Search

Sundas Maqsood,1,2 Kareem Elsawah,3 Navpreet Dhillon,1 Shady Soliman,3 Masara Laginaf,2 Vaishali Lodhia,2 Damian Lake,1 Samer Hamada,1 Mohamed Elalfy1– 3 1Corneo-Plastic Unit, Queen Victoria Hospital NHS, East Grinstead, UK; 2Eye Department, Maidstone and Turnbridge Wells Hospitals, Maidstone, UK; 3Cornea Department, Research Institute of Ophthalmology, Giza, EgyptCorrespondence: Mohamed Elalfy Tel +44 1342 414560Email m.elalfy@nhs.netObjective: To report the outcomes of using human amniotic membrane-derived dry matrix (AMDDM) in the management of persistent corneal epithelial defects (PEDs) of various etiologies.Methods: A cohort study of 84 patients age range 7 to 92 years with 93 PEDs were treated with AMDDM (Omnigen® using OmniLenz® at two centers (Queen Victoria Hospital and Maidstone Hospital) in the UK. The main outcome measures were healing response of PED and time to heal after application of AMDDM.Results: A total of 106 applications of AMDDM were recorded for 81 patients (52 males, 29 females) with a spectrum of different etiologies. Fifty-eight percent of the eyes showed complete healing, and 28% showed partial decrease of the size of PEDs with average treatment length recorded as 22.4± 12.3 days. In patients with limbal stem cell deficiency (n=44; aniridia=12, chemical injury=9, Stevens–Johnson syndrome=10), 50% of PEDs showed complete healing and 27% showed partial healing. In patients with microbial keratitis (n=21) (bacterial: 13, fungal: 4, herpetic: 3, acanthamoeba: 1) 57% of PEDs showed complete healing and 33% were partially healed. In patients with keratoplasty (n=16), 56% of PEDs showed complete healing and 31% were partially healed. Vision remained stable in 59% and improved in 27% of the study the population.Conclusion: AMDDM can be easily applied in the clinical setting and has demonstrated its efficiency as a new tool to treat persistent epithelial defects.Keywords: persistent epithelial defects, amniotic membrane derived dry matrix, suture less amniotic membrane

Mohamed Elalfy,1,2 Sundas Maqsood,1 Scott Hau,3 Ruben Y Kannan,4 Charles Nduka,4 Samer Hamada,1 Raman Malhotra1 1Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, UK; 2Research Institute of Ophthalmology, Giza, Egypt; 3Moorfields Eye Hospital, London, UK; 4Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, UKCorrespondence: Mohamed ElalfyResearch Institute of Ophthalmology, El-Khalifa, Oula, Giza, 12557, EgyptTel +20235718304Email m.s.elalfy@gmail.comObjective: To report the functional and anatomical outcomes including structural changes in corneal nerve density and morphology using in vivo confocal microscopy (IVCM) after corneal neurotisation in patients with neurotrophic keratopathy (NK), using a sural nerve graft.Patients and Methods: Prospective study of patients undergoing corneal neurotisation for NK. Functional outcomes were measured through visual acuity, slit-lamp examination of corneal and conjunctival staining, tear production (Schirmer’s 1 test), tear film break-up time, tear film meniscus height, quality and osmolarity, central corneal thickness and corneal sensation using Cochet–Bonnet esthesiometry. Structural outcomes were assessed from changes in corneal nerve density and morphology with IVCM. Subjective outcomes were assessed using VFQ-25 and latest telephonic consultation.Results: Between February 2016 and April 2018, 11 corneal neurotisations were performed on 11 patients (3 males, 8 females). Median age was 43 (range 25– 62) years. Mean follow-up was 14.5 (range, 4– 36) months. Snellen visual acuity improved in 6 patients, corneal and conjunctival staining decreased in 10, tear film breakup time increased in 9, tear meniscus height increased in 7, Schirmers test readings increased in 4, tear film osmolarity reduced in 8 and central corneal thickness increased in 10 patients. Corneal sensation improved in nine patients. Complete IVCM data were available in five cases and demonstrated an improvement of corneal nerve density and length at 12 months.Conclusion: This series confirms the fact that the outcomes of this technique are reproducible and that corneal neurotisation surgery helps restore trophic nerve function more consistently than touch-related sensation.Keywords: corneal neurotisation, neurotrophic keratopathy, sural nerve, corneal sensations

Mohamed Elalfy,1– 3,* Sundas Maqsood,1,* Shady Soliman,3 Sherif Momtaz Hegazy,3 Ahmed Abdou Hannoun,3 Zisis Gatzioufas,1,4 Damian Lake,1 Samer Hamada1 1Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, UK; 2Eye Department, Maidstone and Turnbridge Wells Hospital, Maidstone, UK; 3Research Institute of Ophthalmology, Giza, Egypt; 4Eye Department, University Hospital Basel, Basel, Switzerland*These authors contributed equally to this workCorrespondence: Mohamed ElalfyQueen Victoria Hospital, Holtye Road, East Grinstead, West Sussex, RH19 3DZ, UKTel +44 01342414560Email m.elalfy@nhs.netPurpose: To evaluate the incidence, demographics, associated risk factors, management and clinical outcomes of ocular hypertension/glaucoma after Descemet stripping automated endothelial keratoplasty (DSAEK).Methods: A cohort review of 81 DSAEK cases was performed at Queen Victoria Hospital, United Kingdom. Patients with pre-existing glaucoma, transient increased IOP within the first 48 hours post-graft, additional post-transplant surgery, or failed to complete one year follow-up were excluded from the study. Ocular hypertension was defined as intraocular pressure (IOP) elevation > 21mmHg or ≥ 6mmHg from baseline at any postoperative visit. The study looked at the incidence, risk factors, response to anti-glaucoma treatment, graft failure and best corrected visual acuity.Results: The incidence of post-DSAEK ocular hypertension and glaucoma was 51.9% and 13.6%, respectively. Steroid-induced IOP elevation was the most frequent cause, with an incidence of 38.3%. Risk factors such as pseudophakia (p=0.024) and preoperative IOP> 16 (p=0.003) were found to be associated with post-DSAEK ocular hypertension. Preoperative IOP> 16 had 5.27 times risk of IOP elevation. Eyes with graft dislocation and/or detachment were significantly associated with post-DSAEK glaucoma (p=0.038). There was no negative effect of OHT on visual acuity and graft status.Conclusion: Glaucoma and OHT are common postoperative complications of DSAEK. Although steroid-induced IOP elevation was the most frequent cause, there are other reasons associated with development of post-DSAEK glaucoma, including graft dislocation and detachment. Eyes with preoperative IOP> 16 mm Hg may require a close monitoring of IOP. In addition, management by medical treatment results in good visual acuity and graft clarity.Keywords: Descemet’s stripping endothelial keratoplasty, DSAEK, glaucoma, ocular hypertension

Sundas Maqsood,1 Mohamed Elalfy,1– 3 Ahmed Abdou Hannon,2 Sherif Momtaz Hegazy,2 Ebrahim Salah Elborgy2 1Queen Victoria Hospital, East Grinstead, UK; 2Research Institute of Ophthalmology, Giza, Egypt; 3Maidstone and Tunbridge Wells Hospitals, Tunbridge Wells, UKCorrespondence: Mohamed ElalfyResearch Institute of Ophthalmology, 2 El Ahram Street, Giza 12557, Cairo, EgyptTel +202-35718304Email hamezza@yahoo.comBackground: Visual recovery following macula involving rhegmatogenous retinal detachment remains poorly understood. The aim of this work is to correlate the functional and the anatomical changes in retinal vasculature in the foveal avascular zone using optical coherence tomography angiography (OCTA) after successful retinal reattachment repair and correlate this data with retinal thickness and post-operative visual recovery.Methods: A prospective, comparative observational study of 28 eyes of 14 patients with 14 eyes undergoing macula off retinal detachment repair with pars plana vitrectomy, endo-laser and silicone oil-based tamponade compared with 14 fellow healthy eyes at 1, 6 and 12 weeks post-operative period. The study was conducted at the Research Institute of Ophthalmology, Giza, Egypt between February 2018 and August 2018.Results: The foveal avascular zone (FAZ) area in the patients group was not significantly different compared to the control group and was found to be negatively correlated with the central retinal thickness in both the study and control group. The superficial capillary plexus (SCP) area at the FAZ was significantly larger than the deep capillary plexus (DCP) area at the FAZ in both the study and control group over the follow-up period. The DCP area at the FAZ was significantly larger at the 3rd follow-up than the 1st follow-up. The SCP FAZ area was significantly larger than the DCP FAZ area in both the study and control group over the follow-up period. BCVA was found to be negatively correlated to the retinal thickness of the temporal 3 mm paracentral quadrant with no correlation with central foveal thickness (CFT) and the FAZ area.Conclusion: Optical coherence tomography (OCT) and OCTA are valuable noninvasive imaging tools to monitor and predict the structural changes at the foveal avascular zone during the recovery phase after successful retinal reattachment involving macula.Keywords: optical coherence tomography, OCT, optical coherence tomography angiography, OCTA, foveal avascular zone, FAZ, superficial capillary plexus, SCP, deep capillary plexus, DCP, central foveal thickness, CFT

Sundas Maqsood,1 Ahmed Abdou Hannon,2 Mohamed Elalfy,1,3,4 Ebrahim Salah Elborgy,5 Sherif Momtaz Hegazy5 1Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, Sussex, UK; 2Paediatric Ophthalmology Unit, Research Institute of Ophthalmology, Cairo, Egypt; 3Cornea Unit, Research Institute of Ophthalmology, Cairo, Egypt; 4Eye Unit, Maidstone and Turnbridge Wells Hospitals, Maidstone, Kent, UK; 5Retinal Surgical Unit, Research Institute of Ophthalmology, Cairo, EgyptCorrespondence: Mohamed ElalfyResearch Institute of Ophthalmology, 2 El Ahram Street, Giza, Cairo 12557, EgyptTel +20 2-3571-8304Email hamezza@yahoo.comBackground: Inner retina–layer modifications after pars plana vitrectomy (PPV) can be objectively assessed through spectral domain optical coherence tomography (SD-OCT).Methods: This study explored prospectively changes in retinal nerve-fiber layer (RNFL) thickness with SD-OCT in eyes undergoing PPV with silicone oil–based tamponade with and without use of perfluorocarbon liquids (PFCLs) during the early postoperative phase (up to 3 months) at the Research Institute of Ophthalmology, Egypt.Results: Thirty patients were recruited who underwent PPV and silicone oil–based tamponade for either retinal detachment or diabetic retinopathy between April 2019 and September 2019. Mean RNFL thickness showed no significant change during follow-up at the first week (102.90± 30.68 mm), 1 month (107.30± 32.27), or three months (105.90± 36.68; p=0.46, 0.68). There were significant correlations noticed between RNFL thinning and axial length of eyes, intraocular pressure, and use of PFCLs during the follow-up period.Conclusion: The RNFL tends to change postvitrectomy, but not significantly. Careful examination and consistent follow-up is required for postvitrectomy patients with larger axial length and intraoperative PFCL use.Keywords: pars plana vitrectomy, PPV, ganglion-cell complex, GCC, retinal nerve–fibre layer, RNFL, perfluorocarbon liquids, PFCL spectral domain optical coherence tomography, SD-OCT