Unique presentations of aspergillosis endogenous endophthalmitis in two hospitalized patients with severe COVID-19.

We present two ICU-hospitalized patients with coronavirus disease-19 (COVID-19) presenting with endogenous endophthalmitis in one eye and variable manifestations of chorioretinitis in the fellow eye. Two diabetic patients (57 and 62 years old) showed anterior uveitis and yellowish-white subretinal infiltrations. The fellow eye of one patient showed patches of choroiditis, while the other showed full retinal thickness infiltrations. A workup yielded high serum titers of galactomannan, diagnostic of aspergillosis. The widespread use of high doses of corticosteroids in the management of COVID-19 may predispose to various secondary fungal opportunistic infections and may manifest in different forms of chorioretinal infiltration.

Comparison of the effects of femtosecond laser energy on corneal endothelium at two different dissection levels in femtosecond laser-assisted deep anterior lamellar keratoplasty for keratoconus.

PURPOSE: The objective of this study is to compare the endothelial safety of femtosecond laser (FSL) energy at two different dissection depths in FSL-assisted deep anterior lamellar keratoplasty (FSDALK) for keratoconus. METHODS: This prospective double-armed interventional study included 25 eyes from 21 patients with advanced keratoconus who underwent FSDALK (big bubble technique) at a trephination depth of 110 µm in group I (11 eyes) and 80 µm in group II (14 eyes)-all of which were anterior to the Descemet's membrane (DM). Visual acuity measurement, anterior and posterior segment examination, corneal tomography, and specular microscopy were performed preoperatively and at 3, 6, and 12 months, postoperatively. Endothelial cell density, coefficient of variation, percentage of cell hexagonality, and pachymetry were used to evaluate endothelial safety. RESULTS: No statistically significant difference in any of the endothelial safety parameters was found between the two groups. The mean 12-month postoperative endothelial cell loss rate was 17.46% and 12.91% in group I and II, respectively (P = 0.345). Most of the endothelial cell loss occurred during the first 3 months after surgery. Group II showed statistically greater improvement in the mean keratometry values at all follow-up visits. CONCLUSION: The endothelial safety profiles of lamellar FSL cuts at 110 µm and 80 µm anterior to the DM are comparable. Cuts as deep as 80 µm anterior to the DM can be safely applied without causing significant injury to the endothelium. Further studies are needed to compare the endothelial safety profiles of different FSL platforms available in the market. Trial registration PACTR201901615323963. Registered 24 November 2018-retrospectively registered.

Normative Values of Corneal Spherical Aberration, Pupil Size, and Other Key Refractive and Topographic Parameters in a Large Cohort of Egyptian Cataract Surgery Candidates.

PURPOSE: To determine the spherical aberration, pupil size, and other key refractive and topographic parameters in a large cohort of Egyptian cataract surgery candidates, and to investigate any existent relations between the spherical aberration and other possibly related parameters. METHODS: This is a cross-sectional, descriptive study that was conducted at Ain Shams University Hospitals, Cairo, Egypt. The study was performed on the right eyes of 1658 cataract surgery candidates. The mean corneal spherical aberration [Z4] and the pupil diameter, both photopic [P. Pupil] and mesopic [M. Pupil], were measured by the Oculus Keratograph 3, while the white-to-white corneal diameter [WTW], average keratometric readings [average K], axial length measurements [AL] and Anterior Chamber Depth [ACD] were all obtained from the IOL Master 500. RESULTS: The mean age was 65 ± 11.3 years. The mean value of the Z4 was +0.26 ± 0.12 µm [95% Confidence Interval "CI" (0.2570-0.2681)]. The mean values of the measured parameters were: P. Pupil 2.43 ± 0.87 mm [95% CI (2.3867-2.4700)], M. Pupil 4.61 ± 0.91 mm [95% CI (4.5683-4.6557)], WTW 11.72 ± 0.44 mm [95% CI (11.6969-11.7394)], average K 43.89 ± 1.89 D [95% CI (43.7938-43.9701)], AL 24.23 ± 2.21 mm [95% CI (24.1118-24.3166)], and ACD 3.16 ± 0.43 mm [95% CI (3.1414-3.1827)]. Weak statistically significant correlations were found between the Z4 and each of age (r = 0.049, p = 0.044), average K (r = 0.191, p < 0.001), and ACD (r = 0.122, p < 0.001). Multivariate analysis showed weaker relations between Z4 and both average K (beta coefficient= 0.091) and ACD (beta coefficient= 0.130), with an r2 = 0.024. CONCLUSION: This is the first normative data report of corneal spherical aberration [Z4], pupil size, and related refractive and topographic parameters in an old Egyptian population. The detected correlations have a weak clinical relevance and negate the existence of significant relations between the Z4 and the studied refractive and topographic parameters.

Effect of lens thickness and nuclear density on the amount of laser fragmentation energy delivered during femtosecond laser-assisted cataract surgery.

PURPOSE: To study the influence of lens thickness and nuclear density on the amount of laser fragmentation energy delivered during femtosecond laser-assisted cataract surgery. SETTING: Ain Shams University and Al-Watany Eye Hospital, Cairo, Egypt. DESIGN: Retrospective case series. METHODS: This study included eyes of patients with primary cataract of different nuclear densities that had femtosecond laser-assisted cataract surgery using the Catalys Precision system. Variables studied included preoperative lens thickness measured by spectral-domain optical coherence tomography, nuclear density using the Lens Opacities Classification System III, pupil size, laser fragmentation energy, total laser energy, and transversal ultrasound time (Ellips FX). Patients were divided according to the preoperative lens thickness as follows: lens thickness more than 4.8 mm (Group 1) and lens thickness 4.8 mm or less (Group 2). RESULTS: The study included 192 eyes of 120 patients. The amount of laser energy for fragmentation was statistically significantly higher in Group 1 than in Group 2 (5.9 J ± 1.5 [SD] versus 4.5 ± 1.8 J) (P < .001). Laser fragmentation energy and total laser time had a strong positive correlation with lens thickness (r = 0.53, P < .001) but not with nuclear density or pupil size. Lens thickness was positively correlated with age (r = 0.42, P < .001) but not with nuclear density. CONCLUSIONS: The preoperative lens thickness, not density, determined the amount of laser energy delivered. The laser might deliver unnecessary energy for softer and thicker nuclei while delivering less energy for thinner but harder nuclei.

Effect of Limbal Relaxing Incisions on Corneal Aberrations.

PURPOSE: To study the effect of limbal relaxing incisions on corneal aberrations after phacoemulsification with aspheric intraocular lens (IOL) implantation. METHODS: Forty-five eyes underwent microincision cataract surgery with on-axis phacoemulsification incision. These eyes were divided into two groups: limbal relaxing incision group (23 eyes) and control group (22 eyes). In the limbal relaxing incision group, a single limbal relaxing incision was performed on the steepest meridian of corneal topography and the degrees of arc were determined using the DONO-Donnenfeld nomogram. The eyes in the control group were operated on by microincision cataract surgery without limbal relaxing incision. Corneal topography and wavefront analysis over 6-mm pupil size were performed preoperatively and 1 month postoperatively in both groups. Target induced astigmatism vector, surgically induced astigmatism vector, difference vector, magnitude of error, flattening effect, and torque were analyzed using the Alpins vectorial method. RESULTS: The limbal relaxing incision group showed significant reduction in topographic astigmatism by 51.87% of preoperative topographical astigmatism (P < .0001). The mean surgically induced astigmatism of limbal relaxing incision was 1.29 ± 0.71 diopters (D), which was close to the mean target induced astigmatism (1.33 ± 0.20 D), whereas the control group did not show a significant change in topographic astigmatism (0.17 ± 0.11 D; P = .73). Higher order aberrations of the cornea did not show significant change in either group except quatrefoil aberration, which significantly increased in the limbal relaxing incision group but not in the control group, with no significant difference between the two groups regarding corneal aberrations. CONCLUSIONS: Limbal relaxing incision is an effective method in reducing corneal astigmatism with neutral effect on corneal aberrations.

Effect of biaxial versus coaxial microincision cataract surgery on optical quality of the cornea.

CONTEXT: Visual function is determined by a combination of the cornea, which has a larger effect and internal aberrations generated by the intraocular lens and those induced by the surgery. These corneal refractive changes are related to the location and size of the corneal incision. The smaller the incision, the lower the aberrations and the better the optical quality. AIMS: To compare the effect of uneventful coaxial versus biaxial microincision cataract surgery (MICS) on the corneal aberrations. SETTINGS AND DESIGN: Retrospective interventional nonrandomized comparative case study comprised 40 eyes of 36 patients with primary senile cataract. SUBJECTS AND METHODS: They were divided into two groups: Group I (20 eyes) had operated by biaxial MICS and Group II (20 eyes) had operated by coaxial MICS. Each group were assessed by corneal topography and wavefront analysis over 6 mm pupil size preoperatively and 1-month postoperatively. STATISTICAL ANALYSIS USED: Statistical analysis was performed using SPSS for Windows (version 17.0.1, SPSS, Inc.). The paired t-test was used to compare the mean values of corneal aberrations preoperatively and 1-month postoperatively in each group. RESULTS: There was a significant increase in trefoil and quatrefoil in biaxial MICS (P = 0.063, 0.032 respectively) while other aberrations insignificantly changed. The coaxial MICS showed a significant increase in root mean square (RMS) of total high order aberrations (HOAs) (P = 0.02) and coma (0.028), but not the others. In comparison to each other, there was the insignificant difference as regards astigmatism, RMS of individual and total HOAs. CONCLUSIONS: Coaxial and biaxial MICS are neutral on corneal astigmatism and aberrations.