BackgroundThe purpose of this study was to determine the epidemiology of ocular lesions seen in the ophthalmic casualty room of the largest referral hospital in Egypt over 5 years from 2004 to 2008.MethodsThis epidemiologic database study used the medical records at Cairo University Hospital. Data were recorded using the ICD10 classification. Statistical analysis was based on diagnosis, age, gender, residential area, and year of admission.ResultsOver 5 years, 8361 ocular emergencies were admitted as inpatients. Open globe injuries were the most prevalent, comprising 33.46% of emergencies. Most cases were males (69%), in whom the most frequent lesions were open globe injuries, infective keratitis, and lid injuries. The most common ocular emergencies in females were open globe injuries, infective keratitis, endophthalmitis, and glaucoma. The age group 6–16 years accounted for 24% of emergencies, and patients over 45 years accounted for 26.8%. Under the age of 45 years, the most common lesions were open globe injuries (36%), and over this age, the most common lesions were infective keratitis (34.4%). Patients from Upper Egypt accounted for 56.2% of emergencies. A superficial corneal foreign body was the most common reason for attending the ophthalmic casualty room, with 24,844 cases seen over the 5 years of the study, all of which were managed as outpatient procedures. Deep corneal foreign bodies were more common than intraocular foreign bodies. The most common ocular hemorrhage was hyphema. The most common type of glaucoma was acute angle closure.ConclusionSuperficial corneal foreign bodies, open globe injuries, and infective keratitis are the main ocular emergencies seen in the Egyptian population. Corneal foreign bodies are mostly the result of occupational accidents in workers not wearing protective goggles. Violent altercations (41.9%), occupational accidents (26.3%), and motor vehicle accidents (24.4%) were the main circumstances involved in open globe injuries. The most common admissions were for open globe injuries under the age of 45 years and infective keratitis above this age. Upper Egypt was the main referring geographic area.

An ICR injection with subsequent MMC augmented trabeculectomy seems to be an effective combined technique in controlling IOP in eyes with NVG.

PurposeTo evaluate factors behind the delay in diagnosis and treatment among Egyptian patients who present with complicated diabetic retinopathy.MethodsObservational cross-sectional study of diabetic patients with advanced diabetic retinopathy. Patients were asked to answer a questionnaire to assess the impact of several sociodemographic factors.ResultsA total of 397 patients agreed to take the questionnaire. Diabetic vitreous hemorrhage was the most common ocular complication and was found in 359 patients (90.4%). A total of 158 (39.8%) patients knew that diabetes mellitus can be sight threatening, while 240 (60.2%) were not aware until they developed sight threatening complication. A total of 179 patients (45.1%) had early retirement because of visual loss related to diabetes mellitus. Multivariate logistic regression has shown that education, internist, contact with other patients, and media were respectively significant in predicting the awareness of patients about the sight-threatening effect of diabetic retinopathy.ConclusionPatient education regarding diabetes and diabetic eye disease is essential for early detection and compliance with treatment. Illiteracy has a significant impact on development of sight-threatening diabetic complications. The internist is the first line of prophylaxis. Media has to participate more in patient education.

Purpose: To compare the effect of phacoemulsification on corneal epithelial thickness in diabetic and nondiabetic cataract patients. Methods: Fifty eyes with cataracts were enrolled in a prospective comparative interventional study. They were divided into two groups: group A (diabetics) and group B (nondiabetics) and underwent uneventful phacoemulsification. Epithelial thickness was assessed in the central, paracentral, and peripheral cornea on the first day and at 1 week, 1 month, and 3 months postoperatively using spectral-domain ocular coherence tomography. Results: A significant increase in the first-day postoperative central epithelial thickness was noticed in both groups (57.16±3.5 µm and 55.96±2.81 µm in groups A and B, respectively), with increased baseline epithelial thickness of 3.8±2.1 µm and 3.4±2.14 µm in groups A and B, respectively (P<0.001). A significant decrease in epithelial thickness was noticed in both groups after 1 week (−2.40±3.1 µm and −2.76±2.71 µm in group A and B, respectively). No further significant change was noticed in the nondiabetic group at 1 month; however, significant reductions in for central epithelial thickness were found in the diabetic group up to the first month (−0.80±1.9 µm, P=0.05). Central corneal thickness followed the same pattern of change as the epithelium. A nonsignificant delay in visual acuity improvement was noticed in diabetic patients. Conclusion: Phacoemulsification induces a temporary increase in corneal and epithelial thickness that should resolve by the first week postoperatively. However, diabetic patients had slower epithelial recovery that took up to 1 month, which could be reflected in delayed visual recovery with no effect on the final visual outcome.

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Purpose: To evaluate the choroidal thickness (CT) in the macular area in patients with lupus nephritis and to compare the results with both non-nephritic patients and normal control. To assess the relation of CT to serum microRNA146, disease duration, activity index, and medications.Patients and Methods: Thirty-five SLE patients and thirty normal healthy controls were enrolled for this cross-sectional prospective study. All participants have undergone optical coherence tomography using RTVue OCT (Optovue Inc., Fremont, CA, USA). The scan used was the macular cross 6-mm line. We measured CT from the posterior edge of the retinal pigment epithelium (RPE) to the choroid-sclera junction at subfovea, and 750 µm both temporal and nasal to the fovea.Results: The mean central subfoveal CT in patients was 275.7 ± 41.0 µm (214-374 µm), and the mean central subfoveal CT in the control group was 364.5± 23.0 µm (323-411µm). There was a significant thinning at all three points in patients compared to the control group (p<0.001, Mann-Whitney U-test). In the patients group, subfoveal choroid in non-nephritic subgroup showed significant thinning compared to nephritic subgroup (p=0.032, Mann-Whitney U-test). Drusen-like deposits (DLDs) were detected in 22.9% (8/35) of patients and none in control (p=.023). MiRNA146 showed a significant positive correlation with nephritic lupus patients (r=0.036, P=0.04). Conclusion:The choroidal thickness was significantly thicker among the nephritic lupus patients as compared to the non-nephritic subgroup. Both SLE patients' subgroups are thinner than normal control. Subfoveal choroidal thickening can be considered a biomarker in nephritic lupus especially in conjunction with an increase in miRNA146a. All SLE patients are at risk of small Drusen-like deposits.

Purpose: Phacoemulsification surgery requires the use of both hands; however, some surgeons may not be comfortable using their non-dominant hand, especially in critical steps such as chopping. This work aims at assessing whether a virtual reality simulator can help cataract surgeons train their non-dominant hand using the capsulorhexis module. Methods: This was a prospective observational study including thirty ophthalmic surgeons; none of them had previous training on the EyeSi surgical simulator. Twenty-three were experienced, and seven were intermediate surgeons. Surgeons were asked to perform capsulorhexis three times using their dominant hand and then using their non-dominant hand. A performance score based on efficiency, target achievement, instrument handling, and tissue treatment was calculated by the simulator. Results: A significant improvement in the score of surgeons using their non-dominant hand from the first trial (69.57 ± 18.9) to the third trial (84.9 ± 9.2) ( P < 0.001) was found, whereas such improvement was not noted with the dominant hand ( P = 0.12). Twenty-six surgeons managed to reach 90% of the mean score achieved by dominant hand by using their non-dominant hand, 11 (36.7%) from the first trial, seven (23.3%) from the second, and eight (26.7%) from the third. Conclusion: Cataract surgeons showed significant improvement in the scores of their non-dominant hands with simulator training. Thus, it is possible to safely train non-dominant hands for difficult tasks away from the operating room, which would be a fruitful addition to residency training programs.