Rotating Scheimpflug Imaging Indices in Different Grades of Keratoconus

Purpose. To evaluate accuracy of various Keratoconus (KC) screening indices, in relation to Topographic Keratoconus (TKC) grading. Setting. Al Watany Eye Hospital, Cairo, Egypt. Methods. Data of 103 normal (group 1) and 73 KC eyes (group 2), imaged by Pentacam (branded as Allegro Oculyzer), were analysed. Group 2 was divided into 2a: 14 eyes (TKC = 1, early KC), 2b: 25 eyes (TKC = 1 to 2 or 2, moderate KC), and 2c: 34 eyes (TKC = 2 to 3 up to 4, severe KC). Participants were followed up for six years to confirm diagnosis. Area under the receiver operating characteristic curve (AUROC) was calculated for evaluated curvature, elevation, and pachymetry indices with various reference shapes at different diameters. Results. When comparing normal to KC eyes, ten indices had significantly higher AUROC. Only five of them had significantly higher AUROC in early KC compared to normal corneas: Pachymetry Progression Index- (PPI-) Maximum (Max), Ambrósio’s Relational Thickness- (ART-) Max, PPI-Max minus PPI-Minimum (Min), central corneal thickness (CCT), and diagonal decentration of thinnest point from the apex (AUROC = 0.690, 0.690, 0.687, 0.683, and 0.674, resp.). Conclusion. Generally, ten pachymetry and elevation-based indices had significantly higher AUROC. Five indices had statistically significant high AUROC when comparing early KC to normal corneas

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Correlation between ocular biometric parameters and corneal endothelium in a sample of young Egyptian adults

Background: To evaluate the normative values of corneal endothelial cell parameters within a group of healthy young Egyptian adults using specular microscopy and to examine any correlations between endothelial parameters and refractive or biometric parameters. Methods: In this cross-sectional study, specular microscopy was used to study the right eyes of 150 healthy young volunteers and evaluated endothelial cell parameters, including cellular density, hexagonality (HEX), and coefficient of variation (CV) at 15 different points on the back corneal surface, which were later grouped into the central zone and either four quadrants or three annular zones. The same eyes underwent refractive and biometric assessments. Results: Hundred fifty healthy adults were examined, and the age ranged from 20 to 30 years, with a median of 23 (interquartile range, 21–27) years. The mean ± standard deviation of central cell density was 2902.7 ± 270.7 cells/square millimeter. The superior paracentral area had the lowest mean density (2895.8 cells/square millimeter), but the highest mean HEX (67.7%), while the inferior peripheral area had the highest mean density (3100.5 cells/square millimeter) but the lowest mean HEX (64%). The difference in cell density among the three annular zones was not statistically significant (P = 0.365). However, HEX and CV in the central and paracentral zones differed statistically significantly from those of the peripheral zone (P < 0.001 and P = 0.014, respectively). Weak but non-significant correlations were detected between endothelial cell density and all measured refractive and biometric parameters. Conclusions: The findings of this study provided useful normative biometric and specular data in a specific age group and a specific population, and could be useful in planning intraocular surgery in young Egyptian adults. However, future longitudinal studies with a larger sample could refine more endothelial cell parameter specifications over time

Recent modified technique for levator muscle tucking in blepharoptosis surgery

Purpose The aim of this study is to introduce a new modification on the classic technique of levator muscle tucking for correction of mild to moderate blepharoptosis and to evaluate its functional and aesthetic outcome. Patients and methods This is a tertiary-center study that included 180 patients with mild to moderate ptosis with good levator function (≥8 mm) according to Beard’s classification. Patients with severe congenital, recurrent, mechanical, traumatic ptosis, third nerve palsy, Marcus–Gunn jaw winking syndrome, absent Bell’s phenomenon, or associated ophthalmoplegia were excluded. A recently introduced resection tucking procedure with a spindle excision of the levator aponeurosis was performed. The procedure outcome was assessed functionally by measuring the distance between the upper lid margin and the superior limbus in bilateral cases and accordingly they were classified as very good (2 mm), good (2–4 mm), and poor (5 mm) as well as comparing the preoperative to the postoperative margin reflex distance (MRD1) in unilateral cases. Assessing the aesthetic outcome was done by measuring the eyelid height symmetry, presence of lid crease, lid contour, and patients’ postoperative satisfaction. Results The success rate of the procedure was 92.1% [very good (77.7%) and good (14.4%), P < 0.0001]. The MRD1 improved significantly from a preoperative value of 3.28±0.44 mm to 4.44±0.57 mm postoperatively (P < 0.0001). Regarding the aesthetic outcome, symmetrical lid height was achieved in 86.1% of the unilateral cases and in 84% of the bilateral cases, while symmetry of the lid crease was reported in 88.8% of the cases and regularity of the lid contour in 91.6% of the cases. Postoperative patients’ satisfaction was reported by 83% of the patients. The time of procedure was 27.4±4.6 min/eye. Conclusion This modified technique of levator tucking was performed in a short time and proved to be an effective technique, with minimal complications and high aesthetic satisfaction outcome

Cap-preserving SMILE Enhancement Surgery

Abstract Background Different enhancement procedures have been suggested for reduction of residual refractive errors after SMILE. The aim of this study is to evaluate an improved cap-preserving technique for enhancement after SMILE (Re-SMILE). Methods A retrospective case series was conducted at Eye subspecialty center, Cairo, Egypt on 9 eyes with myopia or myopic astigmatism (spherical equivalent – 8.0 and − 12.0D). undergoing SMILE procedure and needed second interference. This was either because the more myopic meridian was more than − 10.0 D and therefore planned to have two-steps procedure (six eyes) or because of under correction needing enhancement (three eyes). Assessment after the primary SMILE procedure was conducted at 1 day, 1 week, 1 month and 3 months postoperatively. Assessment after Re-SMILE was conducted at 1 day, 1 week, 1 month, 3 months, 6 months and 1 year postoperatively. The assessments included full ophthalmic examination, objective and subjective refraction, and rotating Scheimpflug camera imaging. Results Preoperatively, the mean refractive spherical equivalent (MRSE) values were: − 9.36 ± 0. 89. After primary SMILE it was − 2.18 ± 0.71. After Re-SMILE it was − 0.13 ± 0.68. MRSE was significantly improved after both procedures (P < 0.01). The safety index of primary SMILE cases was 1.65 ± 0.62 and for Re-SMILE 1.13 ± 0.34 and the efficacy index was 1.14 ± 0.24 after primary SMILE and 1.11 ± 0.26 after Re-SMILE. Conclusion Centered cap-preserving Re-SMILE is an effective procedure in reducing residual refractive errors after primary SMILE in high myopes

Topographic Asymmetry Indices: Correlation between Inferior Minus Superior Value and Index of Height Decentration

Purpose. To investigate the correlation between decentration index (index of height decentration, IHD) automatically calculated by the Pentacam HR software and the manually calculated inferior minus superior (I‐S) value. Setting. Al Watany Eye Hospital, Cairo, Egypt. Methods. In a retrospective study, history taking, clinical examination, and rotating Scheimpflug camera scanning (by Oculyzer II equivalent to Pentacam HR) were done to 128 eyes: 82 normal, 24 forme fruste keratoconus FFKC (apparently normal cornea with evident keratoconus in the fellow eye), and 22 keratoconus (KC). All cases of corneal scars or previous corneal surgeries were excluded. The (I‐S) value was calculated manually from 10 points astride the horizontal meridian. The IHD is calculated automatically by the device software 1.17r119. Results. The mean (±SD) of (I‐S) value in normal, FFKC, and KC eyes were 0.30 ± 0.93, 0.11 ± 2.03, and 4.62 ± 3.89, respectively, and those of IHD were 0.008 ± 0.004, 0.011 ± 0.005, 0.066 ± 0.067, respectively. The two indices were highly correlated (p<0.0001) with a correlation coefficient (r2 = 0.874). Deduced regression formulae linking the two indices were calculated. Conclusions. The two topographic decentration indices are highly correlated. Deduced formulae were proposed linking them