Effect of subconjunctival bevacizumab injection before primary pterygium excision: a clinical and immunohistochemical study Abd Elmagid M Tag Eldin, Mona M Aly, Marwa A El Kholy Delta Journal of Ophthalmology 2019 20(3):95-99 Purpose The aim of this study was to evaluate the effect of preoperative subconjunctival bevacizumab injection on the clinical and immunohistochemical analysis of primary pterygium. Patients and methods A total of 10 eyes of 10 patients with primary pterygium received a subconjunctival injection of bevacizumab (2.5 mg/0.1 ml) 1 week before simple pterygium excision with bare sclera technique. The control group (10 eyes of 10 patients with primary pterygium) had simple excision of primary pterygium with bare sclera without prior injection. Follow-up was performed on the first week, 2 weeks, 1 month, and 3 months postoperatively to evaluate the surgical site vascularization and occurrence of any complications and to record the rate of recurrence. Immunohistochemical analysis was performed on the excised tissue to detect vascular endothelial growth factor (VEGF) in both groups. Results There was a marked decrease in pterygium vascularity after intralesional injection of bevacizumab. The injection group showed no recurrence after excision of pterygium during the scheduled follow-up period without any recorded complications regarding the use of bevacizumab, whereas the control group showed recurrence of pterygium in three eyes. The immunohistochemical analysis showed lower VEGF in the injected group than in the control group. Conclusion Preoperative injection of bevacizumab effectively reduced vascularity and VEGF concentration of pterygium tissue. A subconjunctival preoperative single dose of bevacizumab was not associated with any adverse effects and was well tolerated. It had a minimizing effect on the extent of vascularization of the pterygium. No recurrence of pterygium was noted in any of the injected patients.

Evaluation of corneal flap symmetry in the optical center by anterior segment optical coherence tomography: mechanical versus femtolaser flaps Abdel Rahman E Sarhan, Mohamed S Abd Elaziz, Marwa A Zaki, Asmaa M Ibrahim, Nehal G Youssef Delta Journal of Ophthalmology 2019 20(3):100-106 Objective The aim of this study was to evaluate corneal flap symmetry in the central 3 mm for subjects undergoing either laser in-situ keratomileusis or femtolaser in-situ keratomileusis for correction of myopia and/or astigmatism. Patients and methods This prospective study enrolled 160 eyes of 80 patients with mild to moderate myopia (<–6.00 D) as well as astigmatism less than −3.00 D. The corneal flaps of 80 eyes were created with the VisuMax femtosecond laser for intended thickness of 100 μm, and the other 80 eyes flaps were created by Moria M2 microkeratome (90 μm head) with intended thickness of 90 μm. The flap thickness was measured with a noncontact spectral-domain anterior segment optical coherence tomography system at three months postoperatively. The flap thicknesses were measured at five points (center and ±1.5 mm from the center) on each of the vertical and horizontal meridian (90° and 180°). Results The mean central thickness of the VisuMax and Moria M2 flaps was 102.06±5.37 and 130.25±12.61 μm, respectively (P<0.0001). In terms of mean flap thickness at each eccentricity, there were significant differences between the two groups, along the four measured eccentricities (P<0.0001). Conclusion The mean flap thickness measurements at each point showed more accurate outcomes in the femtolaser group. Moreover, slight vertical as well as horizontal asymmetry was found in the Moria group, although statistically insignificant.

Corneal densitometry and topography after femtosecond laser-assisted laser in-situ keratomileusis compared with small-incision lenticule extraction Enas Ahmed Hanafy Bakr, Mohamed Ragab, Hazem Elhennawy, Ihab osman Delta Journal of Ophthalmology 2019 20(3):107-111 Purpose The aim of this study was to compare between femtosecond laser-assisted laser in-situ keratomileusis (FS-LASIK) and small-incision lenticule extraction (SMILE) regarding corneal densitometry (CD) and corneal topography. Setting The study was conducted at Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt. Patients and methods The study included 60 eyes of 30 patients divided into two equal groups: 30 eyes were treated using FS-LASIK and 30 eyes were treated using SMILE surgery for myopia and myopic astigmatism to evaluate CD and topography before and after 1 week and 2 months postoperatively using Pentacam HR. Results There was an insignificant difference between the two groups in CD preoperatively (P=0.154), 1 week postoperatively (P=0.180), and 2 months postoperatively (P=0.138). In FS-LASIK group, there was a significant flattening in keratometric values (K1 and K2) of anterior corneal surface as the mean of K1 was 36.33±1.45 and 36.24±1.43 D and the mean of K2 was 37.09±1.55 and 37.00±1.52 D in comparison between 1-week postoperative and 2-month postoperative follow-up visits, respectively. There was an insignificant difference between the two groups in K1 and K2 of the posterior surface preoperatively, 1 week postoperatively, and 2 months postoperatively. Conclusion There was an insignificant difference between the two groups in CD. In the anterior surface, FS-LASIK exhibited more flattening in K1 and K2 than SMILE. Regarding the posterior surface, there was an insignificant difference between FS-LASIK and SMILE.

Correlation of graft–host interface to refractive outcomes after penetrating keratoplasty using anterior segment optical coherence tomography Hoda M Elsobky, Mohamed S Abd Elaziz, Ibraheem G El Hamadan Delta Journal of Ophthalmology 2019 20(3):112-120 Objective The aim of this study was to evaluate the correlation between the graft–host interface and the refractive outcomes after penetrating keratoplasty (PKP) using anterior segment optical coherence tomography. Patients and methods A total of 40 eyes of 38 patients with different corneal pathologies (bullous keratopathy, seven eyes; corneal scar, 20 eyes; and keratoconus, 13 eyes) who underwent PKP were retrospectively reviewed. The wound profiles of the graft–host junctions were classified into well-apposed junction and malapposed one including gap, step, and protrusion with the aid of spectral domain anterior segment optical coherence tomography. The correlations between clinical outcomes and post-PKP wound characteristics were analyzed. Results A total of 320 graft–host junctions from 40 eyes were examined, of which, 130 (40.6%) sections showed a well-apposed junction and 190 (59.4%) sections represented a malapposed junction. The most recorded type of malapposition was protrusion (97 sections=30.3%). When referring to the underlying diseases, well-opposed junctions were most frequently met in bullous keratopathy (66.1%). The alignment pattern showed highly significant differences between the preoperative original disease groups (P=0.001). Spherical equivalent and corrected distant visual acuity showed highly significant differences between the alignment groups, with highest myopic shift in the gap malapposition. Graft–host thickness disparities showed no significant correlations with spherical equivalent (r=−0.184, P= 0.256). Conclusion The alignment pattern of graft–host junctions after PKP varied according to the preoperative original disease and was significantly associated with spherical equivalent and visual acuity.

Cardiovascular and respiratory considerations with topical beta-blockers: is it really old news? Mahmoud Nassar, Mohamed Ali, Nicholas Bennett Delta Journal of Ophthalmology 2019 20(3):121-124 Objective The aim of this study was to identify the prevalence of prescribing topical beta-blockers (TBB) despite documented contraindications in general practice and whether patients were involved in decisions about treatment. Design This was a primary-care-based cross-sectional descriptive study. Introduction Glaucoma is one of the commonest causes of irreversible blindness in the United Kingdom, causing ∼5.9% of blind registration. TBB are currently considered the best adjunctive treatment and are well known for their systemic effects. The effect of concurrent prescription of TBB with systemic contraindications was found to significantly increase the rate of hospitalization and emergency room visits. Patients and methods Electronic medical records of four primary care providers in the North East of England were searched for primary open-angle glaucoma, use of TBB, and known systemic contraindications. Included records were further searched for correspondence from ophthalmology departments to primary care. We contacted those patients whose records showed no documentation of communicating potential risks with patients and rationale of using TBB. Results Of the 49 816 patients registered with the four primary health care providers, 798 (1.6%) had primary open-angle glaucoma. Of these, 279 (35%) were prescribed TBB; 260 (93.2%) of whom had no systemic contraindications. Conclusion Nineteen (6.8%) patients with systemic contraindications were prescribed TBB despite alerts from electronic medical records. Furthermore, these patients were not made aware of the potential risk.

Macular thickness assessment in patients with primary open-angle glaucoma and its correlation with central visual field Madeha A Kamel, Al Zahraa S Mohammed, Maha A Mohammed Delta Journal of Ophthalmology 2019 20(3):125-131 Background Glaucoma is a multifactorial chronic optic neuropathy characterized by typical optic nerve morphological changes and alterations of the visual field (VF). Delayed detection and treatment of glaucoma might result in irreversible blindness. Structural damage precedes the functional damage. Objective The objective of this study was to correlate between macular thickness (MT) affection and central VF changes in patients with primary open-angle glaucoma (POAG). Patients and methods This is a prospective cross-sectional observational study that included 51 eyes diagnosed with POAG. They were evaluated by spectral domain optical coherence tomography, which was compared with several VF parameters, including mean deviation and loss variance. Results A significant correlation was found between VF parameters and decrease in MT (mean deviation: r=−0.506; P=0.000, loss variance: r=−0.492; P=0.000). There was also a significant correlation between thinning of the superior temporal and inferior temporal retinal nerve fiber layer and the decrease of the superior and inferior MT, correspondingly (P<0.001). Conclusion Measurements of the retinal thickness in the macula may be an additional tool for early detection of structural changes and its correlation with functional defects. Measuring the MT by spectral domain optical coherence tomography and using VF 10-2 degrees should be a standard technique in evaluation and follow-up of patients with primary open-angle glaucoma, although the VF is a time-consuming technique.

Comparative study between patients with subclinical diabetic retinopathy and healthy individuals in the retinal microvascular changes using optical coherence tomography angiography Abd El-Magid M Tag El-Din Delta Journal of Ophthalmology 2019 20(3):132-137 Purpose The aim of this study was to compare between patients with subclinical diabetic retinopathy (DR) and healthy individuals in the retinal microvascular changes including vascular density (VD), perfusion density (PD), and foveal avascular zone (FAZ) parameters by using optical coherence tomography angiography (OCTA). Patient and methods A total of 50 individuals were categorized into two groups: group A (healthy individuals) and group B (diabetic patients). Full ophthalmic examination, best-corrected visual acuity, intraocular pressure measurement, fundus fluorescein angiography, optical coherence tomography, and OCTA were done for all patients. Results Statistically significant differences were found between the healthy group and the diabetic group in OCTA parameters. VD and PD were significantly decreased in the diabetic patients (P>0.001). FAZ showed significant changes in area value and perimeter; however, the circularity changes were statistically insignificant. Conclusion OCTA is an effective tool that can provide a noninvasive method in the differentiation between subclinical DR and normal individuals. The FAZ metrics, VD, and PD in patients with subclinical DR showed a significant deviation from the parameters obtained from normal healthy individuals.