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Purpose: To evaluate the anatomical effects of implantable phakic contact lens (IPCL) (Care Group, India) on anterior segment and its visual outcomes .Patients and methods: In a prospective interventional case series study, 60 highly myopic eyes of 32 patients were subjected to IPCL implantation in the Ophthalmology Department of Minia University Hospital, Egypt from January 2019 to June 2021. All patients had complete ophthalmic examination and were followed up for 1 year. Pentacam was used for preoperative and postoperative estimation of anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV) and IPCL vault in the 1st, 3rd, and 12th months. Assessment of corneal endothelium was done using specular microscope preoperatively and after 12 months. Preoperative and postoperative refraction and visual acuity were measured. Results: There was a statistically significant decrease in ACD, ACA, and ACV. There was no significant difference between preoperative and postoperative mean intraocular pressure (IOP) by the 12th month (P=0.163). The mean preoperative endothelial cell count (ECD) was significantly reduced from 2929.3±248 cells/mm2 to 2737.9±303 cells/mm2 at the 12th month (PPP=0.209). In the 12th month, the mean vault was 240±540 μm. No sight threatening complications occurred.Conclusion: Although IPCL induced anatomical changes, it was safe and effective for correction of high myopia.

Purpose To document the presentation of unilateral combined endophthalmitis and orbital cellulitis in patients with COVID-19 infection and study their prognosis. Patients and methods This interventional case series study included 9 patients referred to the Ophthalmology Department, Minia University Hospital with unilateral combined endophthalmitis and orbital cellulitis between April 2020 and March 2021. In addition to the COVID-19 work-up, all patients were subjected to full ophthalmological evaluation and managed according to their ophthalmic and systemic disease. Results The patients were 5 females and 4 males. They had clinical, laboratory and imaging findings that confirmed COVID-19 infection. All patients had unilateral endophthalmitis with orbital cellulitis and profound visual loss in the affected eye. Three patients died due to respiratory failure, while 6 patients recovered systemically. The survived patients developed atrophia bulbi in 4 patients and in 2 patients, the globe retained normal size but with complete visual loss. Conclusion Combined endophthalmitis and orbital cellulitis can be one of the early presentations of patients with COVID-19 infection with poor visual prognosis. Trial registration Clinical registration: clinicaltrials.gov identifier: NCT04456556.

Purpose: To evaluate the use of the resorbable polylactic acid polymer implants (Resorb X) in the management of orbital floor blow-out fractures as regards safety, cosmetic, and functional results. Methods: In a prospective, interventional case series, 22 patients with traumatic blow-out floor fractures underwent lower fornix transconjunctival repair using polylactic acid implant insertion over the defect without fixation. Orbital imaging was done preoperatively, at 1 month and 1 year postoperatively with orbital computed tomography with 2 mm cuts of axial, sagittal, and coronal scans. Outcome measures included the maximum vertical height of the orbit at the fracture plane and its changes over time. Results: At the final follow-up, both limitation of elevation and diplopia improved in 82% of cases, while 63.6% of cases showed improvement of enophthalmos. Radiological restoration of the orbital vertical height was recorded in 100% of cases without implant displacement at 1 month. However, after 1 year, a significant floor bowing was found in 45.5% of cases, which showed a strong positive correlation with preoperative defect size ( r = 0.820). Conclusions: Resorb X mesh plates can be a good option for the safe reconstruction of orbital floor blow-out fractures. Good anatomical and functional results were obtained in small orbital floor defects. Late bowing under pressure may limit their use in medium-sized floor defects.

Purpose To evaluate the use of gold weight implantation in the upper eyelid in the treatment of upper eyelid retraction caused by thyroid ophthalmopathy as regards the cosmetic and functional results and the safety of the procedure. Patients and method This is a surgical intervention case series study. The study was carried out in Ophthalmology Department in El-Minya University Hospital between January 2013 and January 2014. The study was approved by the ethical committee board of El-Minya University. Test weights were applied to the skin of the upper eyelid using special adhesive tape in the sitting position to determine the suitable implantable weight. Three interrupted nonabsorbable sutures (5/0 Dacron) were used to secure the gold weight to the tarsus. The orbicularis was closed using interrupted 6/0 vicryl sutures. The skin was closed using interrupted 6/0 nylon sutures. Results As regards the postoperative results, by the end of the follow-up period, improvement of eyelid retraction was present in all cases. Normal upper eyelid margin position (covering 2 mm of the cornea) was attained in 10 eyelids (76.92%). Undercorrection was observed in 3 eyelids (23.07%). Two eyelids covered 1 mm of the cornea, and 1 eyelid rested at the upper limbus. All patients (100%) were satisfied as regards the cosmetic results, with the degree of satisfaction ranging between very good for 3 patients and excellent for 4 patients. One patient had bilateral brick-shaped appearance. Conclusions Gold weight implantation for treatment of thyroid-related upper eyelid retraction markedly improves the cosmetic appearance of the patient and, to a lesser extent, improves the manifestations of exposure with high patient satisfaction, and it is a relatively easy and safe procedure.

Background The purpose of this paper is to study the etiology, clinical findings, and outcomes of management of cases of orbital cellulitis treated in Minia University Hospital in Upper Egypt over the period of 6 years from July 2009 to July 2015. One-hundred two patients diagnosed to have orbital cellulitis were admitted to the hospital and treated on inpatient basis from July 2009 to July 2015. All patients were subjected to full ophthalmological examination, systemic evaluation, and ear, nose, and throat (ENT) consultation. Axial and coronal CT scan and orbital echography were done for all patients. All patients received medical treatments, and 20 patients needed surgical intervention. Results The source of infection was paranasal sinusitis in 66 patients, trauma in 14 cases, panophthalmitis in 6 patients, and dental infection in 2 cases, and no definite source was detected in 14 cases. Subperiosteal abscess (SPA) developed in 16 patients. The final best corrected visual acuity improved in 58% of the cases, decreased in 4%, and remained unchanged in 38% of cases. No intracranial complication was recorded. Conclusions Good presenting visual acuity and appropriate medical treatment together with early surgical intervention in cases of SPA are important factors to achieve favorable outcomes in orbital cellulitis. All cases with SPA had paranasal sinusitis, and contrary to previous studies, superior SPA location was the most common followed by the medial location.

Purpose. To evaluate the anterior segment, the anatomical position of the implantable collamer lenses (ICL), and its relationship to adjacent ocular structures using Ultrasound Biomicroscopy (UBM).Methods. In a prospective study, 142 myopic eyes of 93 patients implanted with Visian ICL were subjected to UBM examination between March 2010 and January 2015. The relative position of ICL to the adjacent structure and the overall iris configuration were evaluated. The machine calibers were used to measure the minimum central distance between the ICL and anterior lens capsule (vault) and the vertical central distance between the corneal endothelium and the ICL (E-ICL).Results. The mean ICL vault was376±105 μm. The mean E-ICL was2826±331 μm. Contact between ICL and the posterior epithelium of the iris was present in all eyes. The overall iris configuration was flat in 89 eyes. Central anterior convexity was present in 41 eyes and mild peripheral iris bombe in 12 eyes. The haptics could be imaged in the ciliary sulcus in 112 eyes and at least one haptic resting on the lens periphery and zonules in 30 eyes.Conclusion. UBM can provide valuable anatomical information that allows detailed postoperative in vivo assessment of ICL.

Aim of the work To assess the use of combined multidetector computed tomography and instillation dacryocystography (CTDCG) in detection of the level lacrimal drainage system (LDS) obstruction. Methods Twenty-one patients with one-sided epiphora were our candidates for CTDCG. Axial source and post processing images were assessed for clear viewing and the ability to detect the level of LDS obstruction. To our knowledge, no previous studies used this combination in the assessment of the LDS obstruction. Results All patients tolerated the examination well. Various levels of LDS obstruction were detected, common canaliculus in 4 (19%) patients, lacrimal sac in 3 (14.2%), junction between lacrimal sac and NLD in 9 (42.8%) and NLD obstruction in 5 (23.8%) patients. The most common CTDCG findings were dilated opacified lacrimal sac with no opacification of the nasolacrimal duct (NLD) in 9/21 (42.8%) patients. Curved planner reformation (CPR) were excellent to detect the nasolacrimal duct (NLD) obstruction. Conclusion CTDCG is a non-invasive patient friendly procedure that adds benefit in documentation and preoperative planning.

Purpose The aim of this study was to compare direct brow lift and transblepharoplasty browpexy for the management of brow ptosis in terms of cosmetic results, complications, and patient satisfaction. Patients and methods It is a surgical intervention prospective comparative study, 40 brows of 24 patients with brow ptosis were divided into two groups. Group A included 20 brows that were subjected to direct brow lift and group B included 20 brows that were subjected to transblepharoplasty browpexy. Preoperative evaluation included assessment of general and ophthalmological history, brow evaluation, any associated dermatochalasis, ocular examination, cranial nerve examination, visual field assessment, and photographic documentation. Results Bilateral brow ptosis was present in 16 patients, whereas eight patients had unilateral brow ptosis. There were 16 female patients and eight male patients. Their age ranged between 53 and 75 years. The cosmetic complaint of an undesirable appearance was the presenting symptom in 18 patients, whereas functional issues with heaviness and temporal visual field defects were the presenting symptoms in four patients. In group A (direct brow lift), 16 brows were corrected with the brow level at or slightly above the superior orbital margin, whereas four brows were undercorrected. In group B (transblepharoplasty browpexy), 12 brows were fully corrected, whereas eight brows were undercorrected. Conclusion Both direct brow lift and transblepharoplasty browpexy are effective and safe techniques for the correction of brow ptosis. Each procedure has its own advantages.

Purpose The aim of this study was to investigate the sensorineural hearing loss (SNHL) in patients with pseudoexfoliation (PXF) syndrome and its correlation with clinical ophthalmological findings. Methods A total of 25 patients with PXF and 15 age-matched and sex-matched normal controls were subjected to complete ophthalmological and audiological evaluation. The degree of hearing loss was compared between the two groups and correlated with the clinical findings including glaucoma, cataract, and laterality of PXS. The independent-sample Mann-Whitney U -test, the Kruskal-Wallis one-way analysis of variance, the related-sample McNemar test and Pearson's correlation were used for statistical analysis. Results A total of 22 patients had bilateral symmetrical SNHL. Overall, three ears (6%) had normal hearing sensitivity, 29 ears (58%) had mild SNHL, 15 ears (30%) had moderate SNHL, and three ears (6%) had moderately severe SNHL. On an average, patients had mild degree of SNHL in the frequencies 250-2000 Hz, moderate degree of SNHL in the frequency 4000 Hz, and moderately severe SNHL in the frequency 8000 Hz. SNHL was not affected by the association of cataract or glaucoma. A total of 28 ears of the controls had mild degree of hearing loss and two ears had normal hearing sensitivity. Conclusion The prevalence and severity of SNHL increases in cases of PXF compared with age-matched controls. This is not affected by the laterality of ocular involvement, or the presence or absence of cataract or glaucoma. This confirms the systemic nature of the disease and may add to difficulties during ophthalmic surgery when performed under local anesthesia due to difficulty in communication.

Introduction Optic disc edema (ODE) can be caused by a variety of conditions including pseudotumor cerebri, hypertension, diabetes, uveitis, anemia, lymphoma, and papillitis. Improvement in the quality of optical coherence tomography (OCT) can support the diagnosis and management of ODE. OCT may help in this diagnosis by showing peripapillary retinal nerve fiber layer (RNFL) thickening. Aim of the work To evaluate quantitative assessment of optic disc edema by measuring peripapillary nerve fiber layer (RNFL) thickness, and peripapillary maximum neurosensory retinal (MNSR) thickness in the four quadrants using spectral domain OCT. Patients and methods The study was done in El-Minya Investigation Eye Center between May 2012 and May 2013. The study included 21 eyes of 16 patients with optic disc edema and 20 eyes of 11 normal control persons. Both patients and normal control were examined by spectral domain OCT, two sets of measurements were evaluated and compared: Peripapillary RNFL thickness measurement in four quadrants using the standard optic disc cube 200 × 200 acquisition protocol, spectral domain OCT, Peripapillary maximum neurosensory retinal thickness (MNSR) in four quadrants using high definition 5 line images. Results In ODE group, 21 eyes of 16 patients were evaluated. The control group included 20 eyes of 11 normal subjects. The Mean average peripapillary RNFL was 93.1 ± 8.2 in control group 132.3 ± 46 µ in mild ODE, 139.4 ± 29.2 µ in moderate ODE and 264.2 ± 116.9 µ in severe ODE. The mean average peripapillary MNSR in the four quadrants was 350.1 ± 36.3 µm in control group, 458.7 ± 37.3 µm in mild ODE, 634.4 ± 35.01 µm in moderate ODE and 968.3 ± 245 µm in severe ODE. Conclusion There was a statistically significant increase in mean RNFL thickness and mean MNSR in four quadrants in all grades of ODE group compared with the control group ( P = 0.001). There was a strong positive correlation ( r = 0.89, P = 0.001) between the mean MNSR and the mean RNFL in eyes with ODE.

Aim of the work The aim of this work is to study the changes that occur in the posterior corneal surface after laser-assisted in-situ keratomileusis (LASIK) for correction of myopia using Pentacam. Patients and methods In a prospective interventional case-series study, 50 myopic eyes of 27 patients were subjected to the LASIK procedure. Preoperative, 1 week, and 3 months postoperatively, Pentacam examination was performed at the Elminia Roaa Refractive Center between January and October 2011. Pentacam was used for the assessment of preoperative and postoperative pachymetry, anterior and posterior corneal curvatures, anterior and posterior corneal elevations, and asphericity of the posterior corneal surface. Results This study included 50 eyes of 27 patients, 19 women (70.3%) and eight men (29.7%). Patients' age ranged from 20 to 44 years, mean 27.3 ± 7.03 years. No statistically significant changes were found in the posterior horizontal corneal curvature (Rh). A statistically significant change in the posterior vertical corneal curvature (RV) from 6.1 ± 0.3 to 6.06 ± 0.2 mm 1 week after LASIK was found, but increased after 3 months to 6.2 ± 0.3S mm. No statistically significant changes in the posterior mean corneal curvature (Rm) were observed either at 1 week or 3 months after LASIK. A significant change in the Q -value (asphericity) was found both at 1 week and 3 months postoperatively. There were significant changes in the posterior corneal elevation both at 4 and at 7 mm from the center both at 1 week and 3 months after LASIK. Conclusion Post-LASIK changes of the posterior corneal surface affect mainly the vertical curvature, asphericity, and posterior corneal elevation. Fortunately, no case of post-LASIK ectasia was observed during the follow-up period of this study. Further studies are needed to document posterior corneal surface changes in patients with suspected post-LASIK ectasia.