Comparative Evaluation of Colon Cancer Specific Antigen-2 Test and Chromocolonoscopy for Early Detection of Egyptian Patients with Colorectal Cancer.

BACKGROUND: Effective screening of colorectal cancer (CRC) in early stage could reduce the advancement of CRC and therefore mortality. Effective screening is based on either stool dependent tests or colon dependent examination. AIMS: The aim of the study was a comparative evaluation of chromocolonoscopy and Colon Cancer-Specific Antigen-2 test for early detection of colorectal cancer in Egyptian patients. METHODS: This case control study was carried out on 55 patients classified into 3 groups: Group I consisted of twenty patients with precancerous lesions detected by colonoscopy, Group II consisted of twenty patients diagnosed with colorectal cancer and Group III consisted of fifteen individuals (who underwent colonoscopy for other indications) as a control group. All the subjects were subjected to measure occult blood in the stool, measurement of Colon Cancer-Specific Antigen-2 level in serum and tissue and chromo colonoscopy using Indigo Carmine stain. RESULTS: In group II, there was a statistically significant increase in CCSA2 in serum as compared to the other 2 groups. Cutoff >11.3 CCSA2 in serum showed 65% sensitivity, 85% specificity, 81.2% PPV, 70.8% NPV and 70.3% accuracy in the differentiation of group II with cancer colon from group I with premalignant colonic lesions. A cutoff > 9.1 CCSA2 in serum showed 95% sensitivity, 46.67% specificity, 70.4% PPV, 87.5% NPV and 73.5% accuracy in differentiating group II with cancer colon from normal controls (group III). CONCLUSION: CCSA-2 level in serum was significantly higher in cancer colon. Chromoendoscopy has a role in the detection of polyps, both neoplastic and non-neoplastic.

Diagnostic and Prognostic Values of Antinuclear Immunoglobulin G in Pediatric Lupus Patients.

INTRODUCTION: Systemic lupus erythematous (SLE) as an autoimmunedisease caused by self immunoglobulin. It was proposed thatthe chromatin including nucleosomes is the main antigen inthe pathogenesis of SLE, and that antinuclear immunoglobulinG are associated with disease activity. Aim of the study was tostudy the diagnostic and prognostic value of serum levels ofantinuclear immunoglobulin G as the most famous anti-chromatinimmunoglobulin as a diagnostic tool and a disease activity markerin juvenile systemic lupus erythematous. METHODS: The work was conducted on 90 pediatric Lupuspatients who attended to the Pediatric Nephrology Unit ofPediatric Department of Tanta University Hospital. Also on thirtyapparently healthy children with matched age and sex served asa control group. All subjects were subjected to history in details,clinical examination, SLEDAI score, anti-dsDNA and antinuclearimmunoglobulin G assay . RESULTS: The mean serum level of antinuclear immunoglobulinG was statistically significantly higher in patients than controls(P < .001). But there was no statistically significant differencebetween patients' subgroups. There was a weak positive correlationbetween serum antinuclear immunoglobulin G and SLEDAI score(r = 0.213) but strong correlation between anti-dsDNA antibody andSLEDAI score (r = 0.711). Antinuclear immunoglobulin G showedhigher sensitivity but equal specificity to anti-dsDNA antibody forthe diagnosis of pediatric lupus patients. CONCLUSION: Antinuclear immunoglobulin G are more accurate thananti-dsDNA antibodies in the diagnosis of pediatric lupus patientsin anti-dsDNA negative children as antinuclear immunoglobulin Ghave higher sensitivity but as regard to disease activity antidsDNAantibody is more accurate.

Intravitreal diclofenac versus intravitreal bevacizumab in persistent diabetic macular edema: Anatomical and functional outcome.

PURPOSE: To compare the efficacy of diclofenac versus bevacizumab following single intravitreal injection in eyes with persistent diabetic macular edema. METHODS: Fifty eyes with persistent DME were randomly allocated to intravitreal injection of 500 µg/0.1 ml of diclofenac (N = 20) or 1.25 mg/0.05 mL of bevacizumab (N = 20) or to non-treatment (10 eyes). Preoperative and postoperative visual acuity, central, paracentral macular thickness and intraocular pressure (IOP) were recorded and compared between the three groups up to 4 weeks. RESULTS: Diclofenac and bevacizumab groups showed statistically significant reduction in central and paracentral macular thickness (diclofenac: p = 0.006, 0.02 and bevacizumab: p = 0.02, 0.01), without statistically significant difference between the two groups. The two groups showed no statistically significant difference in mean visual acuity or mean line improvement. Mean visual acuity improvement didn't reach statistical significance in either group. Diclofenac group showed statistically significant reduced IOP (P = 0.02). Control eyes did not show any change in mean visual acuity, macular thickness or IOP. CONCLUSION: In persistent DME, diclofenac has a structural effect comparable to bevacizumab on central macular thickness. However, significant functional gain may not be accomplished by single injection. Unlike naïve DME, persistent cases may be confounded by systemic and local factors necessitating repeated injection of diclofenac.

Bimodal imaging of proliferative diabetic retinopathy vascular features using swept source optical coherence tomography angiography.

AIM: To categorize neovessels morphology and to detect response to anti-angiogenic therapy by using structural and angiographic modes of swept source optical coherence tomography (SS-OCT). METHODS: Thirty-two eyes with neovessels at disc (NVD) and neovessels elsewhere (NVE) - as diagnosed by fluorescein angiography- were included. Cross sectional OCT images of disc and macular regions were registered to enface OCT angiography (OCTA), B-scan blood flow over lay and density maps. Three eyes received anti-angiogenic treatment. RESULTS: Pin point registration of cross-sectional OCT and OCTA images differentiated active NVD with vascular elements from fibrous or equivalent fibrovascular elements. En face images delineated NVE as vascular tufts or area of filling while cross-sectional images differentiated NVE from microvascular intraretinal abnormality (IRMA). All cases were associated with enlargement of foveal avascular zone and or areas of capillary non perfusion. Regressed NVD appeared as ghost vessel or pruned vascular loops after injection. CONCLUSION: Structural and angiographic modes of SS-OCT can detect, characterize and categorize the pattern of wide spectrum of neovessels based on blood flow data and density maps. It is potentially useful to detect ischemic changes in the vascular bed and regression of NVD after therapeutic regimens providing substitute for invasive techniques.

Diagnostic accuracy of ganglion cell complex substructures in different stages of primary open-angle glaucoma.

OBJECTIVE: To evaluate diagnostic accuracy of substructure of ganglion cell complex versus peripapillary nerve fiber layer (NFL) thickness using spectral domain optical coherence tomography (SD-OCT) in different stages of glaucoma. METHODS: Thirty eyes were normal, 120 were glaucomatous. Glaucomatous eyes were classified into: early glaucoma (46), moderate glaucoma (48), and severe glaucoma (26). Perimetry and SD-OCT were done. Peripapillary NFL thickness, ganglion cell layer (GCL), macular NFL thickness, combined GCL and macular ganglion cell complex (GCC), were recorded. Area under receiver operating characteristic curves (AUCs) was used to verify performance of different OCT parameters. RESULTS: Peripapillary NFL, GCL, and GCC thickness values were significantly different in all stages of glaucoma. All comparisons were significantly different; normal versus early, early versus moderate and moderate versus severe. The best parameters that distinguished normal from early stage were: peripapillary NFL (AUC: 0.90), GCC (AUC: 0.75), early from moderate stage were: peripapillary NFL thickness (AUC: 0.85), GCL (0.81),GCC (0.81), moderate from severe stage were: GCC (AUC:0.95), macular NFL (AUC:0.91), GCL (AUC:0.89), and peripapillary NFL (AUC:0.88). CONCLUSIONS: Peripapllary NFL and GCC thinning showed paradoxical course. The most diagnosed parameter in early glaucoma was peripapillary NFL and in severe glaucoma was GCC. In severe glaucoma, macular NFL showed higher diagnostic power than GCL and peripapillary NFL. Ganglion cell complex mapping may provide good alternative to optic disc imaging in advanced glaucoma with poor fixation.

Discriminating ability of spectral domain optical coherence tomography in different stages of glaucoma.

PURPOSE: To determine the discriminating ability of retinal nerve fiber layer (RNFL) thickness measured with spectral-domain optical coherence tomography (SD-OCT) in different stages of glaucoma. PATIENTS AND METHODS: Thirty normal, 150 glaucomatous eyes were included. Glaucomatous eyes were graded into early, moderate and severe stages according to one of the global indices called visual field index (VFI). Complete ophthalmic examination, white on white perimetry and SD-OCT were done for all patients. RNFL thickness of quadrants and average thickness were recorded. Area under receiver operating characteristic curves (AUCs) were used to assess the performance of OCT parameters. RESULTS: AVERAGE, INFERIOR AND SUPERIOR RNFL THICKNESS WERE THE BEST PARAMETERS TO DISCRIMINATE NORMAL FROM EARLY GLAUCOMA (AUC: 0.91-86), early from moderate (AUC: 0.77-0.70) and moderate from severe (AUC: 0.85-83). Average RNFL loss was 18% in early glaucoma, 28% in moderate glaucoma and 41% in severe glaucoma. Early damage tends to be focal and in the lower quadrant. A significant correlation was detected between mean VFI and mean RNFL loss. Glaucoma was restaged according to average RNFL loss into early: ⩾97.5 µ, moderate: <97.5-72.5 µ and severe: <72.5 µ. CONCLUSION: RNFL thickness measured with SD-OCT could discriminate the three stages of glaucoma. RNFL loss can be correlated to visual field loss. Future OCT-based staging of glaucoma, adjunctive to perimetry is possible.

Evaluation of rigid gas permeable lens fitting in keratoconic patients with optical coherence tomography.

PURPOSE: To assess fitting of rigid gas permeable (RGP) lenses in patients with keratoconus, using spectral domain optical coherence tomography (SD-OCT). METHODS: The study was conducted on 30 eyes of 30 keratoconic patients fitted with RGP lenses, namely Rose K2 lens. Biomicroscopic examination with and without RGP lens was done. Fluorescein pattern was examined to determine the fitting, if ideal (three-point light touch), steep (central fluorescein pooling) or flat (central heavy bearing touch). Post-lens tear film thickness was measured centrally and at the lens edges using SD-OCT. Patient's comfort was assessed and graded. RESULTS: Mean central post-lens tear film thickness was 35.1 ± 7.3 µ in patients with ideal fitting. Mean post-lens tear film thickness of 50.4 ± 8.2 µ and 25.3 ± 6.1 µ was noted in patients with steep and flat fitting, respectively. Mean post-lens tear film thickness of 102.5 ± 12.1 µ, 85.4 ± 11.4 µ, 135.6 ± 13.3 µ was demonstrated in eyes with ideal, steep and flat edge lift, respectively. Tear film thickness under the edges was significantly (p=0.04) lower in patients unsatisfied with their contact lenses. CONCLUSION: SD-OCT can image and measure the tear film thickness in keratoconic patients with different fitting patterns of RGP lenses. OCT- guided fitting can be used to evaluate and modify the lens parameters to increase patient satisfaction. Lens intolerance may be related to edge lift rather than central fitting.

Is combination therapy interferon and ribavirin in patients with chronic hepatitis C infection toxic for eyes?

BACKGROUND: Many side effects of combination therapy using pegylated interferon (IFN) and ribavirin for treatment of chronic hepatitis C virus (HCV) infection have been well described. Ocular complications are fairly common. Diabetes mellitus (DM) and systemic hypertension are possible suggested risk factors for development of these complications. PURPOSE: To determine the frequency of retinopathy and its risk factors in patients treated with combined pegylated IFN and ribavirin for chronic hepatitis C infection. METHODS: Eligible 98 patients for HCV treatment with pegylated IFN a-2a, a-2b, and ribavirin between October 2011 and March 2012 were included. All patients underwent a baseline full ophthalmological examination, and any visual complaints during treatment prompted a repeat eye examination. RESULTS: Out of the eligible 98 patients, 48 (48.78%) patients received pegylated IFN alpha-2a, and the other 50 (51.21%) patients were treated with pegylated IFN alpha-2b. Out of 98 patients, 21 (21.42%) had diabetes; 19 (19.38%) patients had hypertension and 16 (16.32%) patients had both diabetes; and hypertension. Only 8 patients (8.16%) had documented retinopathy [2 had DM; one had hypertension; 4 had both hypertension and diabetes; and one patient without DM or hypertension]. Univariate logistic regression analysis revealed that diabetic, hypertensive patients are at increased risk for development of IFN-associated retinopathy (IAR) (P=0.007, Odds ratio=6.5, 95% confidence interval=1.56-27. CONCLUSION: Retinopathy in chronic HCV-infected patients undergoing treatment with combination of pegylated IFN-alpha and ribavirin therapy appears to be relatively low, and treatment cessation is rarely needed. Diabetic, hypertensive patients are at increased risk for IAR and are recommended to be ophthalmologically followed-up.

Intraoperative subconjunctival bevacizumab as an adjunctive treatment in primary pterygium: a preliminary report.

BACKGROUND AND OBJECTIVE: To evaluate the safety and efficacy of intraoperative subconjunctival bevacizumab as an adjunctive treatment after surgical excision of primary pterygium. PATIENTS AND METHODS: This was a randomized prospective clinical study. Group 1 (21 eyes) underwent pterygium excision with conjunctivo-limbal autograft. Group 2 (20 eyes) received subconjunctival 1.25 mg/0.05 mL of bevacizumab at the end of the surgery. RESULTS: There were no statistically significant differences regarding age, sex, laterality, or dimensions of the pterygia or grafts between the two groups (P > .05, 95% confidence interval). After 8 months of follow-up, two eyes in group 1 and four eyes in group 2 had recurrent pterygia. One patient in group 2 had lost graft. The difference in recurrence rate between the two groups did not reach statistical significance (P = 0.4, 95% confidence interval). CONCLUSION: Intraoperative subconjunctival bevacizumab following primary pterygium surgical excision is not helpful and possibly harmful. Larger studies are needed.

Predicted versus actual intraocular lens power in silicon-oil-filled eyes undergoing cataract extraction using automated intraoperative retinoscopy.

PURPOSE: To compare predicted intraocular lens (IOL) power obtained with adjusted ultrasound biometry versus actual power obtained with automated intraoperative retinoscopy (AIR) in eyes undergoing combined cataract extraction and silicon oil removal in the same session. METHODS: Fifty eyes with significant cataract; requiring silicon removal were included. Preoperative ultrasonic biometry with adjusted velocity (980 m/s) was recorded. After silicon removal, AIR was done and IOL power was calculated and inserted. Postoperative refraction was recorded up to 3 months. RESULTS: AIR was successfully obtained in all eyes. Significant correlation (p = 0.000, R = 0.91) was detected between mean power of predicted (15.8 ± 8.4) and implanted IOL (11.7 ± 8.5). Mean postoperative refraction was +0.53 ± 0.31 at 1 week, +0.40 ± 0.35 at 1 month and +0.12 ± 0.20 at 3 months. The difference was statistically significant in all time intervals. Myopic shift occurred in 37% of eyes at the third month. CONCLUSIONS: AIR in combined cataract extraction and silicon oil removal is easy and provides predictable outcome in all eyes. It represents a bypass to all methods of biometry based on axial length measurement. Future correction formula based on adjusted ultrasound velocity can be a simple alternative and predictable method.

Intravitreal diclofenac versus intravitreal triamcinolone acetonide in the treatment of diabetic macular edema.

PURPOSE: To compare the efficacy and safety of intravitreal diclofenac versus intravitreal triamcinolone acetonide in the treatment of diabetic macular edema. METHODS: Thirty-two eyes with diffuse diabetic macular edema were randomly allocated to intravitreal injection of 4 mg/0.1 mL of triamcinolone (Group 1: N = 16) or 500 µg/0.1 mL of diclofenac (Group 2: N = 16). Preoperative and postoperative visual acuity, intraocular pressure, and central macular thickness were recorded and compared between the 2 groups up to 12 weeks. RESULTS: Both groups showed statistically significant reduction in central macular thickness (triamcinolone: P = 0.02 and diclofenac: P = 0.01), without statistically significant difference between the 2 groups. Visual improvement was significant only in triamcinolone group (P = 0.05). However, the 2 groups showed no statistically significant difference in mean visual acuity or mean line improvement. Transient elevation of intraocular pressure occurred in 12.5% of the triamcinolone group. Diclofenac group showed statistically significant reduced intraocular pressure (P = 0.02). CONCLUSION: Intravitreal diclofenac is effective in the treatment of diffuse diabetic macular edema up to 12 weeks. Intravitreal triamcinolone and diclofenac appear to have comparable therapeutic effects on retinal thickness. The degree of visual improvement is higher with triamcinolone.

Predictability of vitreous detachment following intravitreal plasmin injection in diabetic macular edema associated with vitreomacular traction.

PURPOSE: To assess preoperative factors associated with postoperative posterior vitreous detachment (PVD) following intravitreal autologous plasmin injection in diabetic macular edema associated with vitreomacular traction. METHODS: Twenty-five eyes with diabetic macular edema associated with vitreomacular traction as documented with optical coherence tomography were included. Approximately 0.2 IU/0.2 ml of autologous plasmin was injected intravitreally. Condition of the posterior vitreous face (degree of detachment, thickness, reflectivity, and diameter of attached vitreous base) was evaluated preoperatively and postoperatively up to 3 months. RESULTS: PVD was achieved in ten eyes (41.7%). There was a significant difference (P = 0.03) in mean posterior vitreous face thickness between the eyes with PVD and the eyes with failed PVD. There was a significant correlation between PVD and both posterior vitreous face thickness (P < 0.03%) and degree of posterior vitreous face reflectivity (P = 0.002). CONCLUSION: In diabetic eyes with vitreomacular traction, the prediction of PVD after plasmin injection is governed by the condition of posterior vitreous face; mainly posterior vitreous face thickness and reflectivity. Eyes with thinner, less reflective posterior vitreous face are more likely to develop PVD.

Three-dimensional characterization of epiretinal membrane using spectral domain optical coherence tomography.

PURPOSE: To describe epiretinal membrane (ERM) features using spectral domain optical coherence tomography "SD OCT" and to delineate the three-dimensional (3D) relationship in eyes with epiretinal membrane. METHODS: Fifty-two eyes of 44 patients with ERM were classified into two groups: idiopathic ERM and secondary ERM. Posterior vitreous face was evaluated. Pattern of ERM attachment was divided into: focal and global. A 3D SD OCT system (5 µm resolution) was used for scanning. Surface maps were used to study retinal topography. RESULTS: Surface maps revealed manner and direction of epiretinal traction, pattern of attachment and blood vessel involvement. In 55.8% of eyes the membrane was globally adherent to the retina. There was a significant association (p = 0.02%) between pattern of membrane attachment and etiological classification of eyes. Posterior vitreous detachment (PVD) was associated with both groups, but no significant difference in between. CONCLUSION: SPECTRAL DOMAIN OCT ALLOWED BETTER CHARACTERIZATION OF ERM INCLUDING: visualization, extension, cleavage plane and zones with free edges. Surface maps revealed the topography of ERM and retina pathology. Idiopathic ERM are significantly associated with global pattern. PVD plays an important role in the pathogenesis of primary as well as secondary ERM.