Phytoremediation of Lebanese polluted waters: a review of current initiatives

Water pollution is presently considered as a serious apprehension in Lebanon. Heavy contamination load of nutrients, heavy metals and organic pollutants can be highly harmful for human health and detrimental to aquatic life and ecosystems. Phytoremediation in natural and constructed wetlands using aquatic macrophytes present a sustainable plant-based technology recognized as a very efficient option in water treatment. The employment of species such as Phragmites, Sparganium, Lemna sp and other aquatic macrophytes not only helps in pollution cleanup but also conserves aquatic communities. To date, two pilot constructed wetlands, Litani River and Bcharreh have been established in Lebanon. These promising initiatives have been, however, accompanied with very limited research studies to examine the role of utilized plants and their efficiency in the remediation process. This paper presents an overview of the status of these initiatives and phytoremediation potential in Lebanon

Newly recorded for the vascular flora of Lebanon: Ferula biverticellata J.Thiébaut (Apiaceae)

During surveys in 2020 on the Lebanese western slopes of Mount Hermon, we detected Ferula biverticellata J.Thiébaut, which is new to the flora of Lebanon. The species has a distribution extending from Mount Hermon, the Golan, and the Hauran in South Syria to the Negev and Transjordan. We discuss the range of this southern Levantine element, its presence in Lebanon, and its conservation status

“No-touch” DMEK surgical technique

Descemet membrane endothelial keratoplasty (DMEK) has become an increasingly popular first line treatment for patients with corneal endothelial disorders and corneal decompensation. The standard surgical technique, and alternative unfolding techniques and their rationales will be discussed

Manual mid-stromal dissection as a low risk procedure to stabilize mild to moderate progressive keratoconus

Abstract Background To evaluate the efficacy of manual mid-stromal dissection in stabilizing progressive keratoconus. Methods Surgeries were performed in 16 eyes of 14 patients with progressive keratoconus. All eyes were examined before and at 1 day, 1 week, 1, 3, 6 and 12 months after surgery, and every 6 months thereafter. Pentacam (simK, Kmax and pachymetry), best corrected visual acuity (BCVA) and subjective refraction were recorded up to the latest follow-up visit (mean follow-up time 6.6 ± 2.4 years). Results All surgeries were uneventful, and no postoperative complications occurred. Keratometry values (n = 15) stabilized in 6/11 eyes (55%) with a preoperative Kmax  60 D showed continued progression. In 11/15 eyes (73%) pachymetry was unchanged. BCVA with spectacles remained stable in 7/12 eyes (58%) and improved ≥2 Snellen lines in 5/12 eyes (42%). BCVA with a contact lens remained stable in 4/9 eyes (44%), improved ≥2 Snellen lines in 3/9 eyes (33%) and deteriorated in 2/9 eyes (22%). Conclusions Manual mid-stromal dissection was effective in 50% of keratoconic corneas with Kmax values < 60 D and may be considered in cases ineligible for other interventions such as UV-crosslinking, stromal ring implantation or Bowman layer transplantation. An advantage of the procedure may be that the tissue is unaltered and that no synthetic or biological implant is required

Quarter-descemet membrane endothelial keratoplasty : one- to two-year clinical outcomes

Purpose:To report clinical outcomes of the first Quarter-Descemet membrane endothelial keratoplasty (Quarter-DMEK) case series performed for central Fuchs endothelial corneal dystrophy.Methods:This is a prospective, interventional case series analyzing the clinical outcomes of 19 eyes of 19 patients with central Fuchs endothelial corneal dystrophy, that is, with guttae predominantly in the 6- to 7-mm optical zone, who underwent unilateral Quarter-DMEK at a tertiary referral center. Main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (ECD), and postoperative complications. Included eyes had up to 2 years of postoperative follow-up.Results:At 6 months postoperatively, all eyes reached a BCVA of >= 20/40 (>= 0.5): 18 of 19 eyes (95%) with >= 20/25 (>= 0.8) and 9 of 19 eyes (42%) with >= 20/20 (>= 1.0). Thereafter, BCVA remained stable up to 2 years postoperatively. The mean donor ECD decreased from 2842 139 cells/mm(2) (n = 19) before implantation to 913 +/- 434 cells/mm(2) (-68%) at 6 months (n = 19), 869 +/- 313 cells/mm(2) (-70%) at 12 months (n = 18), and 758 +/- 225 cells/mm(2) (-74%) at 24 months (n = 13) after Quarter-DMEK. Visually significant graft detachment requiring rebubbling occurred in 8 of 19 eyes (42%).Conclusions:Quarter-DMEK surgery yields visual outcomes similar to those of conventional DMEK and may potentially quadruple the availability of endothelial grafts. Further modifications of the graft preparation and the surgical technique may improve clinical outcomes in terms of lower ECD decrease and fewer graft detachments.Ophthalmic researc

Combined or sequential DMEK in cases of cataract and Fuchs endothelial corneal dystrophy—A systematic review and meta‐analysis

To compare the outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed after phacoemulsification and intraocular lens (IOL) implantation (sequential DMEK) and DMEK combined with phacoemulsification and IOL implantation (combined DMEK) in patients with Fuchs endothelial corneal dystrophy (FECD) and cataract. Systematic literature review and meta-analysis performed according to the PRISMA guidelines and registered in PROSPERO. Literature searches were conducted in Medline and Scopus. Comparative studies reporting sequential DMEK and combined DMEK in FECD patients were included. The main outcome measure of the study was the corrected distance visual acuity (CDVA) improvement. Secondary outcomes were postoperative endothelial cell density (ECD), rebubbling rate and primary graft failure rate. Bias risk was assessed and a quality appraisal of the body of evidence was completed using the Cochrane Robin-I tool. A total of 667 eyes (5 studies) were included in this review, 292 eyes (43.77%) underwent a combined DMEK, while 375 (56.22%) eyes underwent a sequential DMEK surgery. We found no evidence of a difference between the two groups (mean difference, 95% CI) regarding: (1) CDVA improvement (-0.06; -0.14, 0.03 LogMAR; 3 studies, I-2: 0%; p = 0.86); (2) postoperative ECD (-62; -190, 67 cells/mm(2); 4 studies, I-2: 67%; p = 0.35); (3) rebubbling (risks ratio: 1.04; 0.59, 1.85; 4 studies, I-2: 48%; p = 0.89); and primary graft failure rate (risks ratio: 0.91; 0.32, 2.57; 3 studies, I-2: 0%; p = 0.86). Of all the 5 non-randomized studies, all (100%) were graded as low quality. The overall quality of the analysed studies was low. Randomized controlled trials are needed to confirm no difference or superiority of one approach in terms of CDVA, endothelial cell count and postoperative complication rate between the two arms