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The aim was to compare the long-term surgical outcomes of visco-circumferential-suture-trabeculotomy (VCST) and rigid probe viscotrabeculotomy (VT) in patients with primary congenital glaucoma (PCG).The study was conducted on 84 (47 right) eyes of 49 (32 males) children PCG to the pediatric ophthalmology unit of Mansoura Ophthalmic Center of Mansoura University, Egypt between 2015 and 2018. An initial office examination was followed by an examination under general anesthesia to establish the diagnosis of PCG. The children were then scheduled for surgery and the eyes randomly assigned to VCST or VT. Follow-up visits were scheduled at the first day, first week, first, and third months and then every 3 months for 1 year.The mean±SD age of the study children at presentation was 4.8±2.1 and 4.9±1.7 months in the VCST and the VT groups, respectively (P=0.827). The mean±SD preoperative intraocular pressure (IOP) was 29.13±3.3 and 29.89±3.2 mm Hg in the VCST and VT groups, respectively (P=0.292) and 11.9±1.3 and 13.8±1.2 mm Hg at the end of 36 moths of follow-up (P0.001). The IOP at all follow-up time points (except at the third month, P=0.924) was statistically significantly less in the VCST group than in the VT group (at week 1, month 1, 6, 9, 12, 18, 24, 30, and 36 the P0.001). The cumulative probability of success was 100%, 95%, 90%, and 90%, respectively in VSCT and 100%, 72.7%, 97.7%, 90.9%, and 84% in VT at 12, 24, 30, and 36 months.Both VCST and VT were effective and safe for lowering the IOP in PCG with VCST providing a marginal advantage over VT.

To compare trabeculectomy with Ologen implant(Trab-Ologen) to combined viscotrabeculotomy-synechiolysis(VTS) in uncontrolled uveitic glaucoma (UG). A retrospective chart review of 47 patients subjected to VTS(24 eyes) or Trab-ologen(23 eyes) at Mansoura Ophthalmic Center between 2010 and 2016. The patients were evaluated on day 1, week 1, months 1, 3, 6, 12, 18, 24, 30, 36, 42, and 48. The mean ± standard deviation age of patients in the Trab-ologen and VST groups were 38.29 ± 12.5 and 38.91 ± 11.8 years (p = 0.86), respectively. Juvenile Idiopathic arthritis (controlled on methotrexate) was the most common associated systemic disease (3 patients in each group). The mean ± standard deviation of the intraocular pressure (IOP) and IOP-lowering medications preoperatively and at the end of follow up in the Trab-ologen and VST groups were 33.1 ± 2.6 mmHg, 33.2 ± 2.6 mmHg (p = 0.91), 3.4 ± 0.5, 3.4 ± 0.5 (0.90) and 15.4 ± 1.2 mmHg, 13.0 ± 0.9 mmHg (p

Purpose: To report the corneal tomographic characteristics of eyes that had surgery for controlled primary congenital glaucoma (PCG) and to compare it with an age-matched group of normal children. Methods: The study was conducted on 44 (24 right) eyes of 27 children (18 boys) who had surgery for PCG and 60 (31 right) eyes of 32 age-matched control children (9 boys). Children with PCG had a thorough ophthalmic examination and the demographic and medical and surgical history was retrieved from the patients' clinical chart records. After clinical examination, the study participants underwent Scheimpflug imaging using the Pentacam (Oculus Optikgeräte GmbH). Results: Both study and control children were approximately 9 years of age at the time of the study ( P = .39). The eyes with PCG had a spherical equivalent mean ± standard deviation of −4.70 ± 3.50 diopters (D). Eyes with PCG demonstrated a cylinder of −2.80 ± 2.10 D, flatter corneas than control eyes ( P = .0002 and .0012 for flat and steep keratometry, respectively), and statistically significantly higher astigmatism ( P = .011) and thinner corneas, both at pupil center ( P < .001) and thinnest location ( P < .001). There was a statistically significant negative correlation between the postoperative axial length (at the time of the scan) and each of the Scheimpflug parameters flat keratometry ( P = .002), steep keratometry ( P = .003), pachymetry at pupil center ( P = .01), and pachymetry at thinnest location ( P = .009). Conclusions: The eyes of patients with PCG have thinner, flatter, and more astigmatic corneas than the eyes of age-matched control children. [ J Pediatr Ophthalmol Strabismus . 2021;58(4):218–223.]

The aim of the study was to compare the effect of viscotrabeculotomy and the effect of trabeculectomy on the intraocular pressure (IOP) in cases of open angle glaucoma (OAG). Prospective comparative study. The study was conducted on 148 eyes of 148 patients (87 men) presenting with and operated upon for OAG at Mansoura Ophthalmic center of Mansoura University in Mansoura, Egypt from 2012 to 2016. Patients were randomized into viscotrabeculotomy and trabeculectomy groups. Postoperative follow up visits were scheduled at weeks 1 and 2 then months 1, 2, 3, 6, 9, 12, 15, 18, 21 and 24. Complications were noted and managed according to needs. The primary outcome measure was IOP. The study was conducted on 148 eyes (74 right) of 148 patients (87 men). The mean ± SD (range, median) age of the study patients was 50.1 ± 11.5 (20–67, 53) and 51.1 ± 10.0 (27–65, 54.5) years respectively. The mean ± SD (range, median) IOP of the study eyes on maximal tolerated IOP lowering therapy was 23.15 ± 2.31 (19–30, 23.0) and 23.64 ± 1.87 (20–28, 23.0) mmHg respectively and at the end of the 24 months of follow up was 14.91 ± 2.4 (12–23, 14) and 16.64 ± 2.8 (14–25, 16) mmHg respectively (p =

Purpose To assess the long-term results of viscotrabeculotomy in infants with primary congenital glaucoma and to compare its outcome with conventional trabeculotomy. Patients and methods A prospective randomized comparative study included infants with primary congenital glaucoma younger than 2 years. Patients were divided into two groups: viscotrabeculotomy group and conventional trabeculotomy group. Preoperative and postoperative intraocular pressures, corneal diameter, intraoperative and postoperative complications, and success rates were compared between two groups. All the patients were followed up for 5 years. Results The study included 154 eyes of 92 infants distributed randomly among the two groups; 78 and 76 eyes in viscotrabeculotomy and conventional trabeculotomy groups, respectively. In both groups, there was a statistically significant intraocular pressure reduction at all time points of the follow-up periods compared to the preoperative values (p < 0.0001). At 5 years, viscotrabeculotomy group showed significant reduction of the mean postoperative intraocular pressure (49.47%) than conventional trabeculotomy group (48.64%) (p < 0.0001). Intraocular pressure was statistically lower in viscotrabeculotomy starting from 12th month and till the end of the follow-up. At 5 years, the total success rate of viscotrabeculotomy group was 89.74% compared to 85.53% in conventional trabeculotomy group without significant difference (p = 0.487). The postoperative mean values of the cup/disk ratio in viscotrabeculotomy group showed statistically lower values compared to conventional trabeculotomy group (p = 0.019). Postoperative hyphema was statistically higher in conventional trabeculotomy group (p Conclusion Viscotrabeculotomy and conventional trabeculotomy proved to be effective in cases of primary congenital glaucoma. Viscotrabeculotomy appeared to have prolonged stability in controlling the intraocular pressure with higher success rates and lower complications.

Purpose: To compare viscotrabeculotomy with anterior chamber irrigation to Ahmed glaucoma valve implantation for secondary glaucoma following silicone oil removal. Methods: A prospective study was conducted on 43 vitrectomized pseudophakic eyes with persistent glaucoma after silicone oil removal. Patients were randomized to either viscotrabeculotomy with anterior chamber irrigation or Ahmed glaucoma valve implantation. All patients were examined on day 1, week 1, and months 1, 3, 6, 9, 12, 18, and 24 postoperatively. Postoperative complications were noted. Success was defined as an intraocular pressure between 6 and 20 mmHg and with an intraocular pressure reduction of >30% compared with the preoperative intraocular pressure. Results: There were 22 eyes in the viscotrabeculotomy with anterior chamber irrigation and 21 eyes in the Ahmed glaucoma valve implantation group. The mean preoperative and postoperative intraocular pressure in the viscotrabeculotomy with anterior chamber irrigation and Ahmed glaucoma valve implantation groups were 35.5 ± 2.6 mmHg and 35.5 ± 2.4 mmHg and 16.9 ± 0.7 mmHg and 17.9 ± 0.9 mmHg respectively (p˂0.0001). There was a statistically significant intraocular pressure reduction at all follow-up time points compared to preoperative values (p˂0.0001) in both groups. The unqualified success rate in the viscotrabeculotomy with anterior chamber irrigation and Ahmed glaucoma valve implantation groups were 72.73% and 61.9%, respectively. A minimal self-limited hyphema was the most common complication. Conclusions: Both viscotrabeculotomy with anterior chamber irrigation and Ahmed glaucoma valve implantation are effective in lowering the intraocular pressure in glaucoma after silicone oil removal with viscotrabeculotomy with anterior chamber irrigation providing greater reduction, higher success rates, and minimal complications. RESUMO Objetivo: Comparar a viscotrabeculotomia com irrigação da câmara anterior com o implante de válvula de glaucoma de Ahmed para glaucoma secundário após remoção de óleo de silicone. Métodos: Foi realizado um estudo prospectivo de 43 olhos pseudofácicos vitrectomizados com glaucoma persistente após a remoção de óleo de silicone. Os pacientes foram randomizados para viscotrabeculotomia com irrigação da câmara anterior ou implante de válvula de Ahmed. Todos os pacientes foram examinados no primeiro dia, na primeira semana e 1, 3, 6, 9, 12, 18 e 24 meses após a cirurgia. Observaram-se complicações pós-operatórias. O sucesso foi definido como uma pressão intraocular entre 6 e 20 mmHg e uma redução da pressão intraocular >30% em comparação com a pressão intraocular pré-operatória. Resultados: Foram designados 22 olhos para o grupo da viscotrabeculotomia com irrigação da câmara anterior e 21 olhos para o grupo do implante de válvula de Ahmed. A pressão intraocular média pré-operatória foi de 35,5 ± 2,6 mmHg para o grupo da viscotrabeculotomia com irrigação da câmara anterior e pós- e de 35,5 ± 2,4 mmHg no grupo do implante de válvula de Ahmed. e Os valores pós-operatórios foram de 16,9 ± 0,7 mmHg e 17,9 ± 0,9 mmHg para esses mesmos grupos, respectivamente (p

Purpose The aim of the current study was to compare visco-trabeculotomy (VT) with standard trabeculectomy with mitomycin C (Trab-MMC) in the treatment of quiescent neovascular glaucoma (NVG). Methods The study was conducted on 51 eyes of 51 patients presenting with NVG and treated at an Ophthalmic Center in Egypt between March 2014 and April 2017. All study eyes were subjected to a standard protocol of intravitreal injection of ranibizumab followed by panretinal photocoagulation. Eyes were then randomized to either VT or Trab-MMC. Study eyes were followed up for at least 18 months. Success was defined as an intraocular pressure of ≤21 mm Hg and without vision-threatening complications. Complications were noted. Results The mean ± SD (range, median) age of the study patients was 54.1 ± 6.4 (40-67, 54.5) and 52.4 ± 8.8 (38-66, 53) years in the VT (26 eyes) and Trab-MMC (25 eyes) groups, respectively (P = 0.45). The mean ± SD (range, median) intraocular pressure (IOP) of the study eyes was 45.19 ± 2.97 (39-52, 45.5) and 45.64 ± 3.56 (3-53, 45) mm Hg on maximal medical therapy in the VT and Trab-MMC groups, respectively (P = 0.61). At 18 months' follow-up, the mean ± SD (range, median) IOP of the study eyes was 18.19 ± 2.0 (16-23, 17) and 19.92 ± 2.6 (18-26, 19) mm Hg in the VT and Trab-MMC groups, respectively (P = 0.004). There was no difference in postoperative antiglaucoma medication between the 2 groups (P = 0.62). Complications included hyphema and Descemet split in the VT group and an IOP spike in the Trab-MMC group. Success rates were 84.6% and 80% in the VT and Trab-MMC groups, respectively (P = 0.726). Conclusions Both VT and Trab-MMC groups are effective in reducing the IOP in cases of NVG after control of neovascularization with anti-vascular endothelial growth factor and pan retinal photocoagulation.

PURPOSE To compare the outcome of the intraocular pressure (IOP) of Ahmed glaucoma valve (AGV) revision to visco-trabeculotomy (VT) in children's eyes with failed AGV. PATIENTS AND METHODS A prospective randomized study conducted on 41 children (41 eyes) with uncontrolled glaucoma with an AGV presenting to the pediatric ophthalmology clinic of Mansoura Ophthalmic Center between 2011 and 2016. Study eyes were randomized to AGV revision or VT. Success (true and qualified) (IOP

Mai A Mohammed,1 Mohamed Saad Morsy,1 Nashwa Shehata Zeater,2 Nader Bayoumi1 1Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt; 2Resident of Ophthalmology, Damanhour Eye Hospital, Damanhour, EgyptCorrespondence: Mai A Mohammed 36 Kamaleldin Salah, Semouha, Alexandria, EgyptTel +201221081590Fax +203 42 444 41Email mai.abdalnabi@yahoo.comBackground: To evaluate the VEP parameters in operated controlled primary congenital glaucoma (PCG) eyes and compare them to normal age similar children eyes.Methods: A cross-sectional comparative study conducted on 34 (19 right) eyes of 26 (19 males) children operated for PCG and 30 (17 right) eyes of 22 (12 males) age similar control children in a university-based practice. All study participants were subjected to a standard protocol of examination and electrophysiological testing (single flash VEP response, light adapted, pupils not dilated), reporting on the P2 implicit time, N1-P1 and N2-P2 (amplitude).Results: The mean±SD of the age of the study children and controls was 43.22± 33.2 and 55.68± 35.2 months respectively (p=0.217). The mean±SD IOP and cup/disc ratio of the study children were 18.4± 5.2 and 5.2± 3.3mmHg and 0.7± 0.2 and 0.3± 0.3 at presentation and at testing, respectively. The VEP testing was conducted after 21.5± 21.3 months of surgery for PCG. There was no statistically significant differences in P2, N1-P1 and N2-P2 between patients and controls (p=0.941, 0.916,0.945, respectively). There was no statistically significant correlation between most of the clinical characteristics of the study eyes and any of the studied VEP parameters.Conclusion: Operated controlled PCG eyes have VEP parameters that match their normal fellow children.Keywords: primary congenital glaucoma, visual evoked potentials, optic nerve, electrophysiology

Purpose To report on the changes in the natural crystalline lens in primary congenital glaucoma (PCG) eyes that had undergone previous combined angle-filtering surgery with antimetabolites. Settings The pediatric ophthalmology unit of the ophthalmology department of Alexandria Main University Hospital. Design A retrospective chart review. Methods A retrospective chart review of patients presenting with and operated (by combined angle-filtering surgery with antimetabolites) for PCG in the period from 2005 to 2018. Any lens pathology was noted as well as the management and the outcome. Results The records of 422 children (613 eyes) were reviewed. Lens pathology was noted in 54 (8.8%) eyes. Abnormalities in lens clarity (cataract) were detected in 31 (56%) eyes, and abnormalities in lens position (subluxation) were detected in 24 (44%) eyes. Management options included observation (in 28 eyes), lensectomy for aphakia (in 14 eyes), lensectomy with in the bag intraocular lens (IOL) implantation (in 11 eyes), and lensectomy with iris-fixated IOL (in 1 eye). Elevation of intraocular pressure (IOP) occurred in only 4 eyes (of 26 operated eyes, 15.3%) after lens extraction. Conclusions Changes in the natural crystalline lens clarity and/or position occurred in 8.8% (54 of 613) of PCG eyes operated by combined angle-filtering surgery with antimetabolites. Lens extraction was a relatively safe procedure with only 15% (4 of 26) of eyes suffering an elevation of IOP after lens extraction.

To report the flash visual evoked potential (VEP) findings in children with primary congenital glaucoma (PCG) before and after successful surgical control of the intraocular pressure (IOP). The study enrolled children presenting with PCG to the Ophthalmology Department of Alexandria Main University Hospital in the period between June and December 2019. All study participants were subjected to a standard protocol of examination, to confirm the diagnosis of PCG. The child was then referred for flash VEP testing. Peaks were designated as negative and positive waves in a numerical sequence (N1, P1, N2, P2, N3 and P3). The child was then scheduled for surgery within 1 week of presentation. Postoperative VEP testing was scheduled as soon as feasible and was conducted in the same way as the preoperative VEP testing. The study was conducted on 11 (four right) eyes of eight (five males) children. The mean ± standard deviation of the age of the study children at presentation and at postoperative VEP testing was 3.5 ± 1.6 and 5.1 ± 3.0 months, respectively. The study eyes mean ± standard deviation IOP at presentation and at postoperative VEP testing was 23.0 ± 6.7 and 8.3 ± 2.4 mmHg, respectively (p

Background: Pediatric ocular trauma may be a major source of lifelong visual morbidity and disability. Objective: To report on the different types of ocular injury in children in a tertiary referral center. Participants and settings: Children presenting with ocular trauma to the casualty department of the pediatric ophthalmology unit of Alexandria Main University Hospital in Alexandria, Egypt. Methods: The study was conducted from June to December 2018. Upon admission, thorough history was obtained from the attending person(s), and thorough ophthalmic examination was performed. Appropriate treatment was subsequently provided to every case (though not the scope of the current study). Results: A total of 146 children (from a total of 436 patients, 33.5%) (103 males, 70.5%) presented with various types of ocular injuries. The mean age ± standard deviation of the injured children was 98.1 ± 56.4 months. Study participants were almost equally distributed between within and outside of the city of the study locale, with a predominance of patients from urban areas in Alexandria (30%) and from rural areas outside of Alexandria (35.6%). Seventy percent of the care providers of the study children were manual workers. The places of the incidents were almost equally distributed between household (40%) and external environment with a slight predominance of the later (50%). Conclusions: Ocular injuries represent one-third of all ocular injuries in the study locale. Ocular injuries in children occur with an almost equal distribution in both urban and rural areas and in both household and external environments. Mechanical trauma was the most common cause of trauma.

Purpose: To compare releasable and regular sutures in combined angle and filtering surgery for primary congenital glaucoma. Methods: A prospective study was conducted on 39 eyes (26 right eyes) of 39 children (20 boys; 19 girls) who had primary congenital glaucoma treated with combined trabeculotomy-trabeculectomy with mitomycin C and scleral flap closure with regular or releasable sutures. Follow-up was 24 months. Success rates (defined as an intraocular pressure [IOP] < 16 mm Hg without hypotony-related complications and/or lack of IOP-related progression of the disease) were studied and complications were noted. Results: The mean age of the study participants was 6.7 ± 5.8 months (range: 1 to 24 months; median: 5 months) in the regular suture group (20 eyes) and 5.3 ± 2.8 months (range: 1 to 13 months; median: 5 months) in the releasable suture group (19 eyes). The initial glaucoma surgery was successful in 13 (65%) and 13 (68.4%) eyes in the regular suture and releasable suture groups, respectively. The mean IOP was 17.4 ± 7.3 and 16.0 ± 5.4 mm Hg ( P = .84) preoperatively and 8.0 ± 9.7 and 5.8 ± 3.6 mm Hg ( P = .40) at the end of follow-up in the regular suture and releasable suture groups, respectively. There was no statistically significant difference in the clinical parameters between the two groups. Complications included rhegmatogenous retinal detachment, cataract, and superior lens subluxation, with each complication developing in one eye. Conclusions: Releasable sutures were not more advantageous than regular sutures in combined trabeculotomy-trabeculectomy with mitomycin C surgery for primary congenital glaucoma. [ J Pediatr Ophthalmol Strabismus . 2017;54(5):295–301.]

Purpose Primary congenital glaucoma (PCG) accounts for 26–29% of childhood blindness in Egypt. The identification of disease causing mutations has not been extensively investigated. We aimed to examine the frequency of CYP1B1 and MYOC mutations in PCG Egyptian patients, and study a possible genotype/phenotype correlation. Methods Ninety-eight patients with PCG diagnosed at the Ophthalmology department of Alexandria Main University Hospital were enrolled. Demographic and phenotypic characteristics were recorded. Patients and 100 healthy subjects (control group) were screened for two mutations in CYP1B1 gene (G61E, R368H) and one mutation in MYOC gene (Gln48His) using polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP). Phenotypic characteristics pertaining to disease severity were compared. Results Nineteen patients (19%) with PCG were found positive for one or more of the mutations screened for. Seven patients (7%) were homozygous for the G61E mutation. Ten patients (10%) were heterozygous; 6 for the G61E mutation, 2 for the R368H mutation and 2 for the Gln48His mutation. Two patients (2%) were double heterozygotes harboring a R368H as well as a Gln48His mutation. The most common mutation observed was the G61E in 13 patients; 7 homozygotes and 6 heterozygotes for the mutation. The control group were negative for all mutations screened for. No significant correlations between the mutations and phenotype severity were detected. A statistically significant positive correlation however was found between the different mutations and each of the IOP and the cup/disk ratio. Conclusion The current study further endorses the role of CYP1B1 mutations in the etiology of PCG among Egyptian patients and is the first study to report MYOC gene mutation in Egyptian patients with PCG.

To report on the corneal biomechanical characteristics, namely the corneal hysteresis (CH), corneal resistance factor (CRF), as well as the intraocular pressure (IOP) goldman compensated (IOPg), and the cornea compensated (IOPcc), using the ocular response analyzer (ORA) in different age groups in a cohort of normal individuals from the second decade to the seventh decade and beyond. The study was a cross-sectional survey conducted on 997 eyes of 508 normal individuals presenting for a routine ophthalmic examination at Alexandria Main University Hospital in Alexandria University, Alexandria, Egypt. The study subjects were age stratified into decades (10–20, 21–30, 31–40, 41–50, > 50) and the ORA parameters (CH, CRF, IOPg, IOPcc) reported and stratified. Correlations were sought between the ORA parameters and the age, gender, and laterality. The study was conducted on 997 (502 right) eyes of 508 (234 males) normal individuals. The mean ± SD ages of the study groups were 14.7 ± 3.2, 25.9 ± 3.0, 35.3 ± 2.8, 44.6 ± 2.9, and 61.1 ± 7.7 years. The mean ± SD of the CH in the study groups were 10.9 ± 2.4, 9.8 ± 1.5, 9.8 ± 1.4, 9.7 ± 1.7, and 9.5 ± 1.6 mmHg and of the CRF were 10.9 ± 2.4, 9.5 ± 1.7, 9.4 ± 1.8, 9.6 ± 1.9, and 9.6 ± 1.8 mmHg. A statistically significant negative correlation was found between age and each of CH and CRF. IOPcc demonstrated a fairly constant trend in the different age groups whereas IOPg demonstrated an initial decline followed by a gradual rise over time. The corneal biomechanical properties CH and CRF decrease with age. IOPg and IOPcc change minimally with age.

Purpose The aim of the study was to estimate the age-specific and sex-specific prevalence of age-related macular degeneration (AMD) among elderly patients attending Alexandria Main University Hospital. Study design A cross-sectional survey was conducted. Patients and methods Patients aged 55 years or older were randomly selected from those attending different outpatient clinics at Alexandria Main University Hospital. One thousand eyes of 532 patients were included in the study. They underwent full ophthalmic examination with fundus photography. The fundus photographs were graded into early and late AMD according to the International Age-Related Macular Epidemiological Study Group Classification system. Prevalence rates were calculated. Results The overall prevalence of AMD was 6.6%. The prevalence of early and late AMD was 5.3 and 2.4%, respectively. There was a significantly higher prevalence of early and late AMD among those aged at least 75 years as compared with other age groups. The prevalence of AMD among male participants was 9.2% compared with only 4.1% among female participants. When potential risk factors were analyzed, smokers and those suffering from hypertension were associated with a significantly higher prevalence of AMD than were nonsmokers or those without hypertension. Diabetes mellitus was not significantly associated with AMD. Conclusion In this study, the prevalence of early AMD in younger age groups was lower than that found in other population-based studies in western populations. The prevalence of AMD increased with age and was significantly higher among men and smokers.

Purpose To study primary congenital glaucoma characteristics and surgery in a University-based practice in Egypt. Patients and methods The present study was a retrospective chart review of 165 eyes of 112 children who presented and were operated upon between 2005 and 2012 at Alexandria Main University Hospital in Egypt. The charts were reviewed for demographics as well as clinical data. Postoperative data were retrieved till the end of the follow-up period. Complications were noted, and success rates were studied. Results The mean age±SD (range) of the study population at presentation was 6.1±4.4 (1–24) months, and of the follow-up period was 32.3±21.7 (6–78) months. The average (range) number of glaucoma procedures performed for each eye was 1.3 (1–4). The most common primary glaucoma surgical procedure performed was combined trabeculotomy–trabeculectomy with mitomycin C (143 procedures). The mean values (range) of preoperative intraocular pressure (on no intraocular pressure lowering therapy), corneal diameter and thickness, cup/disc ratio and axial length of the study eyes were 18.7±5.9 (5–36) mmHg, 12.8±0.9 (10–17) mm and 619.5±95.2 (433–784) μm, 0.6±0.2 (0–1) and 22.99±1.82 (17.0–30.59) mm, respectively, and postoperatively at last follow-up were 7.4±6.6 (0–46) mmHg, 13.0±0.9 (10–18) mm and 530.6±75.1 (425–823) μm, 0.3±0.3 (0–1) and 24.06±2.13 (20.55–30.75) mm, respectively. Cumulative success by Kaplan–Meier analysis was 0.97, 0.89, 0.83, 0.73 and 0.61 at 1, 2, 3, 4 and 5 years, respectively. Complications included corneal scarring, cataract, intraretinal haemorrhages, hypotony disc oedema, rhegmatogenous retinal detachment and endophthalmitis. Conclusion Combined trabeculotomy–trabeculectomy with mitomycin C is a successful treatment for primary congenital glaucoma. Meticulous, continuous and prolonged follow-up is mandatory for all operated cases to ensure long-term success.

Of 170 children who underwent 248 glaucoma procedures at a single center between 2005 and 2012, 13 eyes of 12 children (5.24%) developed decompression retinopathy, which resolved spontaneously, leaving no visible structural damage to the fundus structures. The mean age of children with hemorrhages was 39.2 ± 63.5 months; of those without, 8.0 ± 9.7 months. The fundus hemorrhages were peripapillary, subfoveal, dot-and-blot, and diffuse. Combined angle and filtering surgery with antimetabolite was the most common procedure performed in all eyes. There were no statistically significant differences between eyes with and without hemorrhages with respect to demographics or preoperative and operative characteristics. No definite ocular risk factor was identified for the occurrence of decompression retinopathy.

Purpose: To compare the effect of two exposure durations of mitomycin C in combined angle and filtering surgery for primary congenital glaucoma. Methods: This was a prospective study conducted in the Department of Ophthalmology at Alexandria Main University Hospital, Alexandria, Egypt, on 75 eyes with primary congenital glaucoma that underwent combined trabeculotomy–trabeculectomy with intraoperative mitomycin C application for 1 minute (MMC 1) or 2 minutes (MMC 2) and were followed up for 24 months. Success rates were studied and complications noted. Success was defined by a composite primary end point of an intraocular pressure (IOP) of less than 16 mm Hg under general anesthesia, without any IOP-lowering medications and with no hypotony-related complications and/or lack of IOP-related progression of the disease as evidenced by worsening of the ocular biometric characteristics. Results: The mean age of the study participants was 6.7 ± 4.1 months (range: 2 to 16 months; median: 6 months) in the MMC 1 group (35 eyes) and 7.7 ± 5.7 months (range: 1 to 32 months; median: 6.5 months) in the MMC 2 group (40 eyes). The initial surgery was successful in 32 (91.5%) and 31 (77.5%) eyes in the MMC 1 and MMC 2 groups, respectively. The mean IOP was 18.4 ± 5.1 and 18.1 ± 6.1 mm Hg preoperatively and 5.5 ± 3.5 and 4.8 ± 2.8 mm Hg at the end of follow-up in the MMC 1 and MMC 2 groups, respectively. There was no statistically significant difference in the clinical parameters between the two groups. Complications included cataracts in each group and hypotony optic disc edema in 3 eyes (7.5%) in the MMC 2 group. Conclusions: Both mitomycin C application durations were effective in combined trabeculotomy–trabeculectomy with mitomycin C for primary congenital glaucoma. The longer duration was not advantageous in disease control and there were no significant differences in complications. [ J Pediatr Ophthalmol Strabismus . 2018;55(3):164–170.]

To study the additive value of deep sclerectomy to the procedure of combined trabeculotomy—trabeculectomy with mitomycin C (CTTM) for the treatment of primary congenital glaucoma. This study is a prospective, randomized case series. The study was conducted on 20 eyes of 20 children with primary congenital glaucoma presenting to the Department of Ophthalmology of the Alexandria Main University Hospital. Preoperative examination under anesthesia was followed by surgical intervention. Postoperative examinations were conducted immediately after surgery and at 1, 2, 3, 6, 9, and 12 months. Intraoperative and postoperative complications, as well as operative time, were recorded. The mean (±SD, range) age of the study patients in the CTTM group and in the combined trabeculotomy–trabeculectomy with mitomycin C with deep sclerectomy (CTTM-DS) group was 4.7 (±2.0, 2–8) and 7.0 (±3.8, 3–13) months, respectively. The mean (±SD, range) preoperative intraocular pressure (IOP) in the CTTM and CTTM-DS groups was 16.7 (4.3, 10–26) and 16.4 (8.4, 8–36), respectively, and these dropped at 12 months of follow-up to 4.9 (2.0, 2–8) and 5.6 (3.3, 2–10), respectively. The mean (±SD, range) of the duration of the operation in the CTTM and the CTTM-DS was 57 (±8, 50–71) min and 53 (±7, 42–64) min, respectively (P=0.428). Two eyes (20%) in the CTTM-DS group developed hypotony disc edema at the first 2 months and resolved spontaneously thereafter. No other complications were noted in either of the groups. The addition of deep sclerectomy to the procedure of CTTM in pediatric glaucoma surgery facilitates the finding of Schlemm’s canal, shortens the duration of surgery, and is not associated with any additional complications. Hence, the author recommends the addition of deep sclerectomy to CTTM surgery for primary congenital glaucoma.

Waardenburg anophthalmia syndrome, also known as microphthalmia with limb anomalies, ophthalmoacromelic syndrome, and anophthalmia-syndactyly, is a rare autosomal-recessive developmental disorder that has been mapped to 10p11.23. Here we show that this disease is heterogeneous by reporting on a consanguineous family, not linked to the 10p11.23 locus, whose two affected children have a homozygous mutation in SMOC1. Knockdown experiments of the zebrafish smoc1 revealed that smoc1 is important in eye development and that it is expressed in many organs, including brain and somites.

Purpose To investigate the role of ultrasound biomicroscopy (UBM) in the evaluation of anterior segment anatomy in cases of congenital and developmental cataract. Setting Alexandria Main University Hospital, Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt. Methods In this cross-sectional nonrandomized unmasked study, ultrasound biomicroscopy (UBM) was used to evaluate the anterior segment anatomy of 32 eyes of 21 children with congenital and developmental cataract. The parents were questioned for details of the children's history. An initial office examination was done to detect visual function, pupil color, lens morphology, corneal clarity, and presence of gross anterior segment anomaly. If the fundus was visible, it was examined in cooperative children after mydriasis. Under general anesthesia, each child was examined by UBM. Results The parameters detected by UBM included anterior chamber depth, lens thickness, zonular fiber length, ciliary process length, anterior chamber angle, and lens morphology. A-scan biometry was also performed to detect anterior chamber biometric characteristics. Conclusion Ultrasound biomicroscopy is a valuable tool for evaluating childhood cataracts and associated ocular anomalies as well as anterior segment biometric characteristics.

Purpose: To report the clinical and genetic study of a child with bilateral anophthalmia. Methods: A 14-year-old Egyptian boy, born from consanguineous parents, underwent a general and a full ophthalmological examination. Mutation screen of the A/M genes with recessive inheritance was done stepwise and DNA was analyzed by Sanger sequencing. Results: Bilateral anophthalmia, arachnodactyly of the feet and high arched palate were observed on general examination. The parents were first cousins and healthy. Sequencing analysis revealed a novel compound heterozygous mutation in one of the copy of exon 2 of VSX2 and a possible deletion of at least exon 2 on the other allele. Conclusions: A compound heterozygous VSX2 mutation associated with anophthalmia was identified in a patient from an Egyptian consanguineous family. This report brings the number of VSX2 mutation in anophthalmia/ microphthalmia (A/M) to 13. Functional consequences of the reported changes still need to be characterized, as well as the percentage of A/M caused by mutations in the VSX2 gene. This family also shows that despite consanguinity, heterozygous mutations can also happen and one should not restrict the molecular analysis to homozygous mutations.

Anophthalmia or microphthalmia (A/M), characterized by absent or small eye, can be unilateral or bilateral and represent developmental anomalies due to the mutations in several genes. Recently, mutations in aldehyde dehydrogenase family 1, member A3 (ALDH1A3) also known as retinaldehyde dehydrogenase 3, have been reported to cause A/M. Here, we screened a cohort of 75 patients with A/M and showed that mutations in ALDH1A3 occurred in six families. Based on this series, we estimate that mutations in ALDH1A3 represent a major cause of A/M in consanguineous families, and may be responsible for approximately 10% of the cases. Screening of this gene should be performed in a first line of investigation, together with SOX2. (C) 2014 Wiley Periodicals, Inc.

Objective and importance: Imatinib–the principle treatment currently available for chronic myeloid leukemia (CML)–may be implicated in neovascular glaucoma (NVG) pathogenesis. Clinical presentation: A 64 year old diabetic female develops CML and receives imatinib treatment develops aggressive bilateral neovascular glaucoma within 1 month of initiation of treatment. The left eye is lost and the right eye was hardly salvaged through panretinal photocoagulation and substitution of imatinib therapy to desatinib therapy. Intervention: Systemic imatinib therapy for CML. Conclusion: Imatinib may be implicated in the causation of NVG in CML patients, who should thus receive regular thorough ophthalmic evaluation as long as imatinib therapy continues.