Protozoan communities serve as a strong indicator of water quality in the Nile River.

The relationship between the protozoan communities and environmental variables was studied in the Nile River to evaluate their potential as water quality indicators. Protozoans were sampled monthly at six sampling sites in the Nile's Damietta Branch across a spatial gradient of environmental conditions during a 1-year cycle (February 2016-January 2017). The Protozoa community was comprised of 54 species belonging to six main heterotrophic Protozoa phyla. The abundance (average, 1089 ± 576.18 individuals L-1) and biomass (average, 86.60 ± 106.13 µg L-1) were comparable between sites. Ciliates comprised the majority of protozoan species richness (30 species), abundance (79.72%), and biomass (82.90%). Cluster analysis resulted in the distribution of protozoan species into three groups, with the most dominant species being the omnivorous ciliate Paradileptus elephantinus. Aluminium, fluoride, and turbidity negatively affected abundance and biomass, while dissolved oxygen and potassium positively impacted biomass. Of the dominant species recorded over the study area, the amoebozoa Centropyxis aculeata was associated with runoff variables, while the bacterivorous ciliates Colpidium colpoda, Glaucoma scintillans, and Vorticella convallaria were related to the abundance of heterotrophic bacteria, phytoplankton biomass, and total organic carbon. Total dissolved salts, PO4, NH3, NO2, dissolved oxygen, and total organic carbon were the strongest causative factors for protozoa distribution. The α-Mesosaprobic environment at site VI confirmed a high load of agricultural runoffs compared to other sites. This study demonstrates that protozoans can be a potential bioindicator of water quality status in this subtropical freshwater river system.

Activation of alpha-7 nicotinic acetylcholine receptor by tropisetron mitigates 3-nitropropionic acid-induced Huntington's disease in rats: Role of PI3K/Akt and JAK2/NF-κB signaling pathways.

Huntington's disease (HD) is an inheritable autosomal-dominant disorder that targets mainly the striatum. 3-Nitropropionic acid (3-NP) induces obvious deleterious behavioral, neurochemical, and histological effects similar to the symptoms of HD. Our study aimed to examine the neuroprotective activity of tropisetron, an alpha-7 neuronal nicotinic acetylcholine receptor (α-7nAChR) agonist, against neurotoxic events associated with 3-NP-induced HD in rats. Forty-eight rats were randomly allocated into four groups. Group I received normal saline, while Groups II, III and IV received 3-NP for 2 weeks. In addition, Group III and IV were treated with tropisetron 1 h after 3-NP administration. Meanwhile, Group IV received methyllycaconitine (MLA), an α-7nAChR antagonist, 30 min before tropisetron administration. Treatment with tropisetron improved motor deficits as confirmed by the behavioral tests and restored normal histopathological features of the striatum. Moreover, tropisetron showed an anti-oxidant activity via increasing the activities of SDH and HO-1 as well as Nrf2 expression along with reducing MDA level. Tropisetron also markedly upregulated the protein expression of p-PI3K and p-Akt which in turn hampered JAK2/NF-κB inflammatory cascade. In addition, tropisetron showed an anti-apoptotic activity through boosting the expression of Bcl-2 and reducing Bax expression and caspase-3 level. Interestingly, all the aforementioned effects of tropisetron were blocked by pre-administration of MLA, which confirms that such neuroprotective effects are mediated via activating of α-7nAChR. In conclusion, tropisetron showed a neuroprotective activity against 3-NP-induced HD via activating PI3K/Akt signaling and suppressing JAK2/NF-κB inflammatory axis. Thus, repositioning of tropisetron could represent a promising therapeutic strategy in management of HD.

Enhanced Deep Learning Model for Classification of Retinal Optical Coherence Tomography Images.

Retinal optical coherence tomography (OCT) imaging is a valuable tool for assessing the condition of the back part of the eye. The condition has a great effect on the specificity of diagnosis, the monitoring of many physiological and pathological procedures, and the response and evaluation of therapeutic effectiveness in various fields of clinical practices, including primary eye diseases and systemic diseases such as diabetes. Therefore, precise diagnosis, classification, and automated image analysis models are crucial. In this paper, we propose an enhanced optical coherence tomography (EOCT) model to classify retinal OCT based on modified ResNet (50) and random forest algorithms, which are used in the proposed study's training strategy to enhance performance. The Adam optimizer is applied during the training process to increase the efficiency of the ResNet (50) model compared with the common pre-trained models, such as spatial separable convolutions and visual geometry group (VGG) (16). The experimentation results show that the sensitivity, specificity, precision, negative predictive value, false discovery rate, false negative rate accuracy, and Matthew's correlation coefficient are 0.9836, 0.9615, 0.9740, 0.9756, 0.0385, 0.0260, 0.0164, 0.9747, 0.9788, and 0.9474, respectively.

Evaluation of optical coherence tomography angiography findings in patients with multiple sclerosis.

Purpose: To evaluate optical coherence tomography angiography findings in patients with multiple sclerosis (MS). Methods: This prospective noninterventional study was conducted on 30 eyes of relapsing-remitting MS patients. Group (1) included 10 eyes with a history of optic neuritis (ON), group (2) included 10 eyes without any history of optic neuritis (MS-ON), and group (3) included 10 eyes of normal age/sex/refraction matched participants. Optical coherence tomography (OCT) and OCT-A (ZEISS Cirrus™ HD-OCT Model 4000 (Carl Zeiss-Meditec, Dublin, CA) of the optic disc were done for all patients. Results: The best-corrected visual acuity was diminished in MS cases, especially in patients with ON with P value <0.001. The retinal nerve fiber layer (RNFL) thickness showed a significant decrease in the average thickness and in all quadrants, notably the temporal quadrant in group 1 (P < 0.001). Ganglion cell layer thickness was diminished in average thickness and in all quadrants in both groups of MS, but only the first group showed statistical significance with P value <0.001). In respect to optic disc perfusion, Average, superficial, and deep vascular density index (AVDI, VDI 1, VDI 2) were statistically significantly lower in groups 1, 2 with (P-value < 0.001). Conclusion: Decreased vascular perfusion of the optic nerve in MS patients, especially in those with ON is strongly correlated with the damage of RNFL and ganglion cell layer detected by OCT.

A Lightweight and Robust Secure Key Establishment Protocol for Internet of Medical Things in COVID-19 Patients Care.

Due to the outbreak of COVID-19, the Internet of Medical Things (IoMT) has enabled the doctors to remotely diagnose the patients, control the medical equipment, and monitor the quarantined patients through their digital devices. Security is a major concern in IoMT because the Internet of Things (IoT) nodes exchange sensitive information between virtual medical facilities over the vulnerable wireless medium. Hence, the virtual facilities must be protected from adversarial threats through secure sessions. This article proposes a lightweight and physically secure mutual authentication and secret key establishment protocol that uses physical unclonable functions (PUFs) to enable the network devices to verify the doctor's legitimacy (user) and sensor node before establishing a session key. PUF also protects the sensor nodes deployed in an unattended and hostile environment from tampering, cloning, and side-channel attacks. The proposed protocol exhibits all the necessary security properties required to protect the IoMT networks, like authentication, confidentiality, integrity, and anonymity. The formal AVISPA and informal security analysis demonstrate its robustness against attacks like impersonation, replay, a man in the middle, etc. The proposed protocol also consumes fewer resources to operate and is safe from physical attacks, making it more suitable for IoT-enabled medical network applications.

Tanta Protocol for Management of COVID-19: Perspectives from a Developing Country.

In late 2019, SARS-COV-2 disease was firstly discovered in Wuhan, China and then it infected millions of people worldwide. Later, the World Health Organization (WHO) described COVID-19 as the first pandemic invading the world in the 21st century. The WHO has declared that the emerging infection will last long enough to force adjustments not only in people's lifestyles but also in the health care system. This amendment is expected to spread through many medical practices and specialties. A lot of diagnostic and therapeutic modalities have been proposed for COVID-19 management. The best strategy for the management of patients requires a multi-disciplinary team approach with correct decisions regarding the right timing of each modality of treatment. The participating multidisciplinary team for COVID-19 management includes six infectious diseases experts in Tanta University; one critical care management expert, an emergency medicine expert and two pharmacists in Tanta University. In this review, we reported our multi-disciplinary team experience with up to date literature guidance to propose a valid protocol for the management of COVID-19 patients in a limited resources setting.

Exploring the Use of Artificial Intelligence Techniques to Detect the Presence of Coronavirus Covid-19 Through Speech and Voice Analysis.

The Covid-19 pandemic represents one of the greatest global health emergencies of the last few decades with indelible consequences for all societies throughout the world. The cost in terms of human lives lost is devastating on account of the high contagiousness and mortality rate of the virus. Millions of people have been infected, frequently requiring continuous assistance and monitoring. Smart healthcare technologies and Artificial Intelligence algorithms constitute promising solutions useful not only for the monitoring of patient care but also in order to support the early diagnosis, prevention and evaluation of Covid-19 in a faster and more accurate way. On the other hand, the necessity to realise reliable and precise smart healthcare solutions, able to acquire and process voice signals by means of appropriate Internet of Things devices in real-time, requires the identification of algorithms able to discriminate accurately between pathological and healthy subjects. In this paper, we explore and compare the performance of the main machine learning techniques in terms of their ability to correctly detect Covid-19 disorders through voice analysis. Several studies report, in fact, significant effects of this virus on voice production due to the considerable impairment of the respiratory apparatus. Vocal folds oscillations that are more asynchronous, asymmetrical and restricted are observed during phonation in Covid-19 patients. Voice sounds selected by the Coswara database, an available crowd-sourced database, have been e analysed and processed to evaluate the capacity of the main ML techniques to distinguish between healthy and pathological voices. All the analyses have been evaluated in terms of accuracy, sensitivity, specificity, F1-score and Receiver Operating Characteristic area. These show the reliability of the Support Vector Machine algorithm to detect the Covid-19 infections, achieving an accuracy equal to about 97%.

Comparison of corneal biomechanical changes after LASIK and F-SMILE with CorVis ST.

PURPOSE: To evaluate changes in corneal biomechanics after LASIK and F-SMILE. SETTING: Elite Eye Center, Tanta, Egypt. DESIGN: Prospective, randomized, unmasked, interventional comparative case series. PATIENTS AND METHODS: A total of 60 eyes were equally divided into two groups; group A: received LASIK and group B: received F-SMILE. Pentacam and CorVis ST parameters were compared before and 6 months after procedures. P ⩽ 0.05 was used for significance of results. RESULTS: bIOP decreased by 0.762 ± 1.211 mmHg in group A (p = 0.092), and by 2.52 ± 1.389 mmHg in group B (p < 0.001) and the difference between groups became significant (p = 0.001). A1 increased significantly in group A only (p = 0.036); while A2 decreased insignificantly in both groups. DAR increased significantly in both groups (p < 0.001, p = 0.022), but the difference between groups remained insignificant (p = 0.461). IR increased significantly in group A only (p < 0.001) and the difference between groups became significant (p = 0.026). ARTH decreased in both groups (p = 0.245, p = 0.695) and the difference remained insignificant (p = 0.928). SP-A1 decreased in group A by 8.89 ± 1.38 mmHg/mm (p = 0.637), and by 32.6 ± 4.39 mmHg/mm in group B (p < 0.001) and the postoperative difference between groups was significant (p = 0.013). CBI increased significantly in group A (p < 0.001), but insignificantly in group B (p = 0.098) and postoperative difference between groups was highly significant (p < 0.001). A significant correlation was found between change in CCT and corresponding changes in DAR, IR, and ARTH after surgery in both groups. CONCLUSION: The significant differences between groups postoperatively as regards bIOP (p = 0.001), IR (p = 0.026), SP-A1 (p = 0.013), and CBI (p < 0.001) indicate stiffer corneas after F-SMILE and suggest less influence on corneal biomechanics than LASIK.

Vision adaptation in the laughing dove (Streptopelia senegalensis, Linnaeus, 1766) inferred from structural, ultrastructural, and genetic characterization.

Neuroanatomy of the retina reflects adaptation and acclimation for dark and light conditions. Retinal cells and genes must be functionally adjusted to various environmental luminosities. Opsins are brilliant molecules to assess the adaptations at the genetic and phenotypic levels. Photic adaptations may reveal new mechanisms that enhance vision abilities. Through the investigation of histological, ultrastructural constituents of the whole retinal layers, and the sequencing of shortwave length sensitive opsin 1 (SWS1) of the laughing dove (Streptopelia senegalensis), the current study confirms the plasticity of the retina in response to the natural photic conditions. Retinal pigmented epithelium has plentiful melanosomes, signifying a highly adapted eye for maximum light perception and protection. Variously colored oil droplets signify high color vision ability. Stratified outer nuclear layer with many Müller cells suggests high sensitivity to dim conditions and high retinal regeneration. The penetration of outer limiting membrane by photoreceptor nuclei and Müller cell microvilli could minimize the light reflection. Oligodendrocytes establish thick myelination demanded for a keen visual acuity. A functional violet sensitive SWS1 with crucial Ser90 is presumed. Molecular phylogeny showed a secondary loss as color vision was shifted back from ultraviolet (UV) sensitivity to the ancestral avian violet sensitivity, thus improving visual resolution. However, SWS1 has some UV sensitive residues. These findings implicate not only spectral adaptations with high color vision ability and acuity but also photoinduced structural reorganizations. Further studies are needed to assess the secrets between photons and the structural genes.

Dissection of two drug-targeted regions of Hepatitis C virus subtype 4a infecting Egyptian patients.

Recently, treatment of HCV infection has been improved after the development of direct acting antivirals (DAAs) which target different viral proteins (NS3-4A, NS5A and NS5B). The activity and effectiveness of these DAAs are affected by the presence of resistance associated substitutions (RASs). This study aimed to characterize HCV genotypes circulating among Egyptian HCV patients, to dissect the full sequences of HCV NS3-4A and NS5B regions, and to characterize RASs associated with NS3-4A and NS5B inhibitors in HCV treatment-naïve patients. Genotyping of 80 HCV samples from treatment-naïve patients was done using restriction fragment length polymorphism and phylogenetic analysis based on some full NS5B sequences. Results showed the prevalence of HCV subtype 4a. Twenty four new full sequences of NS3-4A and NS5B regions of subtype 4a were deposited in the GenBank database. In general, the substitutions associated with NS3-4A-targeting drugs were absent predicting possible responsiveness of Egyptian HCV patients to these drugs. In addition, the absence of amino acid substitutions associated with resistance to Sofosbuvir may predict good response to treatment with Sofosbuvir. Some amino acid substitutions associated with resistance to different classes of non-nucleoside inhibitors were detected. Further investigations on treated Egyptian HCV patients may evaluate the effectiveness of the massively used drugs. Many predicted T-cell-binding epitopes in NS3-4A and NS5B regions were found to be highly conserved in the currently studied isolates; a finding that might be important for HCV vaccine development. We demonstrated potential NS3 epitopes that could be used in engineering T cells against HCV epitopes.

Induction of fetal abnormalities and genotoxicity by molybdenum nanoparticles in pregnant female mice and fetuses.

Increasing the uses of molybdenum (Mo) nanoparticles in a wide range of applications including food, industry, and medicine, resulted in increased human exposure and necessitated the study of their toxic effects. However, almost no studies are available on their genotoxic effects, especially on pregnant females and their fetuses. Therefore, this study was undertaken to estimate the possible induction of genotoxicity and fetal abnormalities, especially fetal malformations and skeletal abnormalities by Mo nanoparticle administration in mice. Oral administration of Mo nanoparticles resulted in significant decreases in the maternal body weight, the number and length of fetuses as well as skeletal abnormalities mainly less ossification and less chondrification. Administration of Mo nanoparticles also caused DNA damage induction which elevated the expression levels of p53, the vital gene in maintaining the genomic stability and cell differentiation in both maternal and fetus tissues. Similarly, the expression levels of E-Cad and N-Cad genes that control skeleton development have also been increased in the tissues of female mice administered Mo nanoparticles and their fetuses. Thus, we concluded that oral administration of Mo nanoparticles induced genotoxic effects and fetal abnormalities that necessitated further studies on the possible toxic effects of Mo nanoparticles.

Effect of Eye Masks on Pain and Sleep Quality in Patients Undergoing Cardiac Surgery: A Randomized Controlled Trial.

BACKGROUND: Impaired sleep is a common complaint among patients undergoing major surgery and may be a contributing factor in postoperative pain. The provision of eye masks to patients after cardiac surgery may reduce postoperative pain through improvements in sleep quality. OBJECTIVE: To examine the effect of nocturnal eye masks on postoperative pain and sleep quality in cardiac surgical patients. METHODS: In this randomized controlled trial, 70 adult patients who had undergone cardiac surgery requiring immediate postoperative care in the intensive care unit were randomly assigned to sleep with or without nocturnal eye masks for the first 3 nights in the unit. A visual analog scale was used to assess pain intensity, and the Arabic version of the Richards-Campbell Sleep Questionnaire was used to assess subjective sleep quality. RESULTS: A total of 66 patients completed the trial. A statistically significant difference was found between groups in mean total Richards-Campbell Sleep Questionnaire score over the 3-day study period (P = .001), with the intervention group reporting better sleep quality. A statistically significant difference was also found between groups in mean pain score on days 1, 2, and 3 (P < .001), with the intervention group having less pain. CONCLUSION: Nocturnal eye masks are a simple, low-risk, low-cost intervention that may contribute to reductions in perceived pain in cardiac surgery patients.

A comprehensive evaluation and first molecular report of Theileria ovis infection in small ruminants in Saudi Arabia.

A total of 1000 clinically healthy small ruminants comprising 500 sheep and 500 goats from five districts within Riyadh Province in Saudi Arabia were investigated by routine Giemsa staining for hematozoan parasites. Out of these, 100 sheep and 95 goat samples were investigated by PCR using three pairs of hemoprotozoan-specific primers. Based on microscopic examination, 33.2% of sheep and 25.2% of goats were found infected with hemoprotozoan parasites, while PCR detected hematozoan infection in 46% of sheep and 33.7% of goats. Extensive molecular characterization of hematozoan infection using six pairs of species-specific primers revealed the dominance of Theileria ovis, rather than any other species, which is recorded for the first time in small ruminants in Saudi Arabia. Prevalence of T. ovis in sheep and goats was found to be the highest in Riyadh (32, 48%) followed by AL-Kharj (31, 35%), Ad-Dawadimi (31, 33%), AL-Majmaah (15, 27%), and Rumah (17, 23%). The highest parasite prevalence was recorded in the 3 years of age and > 4 years of age ruminants, while the lowest prevalence was recorded in < 1 year of age ruminants. No noticeable differences in parasite prevalence between male or female ruminants were recorded. Partial sequencing of 18S rRNA gene revealed the infection of the studied ruminants with four new isolates of T. ovis. Further characterization of the pathogenicity and the clinical effects of these T. ovis isolates in sheep and goats is highly needed. The current results can be helpful in protecting and improving livestock industry in the countries that depend on a high number of small ruminants.

5' UTR and NS5B-based genotyping of hepatitis C virus in patients from Damietta governorate, Egypt.

Chronic hepatitis C virus (HCV) infection is a main health problem in Egypt causing high rates of mortalities. Egypt has the highest HCV prevalence in the world, with specific HCV subtypes epidemic and circulating extensively in the country. Different antiviral therapy protocols have been implemented for treating Egyptian HCV patients. Due to the limited data about HCV in Egypt, this study aimed to genotype HCV strains circulating in the Nile Delta Damietta governorate and to investigate the variation in the nonstructural 5B (NS5B) region targeted by the newly approved antiviral drugs. Thirty HCV samples from treatment-naïve patients were genotyped by restriction fragment length polymorphism. Some samples were genotyped by direct sequencing of their 5' untranslated region (UTR) and NS5B regions. Phylogenetic analysis was also performed on the sequences of their NS5B regions. Fourteen new sequences have been deposited in the GenBank database. Results showed that subtype 4a was prevalent in addition to subtype 1g. None of the previously reported NS5B substitutions were detected in the sequenced isolates from treatment-naïve patients, which may be a good predictor for efficient treatment of HCV Egyptian patients with Sofosbuvir. Further studies on Sofosbuvir treated-HCV Egyptian patients are required to investigate whether any NS5B substitutions can confer resistance to treatment.

Biophysical and biochemical roles of Moringa oleifera leaves as radioprotector.

It has been found that medicinal plants have chemical and/or therapeutic effects on different diseases related to oxidative damage. This work investigates the use of ethanolic Moringa oleifera leaves extract; as a protective and/or therapeutic agent against damage induced by high acute dose of ionizing radiation. Also, this study aims to explore the associations of electrical properties (relaxation time and DC conductivity of bone marrow) with biochemical markers (SOD, CAT and GSH) to detect and prognosticate radiation effects. Biophysical and biochemical data revealed that Moringa extract can improve the electrical properties of bone marrow and the antioxidants levels in the blood. They also showed that the feeding of Moringa leaves extract post irradiation is preferred to recover rapidly and continuously from radiation effects.

Dielectric and thermodynamic study of Hb exploring Moringa Oleifera leaves extract potential against radiation damage.

This work has a major interest of the use of Moringa oleifera leaves extract as protective and protective-therapeutic natural supplement helping the biosystem to stand against irradiation induced damage. Rats were orally administered with Moringa oleifera leaves extract by two modalities. The dielectric properties were measured over the frequency range 106 - 2 × 108 Hz and in the temperature window 283-313 K. The dielectric parameters were used to estimate some thermodynamic state functions and evaluate the energy within the Hb molecule. Information source will be the least invasive way consuming haemoglobin from blood sample. Results indicated that some physical parameters were better indicators than others and different modalities showed variant outcomes. In addition, administration of moringa leaves extract proved to have a significant effect that can be used to reduce radiation damage which may be due to constituents of Moringa.

Testosterone levels and the genetic variation of sex hormone-binding globulin gene of Bubalus bubalis, bulls in Egypt.

Testosterone is themain plasma androgen produced and secreted by male testis. To be bioactive, it binds to sex hormonebinding globulin (SHBG), i.e. the major transporter protein of sex steroids in the blood of mammals and other vertebrate species.Firstly, this study aimed to determine the levels of testosterone in different-age groups of buffalo bulls (Bubalus bubalis) in Egypt, and secondly to screen the genetic polymorphisms in their SHBG gene and to investigatewhether these polymorphisms are associated with the level of the circulating serum testosterone. Blood samples were collected from 67 Egyptian buffalo bulls representing four different age-groups and testosterone concentration was measured by radioimmunoassay. Selected DNA samples from different age-groups were sequenced for the full length of theirSHBGgene.Asignificant increase in the concentration of serum testosterone in buffalo bulls was recorded with the advancement of age from 12/18 to 24/36 months. Based on the number of polymorphisms in SHBG gene, the current study reveals the presence of three bull genotypes, of which one is likely to be associated with low testosterone concentration, while other is likely to be associated with an increased testosterone concentration. Such genetic associations can provide a good tool for the selection of bull genotypes with higher testosterone concentrations, which are indispensible for breeding purposes.

The neuro-ophthalmological effects related to long-term occupational exposure to organic solvents in painters.

PURPOSE: Organic solvents are widely used in many industries, and usually, exposure occurs with mixtures of solvents. Organic solvent mixtures are known for their ability to affect tissues of high lipid content including the myelin sheath in the nervous system. The purpose of this work was to study the evidence that long-term (more than 10 years) exposure to organic solvent mixtures among painters can induce neuro-ophthalmological effects on the function of retinal ganglion cells and the optic tract. METHODS: Twenty workers with long-term occupational exposure to mixed organic solvents were compared to 40 control subjects. The controls were matched for age, gender, and demographic characteristics but were not occupationally exposed to any known organic solvents, using the following comparators: visual evoked potential (VEP), electroretinogram (ERG), color vision (CV), and contrast sensitivity (CS) testing. Environmental monitoring was done in the work environment with consideration to the American Conference of Governmental Industrial Hygienists Threshold Limit Values (ACGIH-TLVs). RESULTS: The exposed group had significantly longer latency and higher amplitude of VEP waves especially P100, higher Color Confusion Index (CCI), especially affecting the blue-yellow spectrum, and lower Log CS. There was no significant difference between exposed and nonexposed groups in full-field flash ERG response; however, in the pattern ERG, the exposed group had significantly longer latency of P50, which reflects changes in the retinal ganglion cell. CONCLUSION: Long-term occupational exposure to mixed organic solvents appeared to affect the optic tract functions in the form of increasing latency of VEP response, affecting the quality of CV and decreasing CS. It also affects the retinal ganglion cell layer with increased latency of P50 of the pattern ERG response.

Vector analysis of astigmatic changes after small-incision lenticule extraction and wavefront-guided laser in situ keratomileusis.

PURPOSE: To evaluate and compare the efficacy of the astigmatic correction after wavefront-guided laser in situ keratomileusis (LASIK) and small-incision lenticule extraction (SMILE) and in myopic eyes. DESIGN: Prospective case series. SETTING: Horus Vision Correction Center and Ellite Vision Correction Center, Alexandria, Egypt. METHODS: Myopic eyes with astigmatism up to 4.00 diopters (D) had wavefront-guided LASIK or small-incision lenticule extraction. Visual and refractive changes were evaluated during a 6-month follow-up. The astigmatic changes were evaluated using the Alpins method. RESULT: The study evaluated 107 eyes (55 patients), 52 eyes having wavefront-guided LASIK and 55 eyes, small-incision lenticule extraction. No statistically significant differences were found in the 6-month postoperative sphere between the 2 groups (P = .652). The postoperative manifest cylinder and spherical equivalent were significantly lower in the wavefront-guided LASIK group (P < .001). The 6-month postoperative cylinder was 0.50 D or less in all eyes in the wavefront-guided LASIK groups and in 79.8% in the small-incision lenticule extraction group (P < .001). Vector analysis showed a significantly higher difference vector (P < .001) and angle of error (P = .021) and a significantly lower correction index (P = .001) in the small-incision lenticule extraction group. The mean magnitude of error was -0.07 ± 0.20 (SD) and -0.20 ± 0.35 in the wavefront-guided LASIK group and small-incision lenticule extraction group, respectively (P = .012). CONCLUSION: Wavefront-guided LASIK and small-incision lenticule extraction were safe and effective for the correction of myopic astigmatism, although there was a trend toward undercorrection with small-incision lenticule extraction.

Comparative Analysis of the Clinical Outcomes of SMILE and Wavefront-Guided LASIK in Low and Moderate Myopia.

PURPOSE: To compare the clinical outcomes of small incision lenticule extraction (SMILE) and wavefront-guided LASIK (WFG LASIK) in eyes with low and moderate myopia. METHODS: This was a prospective, comparative study enrolling 110 eyes with low and moderate myopia (spherical equivalent ≤ 6.00 diopters [D]). Two groups were differentiated according to the surgical technique used: the WFG LASIK group included 51 eyes (51 patients) undergoing WFG LASIK using the STAR S4IR excimer laser and the iDesign aberrometer (Abbott Medical Optics, Abbott Park, IL) and the SMILE group included 59 eyes (59 patients) undergoing SMILE with the VisuMax platform (Carl Zeiss Meditec, Jena, Germany). Visual, refractive, aberrometric, and contrast sensitivity outcomes were evaluated during a 6-month follow-up. RESULTS: Mean efficacy index was 0.92 ± 0.11 and 1.12 ± 0.17 in the SMILE and WFG LASIK groups, respectively (P < .001). Postoperative spherical equivalent was within ±0.50 D in 81.54% and 98% of eyes in the SMILE and WFG LASIK groups (P < .001), and postoperative cylinder was 0.50 or below in 84.7% and 100% of eyes, respectively (P = .038). Mean safety index was 0.98 ± 0.08 and 1.20 ± 0.14 in the SMILE and WFG LASIK groups (P < .001), with losses of lines of corrected distance visual acuity in 6.8% and 0.0% of eyes, respectively. Higher increase in higher order (P < .001) and coma (P < .001) root mean square and higher decrease in contrast sensitivity for 6, 12, and 18 cycles/degree (P ≤ .001) were observed after SMILE. CONCLUSIONS: SMILE and WFG LASIK are efficacious and safe procedures for the correction of low and moderate myopia, but WFG LASIK allows a more predictable outcome and better aberrometric control. [J Refract Surg. 2017;33(5):298-304.].