Peri-levator Betamethasone Versus Triamcinolone Injection in Management of Thyroid Eye Disease-related Upper Eyelid Retraction Without Proptosis.

PURPOSE: To compare the efficacy of peri-levator injection of both betamethasone and triamcinolone in the management of thyroid eye disease-related upper eyelid retraction without proptosis. METHODS: This prospective, double-blind, randomized clinical trial was conducted at Assiut University Hospital, Upper Egypt in the period between December 2021 and October 2023. The study included 47 patients (56 eyes) and was divided into 2 groups. In group A, 1 ml betamethasone was injected into the peri-levator area, while in group B, 1 ml triamcinolone was injected. The injection was repeated every month for up to 5 injections if there was an improvement in margin reflex distance 1 (MRD1). The injection was stopped if MRD1 reached the normal value or if 2 successive injections caused no improvement in MRD1. The postinjection outcome was divided into: 1) effective if MRD1 reached the normal ≤4.5 mm; 2) partially effective if MRD1 was improved but did not reach the normal; and 3) ineffective if there was no improvement in MRD1. The follow up ranged from 6 to 20 months. RESULTS: In group A, the injection was effective in 26 eyes (92.9%) and partially effective in 2 eyes (7.1%). In group B, the injection was effective in 17 eyes (60.7%), partially effective in 6 eyes (21.4%), and ineffective in 5 eyes (17.9%). The mean number of injections was significantly lower in group A than in group B: 1.61 ± 0.50 versus 2.36 ± 1.16. CONCLUSIONS: This study results suggest that betamethasone is more effective with a smaller number of injections than triamcinolone in the management of thyroid eye disease-related upper eyelid retraction.

Bridging the resources gap: deep learning for fluorescein angiography and optical coherence tomography macular thickness map image translation.

BACKGROUND: To assess the ability of the pix2pix generative adversarial network (pix2pix GAN) to synthesize clinically useful optical coherence tomography (OCT) color-coded macular thickness maps based on a modest-sized original fluorescein angiography (FA) dataset and the reverse, to be used as a plausible alternative to either imaging technique in patients with diabetic macular edema (DME). METHODS: Original images of 1,195 eyes of 708 nonconsecutive diabetic patients with or without DME were retrospectively analyzed. OCT macular thickness maps and corresponding FA images were preprocessed for use in training and testing the proposed pix2pix GAN. The best quality synthesized images using the test set were selected based on the Fréchet inception distance score, and their quality was studied subjectively by image readers and objectively by calculating the peak signal-to-noise ratio, structural similarity index, and Hamming distance. We also used original and synthesized images in a trained deep convolutional neural network (DCNN) to plot the difference between synthesized images and their ground-truth analogues and calculate the learned perceptual image patch similarity metric. RESULTS: The pix2pix GAN-synthesized images showed plausible subjectively and objectively assessed quality, which can provide a clinically useful alternative to either image modality. CONCLUSION: Using the pix2pix GAN to synthesize mutually dependent OCT color-coded macular thickness maps or FA images can overcome issues related to machine unavailability or clinical situations that preclude the performance of either imaging technique. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05105620, November 2021. "Retrospectively registered".

Ocular Manifestations of Post-Acute COVID-19 Syndrome, Upper Egypt Early Report.

PURPOSE: To evaluate the ocular manifestations of post-acute COVID-19 syndrome. METHODS: A retrospective, comparative study included 100 patients who had recovered from COVID-19 and 100 controls who were recruited by stratified randomization from hospital registration system and analyzed regarding history, full ophthalmological examination, general examination including internal medicine and neurological evaluation. Laboratory tests were done. RESULTS: Mean±SD of age were 55.5 ± 6.2 in COVID group vs 56.5 ± 5.8 in control group; P value = 0.7. In COVID group, 57 patients (57%) were males vs 51 patients (51%) in control group (P value = 0.39), the other compared parameters including history and risk factors showed non-significant difference except for ESR and D-dimer which were elevated in COVID group. In COVID group, 5 patients (5%) were having retinal vascular occlusion, 2 patients (2%) were having anterior ischemic optic neuropathy AION, 3 patients (3%) were having uveitis and 2 patients (2%) were having central serous chorioretinopathy CSCR. While in control group, 2 patients (2%) were having retinal vascular occlusion, and none had AION, uveitis or CSCR (P value = 0.006). CONCLUSION: Post-acute COVID-19 syndrome could affect the eyes in the form of coagulation problems, neurological morbidities, and other manifestations. This necessitates meticulous follow-up of recovered patients from COVID-19.

Outcome of Pediatric Traumatic Cataract in Upper Egypt: A Tertiary Center Study.

PURPOSE: To demonstrate the demographic features, causative agents, and outcome of pediatric traumatic cataract surgery in eyes without posterior segment involvement at Assiut University Hospital, Upper Egypt. PATIENTS AND METHODS: This is a retrospective study on children (aged <18 years old) who underwent traumatic cataract surgery from January to June 2019. Children with posterior segment injury and those who did not complete 6 months of postoperative follow-up were excluded. The demographic features, mechanism and time of eye injury, clinical features, surgical approach, and outcome were recorded and analyzed. RESULTS: The study included 34 eyes of 34 children, 23 (68%) of them were boys. The mean age at the time of cataract surgery was 10±3.97 years. Twenty-one eyes sustained open globe injury (62%) with the most common cause of trauma was wooden sticks, while 13 eyes had closed globe injury (38%) with the most common cause of injury was thrown stones. The time interval between eye injury and cataract surgery ranged from 1 day to 9 years with a median of 2.05 months. Posterior chamber intraocular lenses were implanted in all eyes; in 33 eyes, the posterior chamber intraocular lenses were implanted primarily at the time of cataract extraction. Corrected distance visual acuity significantly improved from 2.63±0.66 LogMAR preoperatively, to 0.41±0.38 LogMAR postoperatively (p < 0.001). CONCLUSION: Pediatric traumatic cataract is commonly present in primary school age especially after open globe injury. Primary prevention through health awareness should target this age population. Useful vision can be regained with timely proper surgical intervention and posterior chamber intraocular lens implantation. CLINICALTRIALSGOV ID: NCT04630509.

"IRIS SHELF" TECHNIQUE FOR MANAGEMENT OF POSTERIOR SEGMENT INTRAOCULAR FOREIGN BODIES.

PURPOSE: To describe "iris shelf" technique for removal of posterior segment intraocular foreign bodies (IOFBs) through a corneal incision combined with phacovitrectomy and to report its outcomes. METHODS: Medical records of patients with posterior segment metallic IOFBs who had combined phacovitrectomy were collected and analyzed. In all patients, the IOFB was placed on the iris surface after forming the anterior chamber with viscoelastic to be extracted through a corneal phacoemulsification incision. RESULTS: Thirty-three eyes of 33 male patients with a mean age of 31.6 ± 8.3 years were included in the study. The mechanism of injury was hammering in 24 eyes (72.7%) and gunshot in 9 eyes (27.3%). The mean interval between injury and IOFB removal was 14.76 ± 6 days. The mean IOFB volume was 8.5 ± 5.5 mm3, and its longest dimension was 3.45 mm (range, 1-8 mm). The mean preoperative corrected distance visual acuity changed from 20/1,500 (1.79 logarithm of the minimum angle of resolution) to 20/94 (0.67 logarithm of the minimum angle of resolution), postoperatively (P < 0.001). Postoperative complications included retinal detachment (two eyes), proliferative vitreoretinopathy (one eye), epiretinal membrane (one eye), and posterior synechiae (three eyes). CONCLUSION: The "iris shelf" technique with phacovitrectomy is a safe and reproducible approach for posterior segment IOFB extraction through a corneal incision with favorable visual and anatomical outcomes.