Background Superior rectus muscle transposition (SRT) is one of the proposed transposition techniques in the management of defective ocular abduction secondary to chronic sixth nerve palsy and esotropic Duane retraction syndrome (Eso-DRS). The aim of the current study is to report the outcomes of augmented SRT in treatment of Eso-DRS and chronic sixth nerve palsy. Methods a retrospective review of medical records of patients with Eso-DRS and complete chronic sixth nerve palsy who were treated by augmented full tendon SRT combined with medial rectus recession (MRc) when intraoperative forced duction test yielded a significant contracture. Effect on primary position esotropia (ET), abnormal head posture (AHP), limitation of ocular ductions as well as complications were reported and analyzed. Results a total of 21 patients were identified: 10 patients with 6th nerve palsy and 11 patients with Eso-DRS. In both groups, SRT was combined with ipsilateral MRc in 18 cases. ET, AHP and limited abduction were improved by means of 33.8PD, 26.5°, and 2.6 units in 6th nerve palsy group and by 31.1PD, 28.6°, and 2 units in Eso-DRS group respectively. Surgical success which was defined as within 10 PD of horizontal orthotropia and within 4 PD of vertical orthotropia was achieved in 15 cases (71.4%). Significant induced hypertropia of more than 4 PD was reported in 3 patients (30%) and in 2 patients (18%) in both groups, respectively. Conclusion augmented SRT with or without MRc is an effective tool for management of ET, AHP and limited abduction secondary to sixth nerve palsy and Eso-DRS. However, this form of augmented superior rectus muscle transposition could result in high rates of induced vertical deviation.

Objective: To assess the influence of the COVID-19 pandemic on the medication adherence and follow-up of glaucoma patients in the Nile Delta region. Setting: A tertiary care center in the Nile Delta region, Egypt. Study Design: An observational, cross-sectional study. Participants: Patients' records (2019-2020; group A) and (2020-2021; group B) were assessed for missed follow-up visits, medication adherence, number of trabeculectomies performed, and uncontrolled patients. In addition, a telephone-based questionnaire involving randomly chosen 200 patients from B.G.U. was carried out to clarify the potential causes of poor patients' compliance. Results: There was a marked decline in the number of newly diagnosed patients and patients on regular follow-up with incidence rates 0.208 and 0.088 in group (A) and group (B), respectively (P-value < 0.0001). The number of compliant patients in group B decreased with an incidence rate difference of 0.312. The number of trabeculectomies declined in group (B) with an incidence rate in group (A) 0.131 compared to 0.081 in group (B). On the other hand, the number of uncontrolled glaucoma patients increased in group B with an incidence rate difference −0.231 between the two groups. 21.5% of patients who participated in the questionnaire identified financial issues as the leading cause of non-compliance. Comorbidities (19.5%), lockdown and transportation difficulties were also highlighted. Conclusion: COVID-19 had greatly hampered glaucoma care in the Nile Delta region. As a result, we need to implement new technologies like telemedicine and improve patients' awareness of glaucoma care. Training orthoptists and using mobile glaucoma care services would also be helpful ways of managing glaucoma during that pandemic.

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Purpose: To present outcomes of surgical management of primary congenital glaucoma (PCG) in children less than one year of age in a population based at the Nile Delta. Methods: A retrospective review of medical records of patients with PCG less than one year of age at presentation who underwent surgical intervention in a tertiary care facility based at the Nile Delta. All patients underwent measurement of intraocular pressure (IOP), horizontal corneal diameter (HCD), cup-to-disc ratio (CDR) before and after surgery and a minimum of 6 months follow up was required. Surgical success was defined as IOP less than 22mmHg without medications and without progression of main disease parameters. Results: The review revealed 44 eyes of 26 consecutive patients who underwent surgical treatment for PCG. Average age at surgery was 5.2 months and mean follow up was 18.5 months. Preoperative IOP was 28.5±4 mmHg, HCD was 13.7±0.7mm, and CDR (when visible) was 0.65±0.18. A total of 69 surgical procedures were performed with an average of 1.56 procedures per eye. Postoperative IOP was 13.3±4.8 mmHg, HCD was 12.8±0.9mm, and CDR was 0.3±0.2 (P<0.0001). Surgical success was achieved in 32 eyes (72.7%) while sight-threatening postoperative complications were reported in 3 eyes. Conclusion: Surgical management of PCG younger than one year of age achieved good success rate in the region of the Nile Delta with low rate of visually significant postoperative complications. However, larger studies with longer follow up are needed to fully reveal the overall characteristics of PCG in the region.

Background: To determine characteristics and management of consecutive or recurrent strabismus secondary to stretched scar. Methods: This is a retrospective review of all patients diagnosed with late secondary consecutive or recurrent strabismus due to stretched scar from 2012 to 2017. The diagnosis of stretched scar was made in any case of late (≥ 1 month) consecutive or recurrent strabismus associated with underaction of the previously operated muscle. The diagnosis was confirmed intraoperatively by negative forced duction test and the characteristic appearance of the scar tissue. Surgical correction involved excision of the scar tissue with muscle re-attachment to the sclera using non-absorbable sutures. Study parameters include improvement in secondary deviations, degree of muscle underaction and diplopia. Results: 21 consecutive and 6 recurrent cases of stretched scar-induced strabismus were identified and all cases were associated with variable degrees of limited ocular duction. After surgical correction of the stretched scar, consecutive deviations in the form of consecutive esotropia and exotropia were corrected by means of 26.1PD and 65.6PD while recurrent deviations in the form recurrent exotropia and recurrent hypertropia were corrected by means of 34.3PD and 11PD respectively with significant improvement of limited ocular ductions. 21 patients had diplopia at presentation and all were improved after surgery. Conclusion: management of stretched scar-induced secondary strabismus by excision of the stretched scar and muscle fixation to the sclera using non-absorbable sutures significantly corrects secondary deviations and improves limitation of ocular duction.

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The objective of the current study was to evaluate and compare the effectiveness of cranberry extracts and bone marrow cells against chlorambucil (CHB) effect on rats' fertility. Forty adult male albino rats were divided randomly into eight equal groups as the following; normal control, rats injected orally with 0.2 mg/kg of CHB for 14 days, rats injected orally with 100 mg/kg of cranberry extract (CB) for ten days, rats intravenously injected with bone marrow cells (BMC) through tail vain, rats protected with both CB and BMC, rats treated with CHB+CB, rats treated with CHB+BMC and rats treated with CHB+BMC+CB. Genotoxicity were evaluated by counting and comparing the value of sperm abnormalities and normal sperm count. Results show that rats injected with CHB had remarkable increase in sperm head abnormalities as without hook, banana shape and hummer shape. Admission of cranberry extract and bone marrow cells after chemotherapy improved the frequency of the sperm abnormalities.

Bone marrow [BM] have self-renovationcapacity and have been used recently in tumor medicine.Chlorambucil[CHB] is ordinarily utilized chemotherapy to treat varietiesof malignancy patients. This investigation intended to gauge the effectiveness of BM as an invivoantimutagenicagainst CHB.The experimental design relies upon four classes, each class contains ten adult male albino rats as follows: control, rats infused orally with CHB for fourteen days, rats intravenously infused with BM through a tail vein one time, rats infused the mix of CHB and BM. The Anticancer capability of BM was assessed by cytogenetic assay and mitotic index. The declarations of the apoptosis-related genes were examined by RT-qPCR examination. The present study demonstrated a curative effect of BM against thecytotoxic impact of CHB. Infusion of BM after chemotherapy help to diminish the chromosomal aberration, increment mitotic index and decline the Bax/Bcl2 proportion compared with[CHB] class gather that prompts expanding the survival rate of influenced cells with chemotherapy cytotoxicity.