Maamoun Abdul Fattah

Nontuberculous Mycobacterial Ocular Infections: A Systematic Review of the Literature

Nontuberculous or atypical mycobacterial ocular infections have been increasing in prevalence over the past few decades. They are known to cause periocular, adnexal, ocular surface and intraocular infections and are often recalcitrant to medical therapy. These infections can potentially cause detrimental outcomes, in part due to a delay in diagnosis. We review 174 case reports and series on nontuberculous mycobacterial (NTM) ocular infections and discuss etiology, microbiology, risk factors, diagnosis, clinical presentation, and treatment of these infections. History of interventions, trauma, foreign bodies, implants, contact lenses, and steroids are linked to NTM ocular infections. Steroid use may prolong the duration of the infection and cause poorer visual outcomes. Early diagnosis and initiation of treatment with multiple antibiotics are necessary to achieve the best visual outcome.

Central Corneal Thickness After Cross-linking Using High-Definition Optical Coherence Tomography, Ultrasound, and Dual Scheimpflug Tomography: A Comparative Study Over One Year.

PURPOSEnTo assess central corneal thickness (CCT) and corneal haze in keratoconus eyes following corneal cross-linking (CXL).nnnDESIGNnProspective noncomparative case series.nnnMETHODSnForty patients (44 eyes) with keratoconus that had serial evaluation for CCT, following CXL, usingxa0high-definition optical coherence tomography (HD-OCT), ultrasound pachymetry (USP), and dual Scheimpflug tomography. CCT was measured at baseline, then at 2xa0weeks and 1, 3, 6, and 12xa0months postoperatively.nnnRESULTSnThe mean baseline CCT measurements were 470.02xa0μm, 469.79xa0μm, and 466.66xa0μm using the HD-OCT, the USP, and dual Scheimpflug tomography, respectively (Pxa0= .91). Following CXL, the mean CCT measurements by dual Scheimpflug, at all follow-up periods, were lower compared to mean baseline reading (P < .003). The mean CCT measurements by the HD-OCT and USP were similar to baseline readings except for the thicker readings at the 2-week follow-up visit. Overall, the mean CCT obtained by the USP was similar to that obtained by the HD-OCT throughout the 12-month period. However, the mean CCT measurements obtained by dual Scheimpflug tomography were statistically and clinically significantly lower than those obtained by both HD-OCT and USP at all follow-up visits.nnnCONCLUSIONSnUSP and HD-OCT showed better agreement in CCT readings at all visits, and may better estimate the true CCT following CXL as compared to dual Scheimpflug tomography. The lower mean CCTxa0post-CXL as measured by the latter seems to be correlated with the amount of haze that develops afterxa0cross-linking.

Single-step transepithelial versus alcohol-assisted photorefractive keratectomy in the treatment of high myopia: a comparative evaluation over 12 months

Background/aims To evaluate refractive outcomes of single-step transepithelial photorefractive keratectomy (TransPRK) versus alcohol-assisted PRK (EtOH-PRK) for the correction of high myopia. Methods This was a retrospective non-randomised comparative study conducted at the American University of Beirut Medical Center, Beirut, Lebanon. Eyes with myopia (spherical equivalent (SE) larger than −6.00u2005D) that had undergone EtOH-PRK treatment combined with mitomycin C and TransPRK (SE: −7.53±0.90u2005D and −7.24±0.77u2005D, p=0.062), using the Schwind Amaris excimer laser, were included. 59 eyes (37 patients) that had single-step TransPRK were compared with 59 eyes (36 patients) that had EtOH-PRK. Visual and refractive outcomes, including analysis of astigmatism, and corneal higher order aberrations (HOAs) at 6.0u2005mm optical zone, were compared for 12u2005months postoperatively. Results Baseline characteristics were similar between the two groups (p>0.05). The SE deviation from target (SEDT) at 1u2005week, 1, 3, 6 and 12u2005months follow-up visits were similar between groups (p=0.428). At 12u2005months, 81.3% and 73.3% of eyes that had undergone TransPRK and EtOH-PRK, respectively, were between ±0.50u2005D SEDT (p=0.381). Mean cylinder power was 0.33±0.26u2005D versus 0.41±0.30u2005D at 12u2005months follow-up (p=0.140). The mean success index was 0.50±0.50 for the TransPRK group and 0.49±0.52 for the EtOH-PRK group (p=0.939), while the absolute mean angle of error was 7.81°±61.98° vs 13.12°±71.86° (p=0.667), respectively. The change in total, spherical and comatic corneal HOAs were similar in both groups at 12u2005months (p>0.05). Haze was similar between both groups; two eyes had +1 haze at 12u2005months in the TransPRK group versus zero eyes among the EtOH-PRK group (p=0.154). Conclusions Single-step TransPRK for high myopia with or without astigmatism appears to yield similar visual, refractive and safety results as EtOH-PRK.

Epithelial Erosions and Refractive Results After Single-Step Transepithelial Photorefractive Keratectomy and Alcohol-Assisted Photorefractive Keratectomy in Myopic Eyes: A Comparative Evaluation Over 12 Months

Purpose: To evaluate the epithelial erosion incidence and refractive results in myopic eyes undergoing single-step transepithelial photorefractive keratectomy (TransPRK) compared with alcohol-assisted photorefractive keratectomy (PRK). Methods: This was a retrospective nonrandomized comparative study conducted at the American University of Beirut Medical Center. A total of 189 eyes that had undergone single-step transepithelial PRK (TransPRK) were compared with 189 matched eyes that had undergone alcohol-assisted PRK over a follow-up of 1 year. The incidence and symptoms of epithelial erosion were evaluated in both treatment groups using a post hoc questionnaire administered to patients selected in the study. Visual and refractive outcomes, including vector analysis of astigmatism, and corneal higher-order aberrations were also compared at 1-year postoperatively. Results: Baseline characteristics were similar between 2 groups (P > 0.05). A slight difference was detected at 12-month follow-up in the refractive cylinder (P = 0.02) and difference vector (P = 0.01) between eyes that had undergone TransPRK versus alcohol-assisted PRK. All other visual and refractive outcomes were similar at 12-month follow-up between both groups. Of note, 9.9% of patients with alcohol-assisted PRK (10/101) reported to the clinic because of tearing and stabbing sensation within 1 week after contact lens removal as opposed to 1% (1/100) of the TransPRK group (P = 0.0097). Subclinical recurrent epithelial erosion symptoms occurred more frequently in alcohol-assisted PRK: soreness to touch, sharp pains, and eyelid sticking occurred in 26.0% versus 6.6%, 32.5% versus 7.9%, and 26.0% versus 6.6% among the patients who were treated with alcohol-assisted PRK versus those who were treated with TransPRK, respectively (P ⩽ 0.002). Conclusions: Single-step TransPRK for myopic eyes yields refractive results similar to those of alcohol-assisted PRK but shows a lesser incidence of early postoperative epithelial erosions and subsequent subclinical recurrent erosions.

Ophthalmologic Outcomes of Children Born Premature Without ROP: Correlations With Gestational Age and Psychomotor Development

PURPOSEnTo study ophthalmological outcomes of premature children with no retinopathy of prematurity (ROP) and correlate with neurodevelopmental outcomes.nnnMETHODSnA total of 69 former preterm infants were evaluated at 2 to 7 years of age. Detailed ophthalmologic examinations were performed. Neurodevelopment was assessed using the Peabody Developmental Motor Scale and Wechsler Preschool and Primary Scale of Intelligence. Another 69 healthy children served as controls.nnnRESULTSnThe 69 preterm children (38 of 69 boys) and 69 controls (38 of 69 boys) had a mean age of 4.9 ± 1.5 and 4.9 ± 1.4 years, respectively. Compared to controls, preterm infants had vision impairment of 19% versus 1.4% (P = .001), hyperopia of 87% versus 98.5% (P = .21), myopia of 11% versus 1.4% (P = .017), and astigmatism of 39% versus 30.4% (P = .37). Children with any motor disability tended to have worse vision.nnnCONCLUSIONSnIn the absence of ROP, hyperopia was more common in infants 32 weeks or older who weighed more than 1,500 g at birth; other vision problems were similar in subgroups. This may represent impending myopia in those younger than 32 weeks weighing less than 1,500 g. [J Pediatr Ophthalmol Strabismus. 2017;54(1):32-38.].

Five-Year Incidence and Progression of Diabetic Retinopathy in Patients with Type II Diabetes in a Tertiary Care Center in Lebanon

Objective To estimate the 5-year incidence of progression rate and regression rate and risk factors for diabetic retinopathy (DR) in a cohort of Lebanese patients with type II diabetes. Methods We followed a cohort of 462 Lebanese patients with type II diabetes for over 5 years at the American University of Beirut Medical Center. Patients underwent yearly complete ophthalmic evaluation and fundus photographs and were assessed for the incidence, stage, and evolution of DR using modified Airlie House classification. Results Among the 462 patients, 281 had no DR at baseline. The 5-year cumulative incidence of any DR was 10% (95% CI: 6–13), and only baseline microalbuminuria correlated with the development of DR (OR = 10.53, 95% CI: 4.39–25.23, p < 0.0001). Among the 181 patients with baseline DR, the worsening and regression rates of DR were 31.5% (95% CI: 25–38) and 9% (95% CI: 5–13), respectively. Microalbuminuria also approached statistical significance as a risk factor for DR worsening (OR = 1.89, 95% CI: 0.97–3.70, p = 0.06). Conclusion The 5-year incidence of DR in this hospital-based cohort is relatively low. Microalbuminuria was independently associated with the incidence and progression of the disease. We recommend to screen patients with type II diabetes for microalbuminuria as prognostic for the development and worsening of DR.

Comparison between Nonmydriatic Spectral Domain Optical Coherence Tomography and Conventional Ophthalmologic Examination in Detecting Adult Macular Pathology

Objective: To compare nonmydriatic spectral domain optical coherence tomography (NMOCT) to comprehensive ophthalmologic evaluation (COE) in detecting adult macular abnormalities. Methods: This is a single-reader observational pilot study of adults older than 50 years with no known ophthalmologic problems to assess the correlation between NMOCT and COE in detecting macular abnormalities classified as epiretinal, intraretinal, subretinal, or a combination thereof. Subjects underwent NMOCT of the macula followed by COE which included a dilated fundus examination and ancillary tests as needed. Results: A total of 771 eyes of 406 patients were included. Cohen’s kappa coefficient of agreement between NMOCT and COE for detecting any abnormality was high (0.90, p < 0.0001), with NMOCT having an overall sensitivity of 82.65% and specificity of 98.97%. Sensitivities and specificities of NMOCT in detecting each category of macular abnormalities were as follows: epiretinal (86.36%, 99.73%), intraretinal (80.00%, 99.58%), and subretinal (88.89%, 99.73%), respectively. Conclusion: NMOCT is a promising tool for detecting adult macular abnormalities.

Corrigendum to “Five-Year Incidence and Progression of Diabetic Retinopathy in Patients with Type II Diabetes in a Tertiary Care Center in Lebanon”

[This corrects the article DOI: 10.1155/2017/9805145.].

Automated Detection and Measurement of Corneal Haze and Demarcation Line in Spectral-Domain Optical Coherence Tomography Images

Keratoconus is a progressive eye disease that may lead to significant loss of visual acuity. Corneal cross-linking (CXL) is a surgical procedure that halts the progression of keratoconus. One commonly used clinical indicator of CXL success, albeit being an indirect one, is the presence and depth of stromal demarcation line. In addition, corneal haze beyond the demarcation line can be an ominous sign of loss of corneal transparency, which is a much dreaded side effect of CXL. To date, ophthalmologists evaluate the presence and depth of the demarcation line and grade corneal haze using slit lamp biomicroscopy and/or optical coherence tomography (OCT). Interpreting the output of the former is very biased at best, while analyzing the information presented by the latter is time consuming, potentially error prone, and observer dependent. In this paper, we propose the first method that employs image analysis and machine learning to automatically detect and measure corneal haze and demarcation line presence and depth in OCT images. The automated method provides the user with haze statistics as well as visual annotation, reflecting the shape and location of the haze and demarcation line in the cornea. Our experimental results demonstrate the efficacy and effectiveness of the proposed techniques vis-a-vis manual measurements in a much faster, repeatable, and reproducible manner.

Intravitreal Adalimumab for the Control of Breakthrough Intraocular Inflammation

ABSTRACT Purpose: Investigate the efficacy of intravitreal adalimumab in breakthrough panuveitis in patients on systemic adalimumab for more than 3 months. Methods: Retrospective study of patients on systemic adalimumab with breakthrough panuveitis requiring intravitreal adalimumab therapy. Results: Seven eyes of four patients with Adamantiades–Behçet disease panuveitis were included and all were maintained on systemic adalimumab for 7.3 months (range 3–11) with inflammation controlled for 4.1 months (range 2–10) before breakthrough uveitis. The total number of attacks was 13 over 24.5 months (range 12–30). Resolution of attack was defined as return to baseline visual acuity with resolution of inflammatory markers. Three attacks resolved after only one injection and 10 attacks required an average of 2.4 injections (range 2–3). No systemic or ocular complications were noted. Conclusions: Intravitreal adalimumab warrants further investigation as a potentially effective, practical and safe adjunctive therapy for the control of breakthrough inflammation in select patients maintained on systemic adalimumab.