Ocular comorbidities with direct-acting antiviral treatment for chronic hepatitis C virus (HCV) patients.

PURPOSE: The aim of this study is to detect the incidence and nature of ocular complications encountered in chronic hepatitis C virus (HCV) patients treated with direct-acting antiviral drugs. METHODS: This study is a prospective follow-up study on 200 chronic HCV patients attending the Outpatient Hepatology Clinic of National Liver Institute who were indicated for direct-acting antiviral treatment (sofosbuvir, daclatasvir and ribavirin) in the period between January 2017 and December 2017 and referred to the Department of Ophthalmology of Menoufia University hospitals where full ophthalmological examinations were done at the first visit before the treatment, the second visit at the end of the treatment (3 months) and the third visit 3 months later (6 months). Follow-up for those patients was done by slit-lamp examination, IOP measurement by applanation tonometer, colored fundus photographs, fluorescein fundus angiography (FFA), optical coherence tomography. RESULTS: Patients who received direct-acting antiviral therapy showed no ocular complications throughout the 6-month period of follow-up. Besides, BCVA and C/D ratio did not show any changes with no statistically significant differences between three visits. No signs of uveitis appeared in patients prescribed to the therapy protocols. Also, FFA did not show any retinal vascular changes. However, two cases of subconjunctival hemorrhage were observed with triple therapy. CONCLUSION: Direct-acting antiviral treatment including sofosbuvir, daclatasvir and ribavirin appears to be safe and shows no detectable intraocular complications in the six-month follow-up period, and routine ophthalmic follow-up seems to be less required than in older anti-HCV medications.

Corneal biomechanics and intraocular pressure assessment after penetrating keratoplasty for non keratoconic patients, long term results.

BACKGROUND: To evaluate corneal biomechanical properties by the Ocular Response Analyzer (ORA) in non keratoconic patients underwent penetrating keratoplasty (PK). METHODS: Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann- correlated intraocular pressure (IOPg), cornea-compensated IOP (IOPcc) using the ORA, and central graft thickness (CGT) were measured in 30 eyes at least two years after penetrating keratoplasty for non keratoconic indications. IOP using the Goldmann applanation tonometer (GAT) was also obtained after compensation for graft thickness and astigmatism. RESULTS: The mean age of patients was 33.1 ± 10.13 years; indications for PK were herpetic corneal scar (53.3%), corneal stromal dystrophy (23.3%), traumatic corneal opacity (10%), chemical corneal opacity (6.7%), and Fuchs endothelial dystrophy (6.7%). Mean CH and CRF were 8.52 ± 1.81 mmHg, and 8.56 ± 1.59 mmHg, respectively. Mean CGT was 532.43 ± 30 µm. Mean IOP GAT, IOPg, and IOPcc were 11.88 ± 3.66, 14.64 ± 4.08, and 17.27 ± 4.60 mmHg, respectively (P < 0.001). No significant association was found between CGT and IOP readings obtained using either the ORA or GAT. There were significant negative association between CH with both IOP GAT and IOPcc, while CRF had significant positive association with IOPg. CONCLUSION: After penetrating keratoplasty for non keratoconic patients, graft biomechanics does not return to average values even 2 years after the operation; moreover, intraocular pressure measurement with ORA gives higher values than thickness compensated GAT.

Anterior Segment Changes After Femtosecond Laser-Assisted Implantation of a 355-Degree Intrastromal Corneal Ring Segment in Advanced Keratoconus.

PURPOSE: To study anterior segment changes after implantation of a Keraring with a 355-degree arc length in central advanced keratoconus. METHODS: Thirty eyes of 22 patients with advanced central keratoconus (grade 3) and absent corneal scarring underwent femtosecond laser-assisted (VisuMax) implantation of a Keraring 355-degree arc length intrastromal corneal ring segment (ICRS) with a segment thickness of 300 µm. Comprehensive ocular evaluations were performed preoperatively and postoperatively to assess uncorrected distance visual acuity, corrected distance visual acuity, K1, K2, Kmax, corneal volume, anterior chamber depth, corneal elevations, and actual segment position 6 months after the procedure. RESULTS: Corrected distance visual acuity in decimal notation improved significantly from 0.22 ± 0.17 to 0.49 ± 0.22 (P < 0.01). Statistically significant changes were found in the measured parameters with marked reconstruction of the cornea and anterior chamber. However, the actual depth percent of the ring segment was 61.7% ± 5.9%, which was shallower than the intended depth of 80% of corneal thickness. CONCLUSIONS: These findings may help explain the marked improvement in visual parameters obtained from the Keraring 355 degrees in advanced central keratoconus. In addition, these types of rings may be a safe, effective, and minimally invasive way to avoid corneal grafting in advanced keratoconus with a clear cornea.

Stromal lenticule transplantation for management of corneal perforations; one year results.

PURPOSE: To study application of stromal lenticules extracted by femtolaser small incision lenticule extraction (SMILE) surgery as a surgical adjuvant to seal corneal perforations. METHODS: Corneal stromal lenticules obtained through SMILE surgery with central thickness 100 µm or more were fixed over corneal perforation sites using 10-0 nylon interrupted stitches with an overlying single layer of amniotic membrane. Seven patients who had been followed up for a minimum of 12 months were assessed using slit-lamp biomicroscopy, fluorescein stain, tonometry, and best spectacle-corrected visual acuity (BSCVA) measurements. Postoperative complications were recorded throughout the follow up period. RESULTS: Corneal perforations had successfully been sealed in all 7 patients; 3 patients (42.9%) exhibited improved postoperative BSCVA. During the follow-up period of one year, no signs of re-perforation or infections were detected in any patient. CONCLUSIONS: These early findings suggest that the use of corneal stromal lenticules could be a safe and efficient surgical adjuvant for corneal perforation closure with potential clinical application, together with amniotic membrane, as relatively simple and low cost temporary measures to prepare perforated corneas for further definitive procedures.

Longevity results of modified Hughes procedure in reconstructing large lower eyelid defects.

PURPOSE: The purpose of this study was to evaluate the longevity results of modified Hughes procedure in reconstructing large lower eyelid defects. BACKGROUND: The modified Hughes procedure was used to reconstruct large full-thickness lower eyelid defects. Meanwhile, the functional results indicated that ocular surface health in the treated eyes may be affected. PATIENTS AND METHODS: Noncomparative, case series retrospective study was designed after obtaining the approval of the institutional review board at the Ophthalmology Department, Menoufia University, Egypt, where the results of cases who underwent surgery with the modified Hughes procedure during a 7-year interval were evaluated. RESULTS: Eleven patients (seven males and four females) in the age range 59-77 years (mean age 67±5 years) were identified. The follow-up ranged from 12 months to 48 months. Cosmetic, functional, and postoperative results were analyzed. CONCLUSION: Despite the favorable cosmetic results of the Hughes tarsoconjunctival flap, the procedure has its own limitations. The results indicated that it does affect the functions and tear film stability in the treated eyes.