New insights into amiodarone induced retinal and optic nerve toxicity: functional and structural changes.

Background: Amiodarone is widely used for heart arrhytmia. Previous studies have suggested the possibility of optic neuropathy with the chronic use of this drug. Objectives: To identify structural or functional changes in the retina and optic nerve in patients on chronic amiodarone therapy without visual complaints. Methods: This observational study included 15 eyes of 15 patients with cardiac arrythmia on chronic amiodarone treatment and 15 healthy matched subjects as a control group. All subjects underwent electrophysiological tests [pattern visual evoked potential (PVEP), pattern electroretinogram (PERG), multifocal electroretinogram (mfERG), and optical coherence tomography (OCT) and angiography (OCTA)]. Results: There were no statistically significant differences between the two groups regarding the PVEP, PERG, and the mfERG parameters. Macular and optic nerve head OCT and OCTA have not shown statistically significant differences except for the morphological parameters of the optic disc (p = 0.008 for the horizontal and p = 0.013 for vertical cup/disc ratio and p = 0.045 for rim area). Conclusion: Patients on chronic amiodarone therapy have not shown evident structural or functional changes in the retinal or optic nerve as demonstrated by electrophysiological tests, OCT, and OCTA results compared to controls.

Bacillary layer detachment with malignant choroidal tumors: a case series.

PURPOSE: To study the incidence and characteristics of bacillary layer detachment (BALAD) occurring with the two most common choroidal malignancies, choroidal metastasis and choroidal melanoma. METHODS: A retrospective multicentric record analysis. Eyes with a diagnosis of choroidal melanoma or choroidal metastasis that had good-quality fundus photography and spectral domain optical coherence tomography (OCT) scans of the macular and tumor regions allowing for delineation of the retinal layers were included for analysis. Qualitative image evaluation was done by two independent graders for the presence, location, and OCT features of BALAD, as well as any associated intraretinal or subretinal fluid. Demographic and clinical data were also retrieved. RESULTS: Of the 11 eyes with choroidal metastasis and 7 eyes with choroidal melanoma that were included in the final analysis, 6 (54.5%) and 1 (14.3%) had BALAD, respectively. The BALAD co-localized with the subretinal fluid in all cases and with the intraretinal fluid in 1/3 cases (33.3%), was foveal in location in 3 eyes (42.9%), was overlying the tumor in 6 eyes (85.7%), and varied in number and size. Reflectivity within the BALAD was consistently higher than the vitreous and adjacent subretinal fluid, and discernable suspended hyperreflective particles were noted in 5 eyes (71.4%). CONCLUSION: BALAD is relatively common with choroidal metastasis. The OCT features described supplement our recognition of this new entity.

The outcomes of a low-cost, non-valved glaucoma drainage device using mitomycin-C: 1-year results.

PURPOSE: To evaluate the indications, outcomes, and complications of the usage of Aurolab Aqueous Drainage Implant (AADI) using mitomycin-C. METHODS: A retrospective case series of patients who underwent AADI placement using mitomycin-C between April 2018 and June 2020 at Ain Shams University Hospitals, Cairo, Egypt. The data was extracted from the records of the patients with a minimum of 1 year of follow-up. Complete success was defined as IOP ≥ 5 mmHg and ≤ 21 mmHg or reduction of IOP by ≥ 20% from baseline without antiglaucoma medications (AGMs). Qualified success was defined as reaching the same IOP range with the aid of AGM. RESULTS: A total of 50 eyes of 48 patients were included. Neovascular glaucoma represented the commonest indication (13 patients, 26%). The mean preoperative IOP was 34.0 ± 7.1 mmHg, with a median number of AGM of 3 (mean ± SD = 2.84 ± 1), while the mean IOP after 12 months was 14.3 ± 4 with a median number of AGM of 0. (mean ± SD = 0.52 ± 0.89) (p < 0.001). Complete success was achieved in 33 patients (66%). Qualified success was achieved in 14 patients (28%). Thirteen eyes (26%) had variable postoperative complications; none of them required explantation of the device or affected the visual acuity (except one patient). CONCLUSION: AADI with using mitomycin-C and ripcord during the surgery is an effective and relatively safe method of control of IOP in refractory and advanced cases of glaucoma, with an overall success rate of 94%.

Nail Folds Capillaries Abnormalities Associated With Type 2 Diabetes Mellitus Progression and Correlation With Diabetic Retinopathy.

Background: Diabetic retinopathy (DR) is an important microvascular consequence of long-term type 2 diabetes mellitus (T2DM), and it can lead to blindness if not properly diagnosed and managed. Nailfold video capillaroscopy (NVC) is a non-invasive technique for observing capillary microvasculature. Aim: We aimed to evaluate the nail folds capillaroscopic alterations in patients with T2DM by NVC and correlated the results to DR, and their relation to disease duration and hemoglobin A1c (HbA1c). Methods: This cross-sectional study enrolled 62 cases with T2DM (as per the American Diabetes Association criteria). All patients were subjected to NVC and ophthalmological assessment. Results: NVC revealed that Patients with DR showed significantly higher frequencies of tortuous capillaries, branched capillaries and precapillary edema versus non-DR patients with P < .05. The DR patients with longer disease duration (15-20) years had significantly higher frequencies of branched capillaries, tortuous capillaries, microhemorrhages, and dilated apical capillaries. The frequency of tortuosity and precapillary edema were significantly higher in patients with poor glycemic control. The increased capillary width and branched capillaries were detected as predictors of DR in multivariate analysis. Conclusion: NVC is a cost-effective, quick, safe, simple, non-invasive, and newly emerging tool to assess the capillaroscopic alterations in diabetic patients as an indicator of severity of DR.

Phacoemulsification with double-in-bag intraocular lens implantation in nanophthalmic eyes with angle-closure glaucoma.

PURPOSE:  To report the outcomes of phacoemulsification with piggyback intraocular lens (IOL) implantation, with double-in-bag IOLs in the management of angle-closure glaucoma (ACG) in nanophthalmic eyes. METHODS: This is a retrospective case series on nanophthalmic eyes with variable presentations of ACG. Phacoemulsification with double-in-bag IOL implantation was done for the included eyes. Baseline and follow-up corrected distance visual acuity (CDVA), spherical equivalent (SE), intraocular pressure (IOP), and the number of glaucoma medications were evaluated. Surgical details were extracted, and complications were recorded. RESULTS: Six eyes of three patients were included. The mean axial length was 17.24 ± 1.02 mm. The mean preoperative IOP was 20 ± 2.7 mmHg with medical treatment. The mean preoperative CDVA (logMar) was 0.83 ± 0.37 with mean SE 12.7 ± 1.77 diopters. The mean postoperative IOP at 3-month and 1-year follow-ups was 14 ± 5.3 mmHg and 15.5 ± 4.1 mmHg, respectively. Postoperative CDVA was 0.78 ± 0.41, with mean SE -0.04 ± 2 diopters. No significant intraoperative or postoperative complications were reported. One eye developed posterior capsule opacification (PCO), and another eye developed visually insignificant inter-lenticular opacification (ILO). CONCLUSIONS: In the evaluated nanophthalmic eyes with ACG, lens extraction with double-in-bag IOL implantation showed promising results regarding the IOP control as well as the visual and refractive outcomes.

Challenges of personal protective equipment use among ophthalmologists during the COVID-19 pandemic: A multicenter international study.

PURPOSE: To explore the possible challenges and difficulties of using Personal Protective Equipment (PPE) in ophthalmic practice during the Coronavirus disease 2019 (COVID-19) pandemic. METHODS: This is a multicenter, international survey among practicing ophthalmologists across different countries. The survey was conducted from September 9th to October 24th, 2020. It included a total of 23 questions that navigated through the currently adopted recommendations in different clinical situations. The survey also assessed the convenience of using various PPE in ophthalmic practice and addressed the clarity of the examination field while using various PPE during clinical or surgical procedures. RESULTS: One hundred and seventy-two ophthalmologists completed the survey (101 from Egypt, 50 from the USA, and 21 from four other countries). The analysis of the responses showed that most ophthalmologists use face masks without significant problems during their examinations, while face shields followed by protective goggles were the most inconvenient PPE in the current ophthalmic practice. Moreover, most of the participants (133, 77.3%) noticed an increase in their examination time when using PPE. Furthermore, a considerable percentage of the respondents (70, 40.7%) stopped using one or more of the PPE due to inconvenience or discomfort. CONCLUSIONS: Due to the unique nature of the ophthalmic examination, certain PPE are not ophthalmologist-friendly. Innovative PPE should be tailored for prompt, more convenient, and clearer ophthalmological practice.

Choroidal thickness in relation to urinary albumin excretion rate in type 2 diabetes mellitus without retinopathy.

BACKGROUND: To evaluate choroidal thickness (CT) in diabetic patients without diabetic retinopathy (DR) in relation to the urinary albumin excretion rate (UAER). METHODS: This is a prospective case-control study that included a consecutive sample of 120 patients with type 2 diabetes without clinically evident DR and a group of 60 matched healthy controls. Diabetic patients were included in two groups according to their UAER (normoalbuminuria and microalbuminuria). Complete ophthalmological examination was performed followed by optical coherence tomography (SD-OCT) for retinal and choroidal assessment. Twenty-four-hour urine samples were collected for UAER and blood samples for HbA1c and serum creatinine were obtained. RESULTS: The study included 180 eyes from 180 subjects in three groups. Patients with higher levels of albuminuria had a thinner choroid than normal controls, with decremental thinning as albuminuria progressed. Diabetics with normoalbuminuria showed no significant differences from controls. Choroidal thickness showed a significant moderate negative correlation with UAER (r = - 0.58, p < 0.001). Multiple regression analyses for diabetic patients with microalbuminuria demonstrated that UAER is the most important determinant of subfoveal choroidal thickness (SFCT) (p < 0.001). CONCLUSIONS: Decreased CT was significantly correlated with UAER in diabetic patients without retinopathy and otherwise normal kidney functions. This decrease in thickness might be a predictor of DR.

Spike in Rhino-Orbital-Cerebral Mucormycosis Cases Presenting to a Tertiary Care Center During the COVID-19 Pandemic.

Objective: To determine if there was an increase in the rate of cases presenting with rhino-orbital-cerebral mucormycosis (ROCM) to a tertiary care center during the first wave of the coronavirus disease 2019 (COVID-19) pandemic and the characteristics of the presenting cases. Methods: Retrospective observational study reviewing ROCM cases presenting from March 25 until September 25, 2020. Cases fulfilling the clinical, radiological, and pathological/microbiological criteria for diagnosis with ROCM were included. The number of cases presenting during the designated interval, their COVID-19 status, comorbidities, and clinical presentation were analyzed. The number of cases during the corresponding interval in the previous 3 years was used as reference to detect if there was a recent spike. Results: Of the 12 ROCM cases identified, 5 had a concurrent positive reverse transcription PCR (RT-PCR) test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 1 had a prior positive result, and 6 did not have concurrent nor prior positive test results. Nine of the 12 cases had poorly controlled diabetes mellitus, and 2 cases had a hematological malignancy. All cases had orbital invasion, and eight cases had cerebral invasion. The number of cases identified during the interval is much higher than the numbers presenting in the prior 3 years during equivalent intervals (range, one to two cases) than those reported in the literature in different settings in the pre-pandemic era. Conclusions: There is an increased rate of ROCM cases presenting to our center during the first wave of the COVID-19 pandemic. This is a preliminary report, and further studies are needed to corroborate the findings and explain possible underlying links.

Visual disability among patients attending glaucoma clinic in a tertiary hospital.

PURPOSE: To report visual impairment and blindness among the patients attending a glaucoma clinic in a tertiary university hospital and highlight the possible risk factors that could be addressed later. METHODS: A retrospective analysis of the medical records of the patients attending the glaucoma clinic in Ain Shams University Hospitals over a period of one year was conducted. Visual impairment classification was done according to the International Classification of Diseases and Related Health Problems (ICD-11) based on the best-corrected visual acuity in the better-seeing eye. Data including diagnosis, history of previous surgery, and duration of glaucoma were extracted and analyzed. RESULTS: The medical records of the first visit of 118 patients (58 males and 60 females) were included in this study. Secondary glaucoma was the most common type presented (38 patients, 32.2%), followed by primary open-angle glaucoma (35 patients, 29.6%). Sixty-seven patients (56.7%) were considered visually impaired, while seven patients (5.9%) were considered blind. Forty-one patients (34.7%) were considered mono-ocular blind. CONCLUSION: There is a high incidence of visual impairment and blindness among glaucoma patients presented to the glaucoma clinic in the  tertiary hospital. A further nation-wide study and possibly, an early surveillance program for glaucoma are needed.

Measurement of central corneal thickness using Orbscan 3, Pentacam HR and ultrasound pachymetry in normal eyes.

PURPOSE: To assess the agreement between Orbscan 3, Pentacam HR and ultrasound pachymetry (Palm Scan AP 2000) in measuring central corneal thickness. METHODS: Prospective observational cross-sectional study of ninety-two eyes of 48 patients with normal corneas was conducted. Central corneal thickness was measured via Pentacam HR, Orbscan 3 and ultrasound pachymetry. Bland-Altman analysis was used to demonstrate agreement between various methods. RESULTS: Ninety-two eyes of 46 subjects were enrolled. The mean age was 29.67 years (18-59). The average measurements of central corneal thickness were 545.73 ± 29.35 µm, 549.34 ± 29.14 µm and 545.78 ± 31.48 µm for the Pentacam HR, Orbscan and ultrasound pachymetry, respectively. The three devices measurements are closely correlated, with Pearson correlation coefficient ranging from 0.868 to 0.929. The 95 % limits of agreement were 25.2 to - 18 µm between Orbscan and Pentacam central corneal thickness, 25.2 to - 25.7 µm between Pentacam and pachymetry central corneal thickness and 34.4 to - 27.2 µm between Orbscan and pachymetry central corneal thickness. CONCLUSION: In spite of advancement of Orbscan 3, still there are wide agreement limits between CCT measurements obtained via Orbscan 3, Pentacam HR and ultrasound pachymetry; thus, interchangeable use in clinical practice is not recommended.