Intracameral ranibizumab and subsequent mitomycin C augmented trabeculectomy in neovascular glaucoma.

PURPOSE: The purpose of this study is to evaluate the efficacy of intracameral ranibizumab (ICR) injections with subsequent mitomycin C (MMC) augmented trabeculectomy in the management of neovascular glaucoma (NVG). METHODS: This is a prospective, interventional study of NVG, with research conducted between January 2010 and February 2011, at the Ophthalmology Department of Kasr El-Aini Hospital and Petrol Medical Center (Cairo, Egypt). Fifteen patients with NVG were included in the study, all of whom received intracameral ranibizumab (ICR) injections (0.5 mg) into their eyes 4 weeks before MMC augmented trabeculectomies were performed. All patients were followed up for a period of 6 months. RESULTS: Thirteen eyes (86.7%) achieved absence of clinically apparent iris neovascularization after 1 ICR injection and 2 eyes (13.3%) after a second injection. Eight eyes (53.3%) achieved complete success [if the intraocular pressure (IOP) was between 10 and 21 mm Hg] without topical antiglaucoma medications, 6 eyes (40%) had qualified success (if the IOP was within the same range) but with topical antiglaucoma medications, and failure occurred in 1 eye (6.7%) (because the IOP was above 21 mm Hg) despite the use of topical antiglaucoma medications. CONCLUSIONS: An ICR injection with subsequent MMC augmented trabeculectomy seems to be an effective combined technique in controlling IOP in eyes with NVG.

Management of trichiasis with lid margin split and cryotherapy.

PURPOSE: To evaluate outcomes of lid margin split with cryotherapy to the anterior lid lamella for treating trichiasis. METHODS: This prospective study included 20 eyelids of ten patients with trichiasis who were treated with lid margin split and cryotherapy. All patients were followed up for 6 months. RESULTS: Eighteen eyelids (90%) were successfully treated, and two eyelids (10%) developed recurrence within the follow-up period. CONCLUSION: Lid margin split with cryotherapy is an effective and safe method for treating trichiasis.

Sociodemographic factors responsible for blindness in diabetic Egyptian patients.

PURPOSE: To evaluate factors behind the delay in diagnosis and treatment among Egyptian patients who present with complicated diabetic retinopathy. METHODS: Observational cross-sectional study of diabetic patients with advanced diabetic retinopathy. Patients were asked to answer a questionnaire to assess the impact of several sociodemographic factors. RESULTS: A total of 397 patients agreed to take the questionnaire. Diabetic vitreous hemorrhage was the most common ocular complication and was found in 359 patients (90.4%). A total of 158 (39.8%) patients knew that diabetes mellitus can be sight threatening, while 240 (60.2%) were not aware until they developed sight threatening complication. A total of 179 patients (45.1%) had early retirement because of visual loss related to diabetes mellitus. Multivariate logistic regression has shown that education, internist, contact with other patients, and media were respectively significant in predicting the awareness of patients about the sight-threatening effect of diabetic retinopathy. CONCLUSION: Patient education regarding diabetes and diabetic eye disease is essential for early detection and compliance with treatment. Illiteracy has a significant impact on development of sight-threatening diabetic complications. The internist is the first line of prophylaxis. Media has to participate more in patient education.

Epidemiology of ocular emergencies in the Egyptian population: a five-year retrospective study.

BACKGROUND: The purpose of this study was to determine the epidemiology of ocular lesions seen in the ophthalmic casualty room of the largest referral hospital in Egypt over 5 years from 2004 to 2008. METHODS: This epidemiologic database study used the medical records at Cairo University Hospital. Data were recorded using the ICD10 classification. Statistical analysis was based on diagnosis, age, gender, residential area, and year of admission. RESULTS: Over 5 years, 8361 ocular emergencies were admitted as inpatients. Open globe injuries were the most prevalent, comprising 33.46% of emergencies. Most cases were males (69%), in whom the most frequent lesions were open globe injuries, infective keratitis, and lid injuries. The most common ocular emergencies in females were open globe injuries, infective keratitis, endophthalmitis, and glaucoma. The age group 6-16 years accounted for 24% of emergencies, and patients over 45 years accounted for 26.8%. Under the age of 45 years, the most common lesions were open globe injuries (36%), and over this age, the most common lesions were infective keratitis (34.4%). Patients from Upper Egypt accounted for 56.2% of emergencies. A superficial corneal foreign body was the most common reason for attending the ophthalmic casualty room, with 24,844 cases seen over the 5 years of the study, all of which were managed as outpatient procedures. Deep corneal foreign bodies were more common than intraocular foreign bodies. The most common ocular hemorrhage was hyphema. The most common type of glaucoma was acute angle closure. CONCLUSION: Superficial corneal foreign bodies, open globe injuries, and infective keratitis are the main ocular emergencies seen in the Egyptian population. Corneal foreign bodies are mostly the result of occupational accidents in workers not wearing protective goggles. Violent altercations (41.9%), occupational accidents (26.3%), and motor vehicle accidents (24.4%) were the main circumstances involved in open globe injuries. The most common admissions were for open globe injuries under the age of 45 years and infective keratitis above this age. Upper Egypt was the main referring geographic area.