Epidemiology, Etiologies, and Complications of Playtime Open Globe Injuries in Children.

PURPOSE: To study the epidemiology, etiologies, and complications of playtime open globe injuries in children at the Assiut University Hospital, Egypt. METHODS: This prospective cross-sectional study enrolled children with open globe injury who were admitted to Assiut University Hospital during a 6-month period (January to July 2016). All causes of trauma that occurred during playtime (at home, outside home, at the club, or at school) were recorded and analyzed. RESULTS: Eighty-one children (age = 18 years and younger; mean ± standard deviation age = 8.35 ± 4.84 years) were admitted with open globe injury, and 32 of them (39.51%) sustained ocular trauma during playtime. The majority of children were boys (n = 23, 71.88%). The causes of trauma during playtime were: playing with sharp objects (n = 11; 34.38%), playing with a wooden stick (n = 7; 21.88%), falling on the ground (n = 5; 15.63%), trauma by a stone (n = 2; 6.25%), trauma during running (n = 1; 3.13%), playing with a plastic toy (n = 1; 3.13%), and unknown causes (n = 5; 15.63%). The sites of globe perforation were corneal (n = 23; 71.88%), corneoscleral (n = 8; 25%), and scleral (n = 1; 3.13%). CONCLUSIONS: Playtime trauma that causes open globe injury and visual disability is avoidable and constituted approximately half of the open globe injuries in this study population. Corneal involvement occurred in almost all open globe injuries. Parental supervision for children during playtime is crucial to injury prevention. Children should avoid playing with sharp, dangerous objects and desist from playing or running on unsafe ground. [J Pediatr Ophthalmol Strabismus. 2021;58(6):385-389.].

Pix2pix Conditional Generative Adversarial Networks for Scheimpflug Camera Color-Coded Corneal Tomography Image Generation.

Purpose: To assess the ability of pix2pix conditional generative adversarial network (pix2pix cGAN) to create plausible synthesized Scheimpflug camera color-coded corneal tomography images based upon a modest-sized original dataset to be used for image augmentation during training a deep convolutional neural network (DCNN) for classification of keratoconus and normal corneal images. Methods: Original images of 1778 eyes of 923 nonconsecutive patients with or without keratoconus were retrospectively analyzed. Images were labeled and preprocessed for use in training the proposed pix2pix cGAN. The best quality synthesized images were selected based on the Fréchet inception distance score, and their quality was studied by calculating the mean square error, structural similarity index, and the peak signal-to-noise ratio. We used original, traditionally augmented original and synthesized images to train a DCNN for image classification and compared classification performance metrics. Results: The pix2pix cGAN synthesized images showed plausible subjectively and objectively assessed quality. Training the DCNN with a combination of real and synthesized images allowed better classification performance compared with training using original images only or with traditional augmentation. Conclusions: Using the pix2pix cGAN to synthesize corneal tomography images can overcome issues related to small datasets and class imbalance when training computer-aided diagnostic models. Translational Relevance: Pix2pix cGAN can provide an unlimited supply of plausible synthetic Scheimpflug camera color-coded corneal tomography images at levels useful for experimental and clinical applications.

Prevalence and predictors of colour vision defects among Egyptian university students.

BACKGROUND: Nowadays, widespread usage of colours increases the need for accurate estimation of colour vision defects and their effect on performing daily activities and study/work tasks. AIMS: To determine the prevalence and predictors of colour vision defects among Assiut university students and to identify their relationship with self-reported visual function and perceived difficulties in performing daily activities. METHODS: A cross-sectional study was conducted among 1426 students at Assiut University, Egypt. Data were collected by self-administered questionnaire consisting of: personal characteristics, prior awareness of colour vision defects, difficulties in daily colour vision activities, and visual function. Colour vision was assessed using Ishihara's test of colour deficiency. RESULTS: The prevalence of colour vision defects among students was 6.9% (red-green colour vision was 4.3% and total colour blindness was 2.6%). Students with colour vision defects had significantly higher odds ratios for difficulties in daily activities and study/work tasks related to colour perception. Students with colour vision defects had significantly lower mean values of general health, role difficulties, and colour vision scores compared to students with normal colour insight. Male sex and family history of colour vision defects were risk factors. CONCLUSIONS: A non-negligible percentage of Egyptian university students had colour vision defects, which had a negative impact on performing daily activities, executing study/work tasks, and choice of study/work specialties. Colour vision defects affected quality of life with regard to general health, role difficulties and colour vision. Male sex and family history of colour vision defects are nonmodifiable risk factors. This emphasizes the need for genetic counselling, especially in consanguineous marriage.

Flap Sliding Technique for Managing Flap Striae following Laser In Situ Keratomileusis.

PURPOSE: To assess the efficacy and safety of a simple, noninvasive, "flap-sliding" technique for managing flap striae following laser in situ keratomileusis (LASIK). METHODS: This prospective, interventional study included eyes with post-LASIK flap striae. All eyes underwent flap sliding 1-2 days after surgery. Following flap edge epithelialisation, a cellulose sponge was used to gently slide the flap perpendicular to the striae direction. This technique allows for flap striae treatment without flap lifting, avoiding any associated lifting complications. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and refractive error were monitored one day after the flap-sliding procedure. RESULTS: Fifteen eyes (15 patients) with post-LASIK flap striae were managed using the flap-sliding technique. The procedure did not successfully relocate the flap striae in 1 eye, and flap elevation and floating (using a balanced salt solution) were required. Therefore, 14 eyes were included in post-flap-sliding analyses. The UDVA improved in all patients the first day after the flap-sliding procedure was performed, with 11 of 14 eyes (78.57%) reaching an UDVA of 20/25 or better. Complications following flap sliding occurred in 2 eyes (14.29%). One eye had intraoperative epithelial abrasion, and 1 eye had residual postoperative striae outside of the optical zone. CONCLUSION: The flap-sliding technique is a simple, noninvasive, efficient, and safe technique for managing post-LASIK flap striae that develop after epithelial healing in the early post-LASIK period. This trial is registered with NCT04055337.

Refractive Lens Exchange Combined with Primary Posterior Vitrectorhexis in Highly Myopic Patients.

Purpose. To evaluate efficacy and safety of primary vitrectorhexis for posterior capsulotomy in highly myopic patients undergoing refractive lens exchange. Methods. The study is a prospective nonrandomized interventional study. The study comprised 60 eyes of 60 myopic patients. All patients underwent refractive lens exchange (RLE) and foldable IOL implantation combined with primary posterior capsulotomy. We used a 23-gauge vitrectomy probe for the creation of the posterior capsule opening. We followed the patients for one year. Results. During surgery, the IOLs remained well centered in the capsular bag after creation of the capsulotomy. Postoperatively, we did not report any complications related to lens centration or changes in the posterior capsulotomy size. No eye required YAG laser posterior capsulotomy and no cases of retinal detachment (RD) occurred during the follow-up period. Conclusion. Primary posterior vitrectorhexis during RLE is an efficient method in preventing the occurrence of posterior capsular opacification (PCO) and the need for YAG laser posterior capsulotomy with its possible complications.

Spectral domain anterior segment optical coherence tomography in microbial keratitis.

PURPOSE: To investigate the spectral domain anterior segment optical coherence tomography (SDAS-OCT) patterns in microbial keratitis (fungal and bacterial keratitis). DESIGN: Prospective, cross-sectional, observational study. METHODS: Twenty eyes of 20 patients with proven fungal and bacterial microbial keratitis, at different stages of the disease, underwent SDAS-OCT imaging. RESULTS: Eight eyes presented with proven bacterial keratitis (3 Staphylococcus Aureus, 2 Pseudomonas Aeruginosa and 3 Staphylococcus Epidermidis). Twelve eyes presented with proven fungal keratitis of Aspergillus species. Twelve different SDAS-OCT presentations of fungal and bacterial keratitis were found in this study. Our findings in fungal keratitis grasped two unique patterns of early localized and diffuse necrotic stromal cystic spaces. CONCLUSION: SDAS-OCT imaging provided a range of characteristic patterns that could be used as an additional tool in diagnosis and management of bacterial and fungal microbial keratitis.

Pediatric eye injuries in upper Egypt.

PURPOSE: To analyze the patterns, causes, and outcome of pediatric ocular trauma at Assiut University Hospital in Upper Egypt (South of Egypt). METHODS: All ocular trauma patients aged 16 years or younger admitted to the emergency unit of Ophthalmology Department of Assiut University between July 2009 and July 2010 were included in the study. The demographic data of all patients and characteristics of the injury events were determined. The initial visual acuity and final visual acuity after 3 months follow-up were recorded. RESULTS: One hundred and fifty patients were included. The majority of injuries occurred in children aged 2-7 years (50.7%). There were 106 (70.7%) boys and 44 (29.3%) girls. The highest proportion of injuries occurred in the street (54.7%) followed by the home (32.7%). Open globe injuries accounted for 67.3% of injuries, closed globe for 30.7%, and chemical injuries for 2%. The most common causes were wood, stones, missiles, and glass. LogMar best corrected visual acuity at 3 months follow-up was: 0-1 in 13.3%; <1-1.3 in 27.3%; <1.3-perception of light (PL) in 56%; and no perception of light (NPL) in 3.3%. CONCLUSIONS: Pediatric ocular trauma among patients referred to our tertiary ophthalmology referral center in Upper Egypt over a period of 1 year was 3.7%. Of these, 67.3% of cases had open globe injury, 30.7% had closed injury, and only 2% had chemical injury. In Upper Egypt, socioeconomic and sociocultural status, family negligence, and lack of supervision are important factors in pediatric eye injuries, as 92% of children were without adult supervision when the ocular trauma occurred. Nearly 86.6% of children with ocular trauma end up legally blind. Modification of these environmental risk factors is needed to decrease pediatric ocular morbidity.