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Purpose To compare the safety and efficacy of standard 30 min epithelium‐off cross‐linking (CXL) versus photorefractive keratectomy (PRK) combined with accelerated epithelium‐off cross‐linking (AXL) for the treatment of progressive keratoconus (CXL‐Plus). Methods This study was a prospective multicentre comparative clinical study. A total of 125 eyes of 75 patients with grade 1 keratoconus and documented progression were divided into two groups. Group A included 58 eyes treated with standard CXL. Group B included 67 eyes treated with combined PRK and AXL. The recorded data included UDVA, CDVA, subjective and objective refraction, keratometry and pachymetry using corneal topographies preoperatively and postoperatively at 3, 6, 12 and 24 months of follow‐up. Results In group A, at 24 months of UDVA and CDVA were improved from 1.12 ± 0.38 and 0.58 ± 0.42 to 0.66 ± 0.20 and 0.20 ± 0.12 (LogMAR±SD). The spherical equivalent was reduced from 4.03 ± 1.18 to 1.78 ± 1.04 D. The cylinder reduction was 0.32 ± 0.19 D. In group B, at 24 months of UDVA and CDVA were improved from 1.26 ± 0.52 and 0.68 ± 0.36 to 0.58 ± 0.28 and 0.20 ± 0.16 (LogMAR ± SD). The spherical equivalent was reduced from 4.23 ± 0.95 to 1.92 ± 0.74 D. The cylinder reduction was ±1.76 D. Conclusion Surprisingly, standard CXL showed close results to CXL‐Plus at the 24th follow‐up month. Standard CXL acted as a stabilizing procedure associated with a late myopic component reduction. CXL‐Plus acted as a refractive and stabilizing procedure with an early effect on both the myopic and the astigmatic component but no later improvements. Standard CXL seems to be more powerful than AXL in its long‐term effect. Therefore, in the future, we want to test the combination of PRK with standard CXL.

Supplemental Digital Content is Available in the Text., Purpose: To evaluate the effectiveness and safety of combined epithelium-off cross-linking (CXL) with photorefractive keratectomy (CXL Plus) for correction of the myopic and astigmatic components of keratoconus. Methods: Seventy-nine eyes of 46 patients who underwent CXL Plus were enrolled in this retrospective, multicenter, noncomparative clinical study. Uncorrected distance visual acuity, corrected distance visual acuity, refraction, keratometry, and pachymetry measurements were recorded preoperatively and at 3, 6, 12, and 18 months during follow-up. Results: The mean (±SD) preoperative uncorrected distance visual acuity and corrected distance visual acuity were 1.00 ± 0.22 logarithm of the minimum angle of resolution (logMAR) and 0.62 ± 0.38 logMAR, respectively, and improved to 0.71 ± 0.36 logMAR and 0.32 ± 0.18 logMAR postoperatively. The mean k value, mean corneal thickness at the thinnest location, and mean myopic and astigmatic components decreased from 46.58 ± 0.97 D, 473 ± 29 μm, 3.65 ± 1.72 D, and 1.83 ± 0.69 D preoperatively to 43.79 ± 1.17 D, 431 ± 38 μm, 1.02 ± 0.78 D, and 1.15 ± 0.26 D, respectively, during follow-up. Eleven eyes had delayed epithelial healing, 2 had stromal opacities, 1 had primary herpes simplex keratitis, and 5 showed progression of keratoconus. Conclusions: CXL Plus improved the refractive status of keratoconus during 18 months of follow-up, despite its potential early postoperative complications of delayed epithelial healing and corneal haze. CXL Plus reduced the myopic component more than the astigmatic component of keratoconus. However, the safety and stability of the procedure were offset by longer-term postoperative complications and a high rate of postoperative progression of keratoconus.

Background To document the visual acuity, spectral domain optical coherence tomography (SD-OCT) findings and prognosis in10 eyes of 6 patients with foveal damage from solar retinopathy in 1 year. Methods This was a prospective, observational case series of patients presented by solar maculopathy at Ophthalmology department, Sohag University. All patients underwent visual acuity (VA) testing, refraction, dilated fundus examination fluorescein angiography (FA) and SD-OCT (spectral Domain ocular coherence Tomography) imaging and follow up for 1 year. Results The mean age was 16.5 years (range 9–27 years, both eyes are affected in 4 patients. The mean spherical equivalent (SE) was – 0.25 ± 0.50 D. The visual acuity of the affected eyes ranged from 0.4 to 0.9 on presentation. At presentation Significant foveal pathology was identified on SD-OCT in 10 eyes, All eyes showed disruption of the photoreceptor ellipsoid zone and the interdigitation zone on SD-OCT, Follow up of the cases continued for 1 year.100% of cases showed improvement in VA: 20% eyes regained 1, 50% eyes with VA of 0.9; two eyes 20% 0.8 and one eyes (10%) with 0.4. The improvement began after 1 week and reached its maximum and became stationary after the 6th month of follow up, the outer retinal hole persist in OCT in 80% of cases. Conclusion Solar maculopathy has a good prognosis yet shows no improvement after 6 months. Young age might pose as a risk factor.

This study was performed to investigate aberrometric changes of Keratoconus (KC) and its correlation with corneal topographic indices. In a cross sectional study, the researchers included 170 eyes of 138 candidates that were seeking corneal refractive surgery in Sohag refractive center, Sohag, Egypt and had been diagnosed as clinical KC. Patients were divided to mild, moderate, and severe KC. All eyes included in this study were subjected to corneal tomographic evaluation. Corneal aberrometry data was collected from the Sirius topography (Sirius, Costruzione Strumenti Oftalmici, Italy) over a 5-mm diameter. The collected data included Zernike coefficients for corneal aberrations, including total Root Mean Square (RMS), RMS Spherical Aberration (SA), RMS Coma, and RMS astigmatism. The study population was divided to mild, moderate, and severe KC. Mild KC cases included 58 eyes of 46 patients, moderate KC were 64 eyes of 52 patients, and severe KC were 48 eyes of 40 patients. Root mean square total was statistically significant in all groups with a higher p value in moderate KC (P = 0.001) and also was statistically significant when compared in the three groups altogether (P = 0.0001). Coma aberration was statistically significant in mild and moderate KC and when compared between the three groups (P = 0.0001). Root mean square Trefoil aberration was statistically significant only in moderate KC yet was statistically significant when compared in all groups (P = 0.0001). Root mean square astigmatism was statistically significant in mild KC only and when compared in the three groups altogether (P = 0.0001). Spherical aberration was also statistically significant in moderate and severe KC with a P value of < 0.0001 and 0.001, respectively. There was a positive correlation between posterior elevation and RMS values in mild and moderate KC while there was negative or very weak positive correlation in severe KC. There were negative correlations between the thinnest location and RMS values in nearly all variables in the three groups except weak positive correlation with RMS astigmatism in mild KC and with RMS total and coma aberration in severe KC .In conclusion corneal higher order aberrations measured by the Sirius topography system had low to moderate correlation with corneal topographic indices provided by the same device in different grades of KC.

To analyze the visual and refractive outcomes of combined accelerated cross-linking with femtosecond laser intracorneal ring segment implantation for the treatment of pediatric keratoconus.This retrospective multicenter noncomparative clinical study included 63 eyes of 37 patients (age, 9-17 years) who underwent between August and September 2016 combined cross-linking with intracorneal ring segment implantation for keratoconus. Preoperative and postoperative (6, 12, and 18 months) uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), subjective refractions, keratometry (K), and pachymetry measurements were compared.The postoperative spherical equivalent refraction was within ±1 D, ±2 D, and ±3 D in 19 (30.2%), 27 (42.9%), and 37 (58.8%) eyes, respectively. Only 27 eyes achieved the attempted preoperative spherical equivalent refraction. The mean spherical equivalent refraction significantly improved from -6.01 ± 2.97 to -3.13 ± 2.78 D postoperatively (P 0.0001). The mean K average reading significantly decreased from 48.75 ± 4.25 to 46.65 ± 3.89 D postoperatively (P 0.0001). The mean postoperative myopic, astigmatic, and spherical equivalent corrections were -2.17 ± 2.19, -1.52 ± 2.03, and -2.93 ± 2.35 D, respectively. The mean UDVA and CDVA showed significant improvements (0.89 ± 0.33 to 0.40 ± 0.28, P 0.0001; 0.35 ± 0.31 to 0.25 ± 0.24, P = 0.004; respectively) at 18 months postoperatively. Keratoconus progression, segment migration, and segment extrusion were seen in four (6.4%), one (1.6%), and three (4.7%) eyes, respectively, probably contributing to the lower mean postoperative CDVA.Cross-linking plus is only partially effective for pediatric keratoconus. Despite some improvements in vision and keratometry measures, it resulted in complications such as keratoconus progression, segment extrusion, and segment migration that affected the vision in some patients. These findings suggest an assessment of standard epithelium-off collagen cross-linking as a sole procedure to treat pediatric keratoconus in future studies.

Purpose: To compare intraocular pressure (IOP) readings and postoperative inflammation between 2 corticosteroid drops: difluprednate (DP) ophthalmic emulsion 0.05% and prednisolone acetate (PA) 1.0% after uneventful cataract surgery. Patients and methods: randomized, controlled study of 343 patients undergoing uneventful cataract surgery in one eye. Randomization was used to allocate patients to either group: receive prednisolone acetate 1% five times daily or difluprednate 0.05% four times daily for 14 days post-surgery, then tapered over 14 days. Intraocular pressure was measured preoperative, 1st day, 1st week, and one month postoperative. Also, ocular inflammation was monitored in the form of anterior chamber (AC) flare, AC cells, corneal edema and conjunctival congestion. Results: No statistically significant difference in IOP between both groups was detected on postoperative first day and after one month. Yet there was statistically significant difference after first and second week of treatment with higher levels in the difluprednate group. As for ocular inflammation all signs resolved by the end of a month postoperative with no significant difference between both groups. Conclusion: There was significant increased intraocular pressure in the difluprednate group than in the prednisolone acetate group which might be attributed to the increased dosing and duration of use of difluprednate.

Purpose: To evaluate the relative frequencies, clinical profile, and treatment outcomes of paediatric orbital tumours in Upper Egypt. Materials and Methods: In a retrospective, non-comparative, case series study, the authors reviewed the medical records of all children evaluated at Sohag University Hospital, from September 2014 till August 2017, with the diagnosis of orbital tumours and tumour-like lesions. The final diagnosis in each case was established by a combination of history, ophthalmic examination findings, imaging studies, and histopathologic examination if biopsy was performed. Results: A total of 92 orbital lesions were included in this study, which were classified into the following major categories: Cystic (28 cases, 30.4%), vascular (13 cases, 14.1%), Lipomatous (10 cases, 10.9%), inflammatory (9 cases, 9.8%), neurogenic (7 cases, 7.6%), lymphoid/leukemic (6 cases, 6.5%), myogenic (5 cases, 5.4%), lacrimal gland (5 cases, 5.4%), secondary (4 cases, 4.3%), metastatic (3 cases, 3.3%), and histiocytic (2 cases, 2.2%) orbital lesions in order of frequency. The clinical features and treatment outcomes of these lesions will be discussed. Conclusion: A variety of benign and malignant paediatric orbital tumours may be seen in clinical practice. Management of these tumours requires a multidisciplinary approach. Early diagnosis and prompt treatment provide good cosmetic and functional results, and prevent visual loss in the majority of those children.