Context: An objective and quantitative analysis of the normal choroid and retina relation is required for a better understanding of changes that occur in retinal and choroidal diseases. Aims: This study aimed to evaluate choroidal thickness (CT) and corresponding retinal thickness (RT) using enhanced depth imaging mode of spectral-domain optical coherence tomography (SD-OCT) in normal emmetropic eyes. Methods: One hundred and six eyes of healthy, nearly emmetropic eyes of volunteers were examined by Spectralis OCT. Manual measurements of CT were done under the fovea and on the vertical and horizontal line scans at the ETDRS 1 and 3 mm circles. RT was measured in the center foveal subfield and at the same locations of CT measurements. Statistical Analysis Used: Data were analyzed using IBM SPSS software package version 20.0 (SPSS, Inc., Chicago, IL, USA). Results: With a mean age of 50.3 ± 16.5 years, the mean subfoveal choroidal thickness (SCT) was 297.5 ± 86.2 μ while the mean central RT was 264.3 ± 15.9 μ. The mean CT was thinnest at the nasal location but without statistical significance and SCT was higher in males than females. Significant and correlated age-related thinning was observed in both retina and choroid at all locations, except the fovea, where these changes were significant but not correlated. Conclusions: CT has an age-related thinning pattern that correlates with age-related retinal thinning in extrafoveal macular locations. In addition, age can be used as a guide in predicting the normal SCT in emmetropes.

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Purpose: To measure erythropoietin (EPO) level in vitreous and serum of patients with proliferative diabetic retinopathy (PDR) and to detect EPO single nucleotide polymorphism (SNP) genotyping expression in them. Materials and Methods: Concentrations of EPO in vitreous and serum of twenty diabetic patients with PDR undergoing vitrectomy (PDR group) were measured by chemiluminescent immunoassay and compared with those in nondiabetic (ND) patients undergoing vitrectomy for recent retinal detachment (ND group). Genotyping of EPO gene SNP (rs551238) was performed using real-time polymerase chain reaction technique. Results: There were a significant increase in serum EPO level in PDR group than in ND group and a highly significant increase in vitreous EPO level in PDR group than in ND group. Within the PDR group, vitreous EPO level was significantly higher than its serum level; there was up to 6-fold increase in the EPO vitreous level than its serum level. EPO gene SNP rs551238 was significantly associated with PDR in Egyptian patients. Conclusion: The results of the current study suggest the involvement of EPO in the pathogenesis of PDR. Hence, augmenting vascular endothelial growth factor inhibition with the use of EPO inhibitors may provide a better outcome in PDR treatment. The detection of EPO gene SNP rs551238 in Egyptian patients with PDR may help in the identification of the genetic predisposition to diabetic retinopathy in Egyptians and so may help in prevention and early detection of susceptible candidates to PDR.

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Purpose: We aimed to evaluate the best-corrected visual acuity (BCVA) and assess improvement of central macular thickness (CMT) in patients with diffuse diabetic macular edema (DDME) after an intravitreal injection of bevacizumab (Avastin^®) alone, or followed by modified grid macular laser photocoagulation. Subjects and Methods: This was a randomized prospective interventional study that included 78 eyes of 40 patients with DDME, divided into two groups of interventions: Group A received bevacizumab (Avastin^®) injections monthly for 3 months then pro re nata, and Group B received bevacizumab as Group A but followed by grid macular laser photocoagulation 2 weeks after the first injection. Patients were observed monthly for a 12-month period and their BCVA, intraocular pressure, and CMT were recorded. Results: Compared with the baseline, there was a significant decrease of CMT in both groups of patients (−138.3 ± 40.15 vs. −156.5 ± 33.47, respectively). The improvement in ME was more in the combined group than the Avastin^® group (P < 0.0001). After 12-month follow-up, the mean average change in visual acuity letter score was significantly improved in both groups (P < 0.018 and < 0.002, respectively). Conclusion: Combined Avastin^® and modified grid macular photocoagulation led to more stable improvement in the treatment of eyes with DDME.

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Aims: This study aims to study the factors predicting the visual outcome of pars plana vitrectomy (PPV) done for dislocated crystalline or artificial intraocular lens (IOL). Settings and Design: This was a retrospective observational study. Subjects and Methods: The records of patients who underwent PPV with lens retrieval and IOL exchange or repositioning for traumatic or iatrogenic dislocation of crystalline or artificial IOL were reviewed. Pre- and post-operative visual acuity and complications were recorded. Six-month patient follow-up data were reviewed. Statistical Analysis Used: Chi-square test. Results: Final best-corrected visual acuity (BCVA) 6/60 or better was found in the majority of patients who underwent PPV within 1 year of dislocation, but for patients who were delayed for over a year, the final BCVA was <6/60 (P = 0.001). Significant correlations were found between delayed PPV and postoperative retinal detachment (RD) (P = 0.001); between PPV for dislocated nuclear fragment(s) due to complicated cataract surgery and preoperative uveitis (P = 0.007) as well as postoperative cystoid macular edema (CME) (P = 0.001); between preoperative corneal edema and postoperative corneal decompensation (P = 0.03). Finally, the final BCVA <6/60 had significant correlations with preoperative corneal edema (P = 0.001) and uveitis (P = 0.039) and with postoperative corneal decompensation (P = 0.013), CME (P = 0.001), and RD (P = 0.001). Conclusions: In cases of dislocated lens, factors such as delayed intervention, dislocated nuclear fragment(s), preoperative uveitis, and corneal edema were related to increased postoperative sight-threatening complications resulting in poorer visual outcome.

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Aims: The study stands to evaluate the usage of bevacizumab against diabetic retinal neovascularisation. Materials and Methods: The outcome measures of study include the determination of visual acuity and retinal cum macular thickness after bevacizumab administration. Twenty diabetic retinopathy patients were screened for bevacizumab administration and given either one or two doses of bevacizumab. Patient's visual acuity and optical tomography's results were analyzed to determine the vision, retinal, and macular thickness. Statistical Analysis Used: The numeric results were passed through analysis of variance, employing “Student's t-test” as posttest for statistically determining the numeric outcomes. Results: Within 1 month of bevacizumab administration visual acuity (distant vision, near vision, and pinhole vision) was improved to logarithm of the minimum angle of resolution (MAR) 0.63 ± 0.07 from 0.87 ± 0.12 of distant vision. Pinhole vision was improved to log MAR 0.37 ± 0.06 from 0.478 ± 0.07 and near vision was improve to log MAR 0.477 ± 0.071 from 0.528 ± 0.069, and retinal thickness was decreased to 336 ± 17.35 μm from 429 ± 30.20 μm. Mean macular thickness was improved to 363.75 ± 24.54 μm from 452.37 ± 30.99 μm. Conclusion: Hence, the off-label use of bevacizumab for the said treatment may be proven beneficial.

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Purpose: To analyze clinical manifestations, management, and visual outcome in cases with globe perforation due to variable etiologies. Material and Methods: Fifty cases (35 males and 15 females) were included in the study. Out of the fifty cases, 5 cases had perforation after giving posterior subtenon's injection, 2 cases had after injecting subconjunctival gentamycin and dexamethasone, 35 cases after peribulbar anesthesia, 4 cases while taking suture during retinal detachment (RD) surgery, and 4 while making scleral tunnel in RD surgeries. A total of 41 patients underwent vitrectomy, from which 37 patients had vitrectomy with fluid–gas exchange and endolaser and 4 patients had vitrectomy with scleral buckle and silicon oil. Five patients underwent indirect argon laser photocoagulation to seal the retinal break, and in 4 cases, scleral buckle were placed and cryotherapy was done. Results: The final visual acuity after a mean follow-up of 6 months was better than 20/30–20/40 in 28 patients, between 20/40 and 20/60 in 5 patients, and 20/120–20/200 in 17 patients. Conclusion: If diagnosed early and treated adequately, a majority of patients with globe perforation could be saved with a good visual outcome.

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Purpose: The aim of the study was to compare the efficacy and safety of intravitreal triamcinolone acetonide (IVTA) versus posterior subtenon injection of triamcinolone acetonide (PSBTA) for diabetic macular edema (DME). Materials and Methods: The study design was a prospective, interventional, randomized controlled study. Participants: The study participants were 26 patients (Thirty eyes) with DME and central subfield thickness (CST) >250 μm. Intervention: Eyes were randomly assigned to two equal groups; Group A received a single 4 mg IVTA and Group B received a 40 mg PSBTA. Four patients had bilateral DME; they received IVTA in one eye and PSBTA in another eye. Main Outcome Measures: Changes in visual acuity (VA) and CST obtained using optical coherence tomography were measured during a 3-month follow-up. Potential treatment complications were monitored including change in intraocular pressure (IOP). Results: The mean preoperative CST was 393.7 ± 93.0 μm and 351.5 ± 56.4 μm in Group A and B, respectively. Both groups showed comparable significant improvement in CST and VA at 1 and 3 months postinjection compared to preoperative values. The mean CST in Group A was 282.2 ± 65.0 μm compared to 284.0 ± 59.0 μm in Group B at 1 month (P = 0.910) and 276.3 μm ± 71.1 compared to 260.2 μm ± 63.3 at 3 months (P = 0.519). The mean VA in LogMAR in both groups at 3 months was 0.47 ± 0.23 and 0.32 ± 0.29, respectively (P = 0.142), compared to preoperative VA of 0.80 ± 0.19 and 0.68 ± 0.23, respectively. The preoperative IOP was 13.80 ± 2.07 in the IVTA group and 13.07 ± 1.83 in the PSBTA group. IOP showed significantly higher elevation in the IVTA group at 1 and 3 months (19.4 mmHg ± 1.35 and 19.0 mmHg ± 1.36) compared to the PSBTA (16.5 mmHg ± 1.40 and 16.2 mmHg ± 1.50) (P = 0.000). No eyes had IOPs >21 mmHg. Conclusions: Posterior subtenon injection of TA is a safe and valid alternative to the intravitreal injection for the treatment of DME having a comparable effect on VA and CST, yet a lower risk of IOP elevation.

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Background: Correlation of abnormal fundus autofluorescence (FAF) patterns with best-corrected visual acuity (BCVA).Aim: This study aims to evaluate FAF patterns in eyes with early dry age-related macular degeneration (AMD) and correlate these patterns with logarithm of minimum angle of resolution (logMAR) BCVA. Settings and Design: Institutional, descriptive prospective cohort study. Subjects and Methods: One hundred fifty-nine eyes of 103 patients with early dry AMD were recruited. FAF imaging was done for all patients with the aid of confocal scanning laser ophthalmoscopy (cSLO). BCVA was recorded for all patients using logMAR BCVA. Statistical Analysis Used: Data were fed to the computer and analyzed using IBM SPSS software package Version 20.0 (Armonk, NY, USA: IBM Corp). Kruskal–Wallis test for abnormally quantitative variables, to compare between more than two studied groups and post hoc (Dunn's multiple comparisons test) for pairwise comparisons. The significance of the obtained results was judged at the 5% level. Results: Seven FAF patterns have been identified (normal, minimal change, focal increased, linear, patchy, reticular, and speckled pattern). The mean logMAR BCVA among eyes with different FAF patterns was significantly variable. Eyes with patchy FAF pattern had the best mean BCVA (0.15 ± 0.0), while eyes with linear FAF pattern had the worst mean BCVA (0.52). Conclusions: The mean logMAR BCVA was statistically significant variable among different FAF patterns in eyes with early AMD suggesting a possible link between each FAF pattern and the visual prognosis. This finding can aid in determining the visual potential of eyes with early AMD according to FAF pattern in large samples studies.

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Background: Correlation of abnormal fundus autofluorescence (FAF) patterns with optical coherence tomography (OCT) findings. Aims: The aim of this study was to evaluate FAF patterns in eyes with early dry age-related macular degeneration (AMD) and correlate these patterns with OCT findings. Settings and Design: This was an institutional, observational, cross-sectional study. Subjects and Methods: One hundred and fifty-six eyes of 102 patients with early dry AMD were recruited, FAF imaging was done for all patients with the aid of confocal scanning laser ophthalmoscopy. In addition, OCT imaging was done for all patients. Statistical Analysis Used: Chi-square test was used for analysis. Results: Six FAF patterns have been identified (normal, minimal change, focal increased, linear, patchy, and reticular pattern). There was a statistically significant difference in OCT findings (drusenoid retinal pigment epithelial detachment and inner- and outer-segment junction integrity) among various FAF patterns. Conclusions: The OCT findings were statistically significant variable among different FAF patterns in eyes with early AMD suggesting a possible link between each FAF pattern and the changes which take place in retinal structure. This finding can aid in determining the visual prognosis of eyes with early AMD according to FAF pattern in large sample studies.

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