Ophthalmology Clinic Research Articles

Accommodative-vergence disorders in a paediatric ophthalmology clinical setting in Argentina.

To determine the frequency of potential non-strabismic accommodative-vergence anomalies (NSAVA) and investigate associations between NSAVA, refractive errors and age among children attending a paediatric ophthalmology clinic. This study included children and adolescents aged 5-19 years attending an ophthalmology clinic with at least two follow-up visits. At their first visit, children had a comprehensive ophthalmic examination, including refractive error measurement by cycloplegic autorefraction and spectacles were prescribed if necessary. At the second visit, children had an examination of best-corrected visual acuity, convergence and accommodation to identify potential NSAVA. The relationship between age, sex, heterophoria and refractive error and potential NSAVA was assessed by a multivariable logistic regression model. A total of 384 children and adolescents were evaluated. Their mean age was 10.97 ± 3.07 years and 58.9% were females. Forty-two per cent of children failed the NSAVA tests and 34.1% had myopia (≤-0.50 D). Children who failed NSAVA tests self-reported a higher proportion of reading problems (73.7%) compared to those who passed the tests (26.3%; p < 0.001). Children with self-reported reading problems were more likely to have accommodative infacility (57.9%) compared with children without (42.1%; p < 0.001). Refractive error and age were not associated with failure in NSAVA tests (p > 0.05). NSAVA was a frequent cause of vision problems found in a sample of children from an ophthalmology paediatric clinic. Thus, further research is necessary to understand the potential of public health policies to prevent, refer, diagnose and treat those conditions.

Long-term PM2.5 exposure disrupts corneal epithelial homeostasis by impairing limbal stem/progenitor cells in humans and rat models

BackgroundLimbal stem/progenitor cells (LSPCs) play a crucial role in maintaining corneal health by regulating epithelial homeostasis. Although PM2.5 is associated with the occurrence of several corneal diseases, its effects on LSPCs are not clearly understood.MethodsIn this study, we explored the correlation between PM2.5 exposure and human limbal epithelial thickness measured by Fourier-domain Optical Coherence Tomography in the ophthalmologic clinic. Long- and short-term PM2.5 exposed-rat models were established to investigate the changes in LSPCs and the associated mechanisms.ResultsWe found that people living in regions with higher PM2.5 concentrations had thinner limbal epithelium, indicating the loss of LSPCs. In rat models, long-term PM2.5 exposure impairs LSPCs renewal and differentiation, manifesting as corneal epithelial defects and thinner epithelium in the cornea and limbus. However, LSPCs were activated in short-term PM2.5-exposed rat models. RNA sequencing implied that the circadian rhythm in LSPCs was perturbed during PM2.5 exposure. The mRNA level of circadian genes including Per1, Per2, Per3, and Rev-erbα was upregulated in both short- and long-term models, suggesting circadian rhythm was involved in the activation and dysregulation of LSPCs at different stages. PM2.5 also disturbed the limbal microenvironment as evidenced by changes in corneal subbasal nerve fiber density, vascular density and permeability, and immune cell infiltration, which further resulted in the circadian mismatches and dysfunction of LSPCs.ConclusionThis study systematically demonstrates that PM2.5 impairs LSPCs and their microenvironment. Moreover, we show that circadian misalignment of LSPCs may be a new mechanism by which PM2.5 induces corneal diseases. Therapeutic options that target circadian rhythm may be viable options for improving LSPC functions and alleviating various PM2.5-associated corneal diseases.

Optometric Practice Patterns for Acute Central and Branch Retinal Artery Occlusion.

Optometrists are often the first providers to evaluate patients with acute vision loss and are often the first to diagnose a central retinal artery occlusion (CRAO). How quickly these patients present to the optometrist, are diagnosed, and referred for evaluation are major factors influencing the possibility of acute therapeutic intervention. Our aim was to survey the U.S. optometric community to determine current optometric practice patterns for management of CRAO. An anonymous seven-question survey was emailed in 2020 to the 5,101 members of the American Academy of Optometry and the 26,502 members of the American Optometric Association. Of 31,603 optometrists who were sent the survey, 1,926 responded (6.1%). Most respondents (1,392/1,919, 72.5%) worked in an optometry-predominant outpatient clinic and were less than 30 minutes from a certified stroke center (1,481/1,923, 77.0%). Ninety-eight percent (1,884/1,922) of respondents had diagnosed less than 5 CRAOs in the previous year, and 1,000/1,922 (52.0%) had not diagnosed a CRAO in the prior year. Of the optometrists who diagnosed at least one CRAO in the previous year, 661/922 (71.7%) evaluated these patients more than 4 hours after the onset of vision loss. Optometrists who diagnosed a CRAO or branch retinal artery occlusion referred patients to an emergency department (ED) affiliated with a certified stroke center (844/1,917, 44.0%), an outpatient ophthalmology clinic (764/1,917, 39.9%), an ED without a stroke center (250/1,917, 13.0%), an outpatient neurology clinic (20/1,917, 1.0%), or other (39/1,917, 2.0%); most (22/39, 56.4%) who responded "other" would refer to a primary care physician. Optometrists are likely the first providers to evaluate patients with acute vision loss, including from a retinal artery occlusion. However, only 6.1% of optometrists responded to our survey despite 2 reminder emails, likely reflecting the lack of exposure to acute retinal artery occlusions, and a potential lack of interest of optometrists in participating in research. Of the optometrists who reported evaluating a CRAO in the previous year, less than 29% saw the patient within 4 hours of vision loss. In addition, a large portion of optometrists are referring acute CRAO patients to outpatient ophthalmology clinics, delaying appropriate acute management. Therefore, it is imperative that optometrists and ophthalmologists are educated to view acute retinal arterial ischemia as an acute stroke and urgently refer these patients to an ED affiliated with a stroke center. The delay in patient presentation and these referral patterns make future clinical trials for acute CRAO challenging.

Carotid blood flow in abnormal head posture: a prospective observational study exploring facial asymmetry in strabismus

To investigate whether abnormal head posture (AHP) induces changes in common carotid artery blood flow (CCBF), thereby leading to the development of facial asymmetry in the setting of strabismus and ocular torticollis. This was a prospective observational study of pediatric subjects in an urban ophthalmology clinic who underwent bilateral carotid artery ultrasound examination with spectral Doppler in an upright, straight-head posture and with a head tilt of 30°-45° to the right and left. The primary outcome was change in carotid flow on the side of the head tilt. The secondary outcome was change in blood flow on the contralateral side of the head tilt. Seventeen subjects were enrolled, and 34 carotid arteries were assessed. There was no significant difference between upright, straight-head position and head tilt in ipsilateral (7.8 ± 1.8 mL/s vs 7.5 ± 2.0 mL/s [P = 0.4312]) or contralateral (7.8 ± 1.8 mL/s vs 8.1 ± 2.4 mL/s [P = 0.3401]) CCBF. CCBF does not fluctuate with AHP and thus does not appear to be the etiology for facial asymmetry in strabismus.

Contrast enhanced MRI in acute optic neuritis- length of enhancement a visual prognosis indicator?

To study the baseline length of optic nerve enhancement on contrast enhanced MRI in patients with acute optic neuritis and its correlation to visual acuity, color vision, visual field and contrast sensitivity.The prospective cohort study was conducted on 30 patients attending Ophthalmology clinics with complaint of sudden painful loss of vision and clinical examination findings suggestive of acute optic neuritis. All patients underwent contrast enhanced MRI (1.5 Tesla) at presentation and then treated with intravenous and oral steroids with monthly follow up for 3 months. Visual acuity using Snellen’s chart (in LogMAR), Color vision using Ishihara chart and contrast sensitivity by means of Pellie Robson chart were evaluated. The visual field was analyzed by Humphrey’s Field Analyser, using a full threshold 30-2 programme.On contrast-enhanced MRI, all affected optic nerves showed enhancement. The length of portions enhanced for each affected optic nerve was measured. The optic nerves were divided into two categories of length ≤ 17mm and &amp;#62;17mm. At baseline, visual acuity worsened with an increasing length of optic nerve enhancement, color vision and visual field was better in subjects with enhancement &amp;#60;17mm while they do not correlate with the final visual outcome. On the contrary, Contrast sensitivity was found to be improved in subjects with &amp;#60;17mmm of enhancement on the last follow up.Contrast- enhanced MRI plays a critical role as an adjunct to diagnosing acute optic neuritis especially in patients with retrobulbar neuritis. Initial length of enhancement does not correlate with the final visual outcome.

A Case of Korean Herbal Medicine Treatment for Normal Tension Glaucoma using Go-Bang

Objectives: To provide a case report of effective use of Korean herbal medicine treatment to reduce the development and progression of normal-tension glaucoma(NTG).Methods: This case involved a 52-year-old patient who had a history of excimer laser surgery at the age of 25 and was using prescriptions such as Cosopts2 and Xalatan for eye drops. We treated this patient with Korean herbal medicine treatment for 2 years and assessed the progression of NTG based on the optical coherence tomography testresults that he recevied at the ophthalmology clinic every 6 months. Results: During the two years of treatment with Korean herbal medicine, it was observed that the progression of NTG was halted. However, after discontinuing the Korean herbal treatment, the progression resumed.Conclusion: Korean herbal medicine treatment was found to be effective in treating normal tension glaucoma, and a minimum treatment period of two years is necessary for an accurate evaluation of NTG.

The effect of different blood groups on visual evoked potentials

Introduction and aim. Purpose of the study is to determine whether it is required to use different standards when evaluating visual evoked potential (VEP) measurements of healthy individuals with different blood groups. Material and methods. The study consisted of healthy individuals with different blood groups who have applied to the ophthalmology and neurology outpatient clinic of Düzce University Medical Faculty from January to December 2022. The patients went through detailed ophthalmologic examination and VEP test and only the ones with normal results were included to the study. Results. The study consisted of 119 individuals, with a blood group distribution of 30 A, 29 B, 30 AB and 30 O. VEP latency and amplitude changes were compared and no significant difference was observed within 4 groups in terms of P100 and N70 latency and amplitudes. There was N70 latency prolongation in Rh- group and this difference was found to be statistically significant (p=0.009). Rh+ group was found to be high in terms of P100 amplitudes and this was considered statistically significant (both p=0.023). Conclusion. There was no statistically significant difference in the VEP parameters of the individuals with the ABO blood groups hence same VEP normal values can be used for ABO blood groups.

Diabetic Retinopathy - a Common Disease.

Diabetic retinopathy (DR) is one of the most common complications of diabetes mellitus and one of the leading causes of visual impairment in working age individuals in the western world. The treatment of DR depends on its severity, so it is of great importance to detect patients as early as possible, in order to initiate early treatment and preserve vision. Despite currently insufficient screening participation, patients with diabetes already visit ophthalmological practices and clinics above average. Their medical care, including DR diagnostics and treatment has been making up an increasing proportion of ophthalmic activity for years. Since the prevalence of diabetes is increasing dramatically worldwide and a further increase is also predicted for Germany, the challenge for ophthalmologists is likely to grow considerably. As the same time, the diagnostic possibilities for differentiating DR and the therapeutic measures, especially with IVOM therapy, are becoming more and more complex, which increases the time burden in everyday clinical practice. The hope to avoid healthcare deficits and to further improve screening rates and visual acuity prognosis in patients with DR is based, among other things, on camera-assisted screening supported by artificial intelligence. Better diabetes management to reduce the prevalence of DR, as well as longer-acting drugs to treat DR, could also improve the care and help reduce the burden on ophthalmology practices.

Comparing the Effectiveness of Laser Therapy, Medicaments and Surgical Treatment in Patients with Angle Closed Glaucoma

Abstract The study goal was to compare the efficiency of the medicaments, laser and surgical treatment in the patients with primary angle closure glaucoma (PACG) in order to achieve: normalization of intraocular pressure (IOP), maintaining the useful visual acuity and stabilization of visual field loss. All patients were treated at Clinic of Ophthalmology of Clinical Centre Kragujevac in Kragujevac, Serbia, in the period from June 15, 2010 to June 15, 2014. There were 116 patients in this study. They diagnosed with PACG, and they had been adequate selected for this study. They were treated with: medicaments; Nd:YAG (Neodymium:Yittrium Aluminum Garnet) laser iridotomy, and glaucoma surgery. Clinical ophthalmology controls have been introduced once or twice a month, and the vision field loss was tested three times every year. During the monitoring period of one year: no statistically significant difference occurred in terms of changes of the visual acuity among the three study-groups. The best IOP regulation was achieved after the laser treatment (53.4%), followed by the surgical treatment (28.5%), while the weakest was recorded in patients treated with the medicaments (18.1%). The percentage of the visual field loss was the biggest of patients treated with the medicaments (57%), and then the patients treated with the laser iridotomy (35%), while the least one occurred of the patients with the surgical treatment (23%). In the laser-treated group of 62 patients, the frequency of complications was 17.8%; while the out of 33 patients who had been treated (surgical), the frequency of complications was 19%. Laser iridotomy was shown to be effective of 89.5% of study-patients with PACG, while non-reactive studypatients underwent to the trabeculectomy. In addition to the high efficacy of Nd:YAG laser iridotomy in regulating of IOP values of the patients with PACG, the advantage of laser-method was in: the maneuvering of outpatients, it was easy to do, had a short lead time and was used in local anesthesia.

A Datasheet for the INSIGHT University Hospitals Birmingham Retinal Vein Occlusion Data Set.

Retinal vein occlusion (RVO) is the second leading cause of visual loss due to retinal disease. Retinal vein occlusion increases the risk of cardiovascular mortality and the risk of stroke. This article describes the data contained within the INSIGHT eye health data set for RVO and cardiovascular disease. Data set descriptor for routinely collected eye and systemic disease data. All people who had suffered an RVO aged ≥ 18 years old, attending the Ophthalmology Clinic at Queen Elizabeth Hospital, University Hospitals Birmingham (UHB) National Health Service (NHS) Trust were included. The INSIGHT Health Data Research Hub for Eye Health is an NHS-led ophthalmic bioresource. It provides researchers with safe access to anonymized routinely collected data from contributing NHS hospitals to advance research for patient benefit. This report describes the INSIGHT UHB RVO and major adverse cardiovascular events data set, a data set of ophthalmology and systemic data derived from the United Kingdom's largest acute care trust. This data set consists of routinely collected data from the hospital's electronic patient records. The data set primarily includes structured data (relating to their hospital eye care and any cardiovascular data held for the individual) and OCT ocular images. Further details regarding the available data points are available in the supplementary information. At the time point of this analysis (September 30, 2022) the data set was composed of clinical data from 1521 patients, from Medisoft records inception. The data set includes 2196 occurrences of RVO affecting 2026 eyes, longitudinal eye follow-up clinical parameters, over 6217 eye-related procedures, and 982 encountered complications. The data set contains information on 2534 major adverse cardiovascular event occurrences, their subtype, number experienced per patient, and chronological relation to RVO event. Longitudinal follow-up data including laboratory results, regular medications, and all-cause mortality are also available within the data set. This data set descriptor article summarizes the data set contents, the process of its curation, and potential uses. The data set is available through the structured application process that ensures research studies are for patient benefit. Further information regarding the data repository and contact details can be found at https://www.insight.hdrhub.org/. Proprietary or commercial disclosure may be found after the references.

Ultraviyole Işınlardan Korunma ve Güneş Gözlüğü ile İlgili Bilgi, Tutum ve Davranışların İncelenmesi

Objective: The aim of the study is to determine the sunglasses-wearing habits, the level of knowledge about the purpose of wearing sunglasses and the awareness of the effects of sunlight on ocular tissues among patients attending the outpatient clinic. Methods: Between January and March 2023, a questionnaire was administered to people who visited the ophthalmology clinic at the Elbistan State Hospital. 250 people who volunteered to participate in the survey were included in this cross-sectional study. The questionnaire consisted of 10 questions. Results: The mean age of the 250 participants (56% female and 44% male) was 41.94±15.31 years. 90.5% of the villagers, all the illiterate participants and 54.1% of the unemployed participants stated not to know about UV. 82.9% of the university graduates and 80% of the office workers reported knowing about UV. Illiterate participants reported buying sunglasses based on brand and price; most university graduates reported buying sunglasses based on UV protection. When asked about the purpose of wearing sunglasses, most men reported it was to prevent glare, while most women reported it was for aesthetic and cosmetic reasons. 90.5% of villagers and 83.8% of illiterates reported wearing sunglasses for aesthetic and cosmetic reasons. 84.2% of university graduates reported that it was used to protect the eye tissues from the harmful rays of the sun. Conclusion: The study highlights the lack of awareness of sunlight in society and the general lack of sun protection, suggesting the need for health education programs. Informative public service announcements and videos on the topic have been suggested.

COMPARISON OF CYCLOCRYOTHERAPY COMBINED WITH RETROBULBAR CHLORPROMAZINE VERSUS CYCLOCRYOTHERAPY ALONE IN REDUCING THE INTRAOCULAR PRESSURE AND PAIN IN END-STAGE GLAUCOMA

Introduction: Patients with end-stage glaucoma often came with a painful blind eye. One of the managements is cyclocryotherapy (CCT) or retrobulbar chlorpromazine (CPZ). In this study, we aimed to evaluate the combined use of cyclocryotherapy and retrobulbar chlorpromazine versus cyclocryotherapy alone in reducing the intraocular pressure (IOP) and Visual Analog Scale (VAS) pain scores in end-stage glaucoma patients. Methods: Samples were taken from patients who enrolled in the Ophthalmology Clinic of Dr. Sardjito General Hospital from October 2021 to March 2022. Samples were then divided into 2 groups, the CCT+CPZ group received the combination of cyclocryotherapy and retrobulbar chlorpromazine and the CCT group received only cyclocryotherapy. IOP and VAS pain scores pre-operation and 30th-day post-operation were examined. Results: Thirty-three patients were included in the CCT+CPZ group and 17 patients were included in the CCT group. The mean IOP and VAS pain scores 30th-day post-operation in the CCT+CPZ group were 22.6±10.3 mmHg and 1.6±1.3 vs pre-operation 44.9±19.5 mmHg and 7.9±1.7 (p=0.000). Patients in the CCT group also show a significant reduction in both mean IOP and VAS pain scores 31.4±16 mmHg and 2.6±2.3 vs pre-operation 54.4±7.4 mmHg and 8.4±2.1 (p=0.001). Both IOP and VAS pain scores at 30th-day post-operation were significantly lower in the CCT+CPZ group compared to the CCT group (p=0.030 and p=0.013, respectively). Conclusion: There were statistically significant differences between patients who received a combination of cyclocryotherapy and retrobulbar chlorpromazine in reducing the IOP and VAS pain score compared with patients who received only cyclocryotherapy.

In Vitro Acaricidal Effect of Proparacaine HCl on Demodex Folliculorum

Purpose: This research aimed to assess the underlying cause behind the in vitro acaricidal impact of proparacaine HCl on Demodex Folliculorum.&#x0D; Methods: In accordance with Gao's suggestion we epilated a total of 8 eyelashes 4 from the lower and 4 from the upper eyelid of a patient who applied for blepharitis symptoms to the ophthalmology clinic. We fixated 4 of these eyelashes with classical immersion oil and covered them with a coverslip. We wetted 4 of them with Proparacaine Hydrochloride 5 mg (0.5%) and painted them with Na-fluorescein, and covered them with a coverslip.&#x0D; Results: When we examined the eyelashes that were wetted with Proparacaine Hydrochloride under the light microscope there was no difference in mobility in the Demodex of the eyelashes at first 15 minutes. After 30 minutes we saw that the creamy lipid-like structure which is seen normally in the middle of the Demodex was saponified in Demodex. The other Demodex samples that were in the immersion oil were still alive.&#x0D; Conclusions: In this case report, we wanted to evaluate the reason for the acaricidal effect of Proparacaine Hydrochloride a local anesthetic agent on Demodex folliculorum. The idea came true while trying to demonstrate Na-fluorescein uptake of Demodex folliculorum under the microscope after using Proparacaine Hydrochloride5 mg (0.5%) to wet the Na-fluorescein paper and surprisingly we obtained these findings suggesting that it is a substance that may have an anti-acaricidal, anti-demodex effect potential to be a new player for treatment of demodicosis in the future.

A Review on Most Opthalmic Viral Disease Conjunctivitivs (Eye Flu)

Ophthalmology clinics around the world see a lot of patients with conjunctivitis. Severe pain, impaired vision, and a painful pupillary reaction are all red flags for more serious intraocular disorders that should be taken into account while treating suspected cases of conjunctivitis. In patients with unusual findings and a chronic course, it is also important to have a complete medical and ocular history and do a comprehensive physical examination. The existence of a systemic ailment affecting the conjunctiva may be shown by concurrent findings on physical exam and pertinent history. The vast majority of cases of conjunctivitis still originate from viruses. Bacterial conjunctivitis is the second most prevalent cause of infectious conjunctivitis; however it is much less common than viral conjunctivitis. Nearly half of the population experiences allergic conjunctivitis, characterised by symptoms like itching, mucoid discharge, chemosis, and edoema of the eyelids. A patient with conjunctival irritation and discharge who has used preservative-containing eye drops regularly likely has toxic conjunctivitis. Timely diagnosis, proper classification of the various aetiologies, and suitable treatment are essential components of effective management of conjunctivitis.

Adherence to Follow-Up and the Related Factors of Paediatric Glaucoma at a Tertiary Care Centre in Western Saudi Arabia.

Glaucoma is a main cause of blindness globally. In Saudi Arabia, congenital glaucoma is believed to affect 1 in every 2500 live births. In this study, we identified the adherence and evaluated the factors associated with non-compliance (non-adherence) to recommended follow-up appointments at King Abdulaziz University Hospital, a tertiary centre in Jeddah, Saudi Arabia. The medical records of paediatric patients diagnosed with glaucoma between 2009 and April 2022 were reviewed retrospectively. Demographic information, visit dates, scheduled follow-ups, and specific patients' glaucoma histories were all extracted from the records. Patients were categorized as adherent, non-adherent, or lost to tertiary follow-up (LTTF). Of 91 patients, 52 (57.1%) were adherent, 20 (22%) were non-adherent, and 19 (20.9%) were LTTF. Most adherent patients were Saudi (59.3% adherent, 26.5% non-adherent, 14.2% LTTF) (P = 0.02). Adherent patients were far likelier to live further away from the ophthalmology clinic (P = 0.03). The frequency of clinical encounters was statistically significantly different between adherence statuses. The non-adherent group had a higher average number of prescribed ocular medications (P = 0.03). The adherent patients had more frequent visits with elevated intraocular pressure (P = 0.02). A significantly high percentage of paediatric glaucoma patients were non-adherent to follow-up visits. When determining the non-compliance risk among paediatric glaucoma patients, physicians must consider the factors contributing to adherence status, which include nationality, distance to the ophthalmology clinic, and number of prescribed ocular medications.

The psychological status of patients with delayed intravitreal injection for treatment of diabetic macular edema due to the COVID-19 pandemic.

Since the enforcement of the Movement Control Order (MCO) to contain the spread of COVID -19 infection in Malaysia, most clinic appointments have been rescheduled and procedures and surgeries postponed to a later date. Clinic appointments including intravitreal endothelial growth factor (anti-VEGF) treatment for patients with diabetic macular edema (DME) were also no exception to the postponement. This measure takes a psychological toll on patients because of the overwhelming concern for their eye condition. This study was conducted to assess the psychological status of DME patients with delayed anti-VEGF treatment during the pandemic. A cross-sectional study was conducted from September 2020 to March 2021 in Ophthalmology Clinic Hospital Canselor Tuanku Muhriz Universiti Kebangsaan Malaysia (HCTM UKM). Subjects diagnosed with center-involved DME aged between 20 to 80 years who experienced delayed anti-VEGF injection were recruited. Level of depression, anxiety and stress were assessed using DASS-21 questionnaire. Statistical analysis using non-parametric tests were performed to determine the relationship between the DASS-21 score and duration of last injection, in those whose vision was affected by delayed injection and the relationship to the impact of COVID-19 pandemic. Statistical significance was denoted as p < 0.05. A total of 86 respondents with median age of 69 years old participated in this study. Most respondents were Malays (n = 47,54.7%) males (n = 51, 59.3%), had education up to secondary level (n = 37, 43%), unemployed (n = 78, 90.7%), married (n = 72, 83.7%) and living with their family (n = 82, 95.3%). The number of intravitreal injections received was at least three times among the respondents (n = 81, 94.2%). More than half of the respondents (n = 46, 53.5%) had been postponed for more than 12 weeks and felt that their vision was affected after delayed intravitreal injection (n = 47, 54.7%). Most of the subjects did not experience depression, anxiety, or stress. However, there was a significant level of stress scores among those with delayed injection of 9 to 12 weeks (p = 0.004), and significant anxiety (p = 0.029) and stress (p = 0.014) scores found in subjects with vision affected due to delayed treatment. The level of anxiety and stress can be significant in DME patients who experienced delay in intravitreal anti-VEGF treatment. Assessment of psychosocial impacts is important to identify early mental health issues potentially leading to the onset of psychiatry illness, thus early intervention is indispensable.

Comparing the Optical Coherence Tomography Outcomes of Intravitreal Injection Anti Vascular Endothelial Growth Factor in Branch Retinal Vein Occlusion (BRVO)

Background: BRVO is a blockage of the branches of the retinal vein due to a thrombus. The prevalence of 10-year BRVO is 1.6 per 100 subjects. The effect of anti-VEGF injection on BRVO management is effective in improving visual acuity and reducing macular oedema.&#x0D; Case presentation: A man, 32 years old, presented to the ophthalmology clinic at the Dr. M. Djamil General Hospital with a chief complaint of blurred vision in his left eye 1 week before admission. The blurred vision began suddenly. Visual acuity in LE was 20/50 and did not advance with a pinhole. Funduscopic examination of LE showed clear media, rounded papillae with well-defined borders, blood vessels aa:vv = 1:3, venous tortuosity (+) increased in the inferotemporal quadrant; retina: Bleeding (+) with dot blot and flame-shaped inferiorly, exudate (+) cotton wool spots at the inferotemporal region; foveal reflex (+)↓ on the macula. OCT LE examination showed macular intraretinal hypo-reflection and macular thickening with a central macular thickness of 617 μm. The physical examination showed a body weight of 114.9 kg, a height of 173 cm, and a body mass index of 38.4. Within 5 months after 3 times administrations of intravitreal injections of anti-VEGF bevacizumab and ranibizumab, visual acuity of LE: 20/25 was obtained, and increased appearance of the retinal fundus and OCT LE.&#x0D; Conclusion: Intravitreal injection therapy of anti-VEGF bevacizumab and ranibizumab is effective in reducing macular oedema and restoring visual acuity in BRVO.

Prevalence of Diabetic Retinopathy in Adult Diabetics at National Institute of Diabetes and Endocrinology in Cairo

Background Type 2 diabetes is the most common type of diabetes, accounting for around 90% of all diabetes worldwide. The prevalence of type 2 diabetes is high and increasing across all regions worldwide. Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus. It is one of the leading causes of blindness in the working age population and has a great economic impact on society especially on healthcare systems. Optical coherence tomography (OCT) and fundus photography are noninvasive examinations that help the clinician to observe signs of neurodegenerative changes in the retina and detects neuroretinal changes in the early stages of DR and DME. Aim of the Work The aim of our study was to estimate the prevalence and severity of diabetic retinopathy among patients with diabetes mellitus type 2 over 30 years old they will be screened clinically and by fundus photography and optical coherence topography at national institute of diabetes and endocrinology. Patients and Methods This study included 600 eyes from 300 patients. Diabetics were recruited from patients recruited from National institute of Diabetes and endocrinology in the ophthalmic clinic. It was designed as cross sectional hospital based study. This study conducted to estimate the prevalence and severity of diabetic retinopathy and diabetic macular edema among patients with diabetes mellitus type 2 over 30 years old. Using fundus photography and optical coherence topography (SD-OCT) at National Institute of Diabetes and Endocrinology. Results The findings of our study showed that the prevalence of DR irrespective to type was 34% of studied eyes. Also it revealed that 22.3% of studied eyes had diabetic macular edema. Non-proliferative diabetic retinopathy in our study was more common than proliferative diabetic retinopathy. The prevalence of nonproliferative diabetic retinopathy in DR patients in our study was (72.5%) but proliferative diabetic retinopathy (27.5%) in DR patients. The commonest type was mild NPDR (33.3%). There is a strong relation between duration of DM, control of HbA1c, age, treatment with insulin and DR and DME. The longer duration of DM and high levels of HbA1c considered main risk factors of DR and DME. Conclusion The prevalence of DR and DME were 34%and 22.3%, respectively of studied eyes in ophthalmology clinic in National Institute of Diabetes and Endocrinology. These data highlight the substantial public health burden of DR and DME. Old age, Insulin treatment, poor control and the longest duration of DM patients groups are more liable to develop DR and DME.

The Prevalence of Punctal Stenosis as a Cause of Obstructive Epiphora in Ain Shams University Hospitals Ophthalmology Clinic

Background Epiphora or tearing is the presence of a watering eye, which is a common complaint to be referred to oculoplastic clinics for evaluation. Not only does it cause social embarrassment, epiphora can also affect the quality of a patient's life as it may interfere with daily activities, especially reading and driving. Excessive tearing may also hinder proper visual performance. Aim of the Work To calculate the prevalence of punctal stenosis in patients presenting with obstructive epiphora to the outpatient ophthalmology clinic at Ain Shams University Hospitals. Patients and Methods This descriptive cross sectional study included 75 eyes of 51 patients, with the age ranging from 4.5 to 77 years and a mean age of 52.32 ± 16.19 years. The study results showed that punctal stenosis is the most commonly encountered cause of obstructive epiphora in the study population with a prevalence of 62.7%. There was a female predominance of epiphora and punctal stenosis (68%). Results Our study results revealed that epiphora was more prevalent in the older age subgroups, where the highest prevalence was among the oldest age subgroup (&amp;gt; 60 years old) (45.1%). Similarly, punctal stenosis was the most prevalent in the &amp;gt; 60 years old age sub group (56.3%). Conclusion Punctal stenosis is the most commonly encountred cause of obstructive epiphora in the study population, with a female predominance. Moreover, increasing age was shown to be the most important determinant for the existence of punctal stenosis.

Measurement of Sub-Foveal Choroidal Thickness in Hyperthyroid Patients with Thyroid Associated Ophthalmopathy, Using Spectral Domain OCT

Background Thyroid associated ophthalmopathy (TAO) is an auto-immune orbitopathy, associated with thyroid dysfunction. It results in compression of the orbital contents, impairment of the blood flow and thus affects the choroidal and retinal microstructure and function. Aim of the Work The purpose of this study is to measure the central choroidal thickness in active and inactive TAO using Optical Coherence Tomography (OCT) and compare it to the control group. Patients and Methods The cross section study was conducted on participants recruited from the ophthalmology clinic of the National Institute of Diabetes and Endocrinology (NIDE). The study included 160 eyes from 80 participants (40 hyperthyroidism patients and 40 control subjects). Data was collected during the period of December 2019 to June 2020. Results There was no significant difference regarding age, gender, vision and IOP between TAO patients (either active or inactive) and normal subjects. Our study showed that there was a significant increase in sub-foveal choroidal thickness in patients with TAO compared to the control group. It also showed a significant increase in sub-foveal choroidal thickness in the active subgroup more than the inactive subgroup. In addition, a decrease in central foveal thickness was found in patients with TAO compared to the control group, but there was no significant difference found between active and inactive subgroups. Conclusion The findings of this study suggest that there is a significant affection of sub-foveal choroidal thickness and central foveal thickness in thyroid-associated-ophthalmopathy (TAO) patients.