were also included for comprehensiveness. Results: Several studies utilizing different anti-VEGF agents were identified. All the large randomized controlled clinical trials identified utilized primarily...
Background: In the current coronavirus disease 2019 (COVID-19) pandemic, health systems are strug... more Background: In the current coronavirus disease 2019 (COVID-19) pandemic, health systems are struggling to prioritize care for affected patients, however, physicians globally are also attempting to maintain care for other lessthreatening medical conditions that may lead to permanent disabilities if untreated. Idiopathic intracranial hypertension (IIH) is a relatively common condition affecting young females that could lead to permanent blindness if not properly treated. In this article, we provide some insight and recommendations regarding the management of IIH during the pandemic. Methods: The diagnosis, follow-up, and treatment methods of IIH during the COVID-19 pandemic period are reviewed. COVID-19 as a mimic of IIH is also discussed. Results: Diagnosis and follow-up of papilledema due to IIH during the COVID-19 pandemic can be facilitated by nonmydriatic fundus photography and optical coherence tomography. COVID-19 may mimic IIH by presenting as cerebral venous sinus thrombosis,...
Acute idiopathic maculopathy (AIM) was first described as a solitary unilateral retinal pigment e... more Acute idiopathic maculopathy (AIM) was first described as a solitary unilateral retinal pigment epithelial (RPE) lesion with associated neurosensory detachment of the macula that follows a flu-like illness in otherwise healthy young adults. It was thought to result from an inflammatory or infectious process that affects the RPE cells and leads to the breakdown of the outer blood–retinal barrier. Some cases were later associated with Coxsackie virus infection [1, 2]. Clinically, there is a localized retinal detachment with underlying grayish RPE thickening. In some cases, it is eccentric to the foveal center with resultant better visual acuity [2]. Optical coherence tomography (OCT) is useful in diagnosis and shows heterogenous hyperreflectivity with thickening at the level of the RPE [3]. Differential diagnosis includes choroidal neovascularization and central serous chorioretinopathy. We report a patient with biopsy-proven intracranial tuberculomas who developed AIM while being successfully treated with anti-tuberculous therapy. To the best of our knowledge, this is the first report of an association between AIM and tuberculosis.
Abdominal sarcoidosis presenting as bilateral simultaneous optic disc granulomas, 2019
A 24-year-old male presents with diminution of vision in both eyes of acute onset with floaters. ... more A 24-year-old male presents with diminution of vision in both eyes of acute onset with floaters. He has a history of fever of unknown origin. Examination revealed bilateral optic disc granulomas with mild vitritis. Serum angiotensin converting enzyme was found to be elevated and tuberculin skin test was negative. Computed tomography scan of the chest showed clear lung fields with no hilar lymphadenopathy but mildly enlarged pretracheal lymph nodes. Computed tomography scan of the abdomen revealed multiple enlarged abdominal lymph nodes with hepatosplenomegaly, and ultrasound-guided biopsy of one of these lymph nodes showed chronic granulomatous inflammation consistent with sarcoidosis. Immunosuppressive therapy resulted in resolution of ocular inflammation with no recurrence.
REVERSIBLE NEUROTROPHIC KERATOPATHY ASSOCIATED WITH ROSUVASTATIN THERAPY: A CASE REPORT, 2019
Background Rosuvastatin is a 3-hydroxy-3-methyl-glutaryl-CoA reductase enzyme inhibitor that is i... more Background Rosuvastatin is a 3-hydroxy-3-methyl-glutaryl-CoA reductase enzyme inhibitor that is in wide use with few reported ocular adverse events. Objectives To report a case of bilateral neurotrophic keratopathy associated with rosuvastatin therapy that dramatically improved following drug discontinuation. Case presentation A 65-year-old female presented with painless diminution of vision in both eyes of gradual onset and progressive course for 1 month. She had recently started rosuvastatin therapy for hyperlipidemia. Examination revealed bilateral stage 2 neurotrophic keratopathy with impaired corneal sensation which was previously resistant to conservative ulcer treatment. Following discontinuation of rosuvastatin therapy, there was dramatic bilateral improvement in corneal sensation, size of the corneal ulcers, and visual acuity. Conclusion Rosuvastatin may result in reversible trigeminal nerve impairment and neurotrophic keratopathy.
ABSTRACT Bilateral intracavernous internal carotid artery aneurysms are rare. They are more commo... more ABSTRACT Bilateral intracavernous internal carotid artery aneurysms are rare. They are more common in elderly females and are associated with hypertension. We present the computed tomography angiography findings of an 81-year-old female with history of hypertension who came complaining of diplopia and headache. Examination revealed bilateral sixth nerve palsy with left third nerve palsy. External ocular examination was normal. Computed tomography angiography was done and revealed bilateral intracavernous internal carotid artery aneurysms. She was referred to neurosurgery for further management.
Cataract is the leading cause of reversible blindness in developing countries, with variable visu... more Cataract is the leading cause of reversible blindness in developing countries, with variable visual outcome following surgery. This work aims at assessing the outcomes of cataract surgery at Kasr Al Ainy Hospital and identifying the reasons for borderline and poor outcome in the studied group. A total of 150 eyes of patients with cataract and no other ocular pathology were included in this study. Uncorrected visual acuity (UCVA) and corrected visual acuity (CVA), complete ocular examination using slit-lamp, applanation tonometry, and ophthalmoscopy were performed for all patients. Biometry for intraocular lens power calculation and operative data were recorded. Patients were followed for 6 weeks; UCVA, CVA, and any complications were noted. Mean preoperative CVA was 0.16 ± 0.16 (SD) and mean postoperative CVA was 0.66 ± 0.33 (p<0.001). Forty-two percent of surgeries were performed by junior staff under training. Thirty-five surgeries were complicated by posterior capsular rupture...
Clinical and Imaging Findings One Year Following Traumatic Chiasm Transection, 2019
Traumatic chiasm transection is a rare condition characterized by bitemporal hemianopsia followin... more Traumatic chiasm transection is a rare condition characterized by bitemporal hemianopsia following head trauma. In a study of visual complications following head trauma, only 4.4% of patients suffered from chiasmal injuries. Complete transection of the chiasm is even more rare and best visualized using magnetic resonance imaging (MRI). We report the one year follow-up of clinical, visual field, and MRI findings of a patient with complete transection of the optic chiasm following head trauma.
Cataract is the leading cause of reversible blindness in developing countries, with variable visu... more Cataract is the leading cause of reversible blindness in developing countries, with variable visual outcome following surgery. This work aims at assessing the outcomes of cataract surgery at Kasr Al Ainy Hospital and identifying the reasons for borderline and poor outcome in the studied group. A total of 150 eyes of patients with cataract and no other ocular pathology were included in this study. Uncorrected visual acuity (UCVA) and corrected visual acuity (CVA), complete ocular examination using slit-lamp, applanation tonometry, and ophthalmoscopy were performed for all patients. Biometry for intraocular lens power calculation and operative data were recorded. Patients were followed for 6 weeks; UCVA, CVA, and any complications were noted. Mean preoperative CVA was 0.16 ± 0.16 (SD) and mean postoperative CVA was 0.66 ± 0.33 (p&amp;amp;lt;0.001). Forty-two percent of surgeries were performed by junior staff under training. Thirty-five surgeries were complicated by posterior capsular rupture. Mean CVA at 6 weeks in the uncomplicated group was 0.77 ± 0.22; in the complicated group, 0.28 ± 0.34 (p&amp;amp;lt;0.001). Biometry was accurate in 51.6% of cases. Most important causes for suboptimal outcome were aphakia, astigmatism, posterior capsular opacification, and corneal edema. Kasr Al Ainy Hospital achieved CVA 6/9 or more in 69.3% and CVA 6/18 or more in 81.3% of patients. The capsular complication rate was high at 23.3%. The high complication rate is attributed to the nature of the teaching hospital where most surgeons were in their learning periods.
Background. Diabetic macular edema (DME) is a major cause of vision loss in diabetics that is cur... more Background. Diabetic macular edema (DME) is a major cause of vision loss in diabetics that is currently mainly treated by antivascular endothelial growth factor (VEGF) agents. The effect of these agents on macular perfusion (MP) is a current concern. Optical coherence tomography angiography (OCTA) is an imaging modality that allows noninvasive high-resolution retinal microvasculature imaging. Several recent studies evaluated the effect of anti-VEGF agents on the MP of DME patients using OCTA. Our aim is to provide a systematic review of these studies. Methods. Multiple databases were searched including PubMed, Ovid Medline, EMBASE, and Google Scholar for relevant studies published between January 2016 and November 2020 which were included in this review. Studies were compared regarding their design, the number of included patients, the machine and scanning protocol used, the inclusion and exclusion criteria, the number of injections given, the type of anti-VEGF agent used, the outco...
We read with great interest a recent article published by Raina et al. in your journal regarding ... more We read with great interest a recent article published by Raina et al. in your journal regarding the occurrence of 5-fluorouracil associated optic neuropathy in the context of treatment of a case of metastatic colorectal cancer. I too (the first author) have recently reported a similar case of optic neuropathy associated with 5fluorouracil therapy. In the beginning, we would like to congratulate the authors on their diagnosis and management of this difficult case; however, we have several comments regarding their article. First, the authors’ provisional diagnosis for the case was right optic neuritis although the patient presented with severe generalized constriction of his right visual field rather than a central or centrocecal scotoma which would have been more characteristic of an optic neuritis. Second, since the fundus examination was normal, a more accurate diagnosis would have been a retrobulbar or posterior optic neuritis. The magnetic resonance imaging (MRI) of the patient’s orbit with gadolinium, however, as the authors have indicated, did not reveal any enhancement of the optic nerve which was also against the diagnosis of retrobulbar optic neuritis, and should have prompted the authors to seek an alternative explanation for the patient’s presentation since MRI with gadolinium shows the intrinsic optic neuritis lesion in 95% of the cases. A fundus fluorescein angiography, for example, could have probably helped in the differential diagnosis of the condition by demonstrating either leakage in case of optic neuritis, or hypoperfusion in case of ischemic optic neuropathy which the authors later mentioned in the article as another possible cause of the neuropathy in this case. Third, the dramatic improvement of the field defect following corticosteroid therapy may have been the result of resolution of the vasospasm of the posterior ciliary arteries following the cessation of 5-fluorouracil therapy rather than due to an effect of treatment. Finally, the authors concluded that the possible cause of optic neuropathy in their case is probably related to ischemia caused by vasospasm from the 5-fluorouracil which indicates a diagnosis of either anterior or posterior ischemic optic neuropathy and not optic neuritis.
Harlequin syndrome is a condition characterized by autonomic dysfunction leading to hemifacial fl... more Harlequin syndrome is a condition characterized by autonomic dysfunction leading to hemifacial flushing on one side with pallor and impaired sweating on the other side. It is a rare condition that can be both congenital and acquired, with congenital cases being rarer, comprising ∼6% of all Harlequin syndrome cases. Harlequin syndrome is usually associated with other autonomic disturbances including Horner syndrome especially when presenting as a congenital condition. We reported the findings of a rare case of concomitant congenital Horner and Harlequin syndromes in an otherwise healthy 4-month-old male infant patient and provided a review of the current literature.
ABSTRACT A 61-year-old male presents with diplopia of acute onset and progressive course. He has ... more ABSTRACT A 61-year-old male presents with diplopia of acute onset and progressive course. He has a history of previous intracranial haemorrhage that was surgically evacuated 7 years ago and was also associated with diplopia. Examination revealed left complete oculomotor nerve paralysis with a fixed and dilated left pupil. Computed tomography (CT) revealed encephalomalacia, evidence of previous craniotomy, and an incidental left parietal convexity meningioma. CT angiography of the brain revealed a left tortuous duplicate middle cerebral artery with fenestration of its proximal part, an anterior communicating artery aneurysm, and a characteristic capillary blush of the meningioma. Possible mechanisms of oculomotor nerve involvement are discussed.
ABSTRACT A 43-year-old female is referred to our clinic for evaluation of an incidentally discove... more ABSTRACT A 43-year-old female is referred to our clinic for evaluation of an incidentally discovered unilateral papilledema in her right eye of unknown cause. She had no past ocular or medical history. Examination revealed a corrected-distance visual acuity of 20/20 in both eyes. Posterior segment examination showed an elevated right optic nerve head with blurred edges. Ultrasonography failed to reveal optic disc drusen. Visual field testing showed enlargement of the blind spot in the right eye. Magnetic resonance imaging of the brain and orbit was done and revealed enlargement of the intracanalicular and prechiasmatic part of the right optic nerve and a diagnosis of a presumed right intracanalicular optic nerve sheath meningioma was made. She was managed conservatively and several years later remains asymptomatic.
A 22-year-old female presented with gradually progressive blurring of vision for 3 weeks. She als... more A 22-year-old female presented with gradually progressive blurring of vision for 3 weeks. She also complained of continuous headaches and nausea that preceded the diminution of vision. The headaches were present all day and increased with straining and leaning forwards. She had no past ocular or medical history and was only taking acetaminophen for the headaches which provided minimal relief. Examination revealed a corrected distance visual acuity (CDVA) of 20/40 bilaterally. External ocular examination and pupillary exam were normal. Color vision testing was 16/20 in the right eye and 17/20 in the left using Ishihara plates. Anterior segment exam was unremarkable while posterior segment exam revealed bilateral grade IV papilledema (Frisén scale). Visual field testing showed enlargement of the blind spot with generalized field depression in both eyes. Magnetic resonance (MR) imaging of the brain and orbit revealed distended optic nerve sheaths while MR venography was normal. Lumbar puncture revealed a cerebrospinal fluid (CSF) opening pressure of 36 cm H2O with normal composition. The patient was diagnosed with idiopathic intracranial hypertension (IIH). She had a body mass index of 32 and so was strongly advised to lose weight. She also received medical treatment in the form of oral acetazolamide tablets for 1 month but did not tolerate its systemic side effects and so consented to perform optic nerve sheath fenestration (ONSF) in the right eye to prevent further vision loss in both eyes. Before the operation, optical coherence tomography (OCT) (Optos OCT SLO, Optos, Scotland, UK) of the optic nerve head (ONH) was done bilaterally and showed swelling of the peripapillary retinal nerve fiber layer (RNFL) compared to age-matched normative data with enlargement of the optic disc area (Fig. 1a, b). Right ONSF was performed through the medial transconjunctival orbital approach. Briefly, following a localized medial periotomy, the medial rectus muscle was disinserted on 6-0 Vicryl sutures and retracted, then the optic nerve sheath was exposed and multiple longitudinal slits were successfully done in the optic nerve sheath which was accompanied by a CSF gush and collapse of the dural sheath. The rectus muscle was then reinserted, and the conjunctiva closed. Postoperatively, the patient was prescribed topical antibiotic and steroid eye drops as well as an oral antibiotic. One month following the procedure, CDVA improved to 20/20 in the right eye and 20/30 in the left, color vision improved to 17/20 in the right eye and 18/20 in the left, and OCT showed a decrease of the peripapillary RNFL thickness to within normal limits in both eyes with decreased optic disc area (Fig. 1c, d). A follow-up after 3 months revealed continued stabilization of the condition. IIH is a condition characterized by increased intracranial tension without the presence of an intracranial mass lesion and with normal CSF composition [1]. It is more common in young obese females who frequently complain of transient visual obscurations, headaches, and tinnitus [2]. Papilledema is the main sign of IIH, and patients are at risk of developing optic atrophy if left untreated [3]. Treatment can be either medical or surgical depending on several factors including the severity and extent of the disease. The diagnosis and evaluation of papilledema has been mainly subjective and qualitative using clinical examination; however, OCT is a non-invasive imaging modality with very high axial resolution (up to 5 μm) which can obtain optical sections resembling histological sections using interferometry that has been successfully used to provide reliable objective and quantitative assessment of the severity of papilledema [4–6]. This is done by measuring the thickness of the peripapillary RNFL by comparing, interferometrically, the light reflected from the RNFL with light that traveled a known reference path * Ayman G. Elnahry ayman_elnahri@hotmail.com
Background: Diabetic macular edema (DME) is a major cause of vision loss in diabetics worldwide. ... more Background: Diabetic macular edema (DME) is a major cause of vision loss in diabetics worldwide. Anti-vascular endothelial growth factor (anti-VEGF) agents have become the mainstay of treatment of vision loss due to DME. Long-term effects of these agents on the macular perfusion (MP) are a current concern. Objective: To review recently published studies that evaluated the effect of intravitreal injection of anti-VEGF agents on the MP of diabetics with DME. Methods: Different databases were searched including PubMed, Medline, Ovid, Science Direct, and Google Scholar for relevant studies published between 2010 and 2019. All studies found were compared regarding methodology and results and included in this review. Some studies relating to retinal perfusion in general and not strictly MP were also included for comprehensiveness. Results: Several studies utilizing different anti-VEGF agents were identified. All the large randomized controlled clinical trials identified utilized primarily...
Background: In the current coronavirus disease 2019 (COVID-19) pandemic, health systems are strug... more Background: In the current coronavirus disease 2019 (COVID-19) pandemic, health systems are struggling to prioritize care for affected patients, however, physicians globally are also attempting to maintain care for other lessthreatening medical conditions that may lead to permanent disabilities if untreated. Idiopathic intracranial hypertension (IIH) is a relatively common condition affecting young females that could lead to permanent blindness if not properly treated. In this article, we provide some insight and recommendations regarding the management of IIH during the pandemic. Methods: The diagnosis, follow-up, and treatment methods of IIH during the COVID-19 pandemic period are reviewed. COVID-19 as a mimic of IIH is also discussed. Results: Diagnosis and follow-up of papilledema due to IIH during the COVID-19 pandemic can be facilitated by nonmydriatic fundus photography and optical coherence tomography. COVID-19 may mimic IIH by presenting as cerebral venous sinus thrombosis,...
Acute idiopathic maculopathy (AIM) was first described as a solitary unilateral retinal pigment e... more Acute idiopathic maculopathy (AIM) was first described as a solitary unilateral retinal pigment epithelial (RPE) lesion with associated neurosensory detachment of the macula that follows a flu-like illness in otherwise healthy young adults. It was thought to result from an inflammatory or infectious process that affects the RPE cells and leads to the breakdown of the outer blood–retinal barrier. Some cases were later associated with Coxsackie virus infection [1, 2]. Clinically, there is a localized retinal detachment with underlying grayish RPE thickening. In some cases, it is eccentric to the foveal center with resultant better visual acuity [2]. Optical coherence tomography (OCT) is useful in diagnosis and shows heterogenous hyperreflectivity with thickening at the level of the RPE [3]. Differential diagnosis includes choroidal neovascularization and central serous chorioretinopathy. We report a patient with biopsy-proven intracranial tuberculomas who developed AIM while being successfully treated with anti-tuberculous therapy. To the best of our knowledge, this is the first report of an association between AIM and tuberculosis.
Abdominal sarcoidosis presenting as bilateral simultaneous optic disc granulomas, 2019
A 24-year-old male presents with diminution of vision in both eyes of acute onset with floaters. ... more A 24-year-old male presents with diminution of vision in both eyes of acute onset with floaters. He has a history of fever of unknown origin. Examination revealed bilateral optic disc granulomas with mild vitritis. Serum angiotensin converting enzyme was found to be elevated and tuberculin skin test was negative. Computed tomography scan of the chest showed clear lung fields with no hilar lymphadenopathy but mildly enlarged pretracheal lymph nodes. Computed tomography scan of the abdomen revealed multiple enlarged abdominal lymph nodes with hepatosplenomegaly, and ultrasound-guided biopsy of one of these lymph nodes showed chronic granulomatous inflammation consistent with sarcoidosis. Immunosuppressive therapy resulted in resolution of ocular inflammation with no recurrence.
REVERSIBLE NEUROTROPHIC KERATOPATHY ASSOCIATED WITH ROSUVASTATIN THERAPY: A CASE REPORT, 2019
Background Rosuvastatin is a 3-hydroxy-3-methyl-glutaryl-CoA reductase enzyme inhibitor that is i... more Background Rosuvastatin is a 3-hydroxy-3-methyl-glutaryl-CoA reductase enzyme inhibitor that is in wide use with few reported ocular adverse events. Objectives To report a case of bilateral neurotrophic keratopathy associated with rosuvastatin therapy that dramatically improved following drug discontinuation. Case presentation A 65-year-old female presented with painless diminution of vision in both eyes of gradual onset and progressive course for 1 month. She had recently started rosuvastatin therapy for hyperlipidemia. Examination revealed bilateral stage 2 neurotrophic keratopathy with impaired corneal sensation which was previously resistant to conservative ulcer treatment. Following discontinuation of rosuvastatin therapy, there was dramatic bilateral improvement in corneal sensation, size of the corneal ulcers, and visual acuity. Conclusion Rosuvastatin may result in reversible trigeminal nerve impairment and neurotrophic keratopathy.
ABSTRACT Bilateral intracavernous internal carotid artery aneurysms are rare. They are more commo... more ABSTRACT Bilateral intracavernous internal carotid artery aneurysms are rare. They are more common in elderly females and are associated with hypertension. We present the computed tomography angiography findings of an 81-year-old female with history of hypertension who came complaining of diplopia and headache. Examination revealed bilateral sixth nerve palsy with left third nerve palsy. External ocular examination was normal. Computed tomography angiography was done and revealed bilateral intracavernous internal carotid artery aneurysms. She was referred to neurosurgery for further management.
Cataract is the leading cause of reversible blindness in developing countries, with variable visu... more Cataract is the leading cause of reversible blindness in developing countries, with variable visual outcome following surgery. This work aims at assessing the outcomes of cataract surgery at Kasr Al Ainy Hospital and identifying the reasons for borderline and poor outcome in the studied group. A total of 150 eyes of patients with cataract and no other ocular pathology were included in this study. Uncorrected visual acuity (UCVA) and corrected visual acuity (CVA), complete ocular examination using slit-lamp, applanation tonometry, and ophthalmoscopy were performed for all patients. Biometry for intraocular lens power calculation and operative data were recorded. Patients were followed for 6 weeks; UCVA, CVA, and any complications were noted. Mean preoperative CVA was 0.16 ± 0.16 (SD) and mean postoperative CVA was 0.66 ± 0.33 (p<0.001). Forty-two percent of surgeries were performed by junior staff under training. Thirty-five surgeries were complicated by posterior capsular rupture...
Clinical and Imaging Findings One Year Following Traumatic Chiasm Transection, 2019
Traumatic chiasm transection is a rare condition characterized by bitemporal hemianopsia followin... more Traumatic chiasm transection is a rare condition characterized by bitemporal hemianopsia following head trauma. In a study of visual complications following head trauma, only 4.4% of patients suffered from chiasmal injuries. Complete transection of the chiasm is even more rare and best visualized using magnetic resonance imaging (MRI). We report the one year follow-up of clinical, visual field, and MRI findings of a patient with complete transection of the optic chiasm following head trauma.
Cataract is the leading cause of reversible blindness in developing countries, with variable visu... more Cataract is the leading cause of reversible blindness in developing countries, with variable visual outcome following surgery. This work aims at assessing the outcomes of cataract surgery at Kasr Al Ainy Hospital and identifying the reasons for borderline and poor outcome in the studied group. A total of 150 eyes of patients with cataract and no other ocular pathology were included in this study. Uncorrected visual acuity (UCVA) and corrected visual acuity (CVA), complete ocular examination using slit-lamp, applanation tonometry, and ophthalmoscopy were performed for all patients. Biometry for intraocular lens power calculation and operative data were recorded. Patients were followed for 6 weeks; UCVA, CVA, and any complications were noted. Mean preoperative CVA was 0.16 ± 0.16 (SD) and mean postoperative CVA was 0.66 ± 0.33 (p&amp;amp;lt;0.001). Forty-two percent of surgeries were performed by junior staff under training. Thirty-five surgeries were complicated by posterior capsular rupture. Mean CVA at 6 weeks in the uncomplicated group was 0.77 ± 0.22; in the complicated group, 0.28 ± 0.34 (p&amp;amp;lt;0.001). Biometry was accurate in 51.6% of cases. Most important causes for suboptimal outcome were aphakia, astigmatism, posterior capsular opacification, and corneal edema. Kasr Al Ainy Hospital achieved CVA 6/9 or more in 69.3% and CVA 6/18 or more in 81.3% of patients. The capsular complication rate was high at 23.3%. The high complication rate is attributed to the nature of the teaching hospital where most surgeons were in their learning periods.
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Papers by Gehad Elnahry