Ahmed Roshdy Alagorie

Purpose: The present study evaluated the efficacy of suprachoroidal injection of Triamcinolone Acetonide (SCTA) in diabetic macular edema (DME) following pars plana vitrectomy (PPV) using a modified microneedle. Patients and methods: A prospective interventional study was conducted on 60 eyes of 60 patients with centrally involved diabetic macular edema following pars plana vitrectomy (PPV). SCTA was performed at the baseline and repeated after 3 months in case of persistent subretinal or intraretinal fluid, central macular thickness (CMT) more than 300 μm or visual loss by more than one line of the Snellen chart. Results: The present study detected significant reduction of the CMT from 498.3 ± 94.8 μm at the baseline to 212.3 ± 11.9 μm after 12 months of injection with p < 0.001 and a significant improvement of best corrected visual acuity (BCVA) from 1 (0.9– 1.2) at the baseline to 0.5 (0.3– 0.7) after 12 months of injection with p < 0.001. The intraocular pressure (IOP) increased significantly after 3 months of injection with p < 0.001 and then gradually declined to its normal level after 6 months. Inner segment/outer segment (IS/OS) disruption was the only significant predictor of the final CMT; however, the number of injections, IS/OS disruption, baseline BCVA and the HbA1C level were the significant predictors of the final BCVA after injection. Conclusion: Suprachoroidal injection of TA using this microneedle resulted in significant anatomical and functional improvement in previously vitrectomized diabetic macular edema patients with no recorded ocular or systemic adverse events.

Background: Recurrent retinal detachment is one of the major complications after silicone oil (SO) removal. Therefore, finding ways to decrease its incidence would be of great significance. Purpose: The aim of this study was to compare the rate of retinal re-detachment following SO removal in eyes that underwent scleral self-indentation during chandelier-assisted vitreous base shaving compared to the eyes that underwent scleral indentation by an assistant. Patients and methods: This is a retrospective study that included 381 eyes of 381 consecutive patients who underwent SO removal between December 2017 and December 2021, after a successful pars plana vitrectomy for primary rhegmatogenous retinal detachment. Scleral self-indentation (group A) was performed in 186 eyes, while scleral indentation by an assistant (group B) was performed in 195 eyes. The primary outcome measure was the rate of retinal re-detachment after SO removal. The secondary outcome measures were the rate of iatrogenic peripheral retinal tears and intraoperative complications. Results: Retinal re-detachment occurred in 21 (11.29%) eyes in group A compared to 38 (19.49%) eyes in group B, with a statistically significant difference (P=0.027). Iatrogenic retinal tear during vitreous base shaving occurred in two (1.08%) eyes in group A compared with 17 (8.71%) eyes in group B, with a statistically significant difference (P=0.001). Slipped infusion cannula during indentation occurred in two (1.02%) eyes in group B and resulted in serous choroidal detachment in one eye, a complication that was not reported in group A. Lens touch occurred in three (1.61%) eyes in group A versus eight (4.1%) eyes in group B, a statistically nonsignificant difference (P=0.065). Conclusion: Scleral self-indentation during chandelier-assisted vitrectomy facilitated safe and satisfactory vitreous base shaving with a lower risk of retinal re-detachment after SO removal. It was also associated with a lower rate of iatrogenic retinal breaks and intraoperative complications.

Purpose: To evaluate retinal microvasculature parameters during Behcet’s uveitis (BU) remission status reached post treatment with adalimumab via optical coherence tomography angiography (OCTA), and compares the results with those from healthy eyes. Methods: A total of 10 eyes of 10 BU patients presenting during the remission period (within 12 months) of BU involving the posterior segment were enrolled, as were 20 normal eyes of 20 age and sex-matched healthy participants. OCTA images were analyzed. Foveal avascular zone (FAZ), and vessel densities (VD) were calculated and compared. Results: 10 eyes of 10 BU patients and 20 normal eyes of 20 age and sex-matched subjects were included in the study. At baseline, the all 10 eyes had active retinal vasculitis. Retinal vasculitis resolved in all cases (100%) after starting adalimumab. The mean time to complete resolution of inflammation was 3.4 weeks. None of the patients developed any adverse events associated with adalimumab treatment. The FAZ was higher in the BD group than in the control group (p = 0.01). Both the superficial and deep plexuses vessel densities were significantly lower in BD eyes (p Conclusion: BD can cause irreversible damage to the retinal circulation affecting both SCP and DCP. OCTA gives a full view of the retinal microvasculature. Adalimumab was effective in preventing irreversible sight-threatening BD. Adalimumab treatment appears to be associated with improvement of the retinal blood flow more evident in the DCP thus provide better final visual outcome for cases with BD uveitis

Purpose To study the safety and efficacy of pterygium extended removal followed by extended conjunctival transplant for recurrent pterygia. Methods Thirty-three eyes of 33 subjects with recurrent pterygia were enrolled in this prospective case series study. Pterygium extended removal followed by extended conjunctival transplantation was performed in all subjects. One surgeon (WA) performed all surgeries. All subjects completed follow-up for at least 12 months and were evaluated for recurrence and complications. Results The mean age of the participants was 41.2 ± 10.3 years (range 22–60), 7 females (21.2%). The mean duration of follow-up was 25.64 ± 9.24 months (range 12–43). Corrected distance visual acuity (decimal notation) improved from 0.69 ± 0.22 (range 0.2–1.0) at presentation to a 1-year postoperative value of 0.83 ± 0.2 (range 0.3–1.0). No recurrence was reported in all subjects throughout the follow-up period. Transient graft swelling was recorded in 14 cases (42.4%) and resolved in all cases by the first week. All patients developed variable degrees of transient postoperative diplopia that resolved completely by the first 6 weeks. Donor site granuloma developed in 4 cases (12.1%). Spontaneous resolution was observed in 3 cases, while in one case, surgical excision was performed 2 months after the procedure. Conclusions In this study of eyes with recurrent pterygia, pterygium extended removal followed by extended conjunctival transplant was found safe and effective with no recurrence and minimal postoperative complications.

Purpose: To compare the subjective manifest astigmatism to the corneal topographic astigmatism in patients with keratoconus. Methods: This retrospective study included data of 230 keratoconic eyes of 115 patients. Topographic corneal astigmatism (TA), which was measured by pentacam, was compared and correlated to manifest refractive cylinder (MRC) in terms of power, axis, vector components, and mean vector. The difference between TA and MRC was correlated to the maximum keratometric reading (Kmax) and the thinnest pachymetry location (TL), as indicators of keratoconus severity. Results: There was a significant positive correlation between MRC power and TA power (p < 0.001; r = 0.58). TA power was significantly higher than MRC power (p < 0.001). A significant correlation was present between the axis of TA and MRC (r = 0.73; p < 0.001) with the axis of the MRC tending to be more vertical (more against the rule) than the axis of TA. The vector difference between TA and MRC is correlated to the Kmax (p < 0.001; r = 0.62) and TL (p < 0.001; r = 0.3). Conclusions: A significant difference is present between TA and MRC in keratoconic eyes, the power of MRC tends to be less and the axis tends to be more vertical than those of TA; this difference increases as keratoconus becomes more advanced.

Purpose: To assess the impact of the COVID-19 pandemic on urgent retina practice and factors influencing adherence of physicians and patients to safety measures. Methods: In this clinical audit, urgent or emergent vitreoretinal surgical disorders that presented to our hospital during the period of 15th March-15th May 2020 were compared with the period just before the pandemic declaration (15th December 2019-15th February 2020). Additionally, two questionnaires assessing the adherence to safety measures were circulated to the medical personnel and a sample of patients. The collected data were analyzed, and accordingly, recommendations were proposed to the hospital administration and specific corrective measures were applied. The outcome of applying these corrective measures was assessed in the re-audit cycle during the period of 15th June-15th August 2020. Results: There was a significant decrease in the number of urgent or emergent vitreoretinal surgical disorders that presented to our hospital during the pandemic (161 versus 302 cases in a similar period before the pandemic; p = 0.022). Just with the pandemic recession, there was a significant increase in the number of urgent cases (391 versus 161 cases during the pandemic; p = 0.006), also there was an increased number of complex cases. Residents and fellows were less compliant than attending physicians in adherence to safety measures. Conclusion: Delayed presentation of urgent retinal cases during the pandemic highlights the importance of public awareness of urgent conditions that need immediate medical or surgical care. Attention to young physicians during the pandemic is crucial as they are less adherent to safety measures due to work overload.

Purpose To study the safety and efficacy of pterygium extended removal followed by extended conjunctival transplant for recurrent pterygia. Methods Thirty-three eyes of 33 subjects with recurrent pterygia were enrolled in this prospective case series study. Pterygium extended removal followed by extended conjunctival transplantation was done for all subjects. One surgeon (WA) performed all surgeries. All subjects completed follow-up for at least 12 months and were evaluated for recurrence and complications. Results The mean age of the participants was 41.2 ± 10.3 years (range 22–60), 7 females (21.2%). The mean duration of follow-up was 25.64 ± 9.24 months (range 12–43). Corrected distance visual acuity (decimal notation) improved from 0.69 ± 0.22 (range 0.2–1.0) at presentation to a 1-year postoperative value of 0.83 ± 0.2 (range 0.3–1.0). No recurrence was reported in all subjects throughout the follow-up period. Transient graft swelling was recorded in 14 cases (42.4%) and resolved in all cases by the first week. All patients developed variable degrees of transient postoperative diplopia that resolved completely by the first 6 weeks. Donor site granuloma developed in 4 cases (12.1%). Spontaneous resolution was observed in 3 cases, while in one case, surgical excision was performed 2 months after the procedure. Conclusions In this study of eyes with recurrent pterygia, pterygium extended removal followed by extended conjunctival transplant was found safe and effective with no recurrence and minimal postoperative complications.