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Background: DALK is agolden method for treatment of keratoconus with preservation of endothelium. femtosecond laser-assisted DALK (F-DALK) is a new technique used nowadays to overcome difficulties of an old one. Aims: To contrast the results of manual deep anterior lamellar keratoplasty (M-DALK) with (F-DALK) in keratoconus studied cases. Subjects and methods: This prospective interventional research was carried out between January 2021 and December 2022. 36 eyes of 36 studied cases with advanced keratectasia were enrolled in this research and all underwent either manual (17 patients) or (F-DALK) (19 patients) at Tiba Eye Center, Assiut, Egypt. They were done by single surgeon. Results: There was significant improvement in visual acuity at one month, 3 months, six months and 1 year post-operatively in 2 groups. Postoperatively, healing had been more evident post-operatively after the 6th month than after 1st and 3rd month. Side cut healing was more evident in the (F- DALK) patients than manual DALK studied cases with a statistically significant difference among the 2 groups (P 0.02). 12 eyes (63.2%) and 4 eyes (23.5 %) of F-DALK and M- DALK cases presented wound healing patterns Grade 4 respectively. Conclusion: Comparable visual and refractive results are obtained with both techniques; however, corneal wound healing patterns at the side cut were more noticeable with femtosecond assisted DALK. This observation suggests that, when femtosecond technology has been utilized to conduct the side cut for DALK, an active cornea wound healing may allow earlier suture removal. [ABSTRACT FROM AUTHOR]

Background: Astigmatism after keratoplasty continues to be a difficult case for corneal refractive surgeons. Astigmatism is a barrier to visual recovery after a successful corneal transplant, even though graft viability is the primary concern in keratoplasty. Aim and objectives: The aim of the study was to assess the management of postoperative penetrating keratoplasty astigmatism by photorefractive keratectomy. Subject and methods: Study was done between March 2021 and March 2022 at Al-Nahar eye center (Assiut). 30 eyes of 30 patient underwent PTK-PRK (phototherapeutic keratectomy and photorefractive keratectomy), all were done by the same surgeon. Results: The BCVA (Best Corrected Visual Acuity) of the studied eyes ranged from 0.01 to 0.2 with a median value of 0.1 and IQR between (0.1 and 0.2) preoperatively, which was significantly improved after 1 month to have a median value of 0.5 and IQR between (0.4 and 0.58, P=0.003) and kept improving significantly after 2 and 3 months by comparison to preoperative to have a median of 0.7 with IQR (0.7: 0.8) after 2 months and all eyes had a BCVA of 0.8 after 3 months (P<0.001). Conclusion: Clear graft penetrating keratoplasty (PK) improves eyesight. Significant postoperative astigmatism, however, may impair visual acuity to some degree. After keratoconus, patients with astigmatism have more than one treatment option available. [ABSTRACT FROM AUTHOR]

Purpose: To report the causes of uveitis in a referral ocular inflammation clinic in Upper Egypt. Methods: Retrospective medical chart review of all uveitis cases visiting a referral uveitis clinic during the period between January 2015 and January 2020. Results: A total of 982 patients were included. Uveitis was bilateral in 51.7% of the patients. Anterior uveitis was the most common type, followed by posterior uveitis, affecting 34.4% and 25.6% of the study cohort, respectively. About one-third of our patients were beneath the age of 18, and among that group, no specific etiology of uveitis could be determined in about a quarter of the patients by the end of the study period, and juvenile idiopathic arthritis was the most common disease entity. Conclusion: In conclusion, the present report attempted to illustrate the most common causes of uveitis in Upper Egypt. Tuberculosis followed by sarcoidosis were the two leading causes of uveitis in our group of patients. [ABSTRACT FROM AUTHOR]

Background: collagen cross-linking (CXL) is an effective, safe and rapidly progressive treatment modality for treatment of mild to moderate keratoconus not only in hindering the progression of the disease but also in improving the visual, refractive and topographic results. Objective: the study aims to compare the outcomes of standard and accelerated cross-linking in treatment of keratoconus. Patients and Methods: the present prospective study evaluated 99 eyes of 52 patients with keratoconus. They were classified into two groups; group (1) included 50 eyes (received standard CXL; 3Mw/cm2, 30 min) (SCXL group) and group (2) 49 eyes (treated by accelerated CXL; 9Mw/cm2, 10 min) (ACXL group). Spherical equivalent, uncorrected visual acuity, best-corrected visual acuity, and topographical analysis of the cornea were assessed at baseline and within 3 years postoperative. Simulated keratometry was measured in terms of Sim K-1, Sim K-2, K-max, cylindrical value, thickness of the cornea (at the thinnest point) and Q-value were evaluated. Results: postoperative uncorrected distance visual acuity and corrected distance visual acuity didn't significantly changed in both groups. Postoperative spherical equivalent significantly decreased in standard CXL compared to accelerated CXL. Standard CXL had a greater effect in decreasing Simk-1, Simk-2, k-max and k-mean. K-max decreased from 52.33±5.55 to 50.35±5.14; P=0.07 and in accelerated group from 54.58±4.35 to 52.74±4.41; P=0.04. Also, postoperative corneal pachymetery (at thinnest location) was found to be more stable in standard CLX group. Conclusion: both standard and accelerated CXL are effective in early keratoconus management with better results in standard CXL procedure. [ABSTRACT FROM AUTHOR]

Background: spondyloarthritis (SpA) is a group of chronic diseases recognized by arthritis and extraarticular lesions e.g. uveitis, enthesitis, dermatological affection. About 35% of SpA patients may present with recurrent attacks of acute anterior uveitis (AAU). Purpose: it was to detect whether patients with idiopathic recurrent AAU who were positive or negative for Human Leukocyte Antigen B27 (HLA–B27) had a frequency of enthesis lesions compared to that seen in patients with SpA. Patients and Methods: a prospective study of enthesis evident on musculoskeletal ultrasound examination was done on sixty patients and twenty controls, the eighty were categorized into 4 groups; group 1 included 20 patients with known SpA group 2 included 20 with recurrent AAU HLA–B27 positive and didn’t have SpA aspects group 3 included 20 with recurrent AAU HLA–B27 negative and didn’t have SpA and group 4 included 20 healthy controls. Using Madrid Sonography Enthesitis Index (MASEI) twelve enthesis locations were assessed in each participant. Results: a total of 960 entheses sites were examined by ultrasonography in all 80 participants. The MASEI cut-off limit of ≥18 points was 75%, 60%, 45%, and 10% of the participants in the 4 groups; respectively. The MASEI score was significantly higher in groups 1&2 than in groups 3&4. The differences between the two groups were statistically significant. Conclusion: a high percent of HLA–B27 positive patients with idiopathic recurrent AAU without characteristics of SpA have enthesis lesions with about percent to those seen in patients with known SpA. [ABSTRACT FROM AUTHOR]

Background: glaucoma was ranked as one of the major causes of blindness worldwide. Angle-closure glaucoma (ACG) is a type of glaucoma characterized by narrowing or closure of the anterior chamber angle. Objective: to compare the clinical outcomes of phacoemulsification (Phaco) with peripheral iridectomy versus trabeculectomy in management of ACG. Patients and Methods: this study was a prospective, follow-up non-randomized clinical trial, carried out on 50 eyes with ACG. Patients were divided into two groups: group A (n= 25); eyes underwent phacoemulsification with peripheral iridectomy, and group B (n= 25); eyes underwent sub-scleral trabeculectomy. Intraocular pressure (IOP), visual outcomes and postoperative complications were assessed. Patients were followed-up for 6 months. Results: postoperative visual acuity was significantly improved in phaco group compared to that of trabeculectomy group (P <0.001). The mean postoperative IOP was reduced significantly (P < 0.05) in both groups at all time intervals compared to their preoperative values. Anterior chamber depth increased significantly postoperatively in group (A) (p<0.001) however, almost no change was noticed in group (B). Meanwhile, postoperative angle opening distance was increased (p<0.001) in both groups. No significant differences were found between both procedures in Rim area, Rim volume, cup/disc area ratio and maximum cup depth. Eight cases (32.0%) in group (A) and 7 cases (28.0%) in group (B) suffered from postoperative complications with insignificant difference. Conclusion: both procedures are effective in lowering IOP in patients with ACG, but phacoemulsification with peripheral iridectomy significantly improved visual acuity compared to sub-scleral trabeculectomy with almost the same rate of complications. [ABSTRACT FROM AUTHOR]

Background: trabeculectomy and deep sclerectomy (DS) aim to lower intraocular pressure (IOP) in cases of medically uncontrolled primary open angle glaucoma (POAG). The application of Ologen implant is thought to increase the success rate of both procedures. Objective: to compare the application of Ologen implant in trabeculectomy versus deep sclerectomy in patients with uncontrolled POAG. Patients and Methods: this was a follow-up randomized clinical comparative trial included 30 eyes of 26 patients with uncontrolled POAG. They were randomly assigned to two equal groups (n=15 eyes): group (A) underwent trabeculectomy and group (B) underwent deep sclerectomy. Both procedures were augmented with Ologen implant. All patients were subjected to full history taking and complete ophthalmologic examination. Postoperatively, patients were followed up at 6 months. Outcome and complications were assessed. Results: both groups experienced significant reduction in IOP after 6 months postoperative; preoperative and postoperative values were 22.8±3.73 mmHg and 11.07±2.63 mmHg, respectively in group (A) and 20.13±2.26 mmHg and 13.53±2.61 mmHg, respectively in group B, P≤ 0.01. The complete success was 93.0% in group (A) and 80.0% in group (B), (P= 0.475). Group (A) had significantly higher frequency of postoperative complications compared to group B (P≤ 0.01). Conclusion: the application of Ologen implant in both trabeculectomy and deep sclerectomy is effective for IOP reduction and it resulted in better operative success in patients with POAG. Also, deep sclerectomy using Ologen implant is a good and safe alternative to trabeculectomy in patients with POAG, but our obtained results need to be supported by subsequent studies. [ABSTRACT FROM AUTHOR]

Purpose: To report the clinical experience of uveitis associated with Behçet's disease in a cohort of Egyptian patients. Methods: The present study is a retrospective analysis of the medical charts of patients with Behçet's disease, who were referred to a tertiary eye care center in Egypt between June 2010 and June 2018. Results: The current study included 1301 eyes of 681 patients with Behçet's disease. The mean age of the patients at the time of referral was 27.2 ± 3.9 years. Panuveitis was the most common presentation. About 28% of all involved eyes had a final visual acuity < 20/200, by the last follow-up visit. Conclusion: Behçet's disease is an important cause of uveitis in Egypt, and despite the fact that the prognosis of Behçet's uveitis has globally improved in recent years, the visual outcome in Egypt is still not favorable especially in case of delayed referral to tertiary centers. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy, safety and stability of standard epithelium‐off cross‐linking (SCXL) versus accelerated epithelium‐off cross‐linking (ACXL) and transepithelial epithelium‐on cross‐linking (TCXL) in the treatment of progressive keratoconus (KC) in children. Methods: This prospective multicentre controlled trial included 271 eyes (136 children) with grade 1–3 progressive KC who were randomized to undergo SCXL (n = 91, as a control group), ACXL (n = 92) or TCXL (n = 88). Uncorrected and corrected distance visual acuity, subjective refraction, pachymetry, keratometry and corneal topography measurements were recorded preoperatively and 6, 12 and 24 months postoperatively. Results: At 1 year, there was no significant difference in uncorrected distance visual acuity, refractive sphere, cylinder, spherical equivalent or Kmax between the ACXL and SCXL groups; however, during year 2, ACXL regressed while SCXL continued to improve. After 2 years, there were significant differences in all visual, refractive and keratometric components between SCXL and both ACXL and TCXL (p < 0.0001) and between ACXL and TCXL (p < 0.0001). KC progressed in 5.4% of patients who had ACXL and 28.4% of those who had TCXL but in none of those who had SCXL. Vernal keratoconjunctivitis was documented in 43.3% of eyes that progressed postoperatively. Conclusion: SCXL was more effective for paediatric KC and achieved greater stability than either ACXL or TCXL, and ACXL was superior to TCXL. SCXL also achieved marked improvement in both myopia and spherical equivalent; however, these refractive outcomes were unpredictable and uncontrollable. TCXL had a 28.4% failure rate within 2 years. SCXL is preferable for management of paediatric KC. [ABSTRACT FROM AUTHOR]