To report clinical, serological, and histopathological findings in Egyptian patients with dacryoadenitis associated with ImmunoglobulinG4-related disease (IgG4-RD). Methods: We retrospectively revised medical records of patients presented to Al-Azhar University Hospitals with lacrimal gland (LG) swelling between June 2016 and February 2022. We included patients with definite IgG4-related disease (IgG4-RD) diagnosis and excluded those with possible, probable, or unlikely IgG4-RD based on The Japanese Ministry of Health, Labour, and Welfare's 2011 guidelines. Results: Sixteen cases were included in the study (Fourteen females and two males, mean age 39.2±12.2 years); Seven cases met the criteria of Mikulicz disease, and nine cases met full clinical, serological, and histopathological criteria. Mean reported serum IgG was 1792.5 ± 313.7 (range 1063-2134) mg/dl, mean serum IgG4 was 576.25±215.3 (range 112-841) mg/dl, and mean Serum IgG4/IgG ratio was 31.9 ± 12.4%. The mean number of IgG4+ plasma cells/HPF was 74 ± 21.2, and the mean IgG4+ plasma cell percentage was 55 ± 9.7%. Serum IgG4 level showed a positive correlation to tissue IgG4+plasma cell percentage, while serum IgG4/IgG ratio positively correlated to both percentage and number of IgG4+plasma cells. Steroids had a good initial response, but recurrences were common. Conclusion:A considerable proportion of patients with lacrimal gland swelling fall within the range of IgG4-RD. Proper diagnosis requires clinical, serological, and histopathologic correlation. Patients require long follow-up periods.

Background: Nasolacrimal duct obstruction (NLDO) is characterized by epiphora and recurrent episodes of acute dacryocystitis. Despite the temporary effect of antibiotics in the acute phase, it is primarily managed by dacryocystorhinostomy (DCR). There is a new modification of external DCR that is performed without either anterior or posterior flaps. This study aimed to compare the outcomes of flapless and single-flap external DCR in adult patients with chronic symptomatic dacryocystitis secondary to NLDO. Methods: In this retrospective, non-randomized, interventional, comparative study of patients with chronic dacryocystitis secondary to primary acquired NLDO, we compared the surgical outcomes and complication rates of flapless external DCR to those of external DCR with only anterior flap suturing. We excluded patients who declined participation and those with soft stops, nasal problems, lid margin abnormalities, lid malposition or laxity, previous lacrimal surgery, lacrimal fistula, trauma involving the lacrimal drainage system, lack of adequate follow-up, or severe septal deviation or turbinate hypertrophy. Anatomical and functional success rates were determined at the last follow-up visit and were compared. Postoperative complications were recorded and compared between groups. Results: We included 53 patients with a male-to-female ratio of 16 (30.2%) to 37 (69.8%); 25 eyes underwent flapless DCR (group 1) and 28 eyes underwent anterior flap suturing DCR (group 2). The two groups had comparable demographic characteristics (all P > 0.05). Furthermore, anatomical (92.0% in group 1 and 92.9% in group 2) and functional (84.0% in group 1 and 92.9% in group 2) success rates at final follow-up were comparable between groups (both P > 0.05). At the one-month postoperative examination, premature tube extrusion was more often reported in group 1 (12.0%) compared to group 2 (7.1%). At the two-month follow-up examination, tube extrusion was noted in 4.0% in group 1 and 0.0% in group 2, yet the difference failed to attain statistical significance (P > 0.05). Conclusions: We found that neither surgical method was superior in terms of anatomical or functional success rate at a maximum of one year after external DCR. Flapless DCR is a simple, effective, and reproducible alternative to the single anterior flap suturing technique for managing NLDO in adults with chronic dacryocystitis. However, further randomized clinical trials with larger sample sizes and longer follow-up periods are recommended before generalization can be justified.

BACKGROUND: Branch retinal vein occlusion (BRVO) has an incidence of 0.5–1.2%. COVID-19 is associated with both venous and arterial thromboembolisms due to excessive inflammation, hypoxia, immobilization, and diffuse intravascular coagulation. AIM: The present study aims to describe our experience with BRVO in Egyptian COVID-19 patients. PATIENTS AND METHODS: The present retrospective study included 17 polymerase chain reaction (PCR)-proven COVID-19 patients with BRVO. Data obtained from the studied patients included detailed history taking. In addition, patients were diagnosed with BRVO based on a comprehensive ophthalmic evaluation, including logMAR Best-corrected visual acuity assessment, slit-lamp bio-microscopy, fundoscopy, fundus fluorescein angiography, and optical coherence tomography macular assessment. RESULTS: The present study included 17 PCR-proven COVID-19 patients with BRVO. They comprised 9 males (52.9%) and 8 females (47.1%) with an age of 52.8 ± 13.3 years. Fundus examination revealed BRVO as superior temporal in 9 patients (52.9%), inferior temporal in 5 patients (29.4%), superior nasal in 2 patients (11.8%), and inferior nasal in 1 patient (5.9%). The reported retinal thickness was 355.7 ± 41.7 μm. In addition, fundus fluorescein angiography identified ischemic changes in 2 patients (11.8%). CONCLUSION: BRVO is a rare severe complication of COVID-19 infection. In patients with proven or suspected infection with a diminution of vision, there should be high suspicion of BRVO and prompt full-scale ophthalmological examination to exclude the condition.