Journal of the Egyptian Ophthalmological Society, 2020
Purpose To evaluate the role of spectral domain optical coherence tomography (SD-OCT) in affectin... more Purpose To evaluate the role of spectral domain optical coherence tomography (SD-OCT) in affecting the decision making in eyes prepared for silicon oil removal (SOR) and to identify the cases that should have an obligatory preoperative SD-OCT. Patients and methods This prospective nonrandomized study involved patients with silicone-filled eyes recruited over the period from 2015 to 2018. Data from preoperative clinical examination and SD-OCT imaging and proposed modifications on SOR surgery based on both ways of examinations were recorded and compared. Cohen’s Kappa test was used to study the agreement between the clinical and OCT results. Results A total of 146 eyes of 138 patients were included in the study. Before SOR, clinical examination revealed normal macula in 108 (74%) eyes compared with 62 (42%) by OCT. OCT was able to detect significantly higher macular pathologies than did the clinical examination alone (P<0.0005). The number of eyes with macular edema (ME) and epiretinal membrane detected by OCT was significantly higher than that detected clinically (P<0.0005). There was a weak agreement between the results of clinical and OCT examination regarding ME (weighted K=0.426). Modifications added to the routine SOR based on clinical findings were suggested in 25 (17%) eyes compared with 65 (45%) eyes on adding OCT findings in decision making. Superadded modifications based on SD-OCT alone were significantly more in diabetic than nondiabetic patients regarding management of ME and macular retinal detachment (P=0.003). Conclusion SD-OCT was proved to be a helpful tool for following silicone-filled eyes, especially in diabetic patients. Preoperative OCT findings influenced the surgical plans of the routine SOR, thus aided in managing treatable macular lesions such as epiretinal membrane, ME, macular holes, and macular detachment.
AIM: To study the effect of topical dorzolamide 2% on macular thickness reduction in diabetic cys... more AIM: To study the effect of topical dorzolamide 2% on macular thickness reduction in diabetic cystoid macular edema (CME). METHODS: This was a prospective, non-randomized, open study including eyes with diabetic macular edema (DME). All eyes received topical dorzolamide 2% three times daily for one month. Changes in best-corrected visual acuity (BCVA), and central macular thickness (CMT) by optical coherence tomography) were evaluated at 1wk, 1, and 3mo post-treatment. RESULTS: Ninety-three eyes (84 patients) were included. Mean±SD (logMAR) BCVA improved significantly from 1.08±0.26 pretreatment to 0.66±0.24 at 1mo and 0.87±0.26 at 3mo post-treatment (P<0.001 both). The mean±SD CMT was significantly reduced from 535.27±97.4 μm at baseline to 357.43±125.8 μm at 1mo and 376.23±114.5 μm at 3mo post-treatment (P<0.001 both). No significant ocular or systemic side effects were recorded. CONCLUSION: Topical dorzolamide 2% results in significant improvement of mean BCVA and reduction...
Endocrine, Metabolic & Immune Disorders - Drug Targets, 2021
Background: Considering the vital role of vascular endothelial growth factor (VEGF) in the develo... more Background: Considering the vital role of vascular endothelial growth factor (VEGF) in the development of diabetic retinopathy (DR) in one hand and the frequent association between subclinical hypothyroidism (SCH) and DR on the other hand. Objective: The present study was proposed to explore the possible role of VEGF in the relation between SCH and DR, thus we investigated the relation between SCH and VEGF levels in patients with DR. Methods: Two hundred patients with DR were recruited in this study [100 patients with proliferative diabetic retinopathy (PDR) and 100 patients with non-proliferative diabetic retinopathy (NPDR)]. Patients with DR were divided into 2 groups according to thyroid function: patients with SCH or those with euthyroidism. Patients were subjected to careful history taking, and underwent clinical and ophthalmological examination. Fasting blood glucose, glycosylated hemoglobin, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), TSH, F...
Purpose: To evaluate postoperative corneal haze and corneal densitometry following three differen... more Purpose: To evaluate postoperative corneal haze and corneal densitometry following three different corneal cross-linking (CXL) protocols; standard, accelerated, and trans-epithelial (TE). Methods: The study recruited 104 eyes (53 patients) with progressive keratoconus divided into three groups: Group I were subjected to standard CXL, Group II to TE-CXL, and Group III to accelerated CXL (A-CXL) (10 mW/cm2 for 9 min). Subjective and objective corneal haze measures were evaluated before and 3, 6, and 12 months post-CXL using slit-lamp biomicroscopy and Pentacam Sheimpflug camera. Results: There was a significant difference in corneal densitometry between the three groups at 3 and 6 months post-CXL (P < 0.0001). By the 12th month, a significant statistical difference was observed only in zones (0–2 mm) and (2–6 mm) in both the anterior and the central layers. In Group I, the densitometry value of the preoperative anterior stromal layer (anterior 120 μm) was 19.42 ± 1.81. Then, it peaked at 23.12 ± 1.21 at 3 months (P < 0.0001), reached 19.82 ± 1.19 at 6 months (P = 0.007), and decreased to 19.33 ± 3.23 (P > 0.05) at 12 months. In Group II, the preoperative densitometry value of the anterior layer was 19.41 ± 1.21, peaked at 19.72 ± 1.12 at 3 months (P = 0.02), reached 19.04 ± 1.18 at 6 months (P = 0.052), and increased to 19.13 ± 1.37 at 12 months (P = 0.84). In Group III, the preoperative densitometry value of the anterior stromal layer was 19.53 ± 2.23. Then, it peaked at 24.80 ± 1.08 at 3 months (P < 0.0001), decreased to 21.75 ± 1.11 at 6 months (P < 0.0001), and reached 19.77 ± 2.26 at 12 months (P = 0.047). There was no significant correlation between the visual acuity changes and the total corneal densitometry. Conclusion: The TE-CXL group showed a better and earlier recovery from the haze, while the A-CXL group showed a delay in recovering and persistent increased corneal densitometry, mainly in the anterior 120 μ.
Introduction: Pterygium is a common ophthalmic problem in the Middle East where exposures to dust... more Introduction: Pterygium is a common ophthalmic problem in the Middle East where exposures to dust and sun rays are risk factors. The condition is more prevalent in middle-aged males and can be considered as an aging process. The aim of this study is to test both the degenerative and the proliferative components of Pterygium by both reduced glutathione and topoisomerase one activity. Methods: The study applied immunohistochemistry staining for both reduced glutathione and topoisomerase 1. Results: The samples expressed positive glutathione staining in most primary Pterygium conditions and all secondary Pterygium. On the other hand, the topoisomerase 1 immunohistochemistry expressed focal activity in secondary conditions suggesting a progenitor cell role in the pathogenesis of Pterygium in conjunction with oxidative stress. Conclusion: Pterygium represents dual pathology with a proliferative component and a degenerative one that needs further studies. It is possible to use combination...
Purpose: To discuss the ocular manifestations provoked by novel coronavirus 2019 (COVID-19) disea... more Purpose: To discuss the ocular manifestations provoked by novel coronavirus 2019 (COVID-19) disease in humans, the natural history of the disease in the eye, and its treatment. Methods: We designed a narrative review of the ocular manifestations of COVID-19 based on the literature published till July 30, 2020. The databases were PubMed, Scopus, Cochrane Library, Google Scholar, and ScienceDirect. The inclusion criteria were (1) all types of clinical studies and (2) the topic was COVID-19 and its association to the eye regarding the current guidelines. Results: From 168 abstracts screened, 61 papers fully filled the inclusion criteria after the full-text screening. The 61 records include 13 case reports, 17 prospective (case series or cross-sectional) studies, 8 retrospective studies, 12 literature reviews (one systematic review), and 11 letters to the editor. The majority of the papers agreed that ophthalmic manifestations due to COVID-19 were few and rarely encountered. The main ocular pathology seemed to be conjunctivitis, where the viral polymerase chain reaction also happened to be most detectable. Posterior segment or neuro-ophthalmic manifestations were scarce. Viral genome detection in the eye as well as viral portal of entry to the globe is still vague. Conclusion: The exact incidence of ocular manifestations in COVID-19 disease is uncertain. Conjunctivitis is the most prevalent ocular manifestation. It is still a debate whether the eye is a portal of entry for infection.
BACKGROUND Elevated oxidative stress plays a significant role in pathophysiology of keratoconus (... more BACKGROUND Elevated oxidative stress plays a significant role in pathophysiology of keratoconus (KC). Polymorphisms of the antioxidant enzymes as CAT and GPX-1 might alter their antioxidant enzyme capacities leading to increase in the oxidative damage induced KC. AIM To analyze the impact of CAT rs7943316 A/T and GPX-1 rs1050450 C/T single nucleotide polymorphisms (SNPs) on the risk and severity of KC among a group of Egyptian population. SUBJECT & METHODS CAT rs7943316 and GPX-1 rs1050450 SNPs were examined using polymerase chain reaction-restriction fragment length polymorphism in 100 control subjects and 150 KC patients [50 patients (KC stages 1&2), 50 patients (KC stage 3) and 50 patients (KC stage 4)]. RESULTS Patients with TT genotype of CAT rs7943316 were at high risk of developing KC. T allele of GPX-1 rs1050450 was significantly associated with KC risk (P ˂0.001). The frequency of CAT TT genotype and T allele was significantly higher among severe stages of KC compared to mild and moderate stages. GPX-1 T allele frequency was significantly higher among severe stages of KC compared to mild and moderate stages. A very significant decrease in the antioxidant enzyme activities was observed in association with these SNPs. Age of the patients, CAT and GPX-1 SNPs as well as their enzyme activities were independent predictors of KC severity. CONCLUSION Our study suggests that CAT (rs7943316) and GPX-1 (rs1050450) SNPs act as independent predictors for different grades of KC and that these SNPs might have a role in the pathogenesis of the disease.
Purpose To assess the long-term results of viscotrabeculotomy in infants with primary congenital ... more Purpose To assess the long-term results of viscotrabeculotomy in infants with primary congenital glaucoma and to compare its outcome with conventional trabeculotomy. Patients and methods A prospective randomized comparative study included infants with primary congenital glaucoma younger than 2 years. Patients were divided into two groups: viscotrabeculotomy group and conventional trabeculotomy group. Preoperative and postoperative intraocular pressures, corneal diameter, intraoperative and postoperative complications, and success rates were compared between two groups. All the patients were followed up for 5 years. Results The study included 154 eyes of 92 infants distributed randomly among the two groups; 78 and 76 eyes in viscotrabeculotomy and conventional trabeculotomy groups, respectively. In both groups, there was a statistically significant intraocular pressure reduction at all time points of the follow-up periods compared to the preoperative values (p < 0.0001). At 5 year...
PURPOSE To compare the effect on intraocular pressure (IOP) of phacoemulsification combined with ... more PURPOSE To compare the effect on intraocular pressure (IOP) of phacoemulsification combined with viscosynechialysis and trabeculotomy with that of phacoemulsification combined with trabeculectomy in eyes with primary angle-closure glaucoma (PACG) and visually significant cataract. SETTING Mansoura Ophthalmic Center, Mansoura University, Egypt. DESIGN Prospective case series. METHODS This prospective randomized study included patients with uncontrolled PACG and visually significant cataract presenting between 2012 and 2017. The eyes were randomized to phacoemulsification combined with viscosynechialysis and trabeculotomy (phaco-viscosynechialysis group) or phacoemulsification combined with trabeculectomy (phacotrabeculectomy group). Success (true and qualified) (IOP <18 mm Hg without sight-threatening complications) was studied 24 months postoperatively. Intraoperative complications were noted. The primary outcome measure was the IOP before and after surgery. RESULTS The study comprised 59 eyes of 59 patients with a mean age of 59.8 years ± 6.8 (SD) in the phaco-viscosynechialysis group (30 eyes) and 60.3 ± 6.3 years in the phacotrabeculectomy group (29 eyes) (P = .704). The mean preoperative IOP was 28.7 ± 2.14 mm Hg in the phaco-viscosynechialysis group and 28.5 ± 2.11 mm Hg in the phacotrabeculectomy group; the mean at 24 months was 14.5 ± 2.8 mm Hg and 17.3 ± 2.2 mm Hg, respectively (P < .001). The total success rate at 24 months was 90% and 83%, respectively. CONCLUSION Although both techniques were relatively safe and effective in reducing IOP for at least 2 years in eyes with PACG, combined phacoemulsification-viscosynechialysis-trabeculotomy gave better outcomes.
Journal of the Egyptian Ophthalmological Society, 2020
Purpose To evaluate the role of spectral domain optical coherence tomography (SD-OCT) in affectin... more Purpose To evaluate the role of spectral domain optical coherence tomography (SD-OCT) in affecting the decision making in eyes prepared for silicon oil removal (SOR) and to identify the cases that should have an obligatory preoperative SD-OCT. Patients and methods This prospective nonrandomized study involved patients with silicone-filled eyes recruited over the period from 2015 to 2018. Data from preoperative clinical examination and SD-OCT imaging and proposed modifications on SOR surgery based on both ways of examinations were recorded and compared. Cohen’s Kappa test was used to study the agreement between the clinical and OCT results. Results A total of 146 eyes of 138 patients were included in the study. Before SOR, clinical examination revealed normal macula in 108 (74%) eyes compared with 62 (42%) by OCT. OCT was able to detect significantly higher macular pathologies than did the clinical examination alone (P<0.0005). The number of eyes with macular edema (ME) and epiretinal membrane detected by OCT was significantly higher than that detected clinically (P<0.0005). There was a weak agreement between the results of clinical and OCT examination regarding ME (weighted K=0.426). Modifications added to the routine SOR based on clinical findings were suggested in 25 (17%) eyes compared with 65 (45%) eyes on adding OCT findings in decision making. Superadded modifications based on SD-OCT alone were significantly more in diabetic than nondiabetic patients regarding management of ME and macular retinal detachment (P=0.003). Conclusion SD-OCT was proved to be a helpful tool for following silicone-filled eyes, especially in diabetic patients. Preoperative OCT findings influenced the surgical plans of the routine SOR, thus aided in managing treatable macular lesions such as epiretinal membrane, ME, macular holes, and macular detachment.
AIM: To study the effect of topical dorzolamide 2% on macular thickness reduction in diabetic cys... more AIM: To study the effect of topical dorzolamide 2% on macular thickness reduction in diabetic cystoid macular edema (CME). METHODS: This was a prospective, non-randomized, open study including eyes with diabetic macular edema (DME). All eyes received topical dorzolamide 2% three times daily for one month. Changes in best-corrected visual acuity (BCVA), and central macular thickness (CMT) by optical coherence tomography) were evaluated at 1wk, 1, and 3mo post-treatment. RESULTS: Ninety-three eyes (84 patients) were included. Mean±SD (logMAR) BCVA improved significantly from 1.08±0.26 pretreatment to 0.66±0.24 at 1mo and 0.87±0.26 at 3mo post-treatment (P<0.001 both). The mean±SD CMT was significantly reduced from 535.27±97.4 μm at baseline to 357.43±125.8 μm at 1mo and 376.23±114.5 μm at 3mo post-treatment (P<0.001 both). No significant ocular or systemic side effects were recorded. CONCLUSION: Topical dorzolamide 2% results in significant improvement of mean BCVA and reduction...
Endocrine, Metabolic & Immune Disorders - Drug Targets, 2021
Background: Considering the vital role of vascular endothelial growth factor (VEGF) in the develo... more Background: Considering the vital role of vascular endothelial growth factor (VEGF) in the development of diabetic retinopathy (DR) in one hand and the frequent association between subclinical hypothyroidism (SCH) and DR on the other hand. Objective: The present study was proposed to explore the possible role of VEGF in the relation between SCH and DR, thus we investigated the relation between SCH and VEGF levels in patients with DR. Methods: Two hundred patients with DR were recruited in this study [100 patients with proliferative diabetic retinopathy (PDR) and 100 patients with non-proliferative diabetic retinopathy (NPDR)]. Patients with DR were divided into 2 groups according to thyroid function: patients with SCH or those with euthyroidism. Patients were subjected to careful history taking, and underwent clinical and ophthalmological examination. Fasting blood glucose, glycosylated hemoglobin, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), TSH, F...
Purpose: To evaluate postoperative corneal haze and corneal densitometry following three differen... more Purpose: To evaluate postoperative corneal haze and corneal densitometry following three different corneal cross-linking (CXL) protocols; standard, accelerated, and trans-epithelial (TE). Methods: The study recruited 104 eyes (53 patients) with progressive keratoconus divided into three groups: Group I were subjected to standard CXL, Group II to TE-CXL, and Group III to accelerated CXL (A-CXL) (10 mW/cm2 for 9 min). Subjective and objective corneal haze measures were evaluated before and 3, 6, and 12 months post-CXL using slit-lamp biomicroscopy and Pentacam Sheimpflug camera. Results: There was a significant difference in corneal densitometry between the three groups at 3 and 6 months post-CXL (P < 0.0001). By the 12th month, a significant statistical difference was observed only in zones (0–2 mm) and (2–6 mm) in both the anterior and the central layers. In Group I, the densitometry value of the preoperative anterior stromal layer (anterior 120 μm) was 19.42 ± 1.81. Then, it peaked at 23.12 ± 1.21 at 3 months (P < 0.0001), reached 19.82 ± 1.19 at 6 months (P = 0.007), and decreased to 19.33 ± 3.23 (P > 0.05) at 12 months. In Group II, the preoperative densitometry value of the anterior layer was 19.41 ± 1.21, peaked at 19.72 ± 1.12 at 3 months (P = 0.02), reached 19.04 ± 1.18 at 6 months (P = 0.052), and increased to 19.13 ± 1.37 at 12 months (P = 0.84). In Group III, the preoperative densitometry value of the anterior stromal layer was 19.53 ± 2.23. Then, it peaked at 24.80 ± 1.08 at 3 months (P < 0.0001), decreased to 21.75 ± 1.11 at 6 months (P < 0.0001), and reached 19.77 ± 2.26 at 12 months (P = 0.047). There was no significant correlation between the visual acuity changes and the total corneal densitometry. Conclusion: The TE-CXL group showed a better and earlier recovery from the haze, while the A-CXL group showed a delay in recovering and persistent increased corneal densitometry, mainly in the anterior 120 μ.
Introduction: Pterygium is a common ophthalmic problem in the Middle East where exposures to dust... more Introduction: Pterygium is a common ophthalmic problem in the Middle East where exposures to dust and sun rays are risk factors. The condition is more prevalent in middle-aged males and can be considered as an aging process. The aim of this study is to test both the degenerative and the proliferative components of Pterygium by both reduced glutathione and topoisomerase one activity. Methods: The study applied immunohistochemistry staining for both reduced glutathione and topoisomerase 1. Results: The samples expressed positive glutathione staining in most primary Pterygium conditions and all secondary Pterygium. On the other hand, the topoisomerase 1 immunohistochemistry expressed focal activity in secondary conditions suggesting a progenitor cell role in the pathogenesis of Pterygium in conjunction with oxidative stress. Conclusion: Pterygium represents dual pathology with a proliferative component and a degenerative one that needs further studies. It is possible to use combination...
Purpose: To discuss the ocular manifestations provoked by novel coronavirus 2019 (COVID-19) disea... more Purpose: To discuss the ocular manifestations provoked by novel coronavirus 2019 (COVID-19) disease in humans, the natural history of the disease in the eye, and its treatment. Methods: We designed a narrative review of the ocular manifestations of COVID-19 based on the literature published till July 30, 2020. The databases were PubMed, Scopus, Cochrane Library, Google Scholar, and ScienceDirect. The inclusion criteria were (1) all types of clinical studies and (2) the topic was COVID-19 and its association to the eye regarding the current guidelines. Results: From 168 abstracts screened, 61 papers fully filled the inclusion criteria after the full-text screening. The 61 records include 13 case reports, 17 prospective (case series or cross-sectional) studies, 8 retrospective studies, 12 literature reviews (one systematic review), and 11 letters to the editor. The majority of the papers agreed that ophthalmic manifestations due to COVID-19 were few and rarely encountered. The main ocular pathology seemed to be conjunctivitis, where the viral polymerase chain reaction also happened to be most detectable. Posterior segment or neuro-ophthalmic manifestations were scarce. Viral genome detection in the eye as well as viral portal of entry to the globe is still vague. Conclusion: The exact incidence of ocular manifestations in COVID-19 disease is uncertain. Conjunctivitis is the most prevalent ocular manifestation. It is still a debate whether the eye is a portal of entry for infection.
BACKGROUND Elevated oxidative stress plays a significant role in pathophysiology of keratoconus (... more BACKGROUND Elevated oxidative stress plays a significant role in pathophysiology of keratoconus (KC). Polymorphisms of the antioxidant enzymes as CAT and GPX-1 might alter their antioxidant enzyme capacities leading to increase in the oxidative damage induced KC. AIM To analyze the impact of CAT rs7943316 A/T and GPX-1 rs1050450 C/T single nucleotide polymorphisms (SNPs) on the risk and severity of KC among a group of Egyptian population. SUBJECT & METHODS CAT rs7943316 and GPX-1 rs1050450 SNPs were examined using polymerase chain reaction-restriction fragment length polymorphism in 100 control subjects and 150 KC patients [50 patients (KC stages 1&2), 50 patients (KC stage 3) and 50 patients (KC stage 4)]. RESULTS Patients with TT genotype of CAT rs7943316 were at high risk of developing KC. T allele of GPX-1 rs1050450 was significantly associated with KC risk (P ˂0.001). The frequency of CAT TT genotype and T allele was significantly higher among severe stages of KC compared to mild and moderate stages. GPX-1 T allele frequency was significantly higher among severe stages of KC compared to mild and moderate stages. A very significant decrease in the antioxidant enzyme activities was observed in association with these SNPs. Age of the patients, CAT and GPX-1 SNPs as well as their enzyme activities were independent predictors of KC severity. CONCLUSION Our study suggests that CAT (rs7943316) and GPX-1 (rs1050450) SNPs act as independent predictors for different grades of KC and that these SNPs might have a role in the pathogenesis of the disease.
Purpose To assess the long-term results of viscotrabeculotomy in infants with primary congenital ... more Purpose To assess the long-term results of viscotrabeculotomy in infants with primary congenital glaucoma and to compare its outcome with conventional trabeculotomy. Patients and methods A prospective randomized comparative study included infants with primary congenital glaucoma younger than 2 years. Patients were divided into two groups: viscotrabeculotomy group and conventional trabeculotomy group. Preoperative and postoperative intraocular pressures, corneal diameter, intraoperative and postoperative complications, and success rates were compared between two groups. All the patients were followed up for 5 years. Results The study included 154 eyes of 92 infants distributed randomly among the two groups; 78 and 76 eyes in viscotrabeculotomy and conventional trabeculotomy groups, respectively. In both groups, there was a statistically significant intraocular pressure reduction at all time points of the follow-up periods compared to the preoperative values (p < 0.0001). At 5 year...
PURPOSE To compare the effect on intraocular pressure (IOP) of phacoemulsification combined with ... more PURPOSE To compare the effect on intraocular pressure (IOP) of phacoemulsification combined with viscosynechialysis and trabeculotomy with that of phacoemulsification combined with trabeculectomy in eyes with primary angle-closure glaucoma (PACG) and visually significant cataract. SETTING Mansoura Ophthalmic Center, Mansoura University, Egypt. DESIGN Prospective case series. METHODS This prospective randomized study included patients with uncontrolled PACG and visually significant cataract presenting between 2012 and 2017. The eyes were randomized to phacoemulsification combined with viscosynechialysis and trabeculotomy (phaco-viscosynechialysis group) or phacoemulsification combined with trabeculectomy (phacotrabeculectomy group). Success (true and qualified) (IOP <18 mm Hg without sight-threatening complications) was studied 24 months postoperatively. Intraoperative complications were noted. The primary outcome measure was the IOP before and after surgery. RESULTS The study comprised 59 eyes of 59 patients with a mean age of 59.8 years ± 6.8 (SD) in the phaco-viscosynechialysis group (30 eyes) and 60.3 ± 6.3 years in the phacotrabeculectomy group (29 eyes) (P = .704). The mean preoperative IOP was 28.7 ± 2.14 mm Hg in the phaco-viscosynechialysis group and 28.5 ± 2.11 mm Hg in the phacotrabeculectomy group; the mean at 24 months was 14.5 ± 2.8 mm Hg and 17.3 ± 2.2 mm Hg, respectively (P < .001). The total success rate at 24 months was 90% and 83%, respectively. CONCLUSION Although both techniques were relatively safe and effective in reducing IOP for at least 2 years in eyes with PACG, combined phacoemulsification-viscosynechialysis-trabeculotomy gave better outcomes.
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Papers by Amani E Badawi