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Keratoconus was found in 1.12% of patients seeking refractive surgery, with no gender preference. Most cases had bilateral affection. Astigmatism was the most common refractive error to be associated with keratoconus.

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. Pentacam (Wavelight Oculyzer II) and specular microscopy (Tomey EM-3000) were done to all eyes. Keratoconic eyes were classified according to Amsler classification into stage 1, 2 and 3. Stage 1 included 99 eyes, stage 2 included 32 eyes & stage 3 included 19 eyes. Results The mean age of keratoconus patients was 24.07 ± 6.154 years. Forty five cases were males (30%) and 105 cases were females (70%). There was statistically significant difference in endothelial cell density (p < 0.001) and coefficient of variation (p = 0.012) between different stages of keratoconus eyes. Regarding cell surface area, there was statistically significant difference in cell surface area between different stages of keratoconus eyes (p < 0.001). In addition, for cell morphology, there was statistically significant difference between different stages of keratoconus eyes (p < 0.001). Conclusions Qualitative and quantitative structural changes were seen in endothelial cells of keratoconus eyes by using specular microscopy. For stages 1 and 2, keratoconus may not affect the corneal endothelim significantly. The endothelium in stage 3 shows significant changes regarding polymegathism and pleomorphism.

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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 ± 2.47 D (range: −10.0 to −14.0 D) combined with a mean astigmatism of −1.17 ± 1.34 D (up to −4.0 D). The mean LogMAR corrected distance visual acuity (CDVA) was 0.2 ± 0.6. In this study, 225 patients had the bilateral SMILE procedure, whereas 45 patients had a single eye treated with SMILE. Results: One month after surgery, the mean refractive error was 20.72 ± 0.88 D (range: +1 to 21.5 D), and the mean postoperative astigmatism was −0.83 ± 1.04 D. The mean LogMAR UDVA was 0.2 ± 0.34. In the last follow-up visit, 3 years after surgery, all the before mentioned parameters were the same or within minimal changes with no statistically significant difference from the earlier results. However, the spherical error demonstrated a significant change from −0.72 ± 0.88 D at 1 month to −1.17 ± 1.01 D at the end of the follow-up. However, this change had an insignificant visual impact. At the end of the follow-up period, approximately 94% of patients had unchanged CDVA or gained one or more lines, 6% lost one line of CDVA, and 1% lost 2 lines. Conclusions: SMILE may be effective and safe, with a stable and predictable outcome for correction of very high myopia.