Showing papers in "The Open Ophthalmology Journal in 2022"

Early Postoperative Effect of Ripasudil Hydrochloride After Trabeculectomy on Secondary Glaucoma: A Randomized Controlled Trial

Abstract: To evaluate the effect of Rho-associated kinase inhibitor (ripasudil hydrochloride hydrate; ripasudil) eye drops on postoperative intraocular pressure (IOP) after trabeculectomy in eyes with uveitic glaucoma. This was a prospective, observational, controlled, and randomized study. Sixteen eyes of 16 patients with uveitic glaucoma who underwent trabeculectomy without mitomycin C were randomly treated without ripasudil (8 eyes) and with ripasudil (8 eyes). Postoperative IOP and surgical outcomes 3 months after surgery were compared between the two groups. No patient discontinued treatment due to the lack of efficacy or adverse effects of ripasudil during the 3-month study period in the ripasudil group. The mean IOP (mmHg) in the control and ripasudil groups were 42.5 ± 9.8 mmHg /43.9 ± 11.7 mmHg (p = 0.82) at baseline, 14.3 ± 4.9 mmHg /9.0 ± 3.7 mmHg (p = 0.04) at 1 week, 16.3 ± 4.2 mmHg /10.6 ± 3.0 mmHg (p = 0.01) at 1 month, and 16.0 ± 3.4 mmHg /12.5 ± 2.3 mmHg (p = 0.04) at 3 months. The number of laser suture lysis procedures (2.0 ± 0.5 vs 0.4 ± 0.7), the rate of bleb revision by needling (50.0% vs 0.0%), and the mean number of antiglaucoma medications (1.6 ± 1.5 vs. 0.1 ± 0.3) after trabeculectomy were higher in the control group than in the ripasudil group (all p < 0.05). A multivariate analysis showed that the IOP reduction rate at 3 months after surgery was associated with the use of ripasudil and baseline IOP (all p < 0.05). This study demonstrated the therapeutic efficacy, safety, and tolerability of ripasudil for 3 months postoperatively. Ripasudil may effectively reduce postoperative IOP and increase the success rate of trabeculectomy in patients with uveitic glaucoma.

Age-related Changes of the Corneal Endothelium in the Hispanic Elderly Population

Abstract: Purpose: To assess the corneal endothelial morphometry in healthy elderly Hispanic eyes. Methods: A retrospective, cross-sectional, observational, descriptive, and analytical study was designed to assess the central region of the corneal endothelium by specular microscopy. A total of 241 eyes from 125 patients were studied. All eyes included were from healthy patients 65 or older (mean: 74.56± 6.74), without ocular disease or surgeries. Results: The mean cell density (MCD) was 2198.92±493.43 cells/mm 2 . 125 (51.87%) eyes had polymegethism, with a mean coefficient of variation (CV) of 42.89 ± 9.16%. 148 (61.41%) eyes presented pleomorphism, with an average of 46.25 ± 7.13% hexagonal cells. The mean corneal thickness was 527.55±28.37 μm. A statistically significant difference between age groups was found for MCD and pachymetry (P<0.05). 41 eyes (17.01%) had cornea guttata. Conclusion: This study suggests that the elderly Hispanic population has a high prevalence of polymegethism, pleomorphism, and guttata. Surprisingly, the oldest age group (>85) had an above-average MCD, with lower rates of polymegethism and pleomorphism. Trial Registration Number: #ARCC/ECH2019 Date of Registration: October 18, 2019

Ocular Manifestations in Patients with Coronavirus Disease 2019 (COVID-19): A Real World Multicenter Observational Study in Egypt

Abstract: The aim of the work was to evaluate the ocular manifestations in the patients with COVID-19 and its role in the prediction of the course and the outcome of the disease. This retrospective study was conducted at two tertiary referral COVID-19 isolation hospitals in two major university hospitals in Egypt. Two hundred and twenty-eight patients were enrolled in the study. The medical records of patients who had clinically confirmed COVID-19 between 1/5/2020 to 15/7/2020 were retrospectively reviewed. Data were collected from patient charts, including age, sex, accommodation, ocular manifestations, fever, headache, cough, dyspnea, anosmia, cyanosis, abdominal pain, anorexia, liver, kidney, cardiac manifestations, CT, X-ray finding, blood tests, and outcome of the disease. Thirty-four patients with ocular manifestation were finally enrolled in the study with a mean age of 42.1 years; 20 patients (58.8%) were men. The incidence of ocular manifestation was 14.9% (34/228). All patients with ocular manifestations had conjunctivitis (redness, epiphora, foreign body sensation), which had been treated and resolved completely within 10 days in all patients without any permanent ocular damage. There was a trend between the presence of ocular manifestations and the associated milder disease course, although this trend was not statistically significant. Ophthalmic manifestation is common in patients with COVID-19 and it occurs more frequently in patients with mild to moderate form of COVID-19, but it could not predict the patient’s mortality.

Toric Implantable Phakic Contact Lens in the Correction of Stable Keratoconus after Corneal Collagen Crosslinking

Abstract: The study aims to evaluate the safety profile and efficacy of toric Implantable Phakic Contact Lens (IPCL) in patients with stable keratoconus after corneal collagen crosslinking (CXL). A prospective interventional case series study involving 30 keratoconic eyes between 22 to 39 years of age implanted with toric IPCL 6 months after CXL. The refractive error, visual acuity, corneal endothelium, intraocular pressure (IOP), and adverse effects were observed for 12 months following the implantation. The preoperative mean for the sphere was approximately -8.3±3.6, which improved postoperatively by -0.58±0.23 after 1 month, -0.48±0.19 after 3 months, -0.36±0.18 after 6 months, and -0.35±0.2 after 12 months respectively. About the cylinder, the preoperative mean for the cylinder was approximately -3.4±1.6, which improved postoperatively by -1.06±0.3 after 1 month, -0.76±0.19 after 3 months, -0.48±0.28 after 6 months and -0.53±0.12 after 12 months, respectively. The preoperative BCDVA was 0.34±0.13, which increased postoperatively to 0.18±0.11 after 12 months. The mean values for IOP were 14.5±1.5 mm Hg, 15.1±2.09 mm Hg, 13.8±2.2 mmHg, 13.3±1.7 mm Hg, 13.1±1.6 mm Hg at preoperative period, 1 month, 3 months, 6 months and 12 months postoperatively. The mean preoperative endothelial count was 2912.9±111.1 per square millimeter, 2854.7±113.2 cells per square millimeter after 6 months, and 2829.0±112.2 cells per square millimeter after 12 months. Toric IPCL is a safe approach for treating residual refractive errors, particularly astigmatism, after 6 months of CXL in patients with stable KCS.

Status of Childhood Eye Care Services in the Kingdom of Saudi Arabia: Eye Care Professionals’ Perspectives

Abstract: The World Health Organization (WHO) reported that there are approximately 19 million visually impaired children worldwide, and most of the conditions are treatable by early intervention at the primary, secondary, and tertiary levels. To assess the status of paediatric eye care services in the Kingdom of Saudi Arabia A cross-sectional study was conducted among eye care professionals (optometrists and ophthalmologists) in public sector hospitals in various regions of Saudi Arabia. Data were collected through an online self-administered paediatric eye care service questionnaire based on a validated questionnaire. A total of 137 completed questionnaires were obtained, with a response rate of 83%. The highest percentage of trained paediatric teams at hospitals was recorded at 95% in the eastern region (p= 0.024), while the lowest percentage was 44% in the southern region. Trained paediatric nurses were available in 88% of the eastern region hospitals, followed by 56% of the central region hospitals (p= 0.001). Services such as separate paediatric optometry clinics, dedicated ophthalmology outpatient clinics, and advanced diagnostic equipment were significantly higher in number in the eastern region than in the other regions (p˂0.001). The general status of human resources of eye professionals reveals that 73% of the facilities had both trained optometrists and ophthalmologists, approximately 70.8% had anaesthesiologists available, and almost 73.7% had easy access to available paediatricians. The overall quality of paediatric eye-related health care is satisfactory in most Saudi regions. However, there are some discrepancies among the regions in paediatric eye care services and facility types, which may need to be addressed by decision-makers in the Ministry of Health.

Molecular Variants in Genes related to the Response to Ocular Hypotensive Drugs in an Afro-Colombian Population

Abstract: This study aimed to conduct an exploratory analysis of the pharmacogenomic variants involved in ocular hypotensive drugs to understand the individual differential response in an Afro-descendant population. Glaucoma is the leading cause of irreversible blindness worldwide. The pharmacologic treatment available consists of lowering intraocular pressure by administering topical drugs. In Asian and Caucasian people, pharmacogenomic variants associated with the efficacy of these treatments have been identified. However, in Afro-descendant populations, there is a profound gap in this knowledge. This study identified the pharmacogenomic variants related to ocular hypotensive efficacy treatment in Afro-descendant individuals from the Archipelago of San Andres and Providence, Colombia. An analysis of whole-exome sequencings (WES), functional annotation, and clinical significance was performed for pharmacogenomic variants reported in PharmGKB databases; in turn, an in silico available prediction analysis was carried out for the novel variants. We identified six out of 18 non-synonymous variants with a clinical annotation in PharmGKB. Five were classified as level three evidence for the hypotensive drugs; rs1801252 and rs1801253 in the ADRB1 gene and rs1042714 in the ADRB2 gene. These pharmacogenomic variants have been involved in a lack of efficacy of topical beta-blockers and higher systolic and diastolic pressure under treatment with ophthalmic timolol drug. The rs1045642 in the ABCB1 gene was associated with greater efficacy of treatments with latanoprost drug. Also, we found the haplotypes *17 for CYP2D6 and *10 for CYP2C19; both related to reducing the enzyme activity to timolol drug metabolization. In addition, we observed 50 novel potentially actionable variants; 36 synonymous, two insertion variants that caused frameshift mutations, and 12 non-synonymous, where five were predicted to be pathogenic based on several pathogenicity predictions. Our results suggested that the pharmacogenomic variants were found to decrease the ocular hypotensive efficacy treatment in a Colombian Afro-descendant population and revealed a significant proportion of novel variants with a potential to influence drug response.

Clinical Outcomes of Toric Implantable Collamer Lens (T-ICL) and Toric Implantable Phakic Contact Lens (IPCL) for High Myopia with Astigmatism: A Comparative Study

Abstract: Our study aimed to compare the clinical, visual outcomes, and efficacy of toric Implantable Collamer Lens (T-ICL) and toric implantable phakic contact lens (IPCL) in patients with high myopia and astigmatism over a follow-up period of 6 months. A prospective interventional randomized comparative study included 60 myopic eyes divided into 2 groups, group A including 30 eyes that were implanted with T-ICL, and group B, including 30 eyes that were implanted with toric IPCL. The refractive results, visual acuity, central corneal endothelial cell count, and intraocular pressure (IOP) were evaluated at baseline and at 1 and 6 months post-surgery. Any complications either during or after surgery were assessed. In both study groups, the mean central corneal endothelial cell count was significantly decreased after 1 month and improved to reach near pre-operative values after 6 months postoperatively, indicating good lens biocompatibility. A statistically significant increase in IOP was found in both groups during the early follow-up, and a significant decrease after 6 months postoperatively (p=0.036) was reported in group A. A significant reduction in both spherical and cylindrical refractive errors with good predictability was reported in both groups compared with pre-operative values. Regarding the predictability, In T-ICL group (A), the median spherical and cylindrical errors were significantly improved from (-10 D & -4.5 D) pre-operatively to (-0.3 D & - 0.3 D) at the end of 6 months follow up period. Similarly, in the toric IPCL group (B), the median spherical and cylindrical errors were significantly improved from (-11 D & -4.5 D) pre-operatively to (-0.3 D & - 0.3 D) by the end of follow up period. A statistically significant improvement of UCDVA at 6 months postoperatively was found in both groups, as median preoperative LogMAR UCDVA was 1.1 and 1.3 in groups A and B respectively, which was improved to 0.3 in both groups at the end of follow-up period. There were no reported intra- or postoperative complications such as cataract, keratitis, or lens decentration. Toric IPCL is a suitable alternative to T-ICL for the management of high myopia with astigmatism, especially in developing countries, as it is cheaper and easier to implant than T-ICL. However, data over longer follow-up periods are needed to confirm its safety and stability.

Prevalence of Visual Disorders among Urban Palestinian Preschool Children

Abstract: Childhood blindness is a major public health concern since 40% of visual disorders that can cause blindness among children are preventable. Vision screening programs among preschool children have been implemented in several countries as a tool for early detection and intervention of visual disorders. In Palestine, there is a lack of scientific data on the prevalence of visual disorders among children. In addition, vision-screening programs that are currently implemented are neither validated nor effective. Using validated vision screening protocols, a cross-sectional study is conducted to determine the prevalence of visual disorders among urban Palestinian preschool children between the ages of 3 to 5 years in Nablus city. All children attending eight preschools selected using single-stage cluster sampling technique, underwent a validated vision screening administered by trained eye care professionals. The screening protocol was based on a combination of clinical assessment adopted from the Modified Clinical Technique and the Vision in Preschoolers studies, including assessment of visual acuity, ocular alignment, depth perception, color vision, non-cycloplegic retinoscopy, and ocular health. A pass-fail criterion was used to refer all children who did not attend the vision screening for comprehensive eye examination, including cycloplegic retinoscopy and a dilated fundus exam. A chi-squared test was used to determine any association between visual disorders and their independent risk factors. A total number of 764 children underwent vision screening. Out of the 290 children who did not attend the vision screening, 127 children responded to the referral call for comprehensive eye examinations. Refractive error was the most prevalent visual disorder with a prevalence of (29.37%), followed by amblyopia (4.10%), color vision deficiency (1.24%), strabismus (1.24%), and ocular health abnormalities (0.70%). There was no age (p=0.35) and gender (p=0.32) variation in children having refractive errors. Anisometropia was the leading cause for amblyopia (1.32%, n=7), followed by significant refractive error (1.13%, n=6) and strabismus (0.37%, n=2). Refractive error was the most prevalent visual disorder affecting Palestinian preschoolers in Nablus. Anisometropia and significant refractive errors were found to be the major causes of amblyopia. Effective nationwide preschool vision screening programs should be implemented in Palestine to screen amblyogenic risk factors.

Corneal Curvature, Anterior Chamber Depth, Lens Thickness, And Vitreous Chamber Depth: Their Intercorrelations With Refractive Error In Saudi Adults

Abstract: Ocular biometrics, such as corneal curvature, axial length, anterior chamber depth, and lens thickness, play a significant role in the development of refractive error and are essential in many clinical and research applications. To determine means and ranges for corneal curvature, axial length, anterior chamber depth, lens thickness, vitreous chamber depth, and their intercorrelations with refractive error in Saudi adults. A total of 120 eyes of 60 hyperopic and 60 myopic subjects aged 19-26 years old were enrolled in this comparative cross-sectional study. Axial Length (AL), Anterior Chamber Depth (ACD), Lens Thickness (LT), and Vitreous Chamber Depth (VCD) were measured by the SONOMED ultrasound E-Z SCAN AB5500+, A-scan, with a contact technique. An ophthalmometer measured the refractive status objectively by auto-refraction and the corneal radius of curvature. The findings showed that the myopic eyes had a deeper ACD(3.70±0.27mm) than hyperopic eyes (3.28±0.32mm), P=0.0001. However, the hyperopic eyes had a thicker LT (3.84±0.24mm) than the myopic eyes (3.81±0.19mm), P=0.640. The mean of the corneal radius of curvature for the myopic eyes was slightly more curved (7.87±0.23mm) than for the hyperopic eyes (7.95±0.27mm), P=0.602. The myopic eyes had a higher axial length/corneal radius AL/CR ratio (3.12±0.11) than hyperopic eyes (2.89±0.06), with P=0.0001. Myopic spherical equivalent (SPH) positively correlated with VCD and AL/CR ratio, P=0.0001. Vitreous chamber depth/Axial length ratio (VCD/AL) in the myopic eyes was higher (0.693±0.041) than in the hyperopic eyes (0.677±0.018), P=0.000. Hyperopic SPH was positively associated with the VCD/AL ratio, P=0.0001. Myopic eyes had a deeper VCD than hyperopic eyes; there was a strong positive correlation between VCD and myopic SPH. There was a strong positive correlation between the AL/CR ratio and myopic SPH and a VCD/AL ratio and the hyperopic SPH. Thus, the study suggests the possible utility of the AL/CR ratio while assessing the development of myopic refractive error and the VCD/AL ratio when evaluating hyperopic eyes and their associated complications.

Evaluation of the Anterior Chamber Parameters by Pentacam after Toric Implantable Phakic Contact lens (IPCL) Implantation in Moderate to High Myopia with Astigmatism

Abstract: The toric IPCL is posterior phakic intraocular lens used for correction of moderate to high myopia with astigmatism, but after the implantation, there were changes in the parameters of the anterior chamber (AC). The purpose of this study is to assess the parameters of the AC and lens vault after toric IPCL in patients with moderate to high myopia with astigmatism by Pentacam. In a prospective interventional case series, 30 eyes with moderate to high myopia with astigmatism were treated with toric IPCL implantation. Pentacam was done preoperatively, after 1 month, 3 months and 6 months of toric IPCL implantation for evaluation of the AC parameters as the angle of the anterior chamber (ACA), depth of the anterior chamber (ACD) and volume of the anterior chamber (ACV). Also, the lens vault and intraocular pressure (IOP) were evaluated. The ACD was 3.3±0.1 mm preoperatively and changed to 2.5±0.1 mm after 1 month and remained stable at 3 and 6 months postoperatively (p-value =0.001). The ACV was 198.06±25.02 mm3 preoperatively and reduced to 131.5±20.7, 131.8±21.4 and 131.5±20.2 mm3 after 1 month, 3 months and 6 months, respectively(p-value =0.001). The ACA was 42.9±4.1 preoperatively and changed to 26.7±4.3, 26.4±4.2 and 26.7±4.9 after 1 month, 3 months and 6 months, respectively (p-value =0.001). The vault was 458±126.2 um after 1 month, 461±129.6 um after 3 months and 464.6±130.6 um after 6 months (p-value =0.005). The IOP was slightly high during the first month, then reduced to a level near the preoperative values during the second and third follow-up. The Pentacam was a useful tool for follow up of the AC parameters after toric IPCL implantation in patients with moderate to high myopia astigmatism.

Workplace Trauma with Massive Intraorbital Foreign Body, A Dramatic Outcome

Abstract: Intra-orbital foreign bodies [IOFB] are considered a rare condition, and an enormous challenge to surgeons, as it might be difficult to diagnose in some cases even with the current advances in imaging technology. Retained IOFB can be a cause of major visual morbidity and blindness, especially in the working population. In this article, we report a case of IOFB that occurred as a result of workplace related trauma while drilling ceramic. Case report and literature review using PubMed. we present a case of a 30 years old male, not known to have any medical illness, the patient presented to the emergency department after getting trauma while drilling ceramic. Orbital computed tomography [CT] showed multiple high-density objects situated in a circumferential pattern around the globe. The patient underwent lateral canthotomy and cantholysis in the emergency department, followed by three exploratory operations to remove intraorbital foreign bodies [FBs] . Luckily, the patient in our case regained a 0.5 visual acuity, with an impressive improvement in the extraocular muscle motility, with only mild restriction in the upper and lower gazes. The patient was followed up for 2 years after the incident, he was stable during that period. IOFB is an ophthalmological emergency, careful history, examination, and investigations are important steps in diagnosing IOFB since it can be easily missed when depending solely on imaging. Timely management is crucial to prevent irreversible complications.

Emergent Ophthalmic Disease Knowledge among Non-Ophthalmologist Healthcare Professionals in the Western Region of Saudi Arabia: Cross-Sectional Study

Abstract: Patients with emergent ophthalmic diseases are likely to be examined by healthcare providers before an ophthalmologist, so it is essential that nonspecialists have adequate knowledge for recognition and preliminary diagnosis. To assess knowledge of retinal detachment, acute angle-closure glaucoma, temporal arteritis, and central retinal artery occlusion among non-ophthalmologist healthcare professionals. We conducted an observational cross-sectional study of 351 healthcare workers, including medical residents, nurses, pharmacists, and optometrists, in western Saudi Arabia using a self-report questionnaire. Total knowledge scores were 75.21% for retinal detachment and 74.9% for acute angle-closure glaucoma, but only 44.15% for temporal arteritis and 41.88% for central retinal artery occlusion. Stepwise logistic regression revealed that level of education was the most significant factor influencing knowledge of different eye diseases. Ophthalmologists are encouraged to promote greater awareness and provide other healthcare professionals with the knowledge required to recognize emergent eye diseases for early detection.

The Correlation between Adiponectin and Endothelin-1 Systemic levels with Normal-Tension Glaucoma in Metabolic Syndrome Patients

Abstract: The pathomechanism in Normo-tension glaucoma (NTG) is a dysregulation in the optic nerve head, which also occurs in Metabolic syndrome (MetS). Current therapies such as lowering intraocular pressure (IOP) have failed to inhibit the progression of NTG. This encourages various studies to evaluate the role of MetS. This study aims to evaluate the possible role of ET-1, TBARS, FRAP, hsCRP, Adiponectin, and Leptin systemic levels in the pathogenesis of NTG in MetS patients. This is a cross-sectional study conducted at the National Cardiac Center, Harapan Kita Hospital, Indonesia, with 29 patients divided into two groups, namely, with NTG (n=15) and without NTG (n=14). MetS was diagnosed based on the 2006 IDF criteria, while NTG was determined based on the presence of IOP, MD of the visual field, RNFL, and cupping of the disc as assessed by OCT. Furthermore, plasma ET-1, hsCRP, Leptin, and Adiponectin were assayed by ELISA, FRAP and TBARS were measured by colorimetric assay, while comparative and correlative tests were also performed. There was a positive significant correlation between ET-1 and MD in NTG group (p = 0.025 ; r = 0.416 ; CI 95%= 1.85±0.89) as well as adiponectin and RNFL thickness (p = 0.035 ; r = 0.392 ; CI 95% = 2.71±8.27), however, a negative correlation was found between Adiponectin and MD (p = 0.012 ; r = -0.459 ; CI 95% = 5.53±18.68). Furthermore, there were no statistical differences in TBARS, FRAP, hsCRP, and leptin levels between the 2 groups. Based on the results, Adiponectin and ET-1 have potential involvement in the pathogenesis of NTG in MetS patients.

Comparison of Measured Fusional Vergence Amplitudes using Prism Bar and Synoptophore in Sudanese Patients with Near Exophoria

Abstract: Assessment of the fusional vergence amplitudes constitutes one of the most important diagnostic tools to obtain information about the ability to maintain binocular vision. Several techniques can be used to assess this function. However, those methods are not interchangeable, and the measurement repeatability has been questioned. This study aimed to compare fusional vergence range measurements using prism bars and synoptophore in Sudanese patients with near exophoria The study was a comparative cross-sectional hospital-based, performed in the binocular vision clinic at the Al-Neelain Eye Hospital. Fusional vergence amplitudes (positive and negative) were measured on 122 patients (67 females and 55 males), and the mean age and standard deviation were 16.79 ± 5.22 years old using prism bar and synoptophore methods. The findings showed that the higher positive fusional vergence was obtained using the synoptophore method (24.7 ± 7.2 Δ base-out), whereas the prism bar method provided the lower finding (22.6± 7.6 Δ base-out). Conversely, the prism bar method revealed a higher measurement for negative fusional vergence (13.9± 3.9 Δ base-in) than the synoptophore method (12.7± 3.7 Δ base-in). Using the t-test, significant differences were found between all measurements with the two techniques, P<0.05. Measurements of positive and negative fusional vergence amplitudes by the two methods showed no relationship between age and fusional vergence, P>0.05. Given the significant difference in the results obtained between the two methods for measuring the positive and negative fusional vergence amplitudes, caution should be taken when making decisions regarding fusional vergence assessment in patients with latent and manifest strabismus.

Transepithelial Corneal Cross-linking with Supplemental Oxygen in Keratoconus Treatment - Corneal Stromal Demarcation Line and Safety

Abstract: To evaluate the corneal stromal demarcation line and safety of transepithelial corneal cross-linking (CXL) with supplemental oxygen in progressive keratoconus treatment. This is a retrospective review of 25 patients with progressive keratoconus who underwent epithelial-on CXL with supplemental oxygen from December 2019 to February 2022. Outcomes measured include corneal stromal demarcation line depth, volume of cornea treated, endothelial cell count, best-corrected visual acuity, keratometric parameters and post-treatment adverse events. 25 eyes of 25 patients were included and mean age was 28.3 years. Mean follow-up period was 11.5 ± 1.39 months. Pre-operatively, mean ± standard deviation (SD) of K1, K2, Kmax and minimal corneal thickness were 45.9D ± 3.79D, 50.2D ± 4.83D, 57.5D ± 6.98D and 482.3um ± 36.8um respectively. There is no significant difference between pre and post-treatment corneal topographic parameters. There was improvement in BCVA post-treatment. The mean post-treatment corneal stromal demarcation line depth was 367.3 ± 89.8um. The volume of treated cornea including the central corneal epithelial thickness was 73.3 ± 4.39%. There was no reduction in endothelial cell count (ECC) post-procedure (pre-treatment mean ECC±SD: 2695.4 ± 224.5 cells/mm2, post-treatment ECC 2730.1 ± 252.0 cells/mm2, p-value = 0.33). Post-treatment corneal haze was mild and seen in 8 patients postoperatively. One patient developed a non-visual axis involving stromal infiltrate that resolved with topical broad-spectrum anti-microbials. Trans-epithelial CXL with supplemental oxygen for keratoconus treatment achieved comparable corneal stromal demarcation line depth comparable to that of conventional epithelial-off corneal cross-linking and had a similar safety profile.

Ocular Manifestations in Patients with Coronavirus Disease 2019 (COVID-19): A Real World Multicenter Observational Study in Egypt

Abstract: Background: The aim of the work was to evaluate the ocular manifestations in the patients with COVID-19 and its role in the prediction of the course and the outcome of the disease. Methods: This retrospective study was conducted at two tertiary referral COVID-19 isolation hospitals in two major university hospitals in Egypt. Two hundred and twenty-eight patients were enrolled in the study. The medical records of patients who had clinically confirmed COVID-19 between 1/5/2020 to 15/7/2020 were retrospectively reviewed. Data were collected from patient charts, including age, sex, accommodation, ocular manifestations, fever, headache, cough, dyspnea, anosmia, cyanosis, abdominal pain, anorexia, liver, kidney, cardiac manifestations, CT, X-ray finding, blood tests, and outcome of the disease. Results: Thirty-four patients with ocular manifestation were finally enrolled in the study with a mean age of 42.1 years; 20 patients (58.8%) were men. The incidence of ocular manifestation was 14.9% (34/228). All patients with ocular manifestations had conjunctivitis (redness, epiphora, foreign body sensation), which had been treated and resolved completely within 10 days in all patients without any permanent ocular damage. There was a trend between the presence of ocular manifestations and the associated milder disease course, although this trend was not statistically significant. Conclusion: Ophthalmic manifestation is common in patients with COVID-19 and it occurs more frequently in patients with mild to moderate form of COVID-19, but it could not predict the patient’s mortality.

Outcomes of Paediatric Cataract Surgery in Southern Jordan

Abstract: Congenital cataract is the leading global cause of preventable childhood blindness, and the onset of infantile and congenital cataracts is rare. The management of congenital cataracts is still challenging due to associated complications. This study aimed to assess outcomes of congenital cataract surgery with intraocular lens implantation in southern Jordan. A retrospective case series included 20 children with congenital cataract who underwent lensectomy, aged between 1 to 5 years, recruited using a purposive sampling technique. The mean age was 2.9 years ± 1.4. Intraocular pressure was measured preoperatively at baseline and then every three months, followed up postoperatively until one year. Schiotz tonometer is used to measure intraocular pressure. The distribution of IOP and change in IOP values at baseline and post-operative follow-ups showed statistically significantly higher IOP values at three months of follow-up (P=0.03) and the last follow-up visit at 12 months (P=0.001). The results showed a statistically significant increase from baseline in the IOP of the unilateral cataract eye compared to its normal fellow eye (P=0.028). The post-operative evaluation showed that 14 patients demonstrated twenty-seven post-operative complications. Four eyes (14.2%) with posterior synechiae, 2 (7.1%) with anterior synechiae, 3 (10.7%) with decentration of IOL, 8 (28.6%) with pigment on IOL, 3 (10.7%) with transient corneal oedema and 7 (25%) developed post-operative glaucoma. We concluded that post-operative follow-up of one year in pediatric patients treated with congenital cataract surgery showed a significant increase in intraocular pressure.

Inter-changeability Between Anterior Segment Optical Coherence Tomography and Scheimpflug Imaging in the Evaluation of Corneal Opacity

Abstract: To compare the results of corneal evaluation, either the total corneal thickness and corneal opacity depth by both technologies AS- OCT and Scheimpflug imaging by Sirius Scheimpflug placido topography. sixty-eight eyes of sixty- eight consecutive patients with corneal opacities were examined by both AS-OCT and Sirius Scheimpflug imaging. Corneal thickness and corneal opacity depth were measured and compared determining the interchangeability using Bland–Altman plotting. Total corneal thickness was (470.32±62.10) and (463.47±56.47) by AS. OCT and Sirius Scheimpflug imaging, respectively (P value = 0.8). While the actual measurement of corneal opacity, corneal opacity depth was (135.39±119) and (85.45±128) by AS-OCT and Siris Scheimpflug imaging respectively with P value (0.004). AS-OCT and Scheimpflug imaging Sirius may be used interchangeably for measuring both total corneal thickness, while in the determination of corneal opacity depth. the AS-OCT is superior to Scheimpflug imaging in the accuracy of determination of actual boundaries of the corneal opacity.

Neutral Density Filters as a Tool for Cycloplegic Plusoptix-Photorefractor Measurements: An Explorative Study

Abstract: The purpose of this study is to investigate the usefulness of neutral-density (ND) filters in cycloplegic-Plusoptix-photorefractor measurements. No-filter and ND-filter 0.04, 0.1 and 0.2 cycloplegic-Plusoptix-photorefractor measurements were made in 42 hypermetropic eyes. Sphere, cylinder, spherical equivalent (SEQ), J0, and J45 values were compared. Mean Plusoptix-photorefractor pupil sizes were 7.7±0.68 and 7.7±0.72 mm The no-filter failure rate was 16%, with 87% in pupils >7.8 mm. Mean no-filter sphere, cylinder, SEQ, J0 and J45 values were +0.34±0.35D, -0.29±0.22D, +0.20±0.36, -0.00±0.15, and +0.02±0.11, respectively. Only ND-filter-0.04 provided 5% more successful measurements and a clinically significant alteration in the percentage of values exceeding 0.5D for sphere and SEQ (-10% and -20%), but not for cylinder (+5%). Despite the increased accuracy, 21% of the spherical outcome exceeded 0.50D. Furthermore, the single-measure-intraclass-correlation-coefficient between no-filter and ND-filter-0.04 outcome was moderate (sphere 0.78 (0.62-0.87), cylinder 0.59 (0.35-0.75), SEQ 0.68 (0.48-0.82), J0 0.73 (0.54-0.84) and J45 0.57 (0.50-0.86)) and indicated significant individual variation. Bland-Altman-analyses indicated significant bias for sphere and SEQ; p=0.038 and p=0.030. ND-filter-0.04 resulted in a larger proportion of successful measurements and an increased accuracy. However, an unacceptable percentage of inaccuracy was still present compared to retinoscopy. There could be validity issues with the ND-filter 0.04 or the baseline no-filter readings at the start. We conclude that cycloplegic Plusoptix-photorefraction, even with the use of a 0.04 ND filter, is not a suitable method for exact objective refraction purposes in children.

Prevalence of Computer Vision Syndrom and Predisposing Factors Among Engineering Students in Hawass University Institution of Techenology Campus, Hawassa, Ethiopia, 2019.

Abstract: Lack of detail information about the magnitude of the computer vision syndrome (CVS) and the factors which predominantly cause CVS. This study has an importance for further studies as a baseline data. The purpose of this study was to assess the magnitude of CVS and associated factors on students of Hawassa university institution of technology, Hawassa, Ethiopia, 2019. Institution based cross sectional study design was used from March 30 to May 2019. A multi stage sampling was used. Four departments were selected by using simple random sampling. Among each selected departments students was selected by using systematic random sampling and calculating proportion (K) on each selected department based on the proportion of the number of students in each department. And the final sample size was 896. Each student was assessed whether he/she was exposed to any kind of visual display terminal (VDT). Face to face interview, ocular examination and observation during VDT use was performed by five optometrists from March 30 to May 2019. After collected data was cleaned and coded, EPI info 2002 for data entry and SPSS version 16.0 software for data analysis was used. Odds ratio with a 95% CI will be used to display results. P value less than 0.05 in multivariate logistic regressions was used to show statistical significance. The prevalence of Computer vision syndrome is 41.7% and urban(OR =1.66; CI = (1.14, 2.43)), no glass use(OR = 6.01 ; CI = (1.67, 21.63)), reading playing game with VDT (OR = 2.33; CI = (1.33, 4.08)), reading and watching movies with VDT (OR = 1.49; CI = (1.02, 2.18)), using Smartphone (OR = 0.60; CI = (0.38, 0.95)), remote NPC (OR= 3.19; CI = (1.64, 6.25)) and moderate size of VDT (OR = 0.63; CI = (0.41, 0.96)) were significantly associated with CVS. There is 0.39Ds reduction of amplitude of accommodation in students who has CVS. The prevalence of CVS was high in engineering students, mostly having symptoms of tearing. It is better to avoid using VDT like Smartphone for multiple activities like reading, playing game and watching movies and need an eye examination and protective glass to prevent CVS.

Comparison of Clinical Results, Contrast Sensitivity and Optical Quality Following the Implantation of CT LUCIA 611P and TECNIS-1 ZCB00 MonofocalIOLs -12 Month Outcomes

Abstract: To compare the clinical performance, contrast sensitivity and optical quality, following implantation of CT LUCIA 611 P and TECNIS-1 monofocal IOLs following cataract surgery. Design-Prospective, interventional, non-randomized comparative study. Setting- Nethradhama Super Speciality Eye Hospital, Bangalore, India. Eligible patients, undergoing phacoemulsification received implantation with CT LUCIA 611P or TECNIS-One piece (TECNIS-1) monofocal IOLs. Hundred eyes from 100 patients were sequentially divided into CT LUCIA and TECNIS-1 groups, with 50 eyes in each group.Intra-operatively, the mean unfolding time was significantly longer (35.16 ± 10.50 sec) in the TECNIS-1, compared to the CT LUCIA group (12.93 ± 3.80 sec), p= 0.00.At 12 months, 80% (40) eyes in the CT LUCIA and 76%(38) eyes in the TECNIS-1 group had cumulative UDVA of 20/20 or better. No significant differences were found between the mean values of post-op UDVA, CDVA, contrast sensitivity (all spatial frequencies), Objective Scatter Index (OSI), and Modular Transfer Function (MTF) between both groups. A significantly higher value of internal coma and SA for the Tecnis-1 IOL group was noted (p<0.05). However, there was no significant difference between the total HOA, coma and SA for both the groups. Six eyes in the TECNIS-1 group had intra-operative adhesions of the haptics with optic / haptic, requiring additional manipulation. At one year, both monofocal IOLs delivered comparable clinical outcomes.However, CT LUCIA 611P IOL had significantly less internal coma and SA, unfolding time and smoother IOL insertion without any issues due to poor loading.

Ischemia Modified Albumin (IMA) as a New Biomarker in the Ophthalmology Field: A Brief Literature Review

Abstract: This study aimed to review the potential role of ischemia-modified albumin as a biomarker for diagnostic modalities in the ophthalmology field. Articles were reviewed without a specific date. A manual search was also performed by reviewing reference lists of meta-analyses and systematic reviews. All articles were reviewed, and a total of 18 articles were selected by the authors. Oxidative stress increases structural and functional damage to proteins in many ocular diseases. The human serum albumin is a major circulating protein with antioxidative and anti-inflammatory properties. Oxidative stress has been shown to be an important part of etiology and pathogenesis in ocular diseases related to ischemia. Biomarkers that are specific to oxidative stress and ischemia-related ocular pathogenesis are needed to provide an extensive understanding regarding diagnosis, monitoring progression, and new potential target treatment. Ischemia-modified albumin (IMA) as a new promising biomarker might be useful in the early detection and treatment of ocular diseases with ischemic pathogenesis. IMA plays an important role in the progression of ophthalmology diseases, such as diabetic retinopathy, hypertensive retinopathy, cataract progression, seasonal allergies, and glaucoma. Further studies are needed to elaborate these results as a consideration in new testing modalities in clinical practice as well as a new target therapy research.

Outcome of Primary Management of Scleral Rupture without Vitrectomy Jakarta Eye Trauma Study

Abstract: To report the outcome of primary management of scleral rupture without vitrectomy. Descriptive retrospective study of primary surgical management of scleral rupture located anterior to the equator. Initial and final visual acuity (FVA, intra ocular pressure, type of injury (sharp/blunt/projectile), wound length, time interval between the incident and primary repair and cause of injury were recorded. Encircling scleral buckle was placed in case of scleral laceration reaching muscle insertion. Patients who had a follow up of 3 months after the primary repair were included in the study . There were 41 patients out of 78 who had scleral rupture anterior to the equator. The average age was 21.27 + 9.73 years (range 3-50 years). Thirty-three (80.4%) were males and eight (19.6%) were females. Rupture was located superiorly) in 28 (68.3%) patients, and inferiorly in 13 (31.7%) patients. Eight patients underwent encircling buckle. The time interval from the injury till the primary repair less than 8 hours (p 0.000) and 8-24 hours (p 0.000) were associated significantly with FVA improvements. Initial VA correlated with FVA improvement significantly (p 0.001). Two patients with initial VA of LP became NLP, and they had a wound length 11 mm and 12 mm respectively. The primary management of scleral rupture anterior to the equator, without vitrectomy, improves VA significantly. Time interval less than 24 hours and shorter wound length correlated with significant improvement of final VA.

Is Corneal Collagen Cross-Linking Beneficial as an Adjunct to the Conventional Treatment of Bacterial Keratitis?

Abstract: Background: To evaluate the therapeutic effects of corneal collagen cross-linking CXL as an adjuvant to standard antimicrobial agents in the treatment of bacterial keratitis when compared to treatment with antimicrobial agents alone. Methods: This prospective comparative interventional study included 20 eyes of 20 patients with clinical and laboratory evidence of bacterial keratitis who attended the Outpatient Cornea Unit, Ophthalmology Department, Faculty of Medicine in Assiut University Hospital, Assiut, between January 2019 and December 2020.Patients were divided into two groups: group A, treated with CXL using the Dresden Protocol at the EL-Nour Eye Centre, and group B treated with antibiotics alone. Results: Group A had ten patients in the age range of 20-80 years (mean age 49.2 years), while that of group B (ten patients) was 19 -70 years (mean age 47.3 years). The ulcer sizes started to decrease significantly from week 2 in group A to week 3 in group B. The epithelization time was significantly different between the two treatment groups as reepithelization in 60% of group A cases started at week two, while it began at week three in group B. There was no significant difference in the V/A between the two groups after treatment. Conclusion: CXL as an adjunct to topical antimicrobial treatment was more effective in treating bacterial keratitis than conventional antimicrobial therapy alone, as it led to shorter recovery times due to more rapid ulcer healing, resolution of infiltration, and faster symptomatic relief in patients. Despite CXL promoted the ulcer to heal quickly, there was no significant change in V/A before and after CXL or between the CXL with antimicrobial or antimicrobial therapy alone .

Relationship between the Prevalence of Glaucoma (Estimated Through Prescribed Antiglaucomatous Medication) and Access to Ophthalmologists in Norway

Abstract: The relationship between supply and demand in health-care is a challenge. The purpose of the present study is to evaluate to what extent glaucoma prevalence is influenced by local access to eye health-care service in Norway. Population-based cross-sectional study. Data from The Norwegian Prescription Database was used to find the number of users of topical glaucoma medication, grouped by age and county, giving an estimate of glaucoma prevalence. The number of registered ophthalmologists and opticians was obtained from The Norwegian Society of Ophthalmologists and The Norwegian Directorate of Health. In total, 75733 persons were treated with IOP-lowering drugs in Norway in 2018, suggesting an overall glaucoma prevalence of 1.43%. In the age group 70-89 years, the nationwide prevalence was 7.60%, the lowest prevalence being in Oppland (5.98%) and highest in Aust-Agder (9.28%) counties. The number of ophthalmologists per 100000 inhabitants varied from 2.63 to 14.65 in the various counties. A statistically significant correlation was found between glaucoma prevalence in the age group 70-89 years and access to ophthalmological services. Furthermore, the increase in glaucoma prevalence plateaus at roughly 10 ophthalmologists per 100000 inhabitants, indicating that this could cover population demands. This relationship did not apply for opticians. There is a clear correlation between glaucoma prevalence and availability of ophthalmologists in various counties in Norway. Our study indicates a direct relationship between the number of ophthalmologists in the area and the number of people being treated for glaucoma, with prevalence plateauing once a threshold of approximately 10 ophthalmologists per 100000 inhabitants is reached. This finding suggests that low glaucoma prevalence in some regions could be due to limited access to ophthalmological services.

Comorbidities in Corneal Refractive Surgery Candidates: A Cross-Sectional Study

Abstract: Individuals with refractive errors sometimes have other associated ocular and systemic abnormalities. To explore ocular and systemic comorbidities in Corneal Refractive Surgery (CRS) candidates and to examine any contraindications for CRS. This was a cross-sectional study. Medical records of individuals who underwent a refractive surgery screening at Chiang Mai University LASIK Center, Chiang Mai, Thailand, were reviewed. All clinical data of the initial visit were evaluated. Eyes with a history of CRS and phototherapeutic keratectomy were excluded. A total of 1,167 cases (2,334 eyes) were recruited, out of which 643 cases were females (55.09%). Myopia was the most common type of refractive error (2,120 eyes, 90.83%), and 868 (40.94%) eyes had high myopia. Approximately 45% (n=526) of the cases had worn contact lenses. The five most common ocular comorbidities (eyes, proportion) included keratoconus suspect (297, 12.72%), cataract (246, 10.53%), dry eye/probable dry eye (208, 8.91%), glaucoma suspect (184, 7.88%), and amblyopia (149, 6.38%). The most common systemic conditions that affected choices or outcomes of CRS were hypertrophic scar/keloid (169 cases, 14.48%) followed by allergy/asthma (127 cases, 10.88%). A total of 1,028 eyes (44.04%) were excluded from CRS, mainly due to abnormal corneal topography (470/1,028 eyes, 45.72%). Most refractive candidates were myopic and contact lens wearers. Serious ocular sequelae from myopia and contact lens use were not uncommon. Additionally, systemic diseases regularly affected the CRS options. The most common contraindication for CRS was abnormal corneal topography. Our study, thus, emphasizes the need for thorough ocular and systemic screenings of refractive candidates.

Surgical Outcome of Combined MicroPulse Transscleral Laser Therapy with Phaco Emulsification in Patients with Cataract and Glaucoma

Abstract: To determine the effectiveness and safety of combined MicroPulse transscleral laser therapy (TLT) and phacoemulsification in patients with co-existing cataracts and glaucoma. A retrospective consecutive case series of 22 eyes of 19 patients with co-existing cataract and glaucoma. The patients underwent MicroPulse TLT, phacoemulsification, and intraocular lens implantation during the same setting. A comparison of baseline data with the data at 18 months follow-up was made to determine the variation in best-corrected visual acuity (BCVA), intraocular pressure (IOP), and changes in the number of anti-glaucoma drugs. Twenty-two eyes of 19 patients (57.9% were female) underwent combined MicroPulse TLT and phacoemulsification. The mean age was 60.5±9.3 years (range: 39.0 to 76.0). Nine eyes (40.9%) had primary open-angle glaucoma, nine eyes (40.9%) had chronic angle-closure glaucoma, and four eyes (18.2%) had pseudoexfoliation glaucoma. The mean baseline IOP was 26.3±4.7, which was significantly reduced to 15.3±2.4 mmHg (43.9%±10.2%) at 18 months (p<0.001). The median number of glaucoma medications was 4 (2 to 5) at baseline and 2 (0 to 4) at 18 months (p=0.002). The mean BCVA was 0.84±0.31 LogMAR (Snellen: 20/138) at baseline and 0.28±0.23 LogMAR (Snellen:20/38) at 18 months (p<0.001). The mean follow-up period was 15.8±3.0 months (range 12 to 18). Combined MicroPulse TLT and phacoemulsification was a safe and effective procedure that achieved reduction in both IOP and glaucoma medications for up to 18 months, with no associated vision-threatening complications.

Determinants of Glaucoma Therapy Escalation After Descemet-Stripping Automated Endothelial Keratoplasty To Treat Pseudophakic Bullous Keratopathy: A Nested Case-Control Study

Abstract: To study the determinants of glaucoma therapy escalation (GTE) after Descemet-stripping automated endothelial keratoplasty (DSAEK) for pseudophakic bullous keratopathy in an eye-care hospital in Saudi Arabia. This nested case-control study evaluated patients who required medical or surgical treatment for controlling glaucoma after DSAEK (defined as GTE; GTE group). A group of patients who did not require any intervention post-DSAEK served as controls (control group). Data were collected on preoperative, intraoperative, and postoperative parameters for DSAEK. Variables were compared between groups to evaluate risk factors for GTE and graft failure. The study sample comprised 117 eyes (40 in the GTE group and 77 in the control group). Glaucoma was present in 20 (17.1%) of the eyes before DSAEK. The median duration of follow-up was 27 months [Interquartile range (IQR): 24; 42]. Intraoperative complications occurred in 4 eyes, and 2 eyes had a decentered donor button. Graft failure causing vision impairment and GTE at the final follow-up were noted in 19 (16.2%) and 40 (34.2%) eyes, respectively. Glaucoma prior to DSAEK was significantly associated with GTE [odds ratio (OR) = 6.4; 95% confidence interval (CI) 2.4; 18.3; P = 0.0004]. A history of penetrating keratoplasty (PK) was significantly associated with GTE after DSAEK [OR = 6.2 (95% CI 1.5; 24.7) P = 0.008]. At the last visit, GTE and graft failure were positively associated (OR = 27.2, P < 0.005). Escalation of glaucoma therapy was warranted in one in 3 eyes that had undergone DSAEK. GTE and graft failure are interrelated complications. Patients with glaucoma and PK have a higher risk of GTE post-DSAEK.

The Impact of Excessive Use of Digital Devices During the Pandemic of Corona Virus Disease (COVID-19) Among Saudi Arabia Population

Abstract: A substantial increase in using digital devices was observed among the population due to staying at home as a result of the quarantine during the coronavirus pandemic. Consequently, ocular symptoms appeared due to spending several hours of screen time per day. The current study aimed to assess the impact of excessive use of digital devices during the pandemic of coronavirus among the Saudi population. A community-based cross-sectional study was carried out from November 2020 to January 2021 among the Saudi population. Data were collected by using Ocular Surface Disease Index (OSDI) questionnaires for the assessment of symptoms related to dry eye and their effect on vision. A logistic regression model was used to evaluate the association between the risk factors and the symptoms of dry eye. SPSS 22nd edition was used, any p-value <0.05 was considered significant. Out of 1573 participants, 93.8% used mobile, 42.4% experienced uncomfortable sensitivity to the light. There were 49.15% of the participants who showed that none of the time they felt blurry vision, 54.8% did not report double vision, and 30.5% who felt a headache recently after quarantine. About 48% of the participants did not have any ocular symptoms, while 52% had dry eye symptoms (mild 22.3%, moderate 13.7%, and severe 15.9%). When the logistic regression model of risk factors associated with severe symptoms of dry eye was applied, wearing a contact lens was the most significant variable (p<0.0001). Dry eye symptoms increased during the quarantine, which indicated that the digital device users need to learn more about the preventive measures from practitioners in eye healthcare. More studies are warranted to assess the impact of digital device usage on all age groups starting from children up to the elderly population.

Treatment of Dissociated Vertical Deviation by Combined Recession–Resection of the Superior Rectus Muscle versus Recession with Posterior Fixation Suture

Abstract: Management of dissociated vertical deviation (DVD) is still a matter of controversy in strabismus practice. Different surgical techniques are available, ranging from the weakening of the superior rectus or inferior oblique muscles to strengthening of the inferior rectus muscle, with variable success rates. To report the outcomes of correcting DVD by combined recession-resection of the superior rectus muscle and to compare the results with those of superior rectus muscle (SR) recession with posterior fixation sutures. The medical records of patients who had a surgical correction for DVD were retrospectively reviewed. Two groups of patients were identified; Group I (29 patients) was treated with the combined recession –resection of the SR and group II (37 patients) was treated by SR recession with posterior fixation sutures (Faden). Collected preoperative data included age, best-corrected visual acuity, presence of amblyopia, history of previous surgeries and angle of DVD. Operative data such as amount of SR recession and operative time were also extracted. The outcome measures taken at the final postoperative follow up visit included the surgical success rate which is identified as the percentage of patients with absent manifest DVD and the amount of residual latent deviation measured by prism cover test. The mean follow-up period for all patients was 22.6 ±4.6 months. In the last follow-up visit, the surgical success rate was 76% in the combined recession-resection group and 73% in the faden group with no significant difference between both groups (p=0.8). No significant difference was found in the residual latent deviation in both groups as well. The recorded surgical time was significantly shorter in the combined recession- resection group (p<0.001). The reported complications included mild, temporary limitation of elevation without hypotropia in 5 patients (2 in group I (7%) and 3 patients in group II (8%)) with no significant difference between both groups (p=0.8). Combined recession-resection of SR is as effective as SR recession with posterior fixation suture in the management of DVD with the advantages of easier technique and less surgical time.