Evidence-based Guidelines for Keratorefractive Lenticule Extraction Surgery.

Topic: Development of evidence-based guidelines for keratorefractive lenticule extraction (KLEx).

Clinical Relevance: KLEx refers to various corneal refractive procedures involving removal of refractive lenticules of intrastromal corneal tissue, typically through a small incision, thereby eliminating creation of a corneal flap. This technique has rapidly gained popularity as a possible alternative to flap-based procedures; however, no clinical practice guidelines exist for KLEx.

Thyroid gland dysfunction and keratoconus.

Background: The association between keratoconus and thyroid gland dysfunction (TGD) remains controversial. We aimed to determine the frequency of keratoconus among patients with laboratory-confirmed, treatment-naive TGD compared with that of age- and sex-matched healthy controls. Moreover, we investigated the potential relationship between TGD and corneal topographic and tomographic parameters.

Comparing the Postoperative Outcomes of Intrastromal Corneal Ring Segments in Three Different Topographic Patterns of Eccentric Keratoconus.

Purpose: To compare the postoperative outcomes following implantation of KERATACx ring segments (Imperial Medical Technologies Europe GmbH) in patients having eccentric keratoconus with three different topographic patterns.

Methods: This retrospective cohort study was conducted at Maadi Eye Subspeciality Center, Cairo, Egypt. The study included patients with keratoconus who had implantation of KERATACx ring segments.

Visual, ocular surface, and extraocular diagnostic criteria for determining the prevalence of computer vision syndrome: a cross-sectional smart-survey-based study.

Background: The American Optometric Association defines computer vision syndrome (CVS), also known as digital eye strain, as "a group of eye- and vision-related problems that result from prolonged computer, tablet, e-reader and cell phone use". We aimed to create a well-structured, valid, and reliable questionnaire to determine the prevalence of CVS, and to analyze the visual, ocular surface, and extraocular sequelae of CVS using a novel and smart self-assessment questionnaire.

Methods: This multicenter, observational, cross-sectional, descriptive, survey-based, online study included 6853 complete online responses of medical students from 15 universities.

Fungal Keratitis: Diagnosis, Management, and Recent Advances.

Fungal keratitis is one of the major causes of microbial keratitis that may lead to corneal blindness. Many problems related to diagnosis and therapy are encountered in fungal keratitis, including difficulty in obtaining laboratory diagnoses and the availability and efficacy of antifungal medications. Intensive and prolonged use of antifungal topical preparations may not be enough.

Intraocular pressure after combined photorefractive keratectomy and corneal collagen cross-linking for keratoconus.

Purpose: The purpose of this prospective study was to evaluate the effect of combined photorefractive keratectomy (PRK) and corneal collagen cross-linking (CXL) on intraocular pressure (IOP) in patients with keratoconus (KC).

Methods: We included 64 eyes of 34 patients (19 males and 15 females; age: 19-40y) with stages 1-2 keratoconus which had undergone combined wavefront-optimized photorefractive keratectomy and corneal collagen cross linking. Two other groups of patients were added as controls: the PRK group including 110 eyes of 57 patients (23 males and 34 females; age: 18-44y) which had undergone wavefront-optimized photorefractive keratectomy for myopic refractive errors, and the CXL group including 36 eyes of 23 patients (14 males and 9 females; age: 12-38y) with keratoconus, not filling the inclusion criteria for combined PRK and CXL, which had undergone corneal collagen cross-linking.

Prevalence of diabetic retinopathy in patients with diabetes in Alexandria and North-West Delta, Egypt.

Purpose: The purpose of this research was to estimate the prevalence of DR in Alexandria and the North-West Delta region.

Methods: All diabetic patients attending the general ophthalmology clinics (Group 1), diabetic internal medicine clinics (Group 2), or reached out in the local communities (Group 3) were eligible to participate. Fundus photographs were graded according to the Scottish DR grading system by three independent UK-certified graders.

Comparison between three different high fluence UVA levels in corneal collagen cross-linking for treatment of experimentally induced fungal keratitis in rabbits.

Introduction: The aim of this study was to compare the efficacy of Photo-Activated Chromophore for Keratitis - Corneal Collagen Cross-linking (PACK-CXL) of three different total UVA fluence levels and topical voriconazole in treatment of fungal keratitis experimentally induced in rabbits.

Methods: This is an interventional experimental study including both eyes of 16 rabbits (32 eyes). Fungal keratitis was induced by intrastromal injection of Fusarium Solani into the cornea.

Correction of pre-existing astigmatism with phacoemulsification using toric intraocular lens versus spherical intraocular lens and wave front guided surface ablation.

Background: This study aimed to evaluate toric intraocular lens to correct of pre-existing astigmatism at the time of phacoemulsification compared to using of spherical intraocular lens followed by wavefront guided surface ablation.

Results: The patients were classified into three groups: Group A with 20 eyes of 19 patients having phacoemulsification with spherical intraocular lens only as a control group, group B with 20 eyes of 14 patients had phacoemulsification with toric intraocular lens and group C with 20 eyes of 16 patients had phacoemulsification with spherical intraocular lens and wavefront guided PRK three months later. Comparison pre-operative data for all groups showed no statistically significant difference regarding UCVA, BCVA, MRSE, and refractive astigmatism (P>0.

One-Year Outcomes of Intracorneal Ring-Segment Insertion Assisted by Femtosecond Laser Simultaneously Performed with Corneal Collagen Cross-Linking for Treatment of Keratoconus.

Purpose: To assess the results of simultaneously performed femtosecond laser-assisted Keraring intrastromal corneal ring-segment insertion and corneal collagen cross-linking for the treatment of keratoconus.

Patients And Methods: In this retrospective, noncomparative, interventional study, 30 eyes of 24 progressive-keratoconus patients of both sexes aged 18-36 years old with poor best-corrected visual acuity (BCVA) and intolerance to contact lenses were included. All patients had been subjected to complete preoperative and postoperative ophthalmological examinations - unaided VA, BCVA, refraction, Pentacam, and contrast sensitivity examinations at 3-month, 6-month, and 1-year follow-ups.

Descemet's Membrane Endothelial Keratoplasty and Phacoemulsification: Combined versus Sequential Surgery.

Purpose: To compare the outcomes of Descemet's membrane endothelial keratoplasty (DMEK) combined with phacoemulsification versus DMEK following phacoemulsification.

Methods: In this interventional retrospective comparative nonrandomized case series study, patients with Fuchs endothelial corneal dystrophy (FECD) with either cataract or previous cataract surgery with intraocular lens (IOL) implantation were assigned to one of the two groups according to lens status. Group 1 included patients who had cataract and FECD and would undergo triple procedure (phacoemulsification with IOL implantation and DMEK), whereas Group 2 included patients who had FECD and had phacoemulsification with IOL implantation earlier and would undergo DMEK only as a sequential procedure.

Safety and Indicative Effectiveness of Porcine Corneal Lenticular Implants in Patients with Advanced Keratoconus and Post Lasik Ectasia: A Retrospective Clinical Study.

Purpose: This study aimed to evaluate the safety and feasibility of implanting decellularized porcine corneal lenticules in a femtosecond laser-assisted pocket for patients with advanced keratoconus and post-Lasik ectasia.

Methods: This is a retrospective clinical study of implanting a porcine corneal lenticular implant in seven eyes: six with advanced keratoconus and clear cornea and one with advanced post-Lasik ectasia with a follow-up for 12 months. The lenticules are extracted from porcine tissue, subjected to a decellularization process, intensely cross-linked, sterilized and packed.

Clinical Validation of the Automated Characterization of Cone Size and Center in Keratoconic Corneas.

Purpose: To evaluate an automated method for detecting the cone shape characteristics and to assess the cornea specialists' subjective variability of these measures using different maps.

Methods: Topographic images of the anterior and posterior surface of each eye were presented to 12 clinicians in two different types of map: tangential curvature and relative elevation to the best-fit sphere. They were asked to mark the cone center and its boundaries in the two maps without knowing that they belonged to the same patient.

Objective and subjective evaluation of trifocal diffractive intraocular Lens after cataract extraction with phacoemulsification: a prospective clinical study.

Background: This study aimed to assess visual outcomes, quality of vision and patients' satisfaction of a trifocal diffractive intraocular lens after cataract surgery with phacoemulsification.

Results: The study included 36 eyes that underwent implantation of trifocal diffractive intraocular lens (IOL). The residual mean postoperative spherical equivalent was - 0.

Pediatric Keratoconus in A Tertiary Eye Center in Alexandria: A Cross-sectional Study.

Purpose: To describe the clinical presentation, risk factors, and treatment choices documented in a pediatric keratoconus population treated at a tertiary referral center in Alexandria, Egypt.

Methods: : A cross-sectional study of 80 patients with keratoconus aged 18 years or younger referred to the cornea clinic at the Alexandria University Main Hospital between July 2018 and October 2019 was included. Patients' history, initial presentation, best spectacle corrected visual acuity (BSCVA), clinical signs, topographic data, and treatment were recorded.

Corneal endothelial cells changes in different stages of Keratoconus: a multi-Centre clinical study.

Purpose: To assess the corneal endothelial cells morphology and count in keratoconus patients and their correlation with different stages of keratoconus.

Methods: Prospective non randomized multi-centric clinical study included 150 eyes of 150 keratoconus patients. Four centers in Egypt participated in this study included: Departments of Ophthalmology in Alexandria University, Tanta University and Port Said University and Alex I-Care hospital.

A novel Q-value-based nomogram for single intracorneal ring segment implantation versus standard manufacturer's nomogram combined with accelerated cross-linking for treatment of keratoconus: a randomized controlled trial.

Purpose: To compare the efficacy of implanting a single Keraring segment according to a novel Q-value-based nomogram (QN) to that of segment implantation according to the manufacturer's standard nomogram (SN), for keratoconus treatment.

Methods: This was a prospective, randomized controlled trial of 104 patients (104 eyes) with Amsler-Krumeich grade 1 or 2 keratoconus, and type 1 or 2 cone asymmetry determined according to manufacturer's classification. They were randomly distributed into two groups: group A patients (n = 52) underwent Keraring implantation according to the SN, and group B patients (n = 52) underwent implantation of a single (210° arc-length) Keraring segment according to the QN.

Ten years experience of corneal collagen cross-linking : An observational study of 6120 cases.

Purpose: To study the effect of corneal collagen cross-linking (CXL) using riboflavin and ultraviolet rays on cases of corneal ectasia in keratoconus cases, post-laser-assisted in situ keratomileusis ectasia, and pellucid marginal degeneration and to present its long-term results over many years.

Methods: This study was conducted throughout 10 "years" experience in corneal collagen CXL, including 6120 cases. The study consists of two parts: a retrospective and a prospective part.

Association Between Keratoconus and Thyroid Gland Dysfunction: A Cross-Sectional Case-Control Study.

Purpose: To examine the clinical association between thyroid gland dysfunction and keratoconus.

Methods: This was a cross-sectional case-control study conducted between May 2018 and July 2019. After performing Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany) examination, flat, steep, and maximum simulated keratometric readings were recorded for each patient.

Long-Term Refractive Outcome of Small Incision Lenticule Extraction in Very High Myopia.

Purpose: To assess the stability, safety, predictability, and efficacy of small incision lenticule extraction (SMILE) in high myopia.

Methods: The study was conducted as a retrospective noncomparative analysis of the records of 495 eyes of 270 patients treated by the ReLEx SMILE technique for a mean spherical myopic error of -12.84 ± 2.

Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management.

Purpose: To analyze the effectiveness and stability of the refractive, topographic and visual outcomes of the standard cross-linking (SCXL) in keratoconus (KC) management.

Patients And Methods: This study was designed as a retrospective non-comparative study that included 28 KC patients (n=49 eyes) who performed SCXL as a single procedure to treat KC and completed five-year follow-up period. The topographic, refractive and visual data were recorded preoperatively and at 12, 24, 36 and 60 months postoperatively.

Standard cross-linking protocol versus accelerated and transepithelial cross-linking protocols for treatment of paediatric keratoconus: a 2-year comparative study.

Purpose: To compare the efficacy, safety and stability of standard epithelium-off cross-linking (SCXL) versus accelerated epithelium-off cross-linking (ACXL) and transepithelial epithelium-on cross-linking (TCXL) in the treatment of progressive keratoconus (KC) in children.

Methods: This prospective multicentre controlled trial included 271 eyes (136 children) with grade 1-3 progressive KC who were randomized to undergo SCXL (n = 91, as a control group), ACXL (n = 92) or TCXL (n = 88). Uncorrected and corrected distance visual acuity, subjective refraction, pachymetry, keratometry and corneal topography measurements were recorded preoperatively and 6, 12 and 24 months postoperatively.