Purpose To evaluate changes that occur in foveal avascular zone (FAZ) in diabetic hypertensive patients by optical coherence tomography angiography (OCTA). Patients and methods OCTA was performed for 60 eyes of 35 diabetic hypertensive patients. This study was done in Benha University Hospital between February and June 2021. FAZ area was measured by a frame that was centered around it. Moreover, the vessel density was measured also by detecting the superficial vessel density (SVD) and the deep vessel density (DVD). Results In diabetic hypertensive (60 eyes of 35 patients) with average age 55.52 (±6.88) years and mean duration of the disease 12.17 (±7.15) years, the mean value of the FAZ was 0.37 (±0.54) mm, denoting enlargement of the FAZ diameter. In addition, the vessel density showed that there is decreasing in the SVD (43.9±5.89) and it was correlated to the best-corrected visual acuity and age of the patients (P<0.05), while it was highly correlated to the DVD (P<0.001). On the other hand, there was a decrease in DVD with a mean of 43.17±7.44, which was statistically significant with the age of the patients (P<0.05), but there was no significant relationship with duration of the disease, glycated hemoglobin, and best-corrected visual acuity. Conclusion OCTA is a noninvasive technique to image the retinal and choroidal vasculature. The study concluded that diabetic retinopathy in the presence of systemic hypertension leads to increasing of the FAZ area. Moreover, it leads to decreasing in both the SVD and DVD. Also, it allows for early detection and easy follow-up of the disease.

Clinical relevance Early detection of keratoconus (KC) progression and timing for retreatment. Background Q value (coefficient of corneal asphericity) reflects the shape of the cornea, its refractive power, and spherical aberration. In this study, we aimed to analyze the correlation between changes in Q value and progression of KC in children. Patients and methods In this retrospective cross-sectional study, clinical data of 18 eyes of nine children that were diagnosed as bilateral progressive KC (four boys, five girls: mean age of 11.3±1.6 years) were extracted from a Scheimpflug camera (Pentacam) for analysis before (baseline) and annually after bilateral transepithelial corneal collagen cross-linking (TE-CXL) up to 5 years of follow-up. Results At all follow-up visits up to 5 years, Kmax improved significantly (mean change at 5 years was 1.6 D) (P<0.001); uncorrected visual acuity and best-corrected visual acuity showed significant changes at all follow-up visits (P<0.001). In seven (38.8%) eyes, KC had progressed by more than 1.0 D by the last follow-up visit, despite corneal cross-linking. In the last visit, there was a significant negative correlation between mean Q value and Kmax in both 6 and 8 mm anterior corneal zones (Pearson correlation coefficient, r=−0.847, P<0.001, r=−0.605, P<0.001, respectively). Conclusion There is significant negative correlations between changes in corneal asphericity and progression of KC in children, which could be considered with other parameters in early detection of disease progression and timing for retreatment after transepithelial corneal collagen cross-linking.

Purpose To evaluate the outcomes of early pars-plana vitrectomy (PPV) in the management of acute onset endophthalmitis after cataract surgery. Study design Retrospective observational study. Patients and methods We collected data from 11 patients who were diagnosed as acute infectious endophthalmitis within 6 weeks after cataract surgery, from January 2015 to December 2020 and had undergone early 23-G PPV and were followed up for 3 months. We analyzed factors that may affect prognosis and final visual outcomes. Results The mean age was 58±5 years, there was male predominance (72.7%). The mean axial length was 24.76±1.58 mm. The baseline best-corrected visual acuity was 2.3 logMAR and was improved to 1.2 logMAR at the third month (P<0.001). Mixed air/fluid intraocular tamponade was used in 63.6% of patients. About half of the cases had positive cultures (54.5%), and the most frequent organism was Staphylococcus aureus (66.7%). Retinal detachment was reported in 36.4% of patients. The preoperative factors correlated with final best-corrected visual acuity were posterior vitreous detachment and intraocular tamponade. Conclusions Early PPV for acute-onset endophthalmitis after cataract surgery aided in improving final visual outcome and preserving structural and functional integrity of the globe, thus preventing late complications that could affect patients’ quality of life. Factors that influence the final visual outcome were intraocular tamponade and posterior vitreous detachment.

Purpose To evaluate the outcomes of using air versus sulfur hexafluoride (SF6) gas tamponade in management of primary rhegmatogenous retinal detachment (RRD). Study design Retrospective case-series comparative study. Patients and methods We collected data from 120 patients in three tertiary university hospitals, that were diagnosed as primary RRD due to upper retinal break in the period from January 2021 to November 2022 and had undergone 23-G lens-sparing pars-plana vitrectomy with either air tamponade (Air group) or SF6 gas tamponade (SF6 group) and were followed up for 6 months. We analyzed the final visual outcomes between both groups. Results The mean age of the studied patients was 51±13 years (Air group=60 eyes, SF6 group=60 eyes). The mean axial length in Air group was 26.59±1.84 mm, the mean axial length was 26.46±1.49 mm in SF6 group. Best-corrected visual acuity was improved in both groups at the sixth month. In Air group 18.33% had recurrent RRD, while 10% in SF6 group. No significant difference regarding metamorphopsia was reported. Higher rate for cataract progression was noted among SF6 group. Conclusions Both Air and SF6 gas showed favorable results regarding the final visual outcome. Air is a less expensive tamponade with less timing for postoperative-prone positioning. Cataract progression was higher among SF6 group, however, the incidence of recurrent RRD was lower among SF6 group. Missed break was the primary cause for failed retinal reattachment.