Aswan University Hospital Research Articles

Epidemiology of acute kidney injury in Intensive Care Units in Aswan University Hospital

Background: Acute kidney injury (AKI) is a frequent complication in patients admitted to the intensive care unit (ICU) and is associated with adverse outcomes including increased length of ICU and hospital stay, development of chronic kidney disease (CKD) and increased short- and long-term mortality risk. Objective: To screen critically ill patient admitted to ICU in Aswan University Hospital for acute kidney injury from September 2017 up to September 2018. Patients and methods: In this study 538 patients were admitted to the ICU in Aswan University Hospital in Egypt, from August 1st, 2017 to August 1st 2018. This study was a prospective, randomized; hospital based clinical study on critically ill patients in Intensive Care Unit. With inclusion criteria patients who were 18 years or older and admitted to the Intensive Care Unit (ICU). Results: Out of 583 patients admitted to ICU, there were 97 patients had AKI, 64.9% of them already had AKI on the admission while the rest of them (35.1%) developed AKI after admission. There is more than one third of mortality among ICU patients related to AKI (35.1%), while (64.9%) were related to other causes. Conclusion: AKI is associated with high mortality in our ICU setting. Further studies are needed to estimate the burden of AKI among patients before ICU admission

Epidemiology of acute kidney injury in Intensive Care Units in Aswan University Hospital

Background: Acute kidney injury (AKI) is a frequent complication in patients admitted to the intensive care unit (ICU) and is associated with adverse outcomes including increased length of ICU and hospital stay, development of chronic kidney disease (CKD) and increased short- and long-term mortality risk. Objective: To screen critically ill patient admitted to ICU in Aswan University Hospital for acute kidney injury from September 2017 up to September 2018. Patients and methods: In this study 538 patients were admitted to the ICU in Aswan University Hospital in Egypt, from August 1st, 2017 to August 1st 2018. This study was a prospective, randomized; hospital based clinical study on critically ill patients in Intensive Care Unit. With inclusion criteria patients who were 18 years or older and admitted to the Intensive Care Unit (ICU). Results: Out of 583 patients admitted to ICU, there were 97 patients had AKI, 64.9% of them already had AKI on the admission while the rest of them (35.1%) developed AKI after admission. There is more than one third of mortality among ICU patients related to AKI (35.1%), while (64.9%) were related to other causes. Conclusion: AKI is associated with high mortality in our ICU setting. Further studies are needed to estimate the burden of AKI among patients before ICU admission

Pedicled Versus Microvascular Free Flaps Used for Reconstruction of Oral Cavity Defects Following Cancer Ablative Surgery: A Prospective Comparative Study

Background: Oral cancer is currently a major global health issue. In developing countries, oral cavity cancer is estimated to be the third most common malignancy after cancer of the cervix and stomach. Surgical excision plays a major role in the treatment of oral cavity cancer patients. Objective: The aim of the study was to compare between pedicled and free flaps used for oral cavity reconstruction after ablation of squamous cell carcinoma. Patients and methods: This is a prospective comparative study that included 41 patients at National Cancer Institute (NCI) of Cairo University and Aswan University Hospital in the period from 2015 to 2018. Patients were selected from those who were attending the Outpatient Clinic of Head and Neck Surgery Unit at NCI, Cairo University and Aswan University Hospital. Results: Detection of short-term functional outcome regarding the swallowing, speech and oral competence, Contralateral Submental Island Flap (CSMIF) followed by Radial Forearm Free Flap (RFFF) showed better functional results than other flaps. The cosmetic outcome was better in 50% of CSMIF & RFFF cases. The Thoracodorsal Artery Perforator Flap (TDAPF) cases showed a slightly higher care costs than other cases although in other specialized centers the care costs were found to be higher in RFFF cases than others. Conclusion: Oncologic outcomes were better with CSMIF and cosmetic outcomes were better in CSMIF and RFFF cases. Relatively, TDAP flap cases were higher than others in the overall care costs.

Predictors of Complications After Flap Reconstruction of Oral Cavity Defects Following Ablation of Squamous Cell Carcinoma

Background: Head and neck cancers represent the sixth most common cancer worldwide with an incidence of over 600,000 new cases per year. More than 90% of head and neck cancers are squamous cell carcinomas (SCC) that arise from the mucosal surfaces of the oral cavity, oropharynx and larynx. Objective: The aim of the current work was to investigate the predictors of complications after flap reconstruction of oral cavity defects following ablation of squamous cell carcinoma. Patients and methods: This prospective comparative study included a total of 41 patients who diagnosed to have oral SCCs, attending at the outpatient clinic of Head and Neck Surgery Unit, National Cancer Institute (NCI), Cairo University and Aswan University Hospital. Written informed consent of all the subjects was obtained after explaining the benefits and hazards for each method step. This study was conducted between 2015 to 2018. Approval of the ethical committee was obtained. Results: Patients with positive history of neoadjuvant chemoradiotherapy (CRTH) are 52% less likely to developing complications than those with negative history of neoadjuvant CRTH. Detection of the short-term oncologic outcome; in the 4 flaps was better in contralateral submental island flap (CSMIF) cases than others. CSMIF were found to be 58% less liable for recurrence in comparison with pectoralis major myocutaneous flap (PMMCF) that was why it didn't show any clinical or radiologically detectable recurrence within the period of 24 months postoperatively. Thoracodorsal artery perforator (TDAP) flaps were 2.6 times more liable for recurrence in comparison with PMMCF. RFFF flaps were found to be 1.2 times more liable for recurrence in comparison with PMMCF. Conclusion: The chosen 4 flaps for this study are applicable to be used for post ablative oral cavity reconstruction. Our flaps were equal in suitability for defect coverage (50-60%).

Comparative Study between General Anesthesia versus General Anesthesia Combined with Thoracic Epidural Analgesia on Cytokine Response in Laparoscopic Cholecystectomy Patients

Background and Objectives: The main benefits of laparoscopic surgery in comparison to open surgery involve the rapid discharge from recovery room, decreased postoperative hospital stays, reduced postoperative discomfort, easier getting back to work and faster return to ordinary daily life as well as cosmetic surgical wounds. The anesthesia type has an essential role in attenuation of the surgical stress and achievement of these advantages. We aimed to determine the outcome of giving general anesthesia in conjunction with thoracic epidural analgesia (TEA) compared to general anesthesia alone on stress response to surgery and anesthesia by investigating cytokine reaction (interleukin 6 and 8 levels), hemodynamic changes (BP, HR, RR, SPO2), and Visual Analogue Scale (VAS) scores postoperatively in patients subjected for laparoscopic cholecystectomy. Methods: This study included 40 patients aged 20 - 60 years old with American Society of Anesthesiologists physical status (ASA) I and II. They were planned for laparoscopic cholecystectomy at Aswan University Hospital from April 2017 to March 2018. They were randomly allocated into two groups. Group A (n. 20) received general anesthesia only and Group B (n. 20) received general anesthesia in conjunction with thoracic epidural analgesia using fentanyl and bupivacaine in the epidural catheter. Chi-square was applied to differentiate categorical variables, whereas comparison between continuous variables was done by using t-test. Two-tailed p ficant. Results: As regards IL-6 and IL-8 post-operative there is significant difference (p nd and 4th hr and 24th hr postoperative, with significantly increased postoperative levels of IL-6 and IL-8 in comparison to their preoperative baseline values. The largest increase in IL6 & IL8 levels was in group A (GA group). VAS score showed significant lower values in TEA group in comparison to GA group. No significant difference between groups as regard intraoperative and postoperative hemodynamic changes. Conclusion: Regional techniques including TEA attenuate and decrease cytokine reaction secondary to surgery which decreases inflammatory process and improves patient outcome and reduces pain score postoperatively.

Pregnancy Outcomes in Cases of Preterm Prelabor Rupture of Membranes at Aswan University Hospital

Pregnancy Outcomes in Cases of Preterm Prelabor Rupture of Membranes at Aswan University Hospital

Oncological Outcome and Patient Satisfaction in Skin-Sparing Mastectomy and Immediate Breast Reconstruction

Background: Breast cancer represents 10% of all cancers diagnosed worldwide annually and constitute 22% of all new cancers in women. The burden of breast cancer has increased steadily, almost doubling, in terms of estimated new cases annually over a 20-year span. Objective: This study was aimed to evaluate the outcome on oncological standard and patient satisfaction on the aesthetic side with skin-sparing mastectomy and immediate breast reconstruction for patients with early breast cancer. Patients and methods: this study included 80 female patients with breast cancer, 60 cases were operated upon at National Cancer Institute (NCI), Cairo University, 20 cases were operated upon at Oncosurgery Unit, Aswan University Hospitals, between 2015 and 2019. Results: In the current study, all patients were closely followed up to detect any signs of local recurrence (LR). The duration of postoperative follow up ranged from 24 to 48 months with a mean of 31.55 months. Only 1 patient (1.2 %) showed signs of local recurrence after 1 year of surgery. This condition was not associated with any sign of regional or systemic recurrence. This low incidence of local recurrence may be attributed to the early stage of the disease at the time of surgical intervention, the mastectomy procedure itself and the justified administration of neoadjuvant and adjuvant therapy to the studied patients. However, a relatively short period of follow up might be a drawback of obtaining a solid conclusion. Conclusions: It could be concluded that skin sparing mastectomy and Immediate breast reconstruction is a technically feasible and oncologically safe procedure. Accepted cosmetic result was attained in most of patients.

Effect of hemodialysis on Intraocular Pressure

Background: Hemodialysis (HD) is an important and by far the commonest treatment for end stage renal failure (ESRF). Changes in intraocular pressure (IOP) are one of the eye problems among hemodialysis patients. Objective: To evaluate changes in intraocular pressure (IOP) before, during and after single dialysis session. To detect changes in retinal fiber thickness measured by Optical Coherence Tomography (OCT) 6 months after basic examination. Patients and methods: This prospective study was carried out on 80 eyes of 80 patients undergoing regular hemodialysis (HD), both males and females. The study was conducted in Aswan University Hospital. Results: There was statically significant (but clinically not significant) decrease in IOP during HD, but there was no significant decrease when measured six month later. No significant difference in the mean IOP as regarding group’s age, sex and duration of dialysis was found. Significant decrease in mean average RNFL thickness during the six months was noted as well as between age groups. There was no significance decrease in retinal nerve fiber layer (RNFL) thickness regarding sex and duration. Conclusion: As there was loss of RNFL thickness in hemodialysis patients, visual field changes is recommended to be investigated on such patients. Also the effect of hemodialysis on patients with high IOP or glaucoma should be investigated as well.

Predictors of Complications After Flap Reconstruction of Oral Cavity Defects Following Ablation of Squamous Cell Carcinoma

Background: Head and neck cancers represent the sixth most common cancer worldwide with an incidence of over 600,000 new cases per year. More than 90% of head and neck cancers are squamous cell carcinomas (SCC) that arise from the mucosal surfaces of the oral cavity, oropharynx and larynx. Objective: The aim of the current work was to investigate the predictors of complications after flap reconstruction of oral cavity defects following ablation of squamous cell carcinoma. Patients and methods: This prospective comparative study included a total of 41 patients who diagnosed to have oral SCCs, attending at the outpatient clinic of Head and Neck Surgery Unit, National Cancer Institute (NCI), Cairo University and Aswan University Hospital. Written informed consent of all the subjects was obtained after explaining the benefits and hazards for each method step. This study was conducted between 2015 to 2018. Approval of the ethical committee was obtained. Results: Patients with positive history of neoadjuvant chemoradiotherapy (CRTH) are 52% less likely to developing complications than those with negative history of neoadjuvant CRTH. Detection of the short-term oncologic outcome; in the 4 flaps was better in contralateral submental island flap (CSMIF) cases than others. CSMIF were found to be 58% less liable for recurrence in comparison with pectoralis major myocutaneous flap (PMMCF) that was why it didn't show any clinical or radiologically detectable recurrence within the period of 24 months postoperatively. Thoracodorsal artery perforator (TDAP) flaps were 2.6 times more liable for recurrence in comparison with PMMCF. RFFF flaps were found to be 1.2 times more liable for recurrence in comparison with PMMCF. Conclusion: The chosen 4 flaps for this study are applicable to be used for post ablative oral cavity reconstruction. Our flaps were equal in suitability for defect coverage (50-60%).

Effect of hemodialysis on Intraocular Pressure

Background: Hemodialysis (HD) is an important and by far the commonest treatment for end stage renal failure (ESRF). Changes in intraocular pressure (IOP) are one of the eye problems among hemodialysis patients. Objective: To evaluate changes in intraocular pressure (IOP) before, during and after single dialysis session. To detect changes in retinal fiber thickness measured by Optical Coherence Tomography (OCT) 6 months after basic examination. Patients and methods: This prospective study was carried out on 80 eyes of 80 patients undergoing regular hemodialysis (HD), both males and females. The study was conducted in Aswan University Hospital. Results: There was statically significant (but clinically not significant) decrease in IOP during HD, but there was no significant decrease when measured six month later. No significant difference in the mean IOP as regarding group’s age, sex and duration of dialysis was found. Significant decrease in mean average RNFL thickness during the six months was noted as well as between age groups. There was no significance decrease in retinal nerve fiber layer (RNFL) thickness regarding sex and duration. Conclusion: As there was loss of RNFL thickness in hemodialysis patients, visual field changes is recommended to be investigated on such patients. Also the effect of hemodialysis on patients with high IOP or glaucoma should be investigated as well.

Oncological Outcome and Patient Satisfaction in Skin-Sparing Mastectomy and Immediate Breast Reconstruction

Background: Breast cancer represents 10% of all cancers diagnosed worldwide annually and constitute 22% of all new cancers in women. The burden of breast cancer has increased steadily, almost doubling, in terms of estimated new cases annually over a 20-year span. Objective: This study was aimed to evaluate the outcome on oncological standard and patient satisfaction on the aesthetic side with skin-sparing mastectomy and immediate breast reconstruction for patients with early breast cancer. Patients and methods: this study included 80 female patients with breast cancer, 60 cases were operated upon at National Cancer Institute (NCI), Cairo University, 20 cases were operated upon at Oncosurgery Unit, Aswan University Hospitals, between 2015 and 2019. Results: In the current study, all patients were closely followed up to detect any signs of local recurrence (LR). The duration of postoperative follow up ranged from 24 to 48 months with a mean of 31.55 months. Only 1 patient (1.2 %) showed signs of local recurrence after 1 year of surgery. This condition was not associated with any sign of regional or systemic recurrence. This low incidence of local recurrence may be attributed to the early stage of the disease at the time of surgical intervention, the mastectomy procedure itself and the justified administration of neoadjuvant and adjuvant therapy to the studied patients. However, a relatively short period of follow up might be a drawback of obtaining a solid conclusion. Conclusions: It could be concluded that skin sparing mastectomy and Immediate breast reconstruction is a technically feasible and oncologically safe procedure. Accepted cosmetic result was attained in most of patients.

Can Hyponatremia Play a Role in Morbidity and Mortality in Chronic Hepatic Patients in ICU at Aswan University

Background: Hyponatremia is a frequent complication of advanced chronic liver diseases related to an impairment in the renal capacity to eliminate solute-free water that causes a retention of water that is disproportionate to the retention of sodium, thus causing a reduction in serum sodium concentration and hypoosmolality. Objective: The aim of this study is to evaluate the role of hyponatremia on morbidity and mortality in chronic liver diseased patient in ICU unit at Aswan University Hospital. Matients and methods: This study included 90 patients who were suffering of hyponatremia with chronic liver disease and selected from patients in Aswan University Hospital. The patients were 61 males (67.78%) and 29 females (32.22%). Results: About (40%) of patients were discharged and (60%) of patients died. First group: patients with mild hyponatremia about (67.71%) were discharged and about (35.29%) died. Second group: patients with moderate hyponatremia about (65.7%) were discharged and about (34.21%) died. Third group: all patients with severe hyponatremia (100 %) died. Conclusion: hyponatremia play important role in mortality rate of patients with chronic liver disease.

Carbetocin Versus Misoprostol in Prevention of Postpartum Hemorrhage in High Risk Patients

Background: Postpartum hemorrhage (PPH) is a significant problem and a major cause of maternal mortality and morbidity, resulting in up to 28% of maternal deaths. It is a potentially life-threatening complication of both vaginal and cesarean delivery, the prevalence of PPH is approximately 6% of all deliveries. Objective: The aim of this study is to compare the effectiveness and safety of carbetocin and misoprostol for the prevention of atonic postpartum hemorrhage in high risk patients. Patients and Methods: this study is a prospective clinical study which was conducted at the Department of Obstetrics and Gynecology, Aswan University Hospital, in the period from September 2017 till September 2018. One hundred cases were involved in the study and divided into 2 equal groups. The study was approved by the medical ethics committee of Aswan University Hospital and a written informed consent is obtained from all patients. Results: Significant difference was found between the two studied groups as regard mean volume of blood loss. Carbetocin group showed the lowest volume of blood loss. As regard uterine tone after treatment, carbetocin group showed the highest tone compared to misoprostol groups. Significant difference was found between the two groups as regard need for additional uterotonics. The results demonstrated an increased use of additional oxytocics in the misoprostol group (32% of cases) VS (12% of cases) in carbetocin group. Conclusion: According to the results of this study, it's concluded that carbetocin is more effective in controlling the amount of blood loss during delivery and eventually help in the prevention of postpartum hemorrhage in high risk patients.

Surgical Intervention in Adhesive Intestinal Obstruction

Background: Adhesive small bowel obstruction (ASBO) is a common cause for admission to surgical wards in developed countries, particularly following colorectal and pelvic surgery. Despite advances in diagnosis and treatment, the operative intervention rate is between 15 and 30%, the recurrence rate is up to 30% following surgery and the mortality is between 2 and 8%. Objective: The aim of current study was to report the time of surgical intervention of patient with adhesive intestinal obstruction. Patients and Methods: This study included a total of 50 patients with clinical diagnosis of adhesive SBO, attending at Surgical Department, Aswan University Hospital. This study was conducted between January 2018 to December 2018. After clinical and radiological diagnosis of adhesive SBO, all patients were promptly hydrated with Ringer lactate solution and their electrolytes and acid base imbalances were corrected. Results: Successful conservative treatment was noted in 28 patients (66%) with discontinuation of nasogastric decompression within an average period of 2 days followed by discharge on fourth day of admission. 22 Patients (44%) underwent surgery, safe conservative management needed the pre- requisite of having ruled out any possibility if strangulation of the bowel as the first step of management. As for hospital stay patients who underwent conservative therapy have less durations of hospital stay (3-6 days) than those who underwent surgical intervention (7-14 days). Conclusion: ABO remains a common clinical problem. Patients presenting with symptoms and signs consistent with ASBO should undergo plain abdominal X-ray. If this confirms the diagnosis, and there is no clinical suspicion of strangulation, a water soluble contrast agent should be administered by Nasogastric tube.

Carbetocin Versus Misoprostol in Prevention of Postpartum Hemorrhage in High Risk Patients

Background: Postpartum hemorrhage (PPH) is a significant problem and a major cause of maternal mortality and morbidity, resulting in up to 28% of maternal deaths. It is a potentially life-threatening complication of both vaginal and cesarean delivery, the prevalence of PPH is approximately 6% of all deliveries. Objective: The aim of this study is to compare the effectiveness and safety of carbetocin and misoprostol for the prevention of atonic postpartum hemorrhage in high risk patients. Patients and Methods: this study is a prospective clinical study which was conducted at the Department of Obstetrics and Gynecology, Aswan University Hospital, in the period from September 2017 till September 2018. One hundred cases were involved in the study and divided into 2 equal groups. The study was approved by the medical ethics committee of Aswan University Hospital and a written informed consent is obtained from all patients. Results: Significant difference was found between the two studied groups as regard mean volume of blood loss. Carbetocin group showed the lowest volume of blood loss. As regard uterine tone after treatment, carbetocin group showed the highest tone compared to misoprostol groups. Significant difference was found between the two groups as regard need for additional uterotonics. The results demonstrated an increased use of additional oxytocics in the misoprostol group (32% of cases) VS (12% of cases) in carbetocin group. Conclusion: According to the results of this study, it's concluded that carbetocin is more effective in controlling the amount of blood loss during delivery and eventually help in the prevention of postpartum hemorrhage in high risk patients.

The Prevalence of Thyroid Cancer in Patients with Multinodular Goiter

Background: Thyroid cancer is the most common endocrine carcinoma, as it accounts for almost 90% of all endocrine malignancies. The incidence of thyroid carcinoma is about 1-3 cases in every 100,000 population. During the last 30 years, the rate of thyroid cancer incidence has increased worldwide. Objective: The aim of this work was to determine the frequency of thyroid carcinoma in multinodular goiter in patients undergoing thyroidectomy to make a strategy to perform total thyroidectomy (TT) as a rule of treatment. Patients and methods: This retrospective study included the medical charts and surgical data of a total of 50 patients who underwent surgery for goiter at General Surgery Department, Aswan University Hospital between 2015 and 2018. Results: The present study showed that the frequency of papillary carcinoma was 6% of all thyroid diseases (from 50 patients), 60% of incidental thyroid carcinoma as the frequency was high in the 4th decade of life. The present study showed that the frequency of follicular carcinoma was 2% of all thyroid diseases (one case), 20% of ITC. Patient was in the 4th decade. The present study showed that the frequency of undifferentiated thyroid cancer was 2% of all thyroid diseases. Conclusion: It could be concluded that, according to the finding of this study, total thyroidectomy is the preferred method in benign thyroid disease for which surgery is indicated. The advantages of TT include reduction of recurrence rate, achieves a permanent cure of thyroid disorders.

Intravitreal Ranibizumab Monotherapy or Combined with Laser for Diabetic Macular Edema (OCT guided study)

Background: Diabetic retinopathy (DR) is the most frequent ocular complication of diabetes mellitus and the leading cause of blindness in the working age population in developing countries. Objective: The aim of this study was to compare central macular thickness using optical coherence tomography (OCT) between Ranibizumab 0.5 mg monotherapy over Ranibizumab 0.5 mg combined with laser based on mean average change in best-corrected visual acuity (BCVA) over 6 months in diabetic macular edema (DME). Patients and methods: The study was carried out on forty eyes of patients aged 30-75 years old, with type 1 or 2 diabetes mellitus and have visual impairment due to DME. The patients were selected from the Outpatient Ophthalmology Clinic of Aswan University Hospital. Results: Both groups achieved improvement of visual acuity and reduction of the macular thickness but the effect was more pronounced and long lasting in the combined therapy group. Conclusion: The use of more than one line of treatment in combination for patients with diffuse DME could provide more sustained results with the need for less frequent injections and decreasing the recurrence or persistence rate of DME.

Intravitreal Ranibizumab Monotherapy or Combined with Laser for Diabetic Macular Edema (OCT guided study)

Background: Diabetic retinopathy (DR) is the most frequent ocular complication of diabetes mellitus and the leading cause of blindness in the working age population in developing countries. Objective: The aim of this study was to compare central macular thickness using optical coherence tomography (OCT) between Ranibizumab 0.5 mg monotherapy over Ranibizumab 0.5 mg combined with laser based on mean average change in best-corrected visual acuity (BCVA) over 6 months in diabetic macular edema (DME). Patients and methods: The study was carried out on forty eyes of patients aged 30-75 years old, with type 1 or 2 diabetes mellitus and have visual impairment due to DME. The patients were selected from the Outpatient Ophthalmology Clinic of Aswan University Hospital. Results: Both groups achieved improvement of visual acuity and reduction of the macular thickness but the effect was more pronounced and long lasting in the combined therapy group. Conclusion: The use of more than one line of treatment in combination for patients with diffuse DME could provide more sustained results with the need for less frequent injections and decreasing the recurrence or persistence rate of DME.

Is Laparoscopic Appendicectomy an Acceptable Approach in Management of Patients with Acute Appendicitis

Background: Appendicitis is the most common cause of acute abdomen and appendectomy is the most frequent surgical procedure performed in the world in recent times. In the last few years the number of laparoscopic appendectomies performed around the world has dramatically increased. Objective: The aim of the work is to study the acceptance and satisfaction of the patients as regards the laparoscopic approach for management of acute appendicitis and evaluation the results. Patients and methods: It was a comparative study included 100 consecutive patients with acute appendicitis. They were given the options to accept the approach for appendectomy whether open or laparoscopic after discussion the advantages and disadvantages of each approach and the last decision were left to the patient. The study was approved by the medical ethics committee of Aswan University Hospital and a written informed consent was obtained from all patients. Results: The consecutive patients of age ranging from 15-45 years with features suggestive of acute appendicitis were divided into laparoscopic appendectomy group (LA) 70 cases and open appendectomy group (OA) 30 cases, after taking informed consent. LA was done with the help of three trocar/cannulae creating pneumoperitoneum with CO2 whereas OA was performed by McBurney incision. The operating times in OA and LA were 20-70 minutes (mean 30) and 25-95 minutes (mean 55) respectively. Increased doses of analgesics, antibiotics and antiemetics were required in OA, as compared to LA. The mean postoperative hospital stay in LA group was 1.4 days (range 1-3 days) whereas it was in OA group, it was 3.5 days (range 2- 6 days). Conclusion: LA is safe and has major benefits like less postoperative pain, decreased wound infection, early hospital discharged, early return to work and a better cosmetic scar than OA.

Ranibizumab Monotherapy or Combined with Laser versus Laser Monotherapy for Diabetic Macular Edema

Background: Diabetic macular oedema can occur at any stage of retinopathy and is typically characterized by retinal thickening and leakage of extracellular fluid, which are linked with hypoxia and up regulation of vascular endothelial growth factor (VEGF). Objective: The aim of this study was to compare central macular thickness using optical coherence tomography (OCT) between Ranibizumab 0.5 mg monotherapy vs Ranibizumab 0.5 mg combined with laser based on mean average change in best-corrected visual acuity (BCVA) over 6 months in diabetic macular edema (DME). Patients and methods: The study was carried out on forty eyes of patients aged 30-75 years old, with type 1 or 2 diabetes mellitus and have visual impairment due to DME. The patients were selected from the Outpatient Ophthalmology Clinic of Aswan University Hospital. Results: Visual acuity measured as log MAR values in Group A, when comparing the baseline visual acuity with that at the end of follow-up period, there was a significant improvement in vision. Some patients achieved improvement of two lines at the end of six months. In Group B, there was a significant improvement in vision when comparing the baseline reading with the six months reading with an average gain in visual acuity of two or more lines. The central macular thickness improved in both groups without statistically significant difference between them in the first three months post-injection. However, the combined group achieved the highest reduction in the macular thickness at the end of follow-up period. Conclusion: Ranibizumab monotherapy provided significantly superior benefit over standard-of-care laser in patients with visual impairment due to DME being rapidly improved and sustained BCVA over the 6-month treatment period.