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.

Clinical and multimodal imaging characteristics of eyes with Vogt-Koyanagi-Harada disease: An Egyptian experience.

BACKGROUND: Vogt-Koyanagi-Harada (VKH) disease is a vision-threatening inflammatory disorder that is challenging in diagnosis and management. METHODS: Retrospective, record-based analysis of 54 eyes belonging to 27 adult patients that fulfilled the revised diagnostic criteria for VKH between January 2018 and January 2021. Demographic, clinical, and imaging data on presentation and during follow-up visits were collected for each patient. Available imaging studies included B-scan ultrasonography (B-scan US), spectral domain optical coherence tomography (OCT), fundus fluorescein angiography (FFA), and OCT angiography (OCT-A). RESULTS: The female-to-male ratio was 2.38:1. Nineteen patients (70.37%) presented during an initial attack, while eight patients (29.63%) presented during recurrence. The most commonly presenting sign in the posterior segment was exudative retinal detachment (44 eyes, 81.48%). B-scan US was utilized in 4 eyes (7.41%), OCT was utilized in 48 eyes (88.89%) with the most common finding being subretinal fluid (43 eyes, 89.58%), FFA was performed in 39 eyes (72.22%) with the most common finding being punctate hyperfluorescence and late dye pooling (33 eyes, 84.62%), and OCT-A was performed in 30 eyes (55.56%), in which choriocapillaris flow deficit that correlated with disease activity was detectable in 25 eyes (83.33%). Improved visual acuity was noted in 85% of the eyes that were followed up. CONCLUSION: Early diagnosis and treatment of VKH result in favorable visual outcome. Multimodal imaging, with the recent addition of OCT-A, provides complementary data that could serve in diagnosis and monitoring.

Optical coherence tomography and electrophysiological analysis of proptotic eyes due to thyroid-associated ophthalmopathy.

PURPOSE: To study the degree of morphological and functional changes in thyroid-associated ophthalmology (TAO) patients using optical coherence tomography and electrophysiological studies and investigate their clinical correlation. METHODS: A cross-sectional study including 40 patients with TAO and a control group with age- and sex-matched healthy subjects. All subjects underwent a complete ophthalmological examination, proptosis evaluation, spectral domain optical coherence tomography, and electrophysiological tests (pattern and multifocal electroretinograms, and visual evoked potentials). RESULTS: On multiple regression analysis, the degree of proptosis and P50 amplitude were the most important predictors of central foveal thickness (CFT) (ß = - 0.56 and 0.39 and p = 0.03 and 0.01, respectively); while duration of the disease, and clinical activity score (CAS) were the most important predictors of average RNFL thickness (ß = 0.67 and - 0.81 and p = 0.004 and < 0.001, respectively). CONCLUSION: In the absence of fundus changes, macular thinning along with functional alterations noticed by pattern and multifocal electroretinogram could indicate presence of subclinical retinopathy in TAO cases.

Tailoring Screening Guidelines for Retinopathy of Prematurity in Egypt: An Exploratory Multicentric Study.

Background: Retinopathy of prematurity (ROP) is increasing in incidence in developing nations, including Egypt. Secondary prevention requires timely detection through the development of regional screening guidelines, which should be preceded by large-scale studies to characterize the population at risk. Methods: A prospective, multicentric exploratory study that included five large tertiary institutions in an urban Egyptian setting. All infants born with gestational age (GA) < 37 weeks and/or birth weight (BW) ≤ 2000 grams were screened. More mature and heavier infants with unstable clinical course were also included. The primary outcome measure was the rate of ROP and high-risk disease occurrence in relation to underlying risk factors. Results: Of the 768 eyes (384 screened infants), 347 eyes (45.2%) had stage 1 or higher disease, and 43 eyes (5.6%) had high-risk disease. Eyes with stage 1 or higher ROP and treatment-requiring ROP had a mean (± SD) GA of 33.4 (± 2.6) weeks and 32.8 (± 3.2) weeks, and BW of 1842.3 (± 570.1) grams and 1747.6 ± (676.2) grams, respectively. Treatment-requiring eyes belonged to infants that had significantly lower GA and significantly higher prevalence of co-morbidities than non-treatment-requiring eyes. Conclusion: The incidence of ROP and high-risk disease in an urban Egyptian setting are similar to those in comparable settings elsewhere and locally. This exploratory study supports tailoring local screening criteria for ROP, and may aid the future development of national guidelines.

Autosomal Recessive Bestrophinopathy Presenting With a Macular Hole Retinal Detachment.

Purpose: To report a case of autosomal recessive bestrophinopathy (ARB) that presented with macular hole retinal detachment (MHRD). Methods: A case report. Results: A 31-year-old male patient presented with rapid deterioration of vision in the left eye. On fundus examination, bilateral retinal deposits in both eyes, which were brightly hyperautofluorescent, and an MHRD in the left eye could be detected. An electrooculogram demonstrated absent light rise with abnormal Arden's ratio in both eyes. The patient was offered surgery for the MHRD but refused due to the guarded visual prognosis. Follow up of the patient after one year revealed progression of the retinal detachment. Genetic testing revealed a novel, homozygous missense mutation in the BEST1 gene, confirming the diagnosis of ARB. Conclusion: ARB can present with an MHRD. Counseling patients with inherited retinal dystrophies about the visual prognosis following surgical intervention is important.

Assessment of the Effect of Vitiligo on Subfoveal Choroidal Thickness Using Spectral-Domain Optical Coherence Tomography.

BACKGROUND: Vitiligo is a common skin condition affecting 0.5-2% of the population. The exact etiology of the condition is unknown, but the result is autoimmune destruction of melanocytes. The eye is rich in melanocytes, especially in the retinal pigment epithelium and choroid. Little is known about the effect of vitiligo on the choroid of the eye. METHODS: We cross-sectionally examined 31 right eyes of 31 vitiligo patients and 32 right eyes of 32 age- and sex-matched controls for signs of vitiligo affection and then measured the subfoveal choroidal thickness (SFCT) using spectral-domain optical coherence tomography. RESULTS: There was a statistically significant difference between SFCT in the cases group and the control group (Mean ± SD: 251.9 ± 42.0 µm and 296.8 ± 46.4 µm, respectively, p = 0.0002). The thickness correlated negatively with age (r = -0.5) but did not correlate significantly with disease severity or duration (r = -0.201, -0.1781, p = 0.2783, 0.3381, respectively). Additional examination findings included iris and fundus hypopigmented spots, and peripapillary atrophy. CONCLUSION: SFCT is reduced among patients with vitiligo. The clinical implications of such a finding should be studied further, and eye screening programs should be considered.

Revisiting the hallmarks of cancer.

The hallmarks of cancer described by Hanahan and Weinberg have proved seminal in our understanding of cancer's common traits and in rational drug design. Not free of critique and with understanding of different aspects of tumorigenesis coming into clearer focus in the recent years, we attempt to draw a more organized and updated picture of the cancer hallmarks. We define seven hallmarks of cancer: selective growth and proliferative advantage, altered stress response favoring overall survival, vascularization, invasion and metastasis, metabolic rewiring, an abetting microenvironment, and immune modulation, while highlighting some considerations for the future of the field.

Assessing the Awareness of Egyptian Medical Students about Responsible Conduct of Research and Research Ethics: Impact of an Educational Campaign.

This is a quasi-experimental pre-post assessment study utilizing an anonymous self-administered questionnaire to assess Egyptian medical students' awareness about responsible conduct of research (RCR) and research ethics. Students' were assessed before and after an RCR awareness campaign. Our results showed that most of the pre-campaign respondents were not familiar with the basic principles and terms of RCR. An increase in the awareness about RCR across all discussed topics was noted following the campaign. We concluded that an educational awareness campaign is effective in increasing medical students' awareness about RCR and should be incorporated into current medical school curricula in Egypt.