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A study was carried out at the University of KhartoumDemonstration Farm in (2007), to study the performance of two tillageimplements: (disc and chisel plough) and their effect on some soilphysical properties. The results showed that the higher values of boththeoretical and effective field capacities were recorded by chisel plough(1.23 ha/hr and 0.90 ha/hr) as compared to disc plough (0.63 ha/hr and0.50 ha/hr). The higher field efficiency was recorded by disc plough(79.37%) as compared to the chisel plough (73.4%). The fuel consumedwhen using the disc plough was (10.60 l/ha) less than that consumed bythe chisel (13.47 l/ha). Tractor wheel slippages ware found to be 10.92%.and 14.1%. The result also showed that both ploughs decreased the soilbulk density values from 1.54 g/cm3 to 1.51 and 1.49 g/cm3 by disc andchisel plough respectively. Particle density was not affected (P > 0.05) byboth implements . The soil porosity values were also increased for bothimplements. The soil moisture content recorded in two depths 0-15 and15-30 cm were higher for chisel plough (6.53% and 6.9%) as compared todisc plough which recorded 6.3% and 6.5% respectively. The infiltrationrate obtained by the disc plough was 22.2 cm/hr while that of chiselplough was (20.1 cm/hr).

(1) Background: Meibomian gland dysfunction (MGD) among patients with diabetes mellitus (DM) is a common manifestation of dry eye syndrome (DES). (2) Methods: The purpose of this study is to identify clinical parameters and biomarkers useful to improve the follow-up and the treatment of these patients. We have used an ocular surface disease index (OSDI) questionnaire, Schirmer test I/II, tear film break-up time (TF-BUT), fluorescein plus lissamine green staining, Marx’s line (ML), and meibomian gland (MGs) morphology using Sirius® Topographer (CSO, Costruzione Strumenti Oftalmici, Florence, Italy). Blood sample analysis included glucose, glycated hemoglobin, lipid profile, cortisol, dehydroepiandrosterone sulfate (DHEA-S), androstenedione (ASD) and testosterone. (3) Results: Cortisol and ASD were positively correlated with an increase of MG tortuosity, and an Increased level of triglycerides was associated with a reduction of MGs length. DHEAS levels lowered with age and were associated with ocular surface staining. (4) Conclusions: Future studies, perhaps including meibum lipid analysis and tear cytokine levels, may also further elucidate the connection between these parameters, MG architecture and function.

Background: Juvenile idiopathic arthritis (JIA) is a rheumatic condition of childhood that is frequently associated with anterior chronic uveitis. Evidence suggests that uveitis may persist up to adulthood in some cases, possibly causing severe visual impairment. Methods: We conducted a retrospective study on a series of patients aged 16 years or older with JIA-related active uveitis who were referred to the Uveitis Service of Sapienza University of Rome from 1990 to 2019 to evaluate the characteristics of ocular disease in patients with JIA-associated uveitis (JIA-U) who still exhibit uveitis in adulthood. Data on clinical features, treatment, complications and visual outcomes were collected. Results: Twenty adults (85% female; median age 23.4 ± 6.6 years, range 16–38 years) with ongoing uveitis (35 eyes) were identified. The median age at JIA onset was 6.15 ± 2.9 years (range 2–10), and uveitis onset was 8.7 ± 4.7 years (range 3–20). The patients were observed in a median follow-up of 16 ± 7.7 years (range 4–35). Fifty-seven percent of affected eyes (20 eyes) had good visual acuity (>0.4 logMAR), while eleven percent of affected eyes (4 eyes) were blind (≤20/200). Uveitis required topical steroids and mydriatic/cycloplegic in all cases. Orbital steroid injection was performed in 13 eyes. Systemic corticosteroids and biologic drugs were used in 14 patients. Conclusions: Although the visual prognosis of JIA-U has improved in recent years, persistent uveitis up to adulthood is still observed. Therefore, protracted follow-up of JIA-U patients is warranted because of the high burden of delayed visual complications.

Objective To investigate the retinal changes in choroideremia (CHM) patients to determine correlations between age, structure and function. Subjects/Methods Twenty-six eyes from 13 male CHM patients were included in this prospective longitudinal study. Participants were divided into n = 8) and ≥50-year (n = 5) old groups. Patients were seen at baseline, 6-month, and 1-year visits. Optical coherence tomography (OCT), OCT angiography, and fundus autofluorescence were performed to measure central foveal (CFT) and subfoveal choroidal thickness (SCT), as well as areas of preserved choriocapillaris (CC), ellipsoid zone (EZ), and autofluorescence (PAF). Patients also underwent functional investigations including visual acuity (VA), contrast sensitivity (CS), colour testing, microperimetry, dark adaptometry, and handheld electroretinogram (ERG). Vision-related quality-of-life was assessed by using the NEI-VFQ-25 questionnaire. Results Over the 1-year follow-up period, progressive loss was detected in SCT, EZ, CC, PAF, and CFT. Those ≥50-years exhibited more structural and functional defects with SCT, EZ, CC, and PAF showing strong correlation with patient age (rho ≤ −0.47, p ≤ 0.02). CS and VA did not change over the year, but CS was significantly correlated with age (rho = −0.63, p = 0.001). Delayed to unmeasurable dark adaptation, decreased colour discrimination and no detectable ERG activity were observed in all patients. Minimal functional deterioration was observed over one year with a general trend of slower progression in the ≥50-years group. Conclusions Quantitative structural parameters including SCT, CC, EZ, and PAF are most useful for disease monitoring in CHM. Extended follow-up studies are required to determine longitudinal functional changes.

We study the Mila (NE of Algiers) main events of the July–August 2020 seismic sequence including, respectively, the July 17th (Mw 4.6), the August 7th (Mw 4.8), and the August 7th (Mw 4.4) events. First, we located the events hypocenters. Second, we performed a waveform inversion of accelerograms to calculate the seismic moment, the moment magnitude, and the focal mechanisms of the events. The obtained moment magnitudes are, respectively, Mw = 4.6, Mw =4.8, and Mw =4.4, while the calculated seismic moments are, respectively, 0.1019E+17 Nm, 0.1794E+17 Nm, and 0.4653E+16 Nm. The determined focal mechanisms yield pure strike-slip solutions for the three events with nodal plans oriented NE-SW and NE-SW. Additionally, we used InSAR analysis of two Sentinel-1A images, taken before and after the August 7th (Mw 4.8) event, to inventory the triggered landslides. Six landslide areas were identified, located along a 22-km-long and 6.5-km-wide corridor oriented NE-SW. This corridor fits well the spatial distribution of the determined epicenters and the NE-SW nodal plan of the obtained focal solutions. This suggests that the earthquakes are produced by a NE-SW trending left-lateral strike-slip, very close to the Beni-Haroun large dam as can be suggested by the recorded high peak ground acceleration (PGAs) values. Consequently, these results raised the need to reassess the seismic hazard and potential risk of this critical structure and to assess its impact in initiating and inducing seismicity. Also, the Mila earthquakes raised out the need of considering geohazards in seismically active mountainous areas.

Neotectonics and active tectonics in the Dahra region (northern Algeria) are investigated using morpho-structural analysis and field study. This work allowed us to identify several geological structures that exhibit characteristics of typical NE-SW active folds; dissymmetric folds underlined by reverse faults with extrados normal faults. Five “en–echelon” structures were identified, namely, the Djebel Benzekri, the Djebel Semouda, the Abreuvoir, the Bouassas and the Belhacel folds. The determined stress axis from field measurements is comparable to that derived from focal mechanisms solutions of recent earthquakes. The surveyed faults and folds are comparable to that known as seismogenic structures such as the Abou El Hassan and Oued Fodda fault-related folds reactivated during the 1922 (Mw = 6.0) and in 1980 (Ms = 7.3) destructive earthquakes, respectively. As results the offset and the slope determined for these structures could indicate an important rate of deformation. Using the obtained faults parameters the seismic potential is indicated by the capability of these structures to produce Mw > 6.0 earthquakes.

Choroideremia (CHM) is an X-linked recessive chorioretinal dystrophy caused by mutations in CHM, encoding for Rab escort protein 1 (REP1). Loss of functional REP1 leads to the accumulation of unprenylated Rab proteins and defective intracellular protein trafficking, the putative cause for photoreceptor, retinal pigment epithelium (RPE), and choroidal degeneration. CHM is ubiquitously expressed, but adequate prenylation is considered to be achieved, outside the retina, through the isoform REP2. Recently, the possibility of systemic features in CHM has been debated; therefore, in this study, whole metabolomic analysis of plasma samples from 25 CHM patients versus age- and sex-matched controls was performed. Results showed plasma alterations in oxidative stress-related metabolites, coupled with alterations in tryptophan metabolism, leading to significantly raised serotonin levels. Lipid metabolism was disrupted with decreased branched fatty acids and acylcarnitines, suggestive of dysfunctional lipid oxidation, as well as imbalances of several sphingolipids and glycerophospholipids. Targeted lipidomics of the chmru848 zebrafish provided further evidence for dysfunction, with the use of fenofibrate over simvastatin circumventing the prenylation pathway to improve the lipid profile and increase survival. This study provides strong evidence for systemic manifestations of CHM and proposes potentially novel pathomechanisms and targets for therapeutic consideration.

PURPOSE: The diagnosis of neuropathic corneal pain (NCP) is challenging, as it is often difficult to differentiate from conventional dry eye disease (DED). In addition to eye pain, NCP can present with similar signs and symptoms of DED. The purpose of this study is to find an objective diagnostic sign to identify patients with NCP, using in vivo confocal microscopy (IVCM). METHODS: This was a comparative, retrospective, case-control study. Patients with clinical diagnosis of NCP (n=25), DED (n=30), and age and sex-matched healthy controls (n=16), who underwent corneal imaging with IVCM (HRT3/RCM) were included. Central corneal IVCM scans were analyzed by 2 masked observers for nerve density and number, presence of micro-neuromas (terminal enlargements of subbasal corneal nerve) and/or nerve beading (bead-like formation along the nerves), and dendritiform cell (DC) density. RESULTS: There was a decrease in total nerve density in both NCP (14.14±1.03 mm/mm(2)) and DED patients (12.86±1.04 mm/mm(2)), as compared to normal controls (23.90±0.92 mm/mm(2); p

Purpose. To report unusual and rare clinical changes of retinal vessel pattern in a series of patients affected by Juvenile Idiopathic Arthritis (JIA) uveitis with a follow-up longer than 16 years. Methods. A series of three patients with JIA-uveitis followed at the University of Rome “Sapienza” from 1998 to 2014 were reported. The retinal vessels were analyzed with fluorescein angiography using Heidelberg Retinal Angiogram-2 (HRA-2; Heidelberg Engineering GmBH, Dossenheim, Germany) and the Topcon TRC-50LX retinal camera (Topcon Europe, The Netherlands). A Spectralis Domain OCT (SD-OCT) (Spectralis Family Heidelberg, Germany) was performed to evaluate vessel anatomy. Results. Fundus photography showed sheathed vessels localized around the optic disc in every case. Angiography revealed a normal physiology of vessel walls and flow; no sheathing or leakage of dye was observed. SD-OCT demonstrated reflective vessel walls. Vessel lumen appeared patent, and the normal “hourglass configuration” was blurred, but identifiable. Conclusions. Vessel modifications observed in long-standing JIA-uveitis are not signs of vascular inflammation and are not associated to hypoperfusion. In these cases, ophthalmologists should avoid further invasive investigation and should consider introducing SD-OCT as a routine method to evaluate the vessel changes during the follow-up.

This study was conducted at Tamboul Testing and Training Centre, Sudan located at 150km south east of Khartoum during two different seasons (1995 -1996) to investigate the response of wheat productivity to different tillage systems on a heavy clay soil in an area of 2.4ha. The treatments were deferent tillage systems (Zero tillage, ridging, shallow harrowing, heavy harrowing, disc ploughing, disc ploughing+harrowing, split ridging and ridging thrice). These treatments were arranged in randomized complete block design (RCBD) with four replications. A computer program (SAS statistical package) was used to analyze the data while the variations among the means were checked by the least significant difference (LSD).The parameters tested were soil physical properties, crop water requirements (mm/day), plant height (cm), No. of tillering and crop productivity (kg/ha). The results indicated that, tillage systems significantly (P ≤ 0.05) affected clearly soil physical properties. Disc ploughing+harrowing decreased the bulk density (1.3g/cm3) as compared to zero tillage system (1.5g/cm3). Plant height, tillering and yield significantly (P ≤ 0.05) affected by the different tillage systems. Disc ploughing+harrowing gave the highest mean values of plant height (65.83cm), tillering (246) and crop productivity (1305kg/ha) as compared to zero tillage which ranked the least (43.26cm, 202 and 806.8kg/ha, respectively). It is concluded that for increasing the productivity of wheat crop, Disc ploughing+harrowing should be followed and adopted as one of the most important technical packages.

PURPOSE: Using optical coherence tomography angiography (OCTA) to investigate the area with flow in the superficial retinal vessel network (SVRN) and choriocapillaris (CC) layer among male subjects with choroideremia (CHM), female carriers, and normal controls to identify vascular changes. PATIENTS AND METHODS: Images of SRVN and CC layer were acquired in 9 affected males, 5 female carriers, and 14 age- and gender-matched controls using the Angiovue software of the RTVue XR Avanti. RESULTS: The mean age was 33 years for affected male CHM patients (median 30 years), 46 years for female carriers (median 53 years), and 39 years for controls (median 38.5). Mean SRVN area±SD in subjects with CHM was 12.93±2.06 mm(2), in carrier subjects 15.36±0.60 mm(2), and in controls 15.30±1.35 mm(2) (P

Background and objectives: Choroideremia (CHM) is an X-linked recessive chorioretinal dystrophy caused by mutations involving the CHM gene. Gene therapy has entered late-phase clinical trials, although there have been variable results. This review gives a summary on the outcomes of phase I/II CHM gene therapy trials and describes other potential experimental therapies. Materials and Methods: A Medline (National Library of Medicine, Bethesda, MD, USA) search was performed to identify all articles describing gene therapy treatments available for CHM. Results: Five phase I/II clinical trials that reported subretinal injection of adeno-associated virus Rab escort protein 1 (AAV2.REP1) vector in CHM patients were included. The Oxford study (NCT01461213) included 14 patients; a median gain of 5.5 ± 6.8 SD (−6 min, 18 max) early treatment diabetic retinopathy study (ETDRS) letters was reported. The Tubingen study (NCT02671539) included six patients; only one patient had an improvement of 17 ETDRS letters. The Alberta study (NCT02077361) enrolled six patients, and it reported a minimal vision change, except for one patient who gained 15 ETDRS letters. Six patients were enrolled in the Miami trial (NCT02553135), which reported a median gain of 2 ± 4 SD (−1 min, 10 max) ETDRS letters. The Philadelphia study (NCT02341807) included 10 patients; best corrected visual acuity (BCVA) returned to baseline in all by one-year follow-up, but one patient had −17 ETDRS letters from baseline. Overall, 40 patients were enrolled in trials, and 34 had 2 years of follow-up, with a median gain of 1.5 ± 7.2 SD (−14 min, 18 max) in ETDRS letters. Conclusions: The primary endpoint, BCVA following gene therapy in CHM, showed a marginal improvement with variability between trials. Optimizing surgical technique and pre-, peri-, and post-operative management with immunosuppressants to minimize any adverse ocular inflammatory events could lead to reduced incidence of complications. The ideal therapeutic window needs to be addressed to ensure that the necessary cell types are adequately transduced, minimizing viral toxicity, to prolong long-term transgenic potential. Long-term efficacy will be addressed by ongoing studies.

To compare clinical features of uveitis in patients affected by psoriasis and psoriatic arthritis (PsA).A retrospective case-control study.117 patients were affected by uveitis and psoriasis or PsA (92 and 25 patients, respectively) from 2003 to 2013. Axial PsA was associated with unilateral uveitis onset compared to the peripheral pattern (p0.03). The prevalence of eyes with at least one complication involving anterior segment was significantly more represented in the PsA group than the psoriasis one (p = 0.024). Anterior segment complications were more frequently associated with posterior ones in PsA patients than in psoriasis patients (p = 0.005). Most common complications in total sample at baseline examination were cataract (29.7%), ocular hypertension (17%), macular edema (7%), and pupillary seclusion (4.4%).Uveitis in patients with psoriasis and PsA may have distinguishing clinical features. PsA patients have more ocular complications than those with psoriasis. Both groups need an ophthalmological examination to promptly detect ocular co-morbidity.

Background/Aims To report the clinical, histopathological and genetic features of a variant of lattice corneal dystrophy (LCD) associated with two pathogenic mutations in the transforming growth factor-B-induced ( TGFBI ) gene. Methods Clinical characterisation was performed by slit lamp examination and in vivo confocal microscopic imaging (IVCM). Histopathological characterisation was performed with light microscopic examination of an excised corneal button and a peripheral blood samples were collected for TGFBI screening. Results A 42-year-old woman presented with progressive photophobia and decreased visual acuity in both eyes. Slit lamp examination demonstrated punctate and linear branching opacities in the mid and posterior corneal stroma, corresponding to hyper-reflective opacities noted on IVCM and amyloid deposition noted on histopathological examination of an excised corneal button. TGFBI screening revealed two previously reported heterozygous missense mutations: c.337G>A (p.(Val113Ile)) in exon 4 and c.1673T>C (p.(Leu558Pro)) in exon 12. Screening of an affected sibling with a similar phenotype revealed that she was also heterozygous for both mutations, while screening of another sibling with punctate but not linear stromal opacities revealed that she was heterozygous for only the p.(Leu558Pro) mutation. Conclusions The p.(Val113Ile) mutation results in an alteration of the atypical LCD phenotype associated with the p.(Leu558Pro) mutation. This represents only the second report of the alteration of the phenotype of a TGFBI dystrophy by a second, non-homozygous pathogenic mutation, and thus provides insight into the phenotype-genotype correlation of the TGFBI dystrophies.

Purpose: To review the application of the PACK-CXL and to identify different treatment protocols according to the pathogens associated with keratitis. Methods: A systematic review of 21 articles. The primary outcome was the healing of a corneal ulcer, defined as epithelization, blocking corneal melting. The secondary end-point was the recovery of visual acuity. Results: We studied a total of 145 eyes. Infectious keratitis was associated with bacteria in 80 eyes (55.55%), fungus in 24 eyes (16.67%), and protozoa in 13 (8.97%). In 26 (18%), the microbiological culture was negative or not performed. The mean time of re-epithelization was 25.70±29.83days (1–180). A total of 27 patients needed corneal transplantation. The overall probability of blocking corneal melting was 84.13%. Three different protocols for each group of pathogens have been proposed. Conclusion: PACK-CXL still has a limit in its spread. In the future, we hope that each pathogen will be treated with the most efficient and least invas...

The original version of this paper was published with two errors missed by me about one co-author (Azzeddine A. Benhamouche) and one reference citation about Benhamouche et al. (2013). Given in this article is the correct given and family name of one co-author; reference entry and citation.

Northwestern Algeria, Tell Atlas chain, belongs to the converging Africa-Eurasia plate boundary. Several active faults have been previously identified and several earthquakes occurred in the past. In the present study, seismites are observed in the Quaternary deposits. The identified seismites include injection sand dykes, pillar structures, pillow structures, load-cast structures, water escape structures, sismoslumps, thixotropic wedges, and thixotropic bowls. The following arguments support their seismic origin: (i) presence of active faults able of producing strong earthquakes, (ii) the granulometric characteristics of the deposits are favorable to liquefaction, (iii) the observed features, mainly those related to water escape structures, are comparable to those observed in modern earthquakes. Therefore, such features are evidence of the occurrence of earthquakes of M > 5.5 magnitude in this study area, which may occur in the future.

Purpose Diagnosis of graft rejection is based on patient symptoms and on clinical signs detected by slit-lamp biomicroscopy. This study investigated whether laser in vivo confocal microscopy (IVCM) can aid in the diagnosis of corneal graft rejection by detecting cellular corneal changes that take place after transplantation. Design Prospective case-control study. Subjects Thirty-eight eyes of 38 patients with penetrating keratoplasty (15 eyes with corneal graft rejection, 23 eyes without rejection) and 9 age-matched normal controls. Methods Laser IVCM was performed in the corneal grafts centrally. The density of immune cells (IC) was assessed for epithelial, sub-epithelial, stromal, and endothelial layers by 2 masked observers. IC density was compared among different groups and correlated to clinical signs and symptoms of corneal graft rejection. Main Outcome Measurements Outcome measurement was the IC density in the corneal layers and its associations with the presence of clinical signs and symptoms of corneal graft rejection. Results The IC density was significantly different between rejected and non-rejected grafts (P = 0.004) and different from that of normal controls (P = 0.001). Among corneal layers, IC density was significantly higher in rejected grafts than in non-rejected grafts in only the sub-basal (611.54 ± 573.74 vs. 340.61 ± 268.60 cells/mm2, respectively; P = 0.049) and endothelial layers (250.62 ± 267.13 vs. 103.47 ± 81.91 cells/mm2, respectively; P = 0.001). Patients with decreased best corrected visual acuity, Khodadoust line, and anterior chamber cells demonstrated a significant increase in total IC density (P Conclusions Patients with corneal graft rejection demonstrate a significant increase in corneal immune cells, particularly, in the sub-basal and endothelial layers compared to patients with non-rejected grafts and controls. Although symptoms associated with endothelial rejection demonstrate a general increase in IC, pain, irritation, and light sensitivity are associated with increased IC in the sub-basal layer. Assessment of patients with corneal graft rejection by IVCM may serve as an adjunctive tool in the diagnosis and management of corneal graft rejection.

We are thankful to our colleagues Semmane and Khelif for their comment on our paper published in Arabian Journal of Geosciences (AJGS) (Abbouda et al. Arab J Geosci 11:57, Abbouda et al. 2018) giving us an opportunity for fruitful discussions and by providing further information and data on the Mostaganem seismic event. Indeed, monitoring and studying earthquakes in the Tell Atlas chain are interesting and need to be encouraged on both seismotectonic and seismic hazard aspects. The Abbouda et al. 2018 paper, as indicated in the title, treated two aspects of the May 22, 2014, earthquake: the seismological and seismotectonic aspects. The comment of Semmane and Khelif concerns the seismological aspects of this earthquake. Two points are contested by the authors of the comment: (i) the poorly constructed localization of the main chock epicenter and (ii) the nature of the event occurred about 2 h 25 min before the main shock that was described as a foreshock. Concerning the first point, we admit that there was an erratum and we correct it below. For the second point, we consider that our statement about the event occurred at 3 h 57 min 41.4 s (about 2 h 25 min before) is well justified, and we give more explanation below.

On Thursday, 22 of May 2014, at 6 h 22 min 0.3.3 s (GMT + 1) a moderate-sized earthquake struck the Mostaganem, Western Algeria, region. The main shock, recorded by many international and national seismological stations, was preceded by a foreshock, 3 hours before, on May 22, 2014 (Ml = 4.1) at 3 h 57 min 41.4 s and followed by four well-felt aftershocks (M > 3.0) that lasted about 1 year. The main shock did not cause loss of lives but serious panic among the population was reported. The main shock, however, caused cracks in walls and roofs, sometimes destroyed, the old non-engineered and precarious adobe dweller corresponding to I0 = VI–VII (Msk scale). We used accelerograph records to (i) determine the epicenter location (longitude = 0.3537 E, latitude = 35.8598 N, (ii) perform waveforms inversion to calculate the earthquake parameters. The obtained results are, respectively, the seismic moment (M0) = 2.71 E + 16, the Mw = 4.9 and the focal depth = 6 km. The obtained focal mechanism solution shows reverse faulting with small right lateral component with the following nodal plans: NP1, strike = 193.5, dip = 49.5, slip = 57.6 and NP2, strike = 57.8, dip = 50, slip = 122.1. On the other hand, the seismotectonic framework of the Dahra area exhibits a serie of NE-SW trending “en echelon” faulted folds that may be active as suggested by this study.

Mucopolysaccharidoses (MPS) are a heterogeneous group of rare inherited disorders, characterized by the lack or malfunction of lysosomal enzymes necessary for glycosaminoglycan (GAGs) catabolism, and their subsequent accumulation in many tissues and organs throughout the body. An overview of the current knowledge of corneal and anterior segment manifestations in patients with MPS was provided and clinical guidelines for their diagnosis and management were furnished. The anterior segment of the eye is usually involved in every subtype of MPS, with major complications including varying degrees of corneal opacification and raised intraocular pressure (IOP) with development of glaucoma. Their recognition and management can be very useful in the diagnosis of MPS. Novel techniques are available to objectively measure the grade and extent of corneal clouding and give information about the anatomy of the anterior chamber and the structures of the angle beyond the clouded cornea. It is advisable to take advantage of this new instrumentation in order to obtain thorough information on the ocular involvement and its related anterior chamber complications for a better management of patients with MPS, both in terms of visual prognosis and therapeutic outcome.

Cutting-edge image capture and analysis promises to be a new frontier for both diagnosing disease and monitoring treatment response in patients with ocular surface disease. IVCM and AS-OCT both provide important data that allow clinicians to make a pinpoint diagnosis and to prescribe a patient-specific treatment. Through the use of IVCM, it is possible to distinguish a patient with dry eye from one with corneal neuropathy, to know the degree of inflammation present in each condition, to watch nerve regeneration over time, and to note the efficacy of the treatment prescribed at the cellular level. IVCM also provides objective parameters for evaluating and monitoring meibomian gland dysfunction. This instrument is able to detect the density of meibomian gland distribution, gland morphology, the size of their ducts, and the amount of associated inflammation. Along the same lines as IVCM, AS-OCT is a new technology that can be very useful in assessing DED patients, especially those with possible meibomian gland disease. AS-OCT images of glands can assist a clinician by easily visualizing gland engorgement, morphology, prevalence, and length (along with the weight of the tear meniscus). Other dedicated meibomian gland imaging systems such as LipiView™ or Keratograph 5M™ can provide similar information about glands that are of higher quality compared to current AS-OCT images; however, many practices already have AS-OCT and may not have yet invested in a dedicated imaging system for meibomian glands. Together, these pieces of equipment can influence the decision on what form of therapy will be most effective.

Corneal neuralgia, or keratoneuralgia, is a relatively new entity in ophthalmology [1]. Corneal neuropathic pain results from dysfunctional nerves causing perceptions of discomfort. While the exact epidemiology of this disease is still unclear, patients often present with vague perceptions of burning, stinging, eye ache, photophobia [2, 3], or severe eye pain, without significant findings on slit-lamp examination. Many of these patients display migraine features, and thus, in addition to local therapies, systemic medications against migraines (e.g., low-dose tricyclic antidepressants) can be very therapeutic. Comorbid psychiatric conditions (particularly depression and anxiety) should likewise be recognized and addressed for the best outcomes (discussed in Chap. 10). Hereby, we illustrate three patients from our clinics and the diagnostic and therapeutic approach followed to better understand this entity.

Background/AimsTo determine the UK incidence, demographics, aetiology, management and visual outcome for children developing choroidal neovascularisation (CNV).MethodsA prospective population-based observational study of routine practice via the British Ophthalmological Surveillance Unit between January 2012 and December 2013 with subsequent 1-year follow-up in children under 16 years old with newly diagnosed CNV.ResultsTwenty-seven children with CNV were reported. The UK estimated annual incidence for those aged 16 and under was 0.21 per 100 000 (95% CI 0.133 to 0.299). The mean age was 11.1 years (SD 3.9, range 4–16). Fourteen were female. Seventy-seven per cent (22 patients) were Caucasian British. Twenty-three children (85%) had unilateral disease. The most common aetiology included inflammatory retinochoroidopathy (n=9), optic disc abnormalities (n=9) and idiopathic (n=5). Optical coherence tomography was performed in all cases and fundus fluorescein angiography in 61%. Management included observation only (n=10), anti-vascular endothelial growth factor (anti-VEGF) injection of bevacizumab (n=14) or ranibizumab (n=2), or both (n=1), and additional use of oral (n=1) and local (periocular n=2 and intravitreal n=2) steroids in five children with inflammatory retinochoroidopathy. The mean number of anti-VEGF injections was 2±1, with eight patients receiving only one injection. The mean (SD) best corrected visual acuity in LogMAR was 0.91 (0.53) at presentation and 0.74 (0.53) at 1-year follow-up (p=0.09).ConclusionThis is the first population-based prospective study of CNV in children. This is a rare disorder with a poor visual prognosis irrespective of CNV location and the use of anti-VEGF therapy.

BACKGROUND AND OBJECTIVE: To identify qualitative and quantitative features of spectral-domain optical coherence tomography (SD-OCT) as prognostic indicators of visual acuity (VA) loss in patients with choroideremia (CHM). PATIENTS AND METHODS: Retrospective study of 57 male patients with CHM. Central foveal thickness (CFT), subfoveal choroidal thickness (SCT), fundus autofluorescence area, and evidence of outer retinal and choroidal degeneration were analyzed by SD-OCT. RESULTS: Best-corrected VA logMAR at baseline was associated with CFT at baseline (r = −0.47; P < .01), CFT at most recent follow-up (r = −0.27; P < .01), and SCT at baseline (r = −0.31; P < .01). Ellipsoid zone (EZ) rupture was associated with a higher CFT loss (r = 0.33; P < .01) and macular cystic spaces (MCS) with a reduction in VA over time (hazard risk = 0.48; P = .05). CONCLUSION: Reduced CFT at baseline, EZ rupture, and MCS are poor prognostic indicators for VA outcome. [ Ophthalmic Surg Lasers Imaging Retina . 2017;48:711–716.]

To evaluate the peripapillary RNFL (p-RNFL) thickness changes after vitrectomy for epiretinal membrane (ERM). The relationship between p-RNFL thickness change and visual function was assessed.Thirty-five eyes from 35 patients with ERM who underwent vitrectomy with internal limiting membrane (ILM) removal were included. Average p-RNFL and the four quadrants thickness were measured by spectral-domain optical coherence tomography (SD-OCT) before and at one, three, and six months after surgery.At six months after surgery, p-RNFL thickness of the temporal and inferior quadrant was decreased in the operated eyes compared with fellow eyes (p0.05). Pattern standard deviation (PSD) was higher than that of fellow eyes (p = 0.002). The temporal and inferior quadrant p-RNFL thickness showed a relationship with both best-corrected visual acuity (BCVA) outcome and the six-month PSD (p0.05, respectively).The selective decrease in the temporal and inferior p-RNFL thickness after vitrectomy for ERM removal could indicate inner retinal damage related to ILM peeling.

To report the clinical findings and management of a case of Aspergillus flavus endophthalmitis following penetrating keratoplasty (PKP) and combined cataract extraction. Clinical cornea appearance was evaluated by slit-lamp examination. Ocular ultrasonography was performed to evaluate the anterior chamber and vitreous cavity. The cornea was scraped. The corneal-scleral donor rim and media were cultured. The diagnosis of A. flavus infection was made. The patient received fortified antifungal drops (voriconazole 1 % solution) plus systemic voriconazole 400 mg/die. A second corneal transplant was performed, and the anterior chamber was cleaned and washed with a solution of voriconazole 1 %. At the end of follow-up, CDVA was 20/20 and slit-lamp examination showed a clear cornea graft. This case illustrates a severe A. flavus endophthalmitis after PKP and demonstrates the possibilities of visual function restoration. Furthermore, this case describes the different sources of fungal infection after PKP and the different clinical appearances.

PURPOSE: To evaluate the safety of the corneal inlay removal procedure and the reversibility of visual acuities, corneal topography, and corneal biomicroscopy changes in a series of cases. METHODS: Ten cases implanted with one of three versions of the AcuFocus Kamra Inlay (ACI 7000, 7000T, and 7000PDT; AcuFocus, Inc., Irvine, CA) were followed for a minimum of 6 months after corneal inlay removal. RESULTS: The reason for removal was related to subjective dissatisfaction with visual symptoms (8 of 10 patients) such as night glare, photophobia, starburst, blurry vision, and halos. One case of removal was related to inadvertent thin flap and the final case was related to insufficient near vision. Mean uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA) was 0 ± 0.1 logMAR (Snellen 20/20) and 0.5 ± 0.2 logMAR (Snellen 20/40), respectively, preoperatively and 0.1 ± 0.1 logMAR (Snellen 20/25) and 0.5 ± 0.1 logMAR (Snellen 20/63), respectively, 6 months after corneal inlay removal. Mean corrected distance visual acuity (CDVA) and corrected near visual acuity (CNVA) was 0 ± 0.1 logMAR (Snellen 20/20) and 0 ± 0.1 logMAR (Snellen 20/20), respectively, preoperatively and 0 ± 0.1 logMAR (Snellen 20/20) and 0.1 ± 0.1 logMAR (Snellen 20/25), respectively, 6 months after corneal inlay removal. Mean root mean square (RMS) higher-order aberration (HOA) was 0.50 ± 0.12 (range: 0.30 to 0.70) preoperatively and 0.69 ± 0.14 (range: 0.48 to 0.95) 6 months after corneal inlay removal ( P < .8). Weak positive correlation was found between Δt Implant-Removal (Δt I-R), RMS spherical, coma, and HOA at 6 months (Δt I-R vs RMS spherical was r = 0.2, r 2 = 0.5, P < .7; Δt I-R vs RMS coma was r = 0.8, r 2 = 0.6, P < .3; and Δt I-R vs HOA r = 0.8; r 2 = 0.6, P < .9). CONCLUSION: This study suggests that after removal of the corneal inlay, corneal topography and corneal aberrometry are not permanently affected. In more than 60% of patients, CNVA, CDVA, UNVA, and UDVA were similar to the preoperative value. [ J Refract Surg. 2013;29(8):550–556.]

To evaluate outcomes of photorefractive keratectomy up to -10.00 D of myopia and -4.50 of astigmatism and to develop a predictive model for the refractive changes in the long term.Vissum Corporation and Miguel Hernandez University (Alicante, Spain).Retrospective-prospective observational series of cases.This study included 33 eyes of 33 patients aged 46.79±7.04 years (range 40-57) operated with the VISX 20/20 excimer laser with optical zones of 6 mm. No mitomycin C was used in any of these cases. The minimum follow-up was 15 years. The main outcome measures were: uncorrected and corrected distance visual acuity, manifest refraction and corneal topography. Linear regression models were developed from the observed refractive changes over time.Safety and efficacy indexes at 15 years were 1.18 and 0.83, respectively. No statistically significant differences were detected for any keratometric variable during the follow-up (p≥0.103). 15 years after the surgery 54.55% of the eyes were within ±1.00 D of spherical equivalent and 84.85% within ±2.00 D. The uncorrected distance visual acuity at 15 years was 20/25 or better in 60.6% of the eyes and 20/40 or better in 72.73% of the eyes. The correlation between the attempted and the achieved refractions was r=0.948 (p0.001) at 1 year, and r=0.821 (p0.001) at 15 years. No corneal ectasia was detected in any case during the follow-up.Photorefractive keratectomy is a safe refractive procedure in the long term within the range of myopia currently considered suitable for its use, although its efficacy decreases with time, especially, in high myopia. The model developed predicts a myopic regression of 2.00 D at 15 years for an ablation depth of 130 µm.

The purpose of the present study was to develop a discriminant function departing from the biomechanical parameters provided by a non-contact tonometer (Corvis-ST, Oculus Optikgerate, Wetzlar, Germany) to distinguish subclinical keratoconus from normal eyes. 212 eyes (120 patients) were divided in two groups: 184 healthy eyes of 92 patients aged 32.99 ± 7.85 (21-73 years) and 28 eyes of 28 patients aged 37.79 ± 14.21 (17-75 years) with subclinical keratoconus. The main outcome measures were age, sex, intraocular pressure (IOP), corneal central thickness (CCT) and other specific biomechanical parameters provided by the tonometer. Correlations between all biomechanical parameters and the rest of variables were evaluated. The biomechanical measures were corrected in IOP and CCT (since these variable are not directly related with the corneal structure and biomechanical behavior) to warrant an accurate comparison between both types of eyes. Two discriminant functions were created from the set of corrected variables. The best discriminant function created depended on three parameters: maximum Deformation Amplitude (corrected in IOP and CCT), First Applanation time (corrected in CCT) and CCT. Statistically significant differences were found between groups for this function (p=2·10(-10); Mann-Withney test). The area under the Receiving Operating Characteristic was 0.893 ± 0.028 (95% confidence interval 0.838-0.949). Sensitivity and specificity were 85.7% and 82.07% respectively. These results show that the use of biomechanical parameters provided by non-contact tonometry, previous normalization, combined with the theory of discriminant functions is a useful tool for the detection of subclinical keratoconus.

To evaluate the rate and onset of intraoperative and postoperative complications post-phacoemulsification.One hundred sixty-two eyes of 145 patients with uveitis who underwent phacoemulsification between 2006 and 2009 were identified through surgical record review. Fifty-nine eyes of 46 patients met the inclusion criteria. Hazard ratio (HR) and Kaplan-Meier survival probability were calculated for each class of uveitis.Macular edema (ME) resulted to be associated to chronic postoperative inflammation (r = 0.6; p = 0.00) and mostly related to patients who presented more than one postoperative relapse/year (r = 0.2; p = 0.02). Fuchs uveitis resulted to be a risk factor for posterior capsule opacification (PCO) (HR 3.36 IC95%1.0-10.5; p = 0.03). Hypotony and elevated intraocular pressure (IOP) were detected in the anterior uveitis group (0.02 EY).The HR to develop ME was significantly related to chronic anterior uveitis. PCO and elevated IOP are most frequent in Fuchs uveitis. The postoperative visual acuity result was good among all the uveitis groups.

Ocular complications associated with cutaneous lupus erythematosus (CLE) are less studied compared with those ones associated with systemic lupus erythematosus (SLE). The main ocular sites involved in patients affected by discoid lupus erythematosus (DLE) are eyelids followed by orbit and periorbit, the least being cornea. The most common complications are blepharitis usually affecting the lower lid and associated with some type of lid lesion such as plaque or erythematosus patches and madarosis. Few cases with LE profundus (LEP) and ocular complications are reported, but they are associated with orbital inflammatory syndrome and severe complications. The main treatment prescribed is hydroxychloroquine with a dose of 200 mg twice a day for 6 to 8 weeks. Corticosteroids are also used. Intervals between the correct diagnosis and the beginning of the ocular symptoms are commonly delayed. Ophthalmologist should be aware of the ocular manifestation of this autoimmune disease.

To describe the frequencies and risk factors of ocular complications and poor visual outcomes in children with juvenile idiopathic arthritis (JIA).Retrospective cohort study, including 69 consecutive children (116 eyes) affected by JIA-associated uveitis managed at a tertiary uveitis clinic.The incidence of visual loss to the 20/50 or worse threshold was 0.04/eye-year (EY) and to the 20/200 or worse threshold was 0.02/EY. The most common complications at baseline were posterior synechiae (52%), band keratopathy (38%), and cataract (12%). Risk factor for a visual acuity threshold of 20/50 or worse included hypotony (p = 0.01; hazard ratio [HR] 3.7; 95% CI 1.3-10.4); anterior chamber flare1 (p = 0.04; HR 1.3; 95% CI 0.5-3.4); a positive antinuclear antibody (ANA) (p = 0.02; HR1.4; 95% CI 0.8-2.4). Hypotony and positive ANA are also associated to the 20/200 or worse threshold (p = 0.03; HR 5.1; 95% CI 1.1-23.9 and p = 0.04; HR 1.0; 95% CI 0.4-2.3; respectively). Use of immunosuppressive drugs was associated with a reduced risk of visual loss of 20/200 or worse (odds ratio 0.14, 95% CI, 0.02-1.29; p = 0.04).Loss of vision and ocular complications still occur among children with JIA-related uveitis. Prompt diagnosis and a strict follow up associated to immunosuppressive therapy may decrease the poor visual outcome.

Ocular complications associated with cutaneous lupus erythematosus (CLE) are less studied compared with those ones associated with systemic lupus erythematosus (SLE). The main ocular sites involved in patients affected by discoid lupus erythematosus (DLE) are eyelids followed by orbit and periorbit, the least being cornea. The most common complications are blepharitis usually affecting the lower lid and associated with some type of lid lesion such as plaque or erythematosus patches and madarosis. Few cases with LE profundus (LEP) and ocular complications are reported, but they are associated with orbital inflammatory syndrome and severe complications. The main treatment prescribed is hydroxychloroquine with a dose of 200 mg twice a day for 6 to 8 weeks. Corticosteroids are also used. Intervals between the correct diagnosis and the beginning of the ocular symptoms are commonly delayed. Ophthalmologist should be aware of the ocular manifestation of this autoimmune disease.

Introduction: Thyroid ophthalmopathy is a complication most commonly associated with Grave’s disease. The disease course ranges from mild to severe, with severe cases resulting in major visual impairment. Methods: A complete ophthalmic examination in a 35-year-old secundigravida to 14 weeks of gestation presented to the hospital for a routine ophthalmological examination with eyelid retraction in the right eye was made. We studied the course of ocular disease through the gestation with orbit ecography and a 3T MRI. Results: A diagnosis of Grave’s Ophthalmopathy was made. Conclusion: This case presents an unusual course of the GD during pregnancy and a normal post-partum relapse, according to the Th1/Th2 balance. The frequent follow-up and the use of MRI allowed a prompt identification and complete control of the disease.

Intrastromal corneal ring segments (ICRS) were first proposed by Fleming and Reynolds in the late 1970s for the correction of various degrees of myopia [1, 2]. ICRS have gained popularity as a method to correct corneal ectatic diseases such as keratoconus, pellucid marginal corneal degeneration, and post-LASIK ectasia with encouraging results [3].

Keratoconus is often diagnosed after adolescence by modern corneal topography; however, the corneal ectasia process begins much earlier, with the disease underdiagnosed in children. Reports [1–6] demonstrating the efficacy and safety of CXL in children call for the refractive surgeon to consider the utility of the procedure in pediatric patients.

A refractive surgeon should be able to implant an intracorneal ring segment into an appropriate patient before considering a more aggressive procedure.

Corneal ectasia is one of the most serious complications of laser in situ keratomileusis (LASIK), with an estimated incidence between 0.04 and 0.66 % [1–3]. The main symptoms are progressive myopia, irregular astigmatism, and loss of corrected distance visual acuity (CDVA) [4]. Risk factors for these complications are high myopia, undiagnosed forme fruste keratoconus, low residual stromal bed thickness, a large optical zone, and multiple enhancement procedures.

When surgeons have to perform a second surgical procedure in an eye previously treated by radial keratotomy (RK) or, as in this case, arcuate lamellar keratotomy (ALK), they should be aware of the potential risk of flap adhesions and the possibility of tearing and damaging the flap.

As photorefractive keratectomy became a popular refractive surgery procedure, Talamo theorized that the destruction of Bowman’s layer during uneventful photorefractive keratectomy (PRK) causes abnormal healing, subepithelial infiltrates, and associated scarring [1]. Recurrent adenoviral stromal keratitis is thought to express a delayed hypersensitivity immune response to viral antigens in the corneal stroma [2].

Multifocal intraocular lenses (MIOLs) are designed to reduce dependence on spectacles for all vision ranges after cataract surgery or clear lens extraction. The Lentis Mplus IOL (Oculentis GmbH, Berlin) is a sectorial piece refractive multifocal lens made of hydrosmart with an aspheric posterior surface. The multifocality is achieved by implementing a distance piece and a distinct near sector of +3.0 D in the lower IOL segment, comparable to a multifocal spectacle lens. Here we report the case of a patient who developed a hyperopic shift following MIOL implantation and needed additive excimer laser treatment to achieve an adequate visual result [1].

Monovision is the adjustment of one eye for near vision and the other for distance vision. Pseudophakic monovision is a type of monovision used in lens surgery to correct postoperative presbyopia by programmed refractive error from biometry calculations [1].

The refractive surgeon who performs femtosecond LASIK should be familiar with how to manage a vertical gas breakthrough. Proper and timely diagnosis and management can increase the chance of an optimal visual outcome.