IgE Mediated Wheat Allergy Associated with Resistant and Severe Forms of Allergic Conjunctivitis.

Objective: This study aimed to determine the prevalence and criteria of wheat allergy (WA) among patients with resistant allergic conjunctivitis (AC). Methods: A prospective comparative study was conducted on 100 patients with resistant AC. Skin prick-tests (SPTs), total and sIgE against a panel of inhalant and food allergens were performed in all patients' sera. They were divided into 2 groups according to skin prick test (SPT) and specific IgE (sIgE) level, namely the wheat sensitive group (WSG) and wheat tolerant group (WTG). Total ocular symptom scores (TOSS) and 4-point sign scales were correlated for both groups. Results: Ten patients out of 100 with IgE-mediated resistant AC were wheat sensitive, and the other 90 were wheat tolerant patients. WSG included patients of significantly younger age. Positive family history of atopy was proven in 100% of WSG vs. 67% of WTG. A significantly higher frequency of multiorgan allergy was detected in 100% of WSG vs. 20% in WTG (P = 0.0001). Thirty (30%) of WSG had associated allergic rhinitis (AR) and bronchial asthma (BA). Another 30% had an associated AR only, 10% had an associated BA only, and another 20% had an associated skin allergy. TOSS, 4- point sign scale, and total IgE level were significantly higher in WSG. Conclusion: This study provides novel evidence that wheat allergy is responsible for some severe forms of AC.

Closed-Chamber Anterior Capsulorhexis Under Air Tamponade In White Cataract.

PURPOSE: To evaluate the efficacy and safety of a closed-chamber air bubble capsulotomy technique to prevent the Argentinean flag sign (AFS) in patients with white and intumescent cataracts. SETTING: Sohag University, Faculty of Medicine, Ophthalmology Department, Sohag, Egypt. DESIGN: Prospective interventional noncomparative case series. METHODS: Eighty-two eyes of 80 patients with white and intumescent cataracts were included. Eyes with any ocular pathology other than cataract or eyes subjected to previous intraocular surgery were excluded. Needle capsulorhexis was performed under a large air bubble tamponade without capsular staining. Efficacy of the technique was assessed intraoperatively by successful completion of capsulorhexis. Safety of the technique was assessed by the occurrence of intraoperative or postoperative complications. RESULTS: Complete capsulorhexis by the closed-chamber air bubble technique was successful in 75 eyes (91.5%), while capsulorhexis extension occurred in seven eyes. In four eyes with extension, the procedure was shifted to the standard technique of CCC (circular curvilinear capsulorhexis), using a viscoelastic device. A shift to extracapsular cataract extraction (ECCE) surgery occurred in the remaining three eyes, as the extension was so far-gone. No intraoperative or postoperative complications were observed. CONCLUSION: The closed anterior chamber air bubble technique for capsulorhexis is a novel, safe, and effective technique to prevent AFS in white and intumescent cataracts. It is also time-saving and cost-effective, with less likelihood of capsulorhexis extension. The technique is considered a valuable addition to previously described techniques.

One-year evaluation of clinical and immunological efficacy and safety of sublingual versus subcutaneous allergen immunotherapy in allergic conjunctivitis.

BACKGROUND: The aim of this study is to evaluate the clinical and immunological efficacy and safety of allergen immunotherapy (AIT) in patients with allergic conjunctivitis (AC) and to compare between sublingual and subcutaneous routes of administration. METHODS: A prospective comparative case series study was performed on 100 patients with IgE-mediated AC. Patients were referred to allergy clinics for skin prick test (SPT) and AIT. Patients with positive SPT and high-serum IgE level were enrolled in this study. Patients were divided into two groups: sublingual immunotherapy (SLIT) group (50 patients) and subcutaneous immunotherapy (SCIT) group (50 patients). Both groups were followed for 1 year. Efficacy was assessed clinically by comparing pre- and post-treatment symptoms and medication scores and assessed immunologically by comparing pre- and post-treatment serum IgE level and wheal diameter of SPT. Safety of the therapy was assessed by the occurrence of adverse reactions and patient tolerability to the therapy. RESULTS: Patients were either mono- or polysensitized to different allergens. Aeroallergens were significantly more common than food allergens (P = 0.00). The most prevalent aeroallergens were pollens (40%) and house dust (30%). At 12-month follow-up, both routes SLIT and SCIT led to a statistically significant clinical and immunological improvement (P < 0.05). This improvement was evident in all follow-up parameters including total ocular symptom score (TOSS), medication score, total serum IgE level, and wheal diameter of skin prick test (SPT). There was no significant difference between the two routes of administration (SLIT & SCIT) in any of the follow-up parameters (P > 0.05). Patients were able to tolerate the allergen therapy without developing any serious adverse events. CONCLUSION: Aeroallergen polysensitization is common among patients with AC. SPT should be included in the diagnostic workup of those patients. AIT is a safe and effective treatment option for patients with AC as it has the potential to achieve significant reduction in symptom and medication scores without ocular or systemic side effects. There is no significant difference between both routes of administration either SLIT or SCIT in achieving clinical and immunologic improvement; so the patient can choose his preferred method for therapy.

Refractive Results: Safety and Efficacy of Secondary Piggyback Sensar™ AR40 Intraocular Lens Implantation to Correct Pseudophakic Refractive Error.

In this study we evaluate the visual outcomes, safety, efficacy, and stability of implanting of second sulcus intraocular lens (IOL) to correct unsatisfied ametropic patients after phacoemulsification. Methods. Retrospective study of 15 eyes (15 patients) underwent secondary intraocular lens implanted into the ciliary sulcus. The IOL used was a Sensar IOL three-piece foldable hydrophobic acrylic IOL. The first IOL in all patients was acrylic intrabagal IOL implanted in uncomplicated phacoemulsification surgery. Results. Fifteen eyes (15 patients) were involved in this study. Preoperatively, mean log⁡MAR UDVA and CDVA were 0.88 ± 0.22 and 0.19 ± 0.13, respectively, with a mean follow-up of 28 months (range: 24 to 36 months). At the end of the follow-up, all eyes achieved log⁡MAR UDVA of 0.20 ± 0.12 with postoperative refraction ranging from 0.00 to -0.50 D of attempted emmetropia. Conclusions. Implantation of the second sulcus SensarAR40 IOL was found to be safe, easy, and simple technique for management of ametropia following uncomplicated phacoemulsification.

Heat shock protein-70 and hypoxia inducible factor-1α in type 2 diabetes mellitus patients complicated with retinopathy.

PURPOSE: To elucidate the role of heat shock protein-70 (HSP70) and hypoxia inducible factor-1α (HIF-1α) in diabetic retinopathy (DR) patients. DESIGN AND METHODS: A comparative study was done on the serum level of both HSP70 and HIF-1α in 50 patients with type 2 diabetes mellitus (T2DM) without DR, 50 patients with T2DM and DR and 70 healthy control subjects. RESULTS: HSP70 and HIF-1α were significantly increased in T2DM patients compared to controls and increased in patients with T2DM & DR compared to T2DM patients without DR (p < 0.0001). HSP70 did not differ among the patients with different stages of DR, while HIF-1α increased significantly in grades 3 and 4 DR patients compared to grades 1 and 2 DR patients. A strong correlation was found between HIF-1α and the development of DR (r = 0.835, p = 0.00) but not with HSP70. HIF-1α can be used as a predictor for development of DR but not HSP70. CONCLUSIONS: Our study was the first that investigated both HSP70 and HIF-1α in humans and was the first that measured their levels in serum of patients with DR. The study suggested that HSP70 might have a protective function in T2DM patients rather than a therapeutic function. HIF-1α had an upper hand in the development and progression of DR. Induction of HSP70 and blockage of HIF-1α could lead to the development of novel prophylactic and therapeutic strategies for DR and potentially other diabetic complications.

Interchangeability between Pentacam and IOLMaster in phakic intraocular lens calculation.

PURPOSE: To evaluate the agreement and interchangeability between IOLMaster and Pentacam in phakic intraocular lens (IOL) calculations. METHODS: This was a prospective study involving measurement of the anterior segment parameters anterior chamber depth (ACD), white to white (WTW) line, and average anterior corneal curvature (K-reading) on 108 healthy eyes of 56 consecutive patients. Interdevice agreement and interchangeability in phakic IOL calculations was evaluated. RESULTS: Pentacam measured significantly longer ACD measurements (3.54 ± 0.35 mm) than the IOLMaster (3.40 ± 0.37 mm) (p<0.0001); on the other hand, it measured significantly shorter WTW line measurements (11.61 ± 0.44 mm) than the IOLMaster (11.66 ± 0.42 mm) (p = 0.016). No difference was found regarding the average K-readings. For biometry and phakic IOL power calculation, there was no clinically significant difference between the devices, but for phakic IOL diameter calculation the difference was clinically significant. CONCLUSIONS: There is a good agreement in ACD and K-readings between Pentacam and IOLMaster, making them interchangeable in biometry and phakic IOL power calculation, but they are not interchangeable regarding WTW line measurement; the difference will affect the phakic IOL diameter, which would affect lens safety.

Wound sealing-related complications of 25-gauge vitrectomy in proliferative diabetic retinopathy versus simple macular pathology.

PURPOSE: To compare the incidence of wound sealing-related complications of 25-gauge transconjunctival sutureless vitrectomy (25-G TSV) for proliferative diabetic retinopathy (PDR) versus non-diabetic simple macular pathology (SMP). METHODS: A retrospective comparative study was conducted on 377 eyes that underwent 25-G TSV for PDR (n=189 eyes) or non-diabetic SMP (n=188 eyes). Both groups were compared retrospectively and followed for at least 1 month (range 1-6 months). Main outcome measure was the incidence of postoperative wound sealing-related complications in both groups. RESULTS: We found a statistically significant lower incidence of wound sealing-related complications on the 1st postoperative day in the PDR than SMP group (P-value<0.05). The incidence were as follows: 9% vs 18% for hypotony, 0% vs 2% for choroidal detachment, 0% vs 2% for external leakage and 1% vs 8% for conjunctival bleb formation, for the PDR and SMP groups respectively. This was associated with a significantly higher postoperative inflammation and IOP in PDR group. The day 1 higher postoperative IOP and inflammation were correlated with the presence of PDR pathology. CONCLUSION: The higher postoperative inflammation and IOP following vitrectomy in diabetic eyes, especially when combined with endolaser photocoagulation, makes such eyes less susceptible to wound sealing-related complications following sutureless vitrectomy.