Eye emergency during wars; Take-home message for soldiers

War is an organized and prolonged armed dispute between states or nations. It is characterized by high mortality, violence, and social or economic costs. There are multiple causes of war and conflict, including extreme poverty, high unemployment, and social, political, or economic disparities. The incidence of wars has increased since 1950, especially between states. Small Arms Survey reports that warfare kills nearly 133,750 persons, yearly. The rates of disability and death caused by war are more than many major diseases globally. It destroys the healthcare systems and public health services of the included states or societies, which results in more diseases and deaths

Comparing the success rate of external dacryocystorhinostomy with anterior flap versus flap excision in managing chronic dacryocystitis

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

Longitudinal changes in peri-papillary retinal nerve fiber layer thickness in patients with unilateral branch retinal vein occlusion

Background: Associations between retinal venous occlusion (RVO), elevated intraocular pressure, and glaucoma have been reported. Further investigations into structural alterations in the fellow eyes of individuals with unilateral RVO have revealed that the peripapillary retinal nerve fiber layer is thinner than in healthy eyes, suggesting that there may be systemic risk factors common to both RVO and glaucoma. We aimed to evaluate changes in peripapillary retinal nerve fiber layer thickness (pRNFLT) among individuals with unilateral branch retinal vein occlusion (BRVO). Methods: This prospective observational study recruited 30 individuals (60 eyes) with newly diagnosed unilateral BRVO and macular edema, and a control group of 30 healthy individuals (30 eyes) with no abnormalities on fundus examination or concurrent systemic comorbidities. After baseline measurements, the participants were reassessed at 6, 12, and 24 months by measuring global and sectoral pRNFLT using spectral-domain optical coherence tomography. Results: The mean age and sex distributions were comparable between the patient and control groups (both P > 0.05). When compared to fellow eyes, global and sectoral pRNFLT in eyes with BRVO were significantly higher at baseline (all P < 0.05). Over time, pRNFLT decreased dramatically, and by the conclusion of the two-year follow-up, there was a significant reduction from baseline in the affected eyes (all P < 0.05). Likewise, affected eyes experienced a significant improvement in best-corrected distance visual acuity and central macular thickness over the two-year follow-up (both P Less than or equal to 0.001). Comparing the global and all-sector pRNFLT of fellow eyes in the patient group with those of normal eyes in the control group, there were no significant differences at any visit, except in the temporal sector, which revealed a significant reduction in pRNFLT at 24 months in the fellow eyes of patients with unilateral BRVO (P = 0.02).   Conclusions: Patients with unilateral BRVO experienced a significant reduction in pRNFLT in the affected eyes and, to a lesser extent, in the fellow eyes, compared with that of the control arm, suggesting that they are prone to retinal nerve fiber layer damage. The reduction in pRNFLT in the normal fellow eyes of patients with BRVO may be attributed to age or concurrent systemic comorbidities. Further studies with long follow-up periods are required to shed light on the etiology of functional and structural changes in both the retinal nerve fiber layer and ganglion cell complex in the normal and affected eyes of patients with unilateral BRVO

Anterior lamellar recession versus bilamellar tarsal rotation in upper lid cicatricial trichiasis

PURPOSE: In recent years, there has been a significant shift from this destructive procedure to a reconstructive procedure such as anterior lamellar recession (ALR) and bilamellar tarsal rotation (BLTR). The aim is to report the outcomes and success rates of ALR compared to BLTR in patients with upper lid cicatricial trichiasis. MATERIALS AND METHODS: Our study is a prospective, interventional, comparative study that was conducted at the Ophthalmology Department of Al-Azhar University Hospital, New Damietta, Egypt. Our study was conducted on 62 eyes of 45 consecutive patients suffering from upper lid cicatricial trichiasis that required surgical intervention (17 patients were bilateral and 28 were unilateral). Thirty-three of them were treated by ALR (group 1), and 29 of them by BLTR (group 2). All statistical analysis was performed using the SPSS version 26. RESULTS: As regards the immediate postoperative correction, we found that adequate correction was significantly higher in the ALR group at all follow-up periods (P < 0.05). However, the overcorrection and undercorrection were significantly higher in the BLTR group (P < 0.05). Compared to the ALR group, the BLTR group saw a greater undercorrection at 1, 3, and 6 months (9.3%% vs. 0%; P = 0.048, 18.6% vs. 1.8%%; P = 0.009, 18.6%% vs. 1.8%; P = 0.009, 18.6%% vs. 1.8%; P = 0.009, respectively). CONCLUSION: ALR is better than BLTR in the treatment of upper lid cicatricial trichiasis