Aim To evaluate the effect of phacoemulsification surgery on retinal and choroidal microvasculature in diabetic patients using optical coherence tomography angiography (OCTA). Settings and design A prospective comparative case-control study was performed at the Ophthalmology Department of Ain Shams University hospital, between November 2020 and November 2022. Patients and material A total 50 eyes of 35 cataractous patients were included in this prospective study and divided into two groups: the control group (25 eyes of 19 patients) and the diabetic group (25 eyes of 16 patients with mild nonproliferative diabetic retinopathy). All patients underwent routine ophthalmic examination, OCT and OCTA scans of the macula before phacoemulsification surgery and 1 week, 1, 3, and 6 months after the surgery. Results The best corrected visual acuity significantly improved in both groups by ∼ 0.26 logMAR units in control and diabetic groups ( P <0.001 for both). The mean change in central subfoveal thickness was 23.44±43.7 versus 13.6±22 um ( P =0.3) in the control group and the diabetic group, respectively but statistically insignificant. There was insignificant change in each group in all vascular parameters during the follow-up period. In addition, there was insignificant difference between the two groups at each visit in most vascular parameters of superficial vessel density, deep vessel density (DVD), and choriocapillaris vessel density (CC VD). On the other hand, the diabetic groups have significantly lower superficial vessel density of whole image and perifovea at 1 week than controls (42.92±4.54% vs. 46.16±3.98%, P =0.01 in the whole image, respectively) (44.29±4.87% vs. 47.32±3.85%, P =0.018 in perifovea, respectively). The diabetic group also showed significantly higher parafoveal deep vessel density than the control group at 1 month postoperatively: 52.67±4.00 versus 47.24±9.85% ( P =0.014) that leveled up on month 3 and 6 ( P =0.397, 0.538, respectively). The diabetic group showed lower CC VD of the whole image than the control group at 1 week postoperatively: 70.60±2.87 versus 72.22±1.98%, respectively ( P =0.025), and also significantly lower CC VD of perifovea than the control group at 1 week: 71.19±2.82 versus 72.72±2.20% ( P =0.038), 1 month: 71.08±2.87 versus 72.78±2.61% ( P =0.033) and 3 months: 71.35±2.63 versus 72.83±2.52% ( P =0.048). Those values leveled up at the last postoperative visit at month 6 ( P =0.152). Conclusion Phacoemulsification surgery may lead to the transient and mild reduction of choroidal blood flow in diabetic eyes rather than retinal blood flow. Most of choroidal and retinal vascular changes happened in the perifoveal area within 1 week to 1 month postoperatively and rarely extended to 3 months.
Background: Caustic ingestion is still a difficult medical problem, and the outcome is often unexpected. Objectives: This study assessed the usefulness of intoxication data, clinical data and some laboratory parameters in predicting the outcome following caustic ingestion, and test the applicability of DROOL Score (DS) as a prognostic indicator of oesophageal stricture. Methods: Ninety-two patients with caustic ingestion admitted to Poison Control Centre Ain Shams University (PCCASU), during the period from 1st June to November 30, 2015 were prospectively studied. Diagnoses of stricture made via barium study. Results: Sixty-six percentage of cases were children under 5 years. In 48.9% of cases, the caustic agent was alkaline. Symptoms and signs can adequately predict the outcome of corrosive patients. DROOL Score and Total Leucocytic Count (TLC) ≥ 20,000 are useful tools for predicting both stricture formation and mortality, in addition blood pH ˂ 7.2 can also predict mortality. A new value of DS ≤ 5.5 to predict stricture formation and mortality of corrosive patients was proposed. Conclusion: Clinical manifestations can adequately predict the outcome also; DS and TLC ≥ 20,000 have predictive value for outcome prediction of corrosive patients. Moreover, blood pH ˂ 7.2 can predict mortality. A new value of DS ≤ 5.5 was identified as a prognostic indicator of outcome in caustic patients.
Abstract Aim To evaluate the effect of phacoemulsification surgery on retinal and choroidal microvasculature in diabetic patients using optical coherence tomography angiography. Settings and Design A prospective comparative case control study performed at the Ophthalmology department of Ain Shams University hospital, between November 2020 and November 2022. Methods and Material 50 eyes of 35 cataractous patients were included in this prospective study divided into two groups: the control group (25 eyes of 19 patients) and the diabetic group (25 eyes of 16 patients with mild non proliferative diabetic retinopathy). All patients underwent routine ophthalmic examination, OCT and OCTA scans of the macula before phacoemulsification surgery and 1week 1month, 3months and 6months after the surgery. Results The BCVA significantly improved in both group by ∼ 0.26 logMAR units in control and diabetic groups (p < 0.001 for both). the mean change in CST was 23.44±43.7 vs 13.6±22 um (p = 0.3) in the control group and the diabetic group, respectively but statistically insignificant. There was insignificant change in each group in all vascular parameters during the follow up period. In addition, there was insignificant difference between 2 groups at each visit in most vascular parameters of SVD, DVD, and choriocapillaris VD. On the other hand, the diabetic groups has significantly lower SVD of whole image and perifovea at 1 week than controls (42.92 ± 4.54 % vs 46.16 ± 3.98 %, p = 0.01 in whole image respectively) (44.29 ± 4.87 % vs 47.32 ± 3.85 %,p=0.018 in perifovea respectively). The diabetic group also showed significantly higher parafoveal DVD than the control group at 1 month postoperatively : 52.67 ± 4.00 vs 47.24 ± 9.85 % (p = 0.014) that levelled up on month 3 and 6 (p = 0.397, 0.538 respectively). the diabetic group showed lower CC VD of whole image than the control group at 1 week postoperatively: 70.60 ± 2.87 vs 72.22 ± 1.98 % respectively (p = 0.025), and also significantly lower CC VD of perifovea than the control group at 1 week: 71.19 ± 2.82 vs 72.72 ± 2.20 % (p = 0.038), 1 month: 71.08 ± 2.87 vs 72.78 ± 2.61 % (p = 0.033) and 3 months: 71.35 ± 2.63 vs 72.83 ± 2.52 %(p = 0.048). Those values levelled up at the last postoperative visit at month 6 (p = 0.152). Conclusion Phacoemulsification surgery may lead to the transient and mild reduction of choroidal blood flow in diabetic eyes rather than retinal blood flow. Most of choroidal and retinal vascular change happened in the perifoveal area within 1 week to 1 month postoperatively and rarely extended to 3months. Further research is needed to detect its influence on diabetic retinopathy progression.
Abstract Purpose To evaluate the effectiveness of subthreshold micropulse laser as compared to intravitreal injection of ranibizumab in treatment of center involving diabetic macular oedema. Methods A total of 76 eyes of 62 patients with center involving diabetic macular oedema were divided into two groups. Group A received intravitreal injection of ranibizumab while group B received subthreshold micropulse laser with rescue intravitreal injection of ranibizumab. The change from baseline in best correscted visual acuity and central subfield thickness were compared at 3, 6, 9 and 12 months follow-up. Any adverse effects were recorded. Results Group A (n = 34 eyes) experienced a statistically significant improvement in best corrected visual acuity (from 0.32±0.16 Log MAR at baseline to 0.21±0.14 Log MAR at 12 months) (P value =0.006), with a statistically significant reduction in central subfield ghickness (from 352.06±34.34µm to 289.47±58.88 µm) (P value=0.001). Group B (n = 42 eyes), also experienced a statistically significant improvement in best corrected visual acuity (from 0.34±0.22 Log MAR at baseline to 0.13±0.31 Log MAR at 12 months) (P value=0.001), with a statistically significant reduction in central subfield thickness (from 300±47.34µm to 253.12±39.60 µm at 12 months) (P value= 0.009). The mean difference in best corrected visual acuity between the group B and group A was -0.08 Log MAR with a 95% CI ranging from -0.197 to 0.037, which supports the claim of non-inferiority between the two treatment regimens. No adverse effects from subthreshold micropulse laser were recorded in both groups. Conclusion subthreshold micropulse laser with rescue intravitreal injection of ranibizumab was non inferior to intravitreal injection of ranibizumab in treatment of center involving diabetic macular oedema as regards the mean change in best corrected visual acuity.
Abstract Background Diabetes mellitus is a disease of high prevalence as well as incidence and consequence worldwide. An approximate 387 million people have been found to be affected by diabetes mellitus worldwide in 2013. It is presumed that the number of people with diabetes will almost double the current numbers by 2035. Aim of the work To determine what is the most important predictor assessed by spectral domain optical coherence tomographic tomography (SD-OCT) correlates with best corrected visual acuity (BCVA) in eyes with untreated diabetic macular edema (DME). Patients and Methods Sixty eyes of forty three diabetic patients were included in this observational ,non intervention study. The patients’ ages ranged from 50 to 70 years. All cases had DM type2. This study was conducted at ophthalmic clinic of Al Mataria teaching Hospital from January 2018 till November 2018. Informed consent was obtained from all participants before enrolment. All applicable institutional regulations concerning the ethical use of human volunteers were followed during this research. Results In this study, we observed statistically significant correlation between best corrected visual acuity (BCVA) and central subfield thickness (C. S. T), moreover this study detect that the most important OCT pattern affecting vision is the presence of central macular edema. Conclusion In untreated diabetic macular edema cystoid macular edema was the most common OCT pattern and has worest vision during 1st ophthalmic examination
Abstract Background Age-related macular degeneration (AMD) is the leading cause of severe irreversible visual impairment worldwide. The disease has a deep impact on the quality of life of affected person and represents a major socioeconomic challenge. Neovascular age-related macular degeneration (nAMD) is a rapidly progressing disease which impacts central vision. It is responsible for 90% of cases of AMD associated severe vision loss. Choroidal thicknening is hypothesized to occur in the active phase of neovascular AMD. On the other hand, multiple studies reported progressive choroidal thinning in nAMD. Aim to study the correlation between choroidal thickness, and the activity of choroidal neovascularization in cases of neovascular (wet) Age related macular degeneration using Spectral domain Ocular coherence tomography. Methodology Our study included 33 eyes of 30 participants subdivided into neovascular AMD group (23 eyes of 20 patients), and age matched control group (10 eyes of 10 participants). Spectral domain optical coherence tomography (Avanti RTVue XR AngioVue OCT (Optovue Inc, Fremont, USA) was used to measure central foveal thickness (CFT), and subfoveal choroidal thickness (SFCT) after conduction of complete ocular examination and history taking. Results Our study shows a significant decrease in subfoveal choroidal thickness in neovascular AMD group (157.82 + 68.67 µm) when compared to the age matched control group (266.9+ 48.37 µm) with (P value <0.001). But, we found no clinically significant difference in SFCT between active CNV (179.23 + 64.36 µm) and inactive CNV groups (136.4 + 72.97 µm) (P value = 0.19). Conclusion there is a significant thinning of choroid in nAMD in comparison to control. But no statistically significant difference in SFCT between active and inactive choroidal neovascular groups.
Background: Cataract surgery in patients with diabetes is indicated either to improve visual acuity or to allow assessment and treatment of fundus changes. We aimed to document the effects of phacoemulsification on the corneal endothelium in patients with or without diabetes.
Methods: This comparative, prospective, non-randomized controlled interventional study was conducted in patients with visually significant immature senile cataracts in the ophthalmology department at Sohag University Hospital between January 2018 and December 2020. The following data were recorded: corrected distance visual acuity, keratometry readings, refraction, slit lamp examination results, and biometry data. Changes in corneal parameters were documented preoperatively and at 1, 3, and 6 months postoperatively using specular microscopy.
Results: Sixty-four eyes of 64 patients with visually significant senile cataracts were included (32 eyes in the diabetic group and 32 eyes in the non-diabetic control group). We found greater mean endothelial cell loss in the non-diabetic group (179 cells/mm2; 6.4%) than in the diabetic group (134 cells/mm2; 4.8%) at 3 months postoperatively, yet the difference was not significant. The difference could be explained by the higher mean cumulative dissipated energy (CDE) used in the non-diabetic group (5.37 J) than in the diabetic group (4.68 J), although the difference was also not significant. Moreover, we found significantly higher coefficient of variation (CV) in the non-diabetic group than in the diabetic group at 1, 3, and 6 months postoperatively (P = 0.03, P = 0.02, and P = 0.008, respectively).
Conclusions: Endothelial cell density was directly related to the CDE of phacoemulsification and not to diabetes. CV was significantly higher in the non-diabetic group than in the diabetic group. Future studies with a larger sample size, longer follow-up, and more diabetic subgroups with different levels of glycemic control are warranted to verify our conclusions.
How to cite this article: Mahmoud A, Moussa I, Abozaid M, Iqbal M. Outcomes of phacoemulsification on the corneal endothelium in diabetic versus non-diabetic patients: a prospective non-randomized controlled interventional study. Med Hypothesis Discov Innov Optom. 2021 Spring; 2(1): 1-7. DOI: https://doi.org/10.51329/mehdioptometry119
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