Optical coherence tomography angiography of the macula of high myopia in children and adolescents.

BACKGROUND: High myopia represents a health issue and leads to the development of complications that threaten vision. The study of macular changes in high myopia patients has undergone great advances with updated technology via new spectral optical coherence tomography (OCT) and Optical coherence tomography angiography (OCTA). Most of related studies have focused on the adults and additional studies need to investigate macular changes in children and adolescents. This study aimed to evaluate the changes in the macular structure by OCT and the macular vessel density in high myopia in children and adolescents by OCTA. METHODS: A cross-sectional comparative study. The population was divided into two groups: group 1 (4-11 years) and group 2 (12-18 years). The results were comparable to those of control study of the same age group. The two high myopia groups and the control groups were examined by macular OCT and OCTA to evaluate macular thickness and vessel density in the superficial and deep capillary plexuses. RESULTS: OCT measurements of patients in group 1 revealed that central macular thickness was significantly lower in high myopia group than in the control group and measured 220.91 ± 27.87 µm and 258.23 ± 17.26 µm, respectively, (P < 0.0001). However, in group 2 the central macular thickness in the high myopia group and control group was 236.32 ± 27.76 µm and 247.09 ± 16.81 µm respectively, and the difference was not statistically significant (P = 0.09). The parafoveal macular thickness and the perifoveal macular quadrants thickness were significantly lower in high myopic children and high myopic adolescents (P < 0.0001) than age matched controls. The parafoveal and perifoveal vessel densities in the superficial and deep capillary plexuses were lower in the high myopia groups than in the age-matched controls in both groups with a few segment exceptions in group 1. The FAZ was significantly wider in group 1 than in the age-matched emmetropes (P = 0.02). The FAZ was wider in group 2 than controls, but the difference was not statistically significant, (P = 0.75). CONCLUSION: High myopic children and adolescents have thinner macular thickness than comparable age-matched emmetropes and have less vessel density in superficial and deep capillary plexuses with a wider FAZ.

Preservative-Free Topical Anesthetic Unit-Dose Eye Drops for the Management of Postoperative Pain Following Photorefractive Keratectomy.

INTRODUCTION: Ocular pain is a common complication following photorefractive keratectomy (PRK). The level of patient satisfaction with current pain control strategies is not high. This study aims to assess the efficacy and safety of a novel regimen of preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops for post-PRK pain control. METHODS: In a contralateral eye study, 144 eyes of 72 patients who underwent bilateral transepithelial PRK (TransPRK) were stratified into experimental and control groups. The experimental group received preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops five times daily postoperatively until complete epithelial healing, while the control group received sodium hyaluronate 0.2% instead. The main outcome measures were pain scores assessed by the verbal rating scale and visual analogue scale (VRS, VAS), the corneal epithelial defect (CED) area, epithelial healing duration evaluated by slit-lamp biomicroscopy and anterior segment optical coherence tomography (AS-OCT), and endothelial cell density (ECD) measured before and 1 month after surgery. RESULTS: Pain scores assessed by VRS and VAS were significantly lower in the experimental group 8 h after surgery, and 1, 2, and 3 days postoperatively (P < 0.001). The mean CED area showed no significant differences between the two groups at different follow-ups (P value > 0.05). The corneal epithelial healing had a mean duration of 3.32 ± 0.47 days in both studied groups and was parallel in both eyes of each patient. In each group, 49 eyes (68%) and 72 eyes (100%) had a fully epithelialized surface on the third and fourth postoperative days, respectively. No significant changes were observed in the mean ECD 1 month following surgery in both groups (P value > 0.05). CONCLUSION: Preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops are effective and safe in controlling early postoperative pain following TransPRK. The availability of the single-dose unit preparation can overcome the problem of topical anesthetic abuse. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05733741.

Diagnostic value of salivary gland ultrasonography for secondary Sjögren syndrome in patients with systemic lupus erythematosus.

BACKGROUND: Salivary gland ultrasound (SGUS) is a reliable technique for assessing the salivary glands in patients with primary Sjögren's syndrome (SS); however, the role of SGUS for diagnosis of secondary SS (sSS) in patients with systemic lupus erythematosus (SLE) was not examined. OBJECTIVE: To assess the diagnostic value of SGUS for sSS in patients with SLE, and to investigate the relationship between SGUS findings with clinical and laboratory characteristics of patients with SLE. PATIENTS AND METHODS: This cross-sectional study included 49 patients with SLE. The diagnosis of sSS was confirmed according to the 2016 ACR/EULAR criteria. Salivary gland US was performed for all patients and graded using a validated Hocevar scoring system. A complete clinical and laboratory workup for SLE was assessed. Schirmer's test and the ocular staining were performed. RESULTS: Of the 49 patients with a mean age of 30.2 ± 9.6 years, 98% were female. 19 (38.8%) had sSS. SGUS changes consistent with sSS (≥17) were found in 29 (59.2%) of the patients. Patients with higher SGUS score had more sicca findings as well as positive anti-Ro, anti-La antibodies, and poorer psychological stress (p < 0.05). The SGUS (≥17) showed a sensitivity of 84.2% and a specificity of 56.7% for sSS diagnosis, with an area under the curve of 0.77 (95% CI: 0.63, 0.91). CONCLUSION: We propose salivary gland ultrasound as a non-invasive method in the diagnostic workup for sSS in patients with SLE. Further studies to confirm the diagnostic value of SGUS in a larger sample of patients with sSS will be necessary.

Prophylaxis of macular edema after cataract surgery in diabetic patients, topical Nepafenac versus intravitreal Ranibizumab.

PURPOSE: To compare effect of topical Nepafenac versus intravitreal Ranibizumab on macular thickness after cataract surgery in diabetic patients with no preoperative macular edema. PATIENTS AND METHODS: A prospective randomized controlled study recruited diabetic patients with visually significant cataract and no diabetic macular edema (DME). Patient underwent uncomplicated phacoemulsification with IOL implantation and were randomly assigned to receive post-operative topical Nepafenac, intra-operative intravitreal Ranibizumab, or no prophylactic treatment. Changes in subfoveal and perifoveal macular thickness were assessed by SD-OCT. RESULTS: The mean central macular thickness showed a significant increase in all study groups 1 week and 1 month postoperative when compared to baseline. At 3 months postoperative, there was a significant difference between Nepafenac and Control group (p = 0.017), Ranibizumab and Control groups (p = 0.009) with no significant difference between Nepafenac and Ranibizumab group (p = 0.545) regarding CMT. Comparable results could be detected as regarding peri-foveal macular thickness changes. Concerning BCVA, there was a significant difference between topical Nepafenac/control (p = 0.001) and intravitreal Ranibizumab/control (p = 0.004) at 1-week visit. No significant difference in BCVA was observed between Nepafenac and Ranibizumab group throughout the whole study period. In postoperative visits, cystoid macular edema occurred in three patients (7.9%) in Nepafenac group, one patient (2.7%) in Ranibizumab group, and seven patients (17.07%) in control group. CONCLUSION: Both postoperative topical Nepafenac and intra-operative intra-vitreal Ranibizumab are effective adjunctive to phacoemulsification in diabetic patients for prophylaxis of macular edema.

Comparison of structural and functional outcome of aflibercept versus ranibizumab in patients with myopic choroidal neovascularization.

PURPOSE: To compare visual functional improvement and retinal structural changes of aflibercept versus ranibizumab for the management of treatment-naïve choroidal neovascularization related to pathological myopia. PATIENTS AND METHODS: A prospective randomized study included patients suffering from myopic choroidal neovascularization. Patients received three intravitreal injections of aflibercept (2 mg) or ranibizumab (0.5 mg) in 1:1 ratio every 4 weeks. Ophthalmic evaluation and optical coherence tomography were performed at baseline, 1, 2, and 3 months after last injection. Primary outcome measure was the visual acuity change from baseline to month 3 after injection. Secondary outcome measures included change in retinal thickness and the relation of morphological and functional changes to baseline assessment parameters. RESULTS: A total of 48 myopic patients (48 eyes) suffering from myopic choroidal neovascularization were randomly assigned to receive either aflibercept (Group A) or ranibizumab (Group B). In Group A, best-corrected visual acuity significantly improved from 0.53 ± 0.10 logMAR to 0.38 ± 0.11 logMAR, at 3 months, and from 0.55 ± 0.11 logMAR to 0.39 ± 0.12 logMAR in Group B. Whereas, retinal thickness reduced from 317.7 ± 53.6 µm to 164.5 ± 81.9 µm in Group A, and from 321.1 ± 98.8 µm at baseline to 178.9 ± 64.5 µm in Group B at month 3. Changes in best-corrected visual acuity and central macular thickness were statistically insignificant between the two groups at final visit. CONCLUSION: Both aflibercept and ranibizumab provided a significant improvement in visual acuity and retinal thickness in patients with myopic choroidal neovascularization. Comparable functional and architectural results were achieved by both treatment modalities.

Comparison of the phaco chop and drill-and-crack techniques for phacoemulsification of hard cataracts: A fellow eye study.

PURPOSE: To quantify the intraoperative parameters and postoperative outcomes after using the phaco chop technique in one eye and drill-and-crack technique in the other eye in patients with bilateral dense brunescent cataract. METHODS: The Lens Opacities Classification System III grading system was used to select 132 eyes of 66 patients with bilateral nuclear opalescence (NO) grade NO4 or grade NO5. One eye in each patient with bilateral dense brunescent cataract was subjected to phacoemulsification using the phaco chop technique, while the other eye was subjected to phacoemulsification with the drill-and-crack technique for nucleus disassembly. The intraoperative parameters were quantified. Surgical outcome was assessed preoperatively and 1 day, 4 weeks and 12 weeks postoperatively, and the outcomes of the two techniques were compared. RESULTS: There was no significant difference between the techniques in operative parameters [cumulative dissipated energy (p = 0.74), surgical time (p = 0.68) or surgical difficulty during nucleus disassembly (p = 0.80)]. There was no significant difference in the postoperative change in central corneal thickness between the techniques at day 1, 4 weeks and 12 weeks or in corneal endothelial cell density loss at 4 and 12 weeks (p > 0.05). There was no significant difference between the techniques in the mean corrected distance visual acuity (logarithm of the minimum angle resolution) at 4 weeks postoperatively (p = 0.25). CONCLUSION: The phaco chop and drill-and-crack techniques are equally effective for disassembly of hard NO4 and NO5 cataracts.

Morphological Characteristics of Normal Foveal Avascular Zone by Optical Coherence Tomography Angiography.

PURPOSE: To provide quantitative measurements for the foveal avascular zone (FAZ) and to describe its morphological characteristics by optical coherence tomography angiography (OCT-A). DESIGN: Cross-sectional observational case series. METHODS: Healthy volunteers were recruited and evaluated using Triton-DRI SS-OCT Angiography. A 4.5 × 4.5 mm square was evaluated by OCT-A center around the fovea. Superficial and deep capillary plexus were identified, and different quantitative measurements were conducted along with categorization of the FAZ pattern. RESULTS: Eighty-two eyes (41 volunteers) were evaluated. Mean age was 30.59 ± 7.6 years (23-42 years). Mean subcentral retinal thickness was 200.1 ± 5.66 um (192-210 um). The number of terminal vessels was variable (range, 8-11). Mean maximum terminal vessel-to-vessel intervening distance was 527.8 ± 60.3 um (471-674 um). Mean minimum terminal vessel-to-vessel intervening distance was 296.7 ± 45.8 um (233-373 um). Mean maximum horizontal diameter of FAZ (superficial) was 716.17 ± 124.09 um, while mean maximum vertical diameter of FAZ (superficial) was 667.76 ± 131.28 um. Mean maximum horizontal diameter of FAZ (deep) was 823.19 ± 144.92 um, while mean maximum vertical diameter of FAZ (deep) was 794.03 ± 150.28 um. OCT-A detected different FAZ patterns; horizontally oval configuration in 32 eyes (39%), rounded configuration in 24 eyes (29.3%), pentagon configuration in 14 eyes (17.1%), and vertically oval and nonspecific configuration in 6 eyes each (7.3%). CONCLUSION: OCT-A could efficiently provide both quantitative and qualitative assessment of normal FAZ; such characterizations were difficult by standard FAZ assessment procedures like FFA.

Correlation between corneal demarcation line depth in epithelium-off and trans-epithelium accelerated corneal cross linking and keratoconus progression.

AIM: To compare corneal demarcation line (DL) depth in both accelerated epithelium-off and trans-epithelium cross linking (CXL) using anterior segment optical coherence tomography (AS-OCT) and its relation to maximum keratometry (Kmax) progression in both techniques. METHODS: A prospective comparative interventional study where patients with mild to moderate keratoconus (KC) were classified into two groups: accelerated epithelium-off and trans-epithelium CXL based on corneal pachymetry. Assessment of corneal DL depth was carried out after 3mo by AS-OCT. Kmax readings were evaluated after one year follow up using the Scheimpflug imaging system. RESULTS: Study included 74 eyes of 44 patients. Group A underwent epithelium-off CXL (41 eyes), while Group B underwent trans-epithelium CXL (33 eyes). At 3mo follow up, mean corneal DL depth in Group A was 219.9±58.4 µm while in Group B was 127.2±7.8 µm (P<0.05). The mean Kmax changed from 51.9±3.9 to 51.3±4.2 diopters in Group A and from 53.1±4.1 to 53.6±5 diopters in Group B with insignificant difference in Kmax changes in either group (P>0.05). In addition, no significant change in corneal pachymetry was found in both groups (mean change at 1y: 6.4±4.7 and -10.1±2.3 µm in Groups A and B respectively). CONCLUSION: Despite a significantly deeper corneal DL depth created by accelerated epithelium-off CXL technique compared to accelerated trans-epithelium CXL, there is no significant impact on keratoconus progression.

Serum 14-3-3η protein is associated with clinical and serologic features of Sjögren's syndrome in patients with systemic lupus erythematosus: a cross-sectional analysis.

INTRODUCTION/OBJECTIVES: Systemic lupus erythematosus (SLE) and Sjögren's syndrome (SS) may coexist and carry a higher risk for future comorbidities. Although 14-3-3η protein is recently a known diagnostic marker in rheumatoid arthritis (RA), its role has not been investigated in SLE. The aim of this study was to compare serum 14-3-3η protein level in SLE and RA patients and to examine its association with clinical and laboratory features in SLE patients. METHODS: Eighty-four SLE patients and 39 RA patients were included. Sociodemographic, SLE disease activity index (SLEDAI), and damage index were assessed for SLE patients. Data about secondary SS were collected. 14-3-3η was measured by ELISA; titres above 0.19 ng/ml were considered positive. RESULTS: Serum 14-3-3η protein in SLE was significantly lower than in RA (0.37 ± 0.09 vs 1.5 ± 0.51; p < 0.001). 14-3-3η protein level was comparable between SLE patients with and without arthritis (0.29 ± 0.8 vs 0.15 ± 0.08 respectively; p = 0.20). Serum 14-3-3η protein level was higher in SLE with secondary SS features compared to those without (0.22 ± 0.10 IU/ml vs 0.11 ± 0.04 IU/ml; respectively, p < 0.001). There were no differences in 14-3-3η positivity for other lupus criteria or correlation of 14-3-3η titer with SLEDAI. 14-3-3η protein at 1.11 ng/mL yield a secondary SS diagnostic accuracy of 71%. CONCLUSIONS: Serum 14-3-3η protein level is high in SLE-associated SS. The 14-3-3η protein level was able to distinguish patients with secondary SS among patients with SLE. Studying the role of 14-3-3η protein in Sjögren's syndrome would be considered in further larger scale studies to confirm the impact of any association. Key Points • Serum 14-3-3η protein level is significantly higher in systemic lupus patients with secondary Sjögren's syndrome (SS) in comparison to those without. • Serum 14-3-3η protein can be used as a useful marker to distinguish patients with secondary SS among patients with systemic lupus. • 14-3-3η protein level shows no difference between systemic lupus patients with and without arthritis.

Early weaning versus prolonged administration of aqueous suppressants for prevention of hyperencapsulation in paediatric Ahmed glaucoma valve.

PURPOSE: To investigate the role of early and prolonged administration of aqueous suppressants in reduction of hyperencapsulation and intraocular pressure (IOP) control after paediatric Ahmed glaucoma valve (AGV) implantation. METHODS: A prospective randomized interventional study recruited children who had AGV implantation for paediatric glaucoma. All patients received postoperative Timolol 0.5% for either 12 months (Group A) or 3 months (Group B). Additional IOP-reducing medications were added if IOP exceeded 21 mmHg or hyperencapsulation developed in either group. Primary outcome measures were rate of hyperencapsulation and reduction of IOP. RESULTS: Eighty sex children completed the 12-month follow-up visits. Baseline IOP was significantly reduced from 31.95 ± 9.1 to 16.94 ± 3.4 mmHg at 12 months in Group A and from 32.7 ± 7.4 to 19.85 ± 6.9 mmHg at 12 months in Group B. IOP was significantly lower in Group A than B at 6-, 9- and 12-month follow-up visits. In the first 4 months, the hyperencapsulation rate was similar in both Group A (six eyes, 13.3%) and Group B (seven eyes, 17.1%). However, the hyperencapsulation rate was significantly lower in Group A than B at both 6 months (22.5% versus 36.6%) and 12 months (31.1% versus 46.3%). Anti-glaucoma medications were significantly lower in Group A than B at both 6 months (1.3 versus 3.2 drugs) and 12 months (1.5 versus 3.6 drugs). CONCLUSION: Early and prolonged use of aqueous suppressants significantly reduced the rate of hyperencapsulation and provided better IOP control after paediatric AGV implantation.

Comparison of IOP Measurement by Goldmann Applanation Tonometer, ICare Rebound Tonometer, and Tono-Pen in Keratoconus Patients after MyoRing Implantation.

PURPOSE: To evaluate the different IOP readings by Goldmann applanation tonometer (GAT), ICare rebound tonometer, and Tono-Pen in keratoconus patients after MyoRing implantation. To assess the influence of central corneal thickness (CCT) and thinnest corneal location (TCL) on IOP measurements by different tonometers. SETTING: Prospective observational study was conducted in two private centers in Egypt from February 2015 to November 2016. METHODS: Seventeen eyes of 10 patients suffering from keratoconus and who underwent MyoRing implantation were recruited. All subjects underwent GAT, ICare, and Tono-Pen IOP measurements in random order. Central corneal thickness and thinnest corneal location were assessed by Pentacam. Difference in mean in IOP readings was assessed by T-test. Correlation between each pair of devices was evaluated by Pearson correlation coefficient. The Bland-Altman analysis was used to assess intertonometer agreement. RESULTS: Seventeen eyes (10 patients) were evaluated. The mean IOP reading was 13.9 ± 3.68, 12.41 ± 2.87, and 14.29 ± 1.31 mmHg in GAT, ICare, and Tono-Pen group, respectively. There was a significant difference between IOP readings by GAT/ICare and Tono-Pen/ICare (p value: 0.032 and 0.002, respectively) with no significant difference between GAT/Tono-Pen (p value: 0.554). Mean difference in IOP measurements between GAT/ICare was 1.49 ± 2.61 mmHg, Tono-Pen/ICare was 1.89 ± 2.15 mmHg, and GAT/Tono-Pen was -0.39 ± 2.59 mmHg. There was no significant correlation between the difference in IOP readings among any pair of devices and CCC or TCL. The Bland-Altman analysis showed a reasonable agreement between any pair of tonometers.

Switching to Aflibercept in Diabetic Macular Edema after Unsatisfactory Response to Other Anti-vascular Endothelial Growth Factor Drugs.

PURPOSE: To evaluate the efficacy of switching to aflibercept in diabetic macular edema (DME) with suboptimal response to previous anti-vascular endothelial growth factor (anti-VEGF) injections. METHODS: A prospective interventional case series study recruited patients from a single center diagnosed with DME with suboptimal response to anti-VEGF injections. Three consecutive monthly injections of aflibercept were performed. The primary outcome measure was mean change in visual acuity after switching to aflibercept. RESULTS: Forty-two patients (42 eyes) were included. Baseline logarithm of the minimum angle of resolution (logMAR) visual acuity was 0.87 ± 0.23 and improved significantly to 0.62 ± 0.29, 0.56 ± 0.34, and 0.46 ± 0.35 at 1, 2, and 3 months, respectively, after the first injection. Mean baseline retinal thickness was 451.57 ± 107.09 µm and decreased significantly at 1, 2, and 3 months after switching to aflibercept (346.52 ± 79.03, 328.24 ± 81.98, and 313.71 ± 85.79 µm, respectively). Both visual improvement and mean change in retinal thickness were significant in patients with pre-aflibercept best-corrected visual acuity less than 1.0 logMAR but were not significant in patients with best-corrected visual acuity more than 1.0 logMAR. CONCLUSIONS: Switching to aflibercept in DME patients with an unsatisfactory response to previous anti-VEGF injections provided acceptable short-term visual and retinal architectural improvement.

Comparison of Laser In Situ Keratomileusis Flap Morphology and Predictability by WaveLight FS200 Femtosecond Laser and Moria Microkeratome: An Anterior Segment Optical Coherence Tomography Study.

PURPOSE: To evaluate laser in situ keratomileusis (LASIK) flap thickness predictability and morphology by femtosecond (FS) laser and microkeratome (MK) using anterior segment optical coherence tomography. METHODS: Fifty-two candidates for the LASIK procedure were stratified into two groups: FS laser-assisted (Allegretto FS-200) and MK flap creation (Moria 2). Flap thickness was determined at five points. The side-cut angle was measured in three directions at the margin interface. LASIK flap assessment was performed one month postoperatively by Spectralis anterior segment optical coherence tomography. RESULTS: Fifty-two patients (93 eyes) were recruited; 49 eyes were stratified to the FS group and 44 eyes to the MK group. The FS group had relatively even flap configurations, and the MK group had meniscus-shaped flaps. Mean differences between planned and actual flap thickness were 12.93 ± 8.89 and 19.91 ± 5.77 µm in the FS and MK groups, respectively. In thin flaps (100 to 110 µm), there was a significant disparity between the two groups (7.80 ± 4.71 and 19.44 ± 4.46 µm in the FS and MK groups, respectively). However, in thicker flaps (130 µm), comparable flap thickness disparity was achieved (18.54 ± 9.52 and 20.83 ± 5.99 µm in the FS and MK groups, respectively). Mean side-cut angle was 74.29 ± 5.79 degrees and 32.34 ± 4.94 degrees in the FS and MK groups, respectively. CONCLUSIONS: Comparable flap thickness predictability was achieved in thicker flaps (130 µm), while the FS laser technique yielded a more predictable result in thinner flaps (100 to 110 µm). Different flap morphology was observed in meniscus flaps in MK-LASIK and flap morphology in FS-LASIK.

Scanning electron microscopic characteristics of manually loaded and preloaded foldable acrylic intraocular lenses.

PURPOSE:: To compare surface alterations between preloaded and manually loaded intraocular lens. METHODS:: Scanning electron microscope was utilized to evaluate surface alteration and deposits in four different types of intraocular lenses: preloaded hydrophobic acrylic, preloaded hydrophilic acrylic, manually loaded hydrophobic acrylic, and manually loaded hydrophilic acrylic. Six lenses with different powers (+6 D, +22 D, and +29 D) were used from each category, to represent different thickness categories of the intraocular lenses. RESULTS:: In total, 30 intraocular lenses have been evaluated in this study: 4 from the control group (2 hydrophobic and 2 hydrophilic lenses) and 12 from the preloaded intraocular lens and manually loaded groups (6 hydrophilic and 6 hydrophobic lenses with different powers). Surface deposits were found in eight hydrophobic intraocular lenses compared to a single intraocular lens with scattered deposits on the optical surface of a hydrophilic intraocular lens. In manually loaded intraocular lens group, five hydrophobic and one hydrophilic intraocular lenses showed identifiable marks on the optical surface. In the preloaded intraocular lens group, three hydrophobic intraocular lenses showed identifiable marks on the optical surface and three hydrophobic intraocular lenses showed surface wrinkling. All hydrophilic intraocular lenses revealed no identifiable marks. CONCLUSION:: Surface alterations and deposits are a common finding in both preloaded and manually loaded intraocular lenses. Water content of acrylic intraocular lenses is an important factor predisposing to these changes, and hydrophobic intraocular lenses are more vulnerable than hydrophilic lenses. The impact on the final visual outcome needs further studies.

Comparison between Ologen implant and different concentrations of Mitomycin C as an adjuvant to trabeculectomy surgery.

CONTEXT: Trabeculectomy is the most common surgical procedure for treatment of glaucoma. To improve success rates, adjuvants were utilized as Mitomycin C (MMC) and Ologen implant. AIMS: This study aims to establish efficacy and safety of Ologen implant versus MMC in trabeculectomy. SETTING AND DESIGN: A prospective, comparative clinical study was conducted at the Department of Ophthalmology, Assiut University, between December 2014 and April 2016. SUBJECTS AND METHODS: Patients with primary open-angle glaucoma (OAG), primary narrow-angle glaucoma and secondary OAG were assigned equally to trabeculectomy with Ologen, 0.4 mg/mL or 0.2 mg/mL MMC. The study outcome measures were reduction in intra-ocular pressure (IOP), success rates, survival analysis, and rate of complications. STATISTICAL ANALYSIS USED: SPSS software Version 17.0 (SPSS, Inc., IL, USA) was utilized. RESULTS: Thirty eyes were included in the study. Mean baseline IOP in Ologen, MMC 0.4 and MMC 0.2 groups were 27.43 ± 2.97, 28.4 ± 3.24, and 27.56 ± 2.69 mmHg, respectively. At week 24 follow-up, mean IOP in Ologen, MMC 0.4 and MMC 0.2 groups were 18.55 ± 3.18, 16.2 ± 3.22, and 16.93 ± 3.04 mmHg, respectively. No significant inter-group difference was noticed at any visits. Complete success was achieved in 10%, 40%, and 30%, whereas incomplete success in 70%, 50%, and 60%, respectively in Ologen, MMC 0.4 and MMC 0.2 groups. No treatment group difference was reported by Kaplan-Meier analysis. Shallow anterior chamber occurred more in Ologen and MMC 0.4 groups. A single case of serous choroidal effusion had occurred in MMC 0.4 group. CONCLUSION: Ologen implant is a promising alternative to MMC for improving the success rate of trabeculectomy.

Melanocytoma of the Optic Nerve Head, Thirty-Month Follow-Up.

INTRODUCTION: Optic nerve head (ONH) melanocytoma is a benign pigmented tumor that is detected as a dark brown mass on or adjacent to the optic disc. Ultrasonography, optical coherence tomography (OCT), and fundus fluorescein angiography (FFA) can be used to differentiate it from other pigmented tumor as well as to monitor tumor growth. Visual field changes are variable in ONH melanocytoma. Usually, ONH melanocytoma has a stationary course with few cases of progressive growth or malignant transformation. CASE PRESENTATION: A 54-year-old female complained of blurring of vision. Best-corrected visual acuity (BCVA) was 0.9 in both eyes. On routine fundus examination, an elevated pigmented lesion was found, involving the optic nerve head of the left eye. B-scan ultrasound demonstrated a mass arising from ONH. FFA revealed blocked fluorescence corresponding to pigmented mass. HR-OCT scans showed a dome-shaped, elevated ONH lesion with highly reflective layer and optical shadowing behind it, obscuring most of the optic nerve head details. On regular follow-up for 30 months, the lesion had neither changed in its size nor affected the patient's visual acuity. CONCLUSION: ONH melanocytoma is a benign tumor with rare malignant transformation and visual impairment.