Purpose: To report on the underlying risk factors, clinical characteristics, presentation, and survival of coronavirus disease 2019 (COVID-19) associated mucormycosis (CAM) cases referred for ophthalmological consultation in two different Egyptian settings during the third viral pandemic wave (April to August of 2021). Methods: A multicentric, retrospective analysis involving one public and two private hospitals in metropolitan Cairo, and two university hospitals in upper Egypt (Aswan and Assuit). Cases that fulfilled the diagnostic criteria of mucormycosis, with a prior or concurrent COVID-19 infection, were included. Results: Of the 26 patients included in the final analysis, 15 (57.7%) were from Cairo and 11 (42.3%) were from upper Egypt. Twenty-five patients (96.2%) had poorly controlled diabetes mellitus and 20 (76.9%) had received corticosteroid treatment for COVID-19, of which 30.8% had mild or moderate disease. The median duration from COVID-19 till the onset of CAM was 20.5 days. No visual function could be detected in the affected eye of 16 patients (61.6%) on presentation. The mortality rate was 46.2% despite surgical debridement in half of the cases that died. Conclusion: CAM continues to be a concrete threat throughout Egypt, especially in patients with poorly controlled diabetes mellitus and those who inadvertently receive steroid therapy. It remains to be seen if increased vaccination coverage and early detection due to increased awareness would result in declining rates and adverse sequelae of CAM. A national registry would allow for better monitoring of the disease trends.

BackgroundTo describe objectively the possible structural changes of the macula and optic nerve head in the free eyes of unilateral cured retinoblastoma patients and, also after enucleation using spectral domain optical coherence tomography.MethodsA cross sectional study involving 60 patients subdivided into three groups; 15 unilateral RB patients in whom enucleation was indicated as a sole treatment performed earlier in life [(study group (I)], 15 unilateral RB patients who had completely regressed disease with a preserved eye [(study group (II)] and 30 age and sex matched healthy controls. The remaining and free eyes in study groups and right eyes of control group had full ophthalmological examination, static automated perimetry and optical coherence tomography of the macula and optic nerve head.ResultsIn study group (II); a significant thinning of total macula, central fovea, ganglion cell layer (GCL), ganglion cell complex (GCC), and some sectors of outer nuclear layer (P- values ≤0.05) was found with no significant difference in peripapillary nerve fiber layer (pRNFL) thickness and optic nerve head parameters compared to the control group and the study group (I). A significantly thickened total macula, GCL, GCC, and pRNFL in study group (I) compared to study group (II). Thickened pRNFL was significantly correlated to standard automated perimetry pattern deviations. No significant difference was found between study group (I) and control group.ConclusionRetinoblastoma eyes characterized by thinning of central fovea, GCL, GCC compared to the control group. After unilateral enucleation, increased GCC and pRNFL thicknesses were detected compared to retinoblastoma group.

Background Tear meniscus is one of the most important indices for therapeutic evaluation in treatment for obstruction of the lacrimal drainage system, which can be assessed by slit lamp examination and fluorescein dye disappearance test as a semi quantitative measurement. Recently Anterior Segment Optical Coherence Tomography has enabled noninvasive and quantitative assessment of tear meniscus. Objective To evaluate if measurement of tear meniscus by anterior segment OCT(AS-OCT) is a reliable method of assessment of improvement after Dacryocystorhinostomy (DCR) compared to other known methods which include dye disappearance test and lacrimal passages irrigation. Patients and Methods A prospective interventional study that included 16 eyes from 15 patients with primary acquired nasolacrimal duct obstruction who received external Dacryocystorhinostomy (ex-DCR) from March 2019 till November 2019, were evaluated prospectively on their tear meniscus height (TMH), tear meniscus area (TMA), and tear meniscus volume (TMV) changes by AS-OCT. Measurements were performed before surgery and 3 months after surgery. Results The results showed a highly significant decrease in all tear meniscus parameters (TMH, TMA, TMV) after DCR in patients with primary acquired nasolacrimal duct obstruction (PANDO), we concluded that AS-OCT can evaluate TM noninvasively and quantitatively, therefore it can be used as a reliable method of assessment of improvement after DCR compared to other known methods which include dye disappearance test and lacrimal passages irrigation. Conclusion Perioperative TM changes after ex-DCR can be evaluated noninvasively and quantitatively with use of AS-OCT, therefore it can be used as a reliable method of assessment of improvement after DCR, compared to other known methods which include dye disappearance test and lacrimal passages irrigation.

Background: Osteoporosis is a global age-related health problem in both male and female elderly, affecting the microstructure of bone. Although osteoporosis is normally associated with old age and estrogen deficiency, diabetes mellitus (DM), also contributes to and/or aggravates bone loss in osteoporotic patients Diabetes can affect bone through multiple pathways including obesity, changes in insulin levels, higher concentrations of advanced glycation end products in collagen, microangiopathy, inflammation and lower insulin-like growth factor-I (IGF1). Aim of the work: Studying the alterations in bone metabolism in diabetic patients and its relation to IGF1. Subjects and methods: The study included 83 participants, 53 of them were diabetics, and 30 participants were age and sex matched healthy subjects. Patients with hepatic or renal diseases, post-menopausal females,males older than 50 years, steroid medication intake,smoking, alcohol intake and other endocrinal disease causing osteoporosis were excluded. Blood samples were obtained from all subjects to measure calcium,phosphorus, parathyroid hormone, HBA1c and IGF1. DEXA scan were done to all subjects to evaluate bone quality. Results: IGF1 concentration did not show any significant difference between total diabetic patients and control but its concentration was lower in type 1 DM than type 2 but did not reach a significant value. Whole diabetic group showed significantly lower BMD when compared to controls. In addition , type 1 DM subgroup showed lower BMD than type 2 DM subgroup .Osteoporosis and/or osteopenia showed significantly higher incidence in whole diabetic group, type 1 DM subgroup when compared to controls and in type 1 DM subgroup when compared to type 2 DM subgroup,IGF1 was negatively correlated with HbA1C in type 1 DM. No other significant differences were found in laboratory data between different studied groups except for HbA1c which was significantly higher in whole diabetic groups in comparison to control group. Conclusion: Diabetes mellitus either type 1 or type 2 can lead to bone defects but in type 1 DM more damage to bone occurred than in type 2, IGF1 concentration is lower in type 1DM than in type 2 DM and is negatively correlated with HA1C in type 1 DM.

Study design; Pilot randomized controlled study. Objective To compare success rates of endoscopic endonasal dacryocystorhinostomy and nasolacrimal duct intubation in congenital nasolacrimal duct obstruction (NLDO) in a trial to define the superiority of either technique. Patients & Methods Sixty-six eyes of 61 patients were diagnosed as having epiphora and mucopurulent discharge due to congenital NLDO. The patients were randomly divided into two groups; Group A; 33 eyes of 28 patients (treated by probing and silicone intubation only (NLDI)) and Group B; 33 eyes of 33 patients (treated by endoscopic endonasal dacryocystorhinostomy and silicone tube intubation (EDCR). All tubes were removed 6 months after the operation. Results The success rate, defined as complete resolution of clinical symptoms and signs after 6 months of follow up, was 72.7 % in Group A and 81.8% in Group B. Although the success rate was higher in Group B, yet the difference was shown to be statistically nonsignificant. Preoperative symptoms were assessed postoperatively after tube removal. Complete cure had a higher rate of occurrence in Group B than in Group A (27eyes (81.8%) versus 25 eyes of 22 patients (75.8%) respectively). Postoperative positive fluorescein dye disappearance test (FDDT) after tube removal was more in Group B than in Group A (27 eyes (81.8) versus 24 eyes of 21 patients (72.7 %) respectively). In Group A, silicone tubes had to be repositioned due to prolapse in 3 eyes of 3 patients (9.1%) and had to be removed early in 3 eyes of 3 patients (9.1%) due to failure of repositioning. In Group B, silicone tubes did not require early tube extraction before the date of removal in any of the patients. Intraoperative, there was only one case (3.0%) of fat prolapse during EDCR in Group B with no subsequent postoperative complications. Hemostasis did not represent a problem in any of the patients. Postoperative complications occurred more in Group B than Group A (21 eyes (63.6%) versus 13 eyes of 13 patients (39.4 %) respectively). Late complications occurred more in Group B than Group A (18 eyes (54.5%) versus 12 eyes of 12 patients (36.4%) respectively) in the form of persistent epiphora and tube prolapse. Conclusion The success rate of pediatric EDCR was higher than that of pediatric NLDI. The difference was statistically non-significant. Complications were comparable between the two groups. The study, being pilot in its comparative aspect between endoscopy and intubation, opens the horizon for further study on a larger group that probably will expand this difference.