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Amin E Nawar Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, EgyptCorrespondence: Amin E Nawar, Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, 31516, Egypt, Tel +20 1140095692, Email nawar20012002@gmail.comPurpose: The present study evaluated the effectiveness of suprachoroidal injection of triamcinolone acetonide (TA) in resistant diabetic macular edema (DME) using a modified microneedle.Patients and Methods: This is a prospective nonrandomized interventional study that was conducted on 55 eyes of 39 patients with centrally involving DME resistant to previous antivascular endotheli qal growth factor (VEGF) agents. All patients received suprachoroidal injection of triamcinolone acetonide 4 mg/0.1 mL by a modified specialized microneedle.Results: The mean central macular thickness (CMT) decreased sign ificantly from 478.7± 170.2 μm before injection to 230.2± 47.4 μm after 12 months with p-value < 0.001. Significant improvement of the mean best corrected visual acuity (BCVA) from 1.193± 0.2 by logMAR at the baseline to 0.76± 0.3 by logMAR was achieved after 12 months with p-value < 0.001. The IOP increased significantly at one month after injection and returned to the baseline value at the third month. Eyes with more baseline CMT and worse baseline BCVA achieved worse final BCVA 12 months after injection. Eyes with inner segment/outer segment (IS/OS) disruption and neurosensory detachment (NSD) showed worse final visual outcomes. IS/OS segment disruption, NSD and baseline BCVA were the main independent predictors of the final BCVA.Conclusion: Suprachoroidal injection of TA using this new modified microneedle resulted in marked anatomical and functional results in cases of DME resistant to previous anti-VEGF drugs with no serious ocular or systemic side effects. The study was prospectively registered with clinical trial.gov ID (NCT04690608) in 27– 12-2020.Keywords: diabetic macular edema, suprachoroidal injection, triamcinolone acetonide, optical coherence tomography

Purpose: To evaluate optical coherence tomography angiography findings in patients with multiple sclerosis (MS). Methods: This prospective noninterventional study was conducted on 30 eyes of relapsing-remitting MS patients. Group (1) included 10 eyes with a history of optic neuritis (ON), group (2) included 10 eyes without any history of optic neuritis (MS-ON), and group (3) included 10 eyes of normal age/sex/refraction matched participants. Optical coherence tomography (OCT) and OCT-A (ZEISS Cirrus™ HD-OCT Model 4000 (Carl Zeiss-Meditec, Dublin, CA) of the optic disc were done for all patients. Results: The best-corrected visual acuity was diminished in MS cases, especially in patients with ON with P value

Background: Intravitreal injections (IVIs) are considered one of the most important and minimally invasive procedures for treatment of many retinal diseases. Recently the instillation of povidone iodine to the surface of the eye is the only proven prophylactic measure that can lower the risk of endophthalmitis following intravitreal injection. Objective: The study aims to assess the antimicrobial efficacy of lower povidone iodine concentrations 2.5% and 1.25% in intravitreal injection. Methodology: This is a prospective interventional study that was conducted on 60 eyes of 45 patients with diabetic macular edema, retinal vein occlusion (RVO) and age related macular degeneration (AMD). Patients were divided into three groups, group one involved 20 eyes that received application of povidone iodine 5%, groups 2 and 3 received povidone iodine 2.5% and 1.25% respectively. Conjunctival swabs were taken before and after povidone iodine in the three groups, colony forming units (CFU) were calculated to detect the efficacy of povidone iodine in decreasing the bacterial load of the conjunctiva. The patient discomfort was recorded in a chart scale to evaluate pain. Results: The CFU was markedly decreased in the 3 groups with no detected statistical significance between all groups confirming the antiseptic efficacy of lower concentrations of povidone iodine. The lower concentration 1.25% showed more patient comfort and tolerability with lower score on pain chart scale. Conclusion: Lower concentrations of povidone iodine can achieve similar antiseptic effect compared to the standard 5% concentration with better tolerability.

Amin E Nawar Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, EgyptCorrespondence: Amin E Nawar, Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, 31516, Egypt, Tel +20 1140095692, Email nawar20012002@gmail.comPurpose: The present study evaluated the efficacy of combined suprachoroidal injection of triamcinolone acetonide (TA) using a modified microneedle with intravitreal injection of ranibizumab in branch retinal vein occlusion (BRVO) patients.Patients and methods: This is a prospective randomised interventional study that was conducted on 60 eyes of 60 patients with non ischemic BRVO. Patients were divided in two groups, group (1) 30 patients who received intravitreal injection of 0.05 mL (0.5 mg) of ranibizumab, group (2) included 30 patients who received baseline combined intravitreal injection of 0.05 mL (0.5 mg) of ranibizumab and suprachoroidal injection of triamcinolone acetonide (4mg/0.1mL), both groups received monthly injection of ranibizumab on pro-re-nata (PRN) regimen for 1 year duration of the study.Results: Group 2 received less number of injections (2.47 ± 1.2) as compared to group 1 (4.4 ± 1.5). Both groups achieved significant reduction of central macular thickness (CMT) after 12 months of injection with p value < 0.001. Both groups showed significant improvement of best corrected visual acuity (BCVA) after 12 months with p value < 0.001. Group 2 showed more significant improvement of BCVA after 6 and 12 months. The baseline CMT and the number of injections were the main predictors of the final BCVA in group 1, while the baseline BCVA was the only predictor of final BCVA in group 2.Conclusion: Combined suprachoroidal injection of TA using this modified microneedle with intravitreal injection of ranibizumab resulted in more significant improvement of BCVA and reduction of CMT compared with ranibizumab monotherapy with no reported ocular or systemic side effects. The study was prospectively registered with clinical trial.gov ID (NCT04690608) in 27-12-2020.Keywords: branch retinal vein occlusion, suprachoroidal injection, triamcinolone acetonide

Introduction Silicone oil (SO) has been used in complex cases of retinal detachment with proliferative vitreoretinopathy (PVR), giant retinal tear, and traumatic cases. This study aimed to assess macular structural changes in SO filled eyes after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment with PVR. Patients and methods This is a prospective interventional study that was conducted on 60 SO-filled eyes after successful PPV for rhegmatogenous retinal detachment with grade C PVR; SO was left in all eyes for a duration of 3 months. Thorough ophthalmic evaluation in Ophthalmology Department, Tanta University, Egypt was performed including best corrected visual acuity (BCVA), fundus examination, and anterior segment examination. Optical coherence tomography was done for all patients at presentation to assess the macular area. Results Epiretinal membrane (ERM) was detected in 14 (23.3%) eyes, cystoid macular edema (CME) in 21 (35%) eyes, photoreceptor disruption in 21 (35%) eyes, macular hole in one (1.7%) eye, and foveal thinning in 18 (30%) eyes. The BCVA was positively correlated with the presence of ERM, CME, and photoreceptor disruption and the results were statistically significant with ERM and photoreceptor nonintegrity with P values of 0.049 and 0.001 respectively. In addition, there is no significant correlation between changes in central retinal thickness and BCVA. Conclusion Visual loss after successful PPV in SO filled eyes can occur due to macular changes like CME, ERM, photoreceptor disruption, foveal thinning, and macular hole.

Background Diabetic macular edema (DME) is a leading cause of visual loss in diabetic patients and is managed using multiple anti-vascular endothelial growth factor (VEGF) agents such as bevacizumab, ranibizumab and aflibercept. The present study evaluates effectiveness of intravitreal injection of ziv-aflibercept in resistant diabetic macular edema. Methods This is a prospective interventional study that was carried out on 59 eyes of 40 diabetic patients with diabetic macular edema resistant to three prior consecutive ranibizumab injections. On all patients, thorough ophthalmic evaluation including optical coherence tomography was performed. In patients with persistent intraretinal or subretinal fluid, ziv- aflibercept 1.25 mg (0.05 ml) was administered by intravitreal injection monthly during the 6 month study period from June to December 2019. Results The central macular thickness (CMT) decreased significantly from 395.08 ± 129.9 um at baseline to 282.39 ± 95.278, 245.36 ± 79.861 and 201.17 ± 54.042 after 1, 3 and 6 months of treatment respectively (p p = 0.001). After treatment, negative correlations were detected between age, number of injections, duration of DM and level of glycated hemoglobin (HbA1c) and variation of both CMT and BCVA. The only significant predictor for low final CMT after 6 months of injection was the CMT after 3 months of injection (p = 0.001). Conclusion Ziv-aflibercept is a highly effective and safe drug in cases of DME resistant to previous ranibizumab injections especially in low-income countries. Trial registration This study was retrospectively registered at clinicaltrials.gov (ID: NCT04290195) on 28-2-2020.

Background: Myopic choroidal neovascularization (CNV) is the most common sight threatening complication in high myopia. The present study evaluates the efficacy and safety of intravitreal injection of ziv-aflibercept in patients with myopic CNV. Methods: This is a prospective interventional study that was conducted on 20 eyes of 20 patients with active myopic CNV. Twelve patients were 40 years old or more. The study was performed in Ophthalmology department, Tanta University Eye Hospital ,Tanta University, Egypt. Complete ophthalmic evaluation was performed including best corrected visual acuity (BCVA), fundus examination and anterior segment examination. OCT was done for all patients at baseline and monthly after injection during the 6 months follow up period of the study. Statistical calculations were performed using the computer program SPSS (S tatistical Package for the Social Science) . Results: The younger age group received lower number of injections than the older age group, the best corrected visual acuity ( BCVA) and the central macular thickness (CMT) improved significantly in both groups with more improvement in the younger age group as regarding the BCVA. No significant correlation was found between the final BCVA and both the spherical equivalent and the central macular thickness after 6 months.No significant changes in IOP after intravitreal injection were detected in both groups .No complications were reported apart from mild sub conjunctival hemorrhage that occurred in three eyes after injection. Conclusion: Ziv-aflibercept is a highly effective and safe drug in cases of active myopic CNV that can produce similar results to other anti VEGF agents with less cost. The study was retrospectively registered with clinical trial .gov ID (NCT04290195) in 26-2-2020.

Background Retinal vein occlusion is one of the most common vascular disorders that can cause visual loss. It is classified into central retinal vein occlusion (CRVO) and branch retinal vein occlusion. The most common cause of visual loss in CRVO is cystoid macular edema. Intravitreal injection of many antivascular endothelial growth factor agents can treat cystoid macular edema that occur owing to CRVO. Purpose The aim of the present study was to evaluate the efficacy of a new drug (Ziv-aflibercept) in the management of patients with CRVO. Patients and methods This is a prospective interventional study that was conducted on 15 eyes of 15 patients of recently diagnosed nonischemic CRVO of less than 2-month duration. Three loading doses of 1.25 mg of Ziv-aflibercept were given 1 month apart for each patient and then continued as needed in a pro re nata regimen. Complete ophthalmic evaluation was done at the Ophthalmology Department of Tanta University, including best-corrected visual acuity (BCVA), fundus examination, intraocular pressure measurement, and anterior segment examination. Optical coherence tomography (TOPCON 3D optical coherence tomography machine) was done for all patients at presentation and 1 month after each injection and then monthly during the follow-up period, which persisted for 6 months. Results The intraocular pressure did not show a statistically significant increase after intravitreal injection of Ziv-aflibercept. The BCVA improved significantly from 0.87±0.10 to 0.32±0.12 LogMAR after injection (P=0.001). The central macular thickness decreased significantly from a baseline value of 771±141.87 μm before injection to 306.67±91.51 μm after the three loading doses and to 208.07±12.97 μm after 6 months (P=0.001). There was no statistically significant correlation between the final BCVA and the final central macular thickness after 6 months (r=0.054, P=0.848). No serious complications were reported, such as endophthalmitis, vitreous hemorrhage, retinal detachment, or stroke. Conclusion Ziv-aflibercept is a highly effective drug in cases of nonischemic CRVO with a high safety profile and a relatively low cost.