Evaluation of corneal epithelial thickness mapping using anterior segment OCT in children with vernal keratoconjunctivitis.

PURPOSE: To evaluate the corneal epithelial thickness by anterior segment OCT in children with vernal keratoconjunctivitis (VKC) compared to normal participants. PATIENT AND METHODS: A cross-sectional case control observational study was conducted on children aged from 5 to 18 years with VKC. The study included 142 eyes divided into two groups: 71 eyes of VKC group and 71 eyes of age matched control group. Anterior segment OCT epithelial mapping for the central 5-mm was done to evaluate epithelial thickness-based variables. RESULTS: Corneal epithelial thickness mapping showed significant superior thinning (51.07 ± 4.11) µm in VKC group compared to controls (52.54 ± 2.01) µm (p = 0.008), a decreased MIN epithelial thickness (45.99 ± 6.52) µm compared to controls (50.11 ± 1.91) µm (p < 0.001) and more negative (MIN-MAX) value (- 11.77 ± 9.38) indicating focal epithelial thinning compared to (- 5.80 ± 1.88) in controls (p = 0.001). In palpebral VKC, MIN epithelial thickness showed significant thinning (48. 38 ± 3.45) µm compared to controls (50.11 ± 1.91) µm (p = 0.001). Eyes with mixed VKC showed superior epithelial thinning (50.70 ± 4.59) µm compared to (52.54 ± 2.01) µm in controls (p = 0.025) and significant decreased MIN epithelial thickness (43.78 ± 7.83) µm compared to (50.11 ± 1.91) µm in control group. CONCLUSIONS: VKC is a disease primarily affecting the corneal epithelium. Corneal epithelial thickness mapping may be considered to assess the integrity of the ocular surface in eyes with VKC, and to detect corneal epithelial changes. Disease phenotype may influence the corneal epithelial changes, and the disease duration is another factor influencing these changes.

Vancomycin-associated retinal hemorrhages in pediatric age group: A case report.

PURPOSE: To report a case of possible post-lensectomy vancomycin-induced retinal hemorrhages in a 9-month-old infant to raise awareness of this rare postoperative complication in the pediatric age group. OBSERVATION: A retinal vascular occlusion-like findings were noted bilaterally after sequential uneventful parsplicata lensectomy in a 9-month-old infant during the very early postoperative follow-up (1-2 days). The case was recorded with no remarkable intraoperative events and received intraoperative vancomycin 20µg/ml in irrigating solution (a routine endophthalmitis prophylactic protocol). CONCLUSIONS AND IMPORTANCE: Vancomycin-associated hemorrhagic occlusive retinal vasculitis (HORV) is a rare reported postoperative complication of intraocular prophylactic vancomycin injection. Although all documented cases were reported in elderly patients aged 50 years and above, all presented with almost common findings of occlusive retinal vasculitis. To the best of author's knowledge, this is the first reported case of presumed HORV in pediatric age group. The author finds this of utmost importance to demonstrate the case to expand awareness of this possible complication in the pediatric age group as well.

The Effect of Strabismus Muscle Surgery on Corneal Biomechanics.

PURPOSE: Studying the early effect of different extraocular muscle (EOM) surgeries on corneal biomechanics. SUBJECTS AND METHODS: This is a prospective, nonrandomized, interventional study, in which 42 eyes of 29 candidates for EOM surgery for strabismus correction at Cairo university hospitals, aged 14-37 years, were recruited. All participants had measuring of the visual acuity, refraction (spherical equivalent (SE)), assessment of the EOM motility and muscle balance, sensory evaluation, fundus examination, and assessing the ocular biomechanics using the Ocular response analyzer (ORA, Reichert, INC., Depew, NY) noting the corneal hysteresis (CH) and corneal resistance factor (CRF) preoperatively. Same patients were reassessed using ORA 4 weeks postoperatively following a different standard EOM surgery (recti weakening/strengthening and inferior oblique weakening either (graded recession) according to the surgical indication, and ∆CH and ∆CRF were calculated, each is the preoperative - the postoperative value. RESULTS: ∆CH and ∆CRF = -0.78 ± 1.56 and -0.72 ± 2.15, respectively, and a highly significant difference was found between each of the pre- and postoperative CH and CRF (p < 0.001). 18 eyes had single EOM surgery, while 24 had multiple (2 or 3) EOM surgery; ∆CH in the single group = -1.28 ± 1.5, and ∆CH in the multiple group = 0.4 ± 1.49 (p=0.07). 23 eyes had EOM weakening surgery, while 18 had combined weakening and strengthening EOM surgery: ∆CH in the weakening group = -1.24 ± 1.77 and ∆CH in combined group = -0.26 ± 1.07 (p=0.04). A nonsignificant difference was found for ∆CRF (p=0.53). CONCLUSION: A different EOM surgery has an early tendency for increase of the postoperative CH specially for muscle weakening procedures (recti recession/inferior oblique muscle weakening).

Endoscopic-Assisted Scleral Fixated IOL in the Management of Secondary Aphakia in Children.

Purpose. To evaluate the short-term postoperative outcomes in endoscopic-assisted sclera fixation intraocular lens (IOL) for the management of secondary aphakia in children. Methods. This is a prospective study, whereas 40 aphakic eyes with absence of a good capsular support were implanted by endoscopy-assisted sclera fixation technique. Results. No major intraoperative complications were recorded. All cases were followed up for 6 months. Only transient ocular hypertension occurred in 10 (25%) eyes. Lens decentration and/or tilting were clinically detected in 2 eyes (5%). Ultrasonic biomicroscopic (UBM) examination revealed lens tilting in 2 (5%) of the operated eyes, despite the proper haptics positioning in the ciliary sulcus. Postoperative vitreous hemorrhage was reported in 5 eyes (12.5%) in the early postoperative period and retinal detachment in one eye. A postoperative refractive astigmatism ranging from 0.75 D to 3.75 D (mean 1.7 D ± 0.79) was recorded, as compared to mean preoperative values of 2.00 D, with no statistically significant differences being recorded (p ≥ 0.05). An improvement of BCVA, 1-2 lines on Snellen chart at the end of the follow-up period, was detected in 23 eyes (57.5%) with a mean of 0.6 ± 0.08 SD, as compared to a preoperative mean values of 0.5 ± 0.07 SD (p ≥ 0.05). Conclusion. Using an endoscope for transscleral suturing of intraocular lenses in aphakic pediatric eyes might be considered as being an effective technique that can reduce surgical complications, especially postoperative lens decentration.

A Controlled Study on the Correlation between Tear Film Volume and Tear Film Stability in Diabetic Patients.

Purpose. To assess the tear film quantity and correlate it with the quality and stability of the tear film in diabetics and compare them to age matched controls. Introduction. Diabetes affects tear film parameters in multiple ways. Poor metabolic control and neuropathy are postulated factors. To further understand how diabetes affects tear film parameters this study was conducted. Subjects and Methods. Tear meniscus height was measured by anterior segment OCT, along with tear thinning time, a subtype of noninvasive tear break-up time, and blinking rate per minute which were all recorded for 22 diabetic patients. Correlations between these tear film parameters were studied and then compared to 16 age matched controls. Results. A statistically significant difference was found in blinking rate between the diabetic and the control group (P = 0.002), with higher blinking rate among diabetics. All tear film parameters were negatively correlated with duration of diabetes. A positive correlation was found between tear film volume and stability. Conclusion. Diabetes affects the tear film in various ways. Diabetics should be examined for dry eye signs even in absence of symptoms which may be masked by associated neuropathy. Duration of diabetes has an impact on tear film status.

The Effectiveness of Intraocular Methotrexate in the Treatment of Posterior Uveitis in Behçet's Disease Patients Compared to Retrobulbar Steroids Injection.

Aim of Work. To evaluate the efficacy of intravitreal methotrexate (MTX) compared to retrobulbar triamcinolone acetonide (TAA), in controlling posterior segment involvement and inducing remissions among Behçet's disease (BD) patients. Study Design. This is a cross-sectional nonrandomized comparative study. Patients and Methods. 31 adult BD male patients with a mean disease duration of 5.45 years who presented with bilateral posterior segment involvement were included. Each patient received intravitreal injection of 400 µg/0.1 mL (MTX) for the right eye (Group A) and 1 mL of retrobulbar 40 mg/mL TAA for the left eye (Group B). Results. 90% of eyes showed complete improvement of anterior chamber reaction, whereas an improvement in vitreous activity in 77% with no significant differences between both groups (p ≤ 0.1). BCVA improved in 77.4% eyes (Group A) compared to 87.1% (Group B) (p ≤ 0.4). Relapses were noted in 11 eyes (35.5%), in group A, with the mean duration of remission being 19.1 weeks ± 2.13 compared to 7.35 ± 2.8 in 20 eyes (64.5%) in group B (p ≤ 0.1). Conclusion. No statistical differences were found between both treatment modalities; however, based on clinical observations, intravitreal MTX may ensure better control of inflammatory reaction and may encourage longer remission as compared to retrobulbar TAA in BD patients.