Standardization of meibomian gland dysfunction in an Egyptian population sample using a non-contact meibography technique.

AIM: To develop normative data for meibomian gland dysfunction (MGD) parameters, using non-contact meibography technique of Sirius Costruzione Strumenti Oftalmici (CSO) machine, in an Egyptian population sample. METHODS: Observational, cross-sectional, analytic study, in which 104 Egyptian volunteers were included. Both upper lids were examined, using "Sirius CSO" machine. Each eyelid was given a degree of meibomian gland loss (MGL), which was calculated by the software of the machine. RESULTS: Mean percentage MGL in right upper lid was of 30.9%±12.6%, and that of left upper lid was 32.6%±11.8%. Thirty-four volunteers (32.7%) had first-degree MGL in their right upper lid, and 67.3% had second-degree loss. One volunteer (1%) had zero-degree MGL in left upper lid, 28 (26.9%) had first-degree loss, and 75 (72.1%) had second-degree loss. Degree of MGL in right upper eyelid was not related to age, but degree of MGL in left upper eyelid increased with age. There was statistically significant difference between both genders for degree of MGL in right eye (P=0.036) and in left eye (P=0.027). CONCLUSION: Noncontact meibography is a useful non-invasive tool for diagnosing MGL. MGL is diagnosed in 100% of apparently normal individuals; 26.9%-32.7% of which have first-degree MGL, and 67.3%-72.1% have second-degree MGL.

Factors influencing the outcome of goniotomy and trabeculotomy in primary congenital glaucoma.

PURPOSE: To study the prognostic factors influencing intraocular pressure (IOP) reduction and success rates of paediatric goniotomy and trabeculotomy. PATIENTS: Data from patients aged ≤12 years who underwent goniotomy or trabeculotomy for primary congenital glaucoma from 2013 to 2016 were reviewed. The analysis included 452 eyes of which 120 eyes of patients with a median age (IQR) of 6 months (4.1-11 months) underwent goniotomy, and 332 eyes of patients with a median age of 5.2 months (2.3-9.3 months) underwent trabeculotomy. METHODS: Multivariate linear regression analysis was used to predict the correlation of preoperative and operative risk factors to the per cent IOP reduction, while multivariate logistic regression was done to determine independent predictors of failure. Failure was defined as a final IOP >18 mm Hg while on medications or the need for another glaucoma procedure. RESULTS: In the goniotomy group, the median IOP reduction was 19.4% and was positively correlated to a high initial IOP (p≤0.001) while in the trabeculotomy group, it was 36.8% and mostly influenced by preoperative IOP (p≤0.001), corneal clarity (p=0.04), gender (p=0.04) and consanguinity (p=0.03). The failure rate in the goniotomy group was 56% and was influenced by the preoperative cup-to-disc ratio, while in the trabeculotomy group it was 30% and strongly correlated to positive consanguinity (p≤0.001), higher preoperative IOP (p=0.003), female gender (p=0.01) and younger age at surgery (p=0.03). CONCLUSION: Several factors can predict the outcome of angle surgery and can help in deciding the appropriate surgical intervention in paediatric glaucoma. Trabeculotomy seems to be superior to goniotomy in primary congenital glaucoma.

Transscleral sutureless intraocular lens versus retropupillary iris-claw lens fixation for paediatric aphakia without capsular support: a randomized study.

PURPOSE: To compare results of sutureless transscleral intraocular lens (IOL) fixation to retropupillary iris-claw lens implantation in cases of paediatric aphakia without capsular support. METHODS: Thirty eyes of children with insufficient capsular support for IOL implantation were randomized to undergo sutureless transscleral IOL fixation or iris-claw lens fixation. The primary outcome was best-corrected visual acuity (BCVA). Secondary outcomes included operative time, astigmatism, central corneal thickness, endothelial cell count (ECC), IOL decentration and tilt, central foveal thickness and complications. RESULTS: There was a significant improvement in BCVA at all follow-up visits, with no significant difference between both groups. 53.3% in the transscleral-fixated IOL group and 80% in the iris-claw IOL group had a final BCVA ≥0.3. The operative time was significantly shorter in the iris-claw IOL group (p = 0.001). IOL decentration and tilt were higher in the transscleral-fixated IOL group, but the difference was not significant. The ECC was reduced by 14.6% in the transscleral-fixated IOL group and 11% in the iris-claw group at 6 months, with no significant difference between both groups (p = 0.5). In the transscleral-fixated IOL group, two eyes developed ocular hypertension and two eyes had IOL decentration, while in the iris-claw IOL group, 1 eye developed glaucoma, three eyes had haptic disenclavation, and one eye had retinal detachment. CONCLUSION: Both techniques yielded a comparable visual outcome. Retropupillary iris-claw lens fixation is a shorter procedure and technically easier than sutureless transscleral fixation, but the risk of disenclavation should be considered especially in younger age groups. Scleral fixation is the only option in case of severe iris damage, but may be associated with more endothelial cell loss.

Constitutional retinoblastoma gene deletion in Egyptian patients.

BACKGROUND: Retinoblastoma is a neuroblastic tumor of childhood with an incidence of 1: 20 000. Retinoblastoma gene (Rb1) is a tumor suppressor gene that is located on the long arm of chromosome 13 at region 14. This study was to evaluate the constitutional monoallelic Rb1 deletion among retinoblastoma families. METHODS: Nine families with an affected Rb proband were evaluated. Clinical examination, pedigree analysis, and complete eye examination were given to patients, their sibs and parents. Standard cytogenetic and fluorescence in situ hybridization (FISH) analyses were carried out for all of them. Also, two sib fetuses were tested for Rb1 deletion. RESULTS: No dysmorphic features were detected in any patient. Developmental milestones were within normal limit except in one proband who had a mild delay. The age of onset ranged from one month to 4 years. Positive family history was found in two families. In one, the father and 3 sibs had retinoblastoma, and in the other, 2 sibs were affected, but the parents were free. Chromosomal study revealed no abnormalities in all parents and sibs. Two patients had mosaic chromosome 13 abnormalities, 46,XY/46,XY,del(13)(pter-->q14:) and 46,XX/46,inv(13)(q14q22). FISH analysis detected mosaic Rb1 deletion in two patients and excluded Rb1 deletion in two fetuses. CONCLUSIONS: The detection of genetic alterations affecting the Rb1 locus is important for the establishment of carriers, and prenatal and presymptomatic diagnosis. The search for deleted Rb1 mosaic cell lines is important for genetic counseling. Germline mutation may be considered as genetic transmission method of the Rb1 gene.