Publications by authors named "Ayman G Elnahry"

39 Publications

Methotrexate monotherapy for unilateral moderately active thyroid-related eye disease.

Clin Case Rep 2021 Jul 9;9(7):e04559. Epub 2021 Jul 9.

Department of Ophthalmology Faculty of Medicine Cairo University Cairo Egypt.

A type 1 diabetic patient with unilateral active thyroid-related eye disease was intolerant to systemic steroid therapy due to uncontrollable blood sugar levels. She was treated with low-dose methotrexate monotherapy, which resulted in a marked improvement of her condition with no adverse events.
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http://dx.doi.org/10.1002/ccr3.4559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8271214PMC
July 2021

Mean macular intercapillary area in eyes with diabetic macular oedema after anti-VEGF therapy and its association with treatment response.

Clin Exp Ophthalmol 2021 Jun 29. Epub 2021 Jun 29.

New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts, USA.

Background: To evaluate the changes in the mean macular intercapillary area (ICA) from sequential enface optical coherence tomography angiography (OCTA) images following intravitreal anti-VEGF therapy in initially treatment-naïve eyes with diabetic macular oedema (DME).

Methods: In this multicenter retrospective study, 6x6 and 3x3 mm customized, total retinal projection enface OCTA images were collected and processed for quantitative assessment of ICA by a customized MATLAB software. Measurements were done in concentric regions centered on the fovea -with the exclusion of foveal avascular zone (FAZ)- in 0.5 mm diameter increments as well as within the intervening rings.

Results: 6x6 mm OCTA images from 46 eyes of 29 patients, and 3x3 mm OCTA images from 23 eyes of 15 patients were included in this study. There was no significant change in mean ICA after treatment in either scan size or in any measurement regions (all p > 0.05). Multivariate analysis revealed that baseline BCVA was significantly correlated with the visual outcome (p = 0.039). Additionally, after correction for age, baseline central retinal thickness (CRT), baseline BCVA, and retinopathy severity, mean ICA in the 1.5 mm circle was found to be a significant predictor of post treatment CRT, (p = 0.006).

Conclusions: Absence of significant change in mean ICA after a minimum of three intravitreal anti-VEGF injections, may indicate that, in the short term, anti-VEGF injections neither impair nor improve macular perfusion in DME. Baseline BCVA was found to be a robust predictor of functional outcome, while inner mean ICA was a significant predictor for macular thickness outcomes. This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1111/ceo.13966DOI Listing
June 2021

Optical Coherence Tomography Angiography of Macular Perfusion Changes after Anti-VEGF Therapy for Diabetic Macular Edema: A Systematic Review.

J Diabetes Res 2021 22;2021:6634637. Epub 2021 May 22.

Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Background: Diabetic macular edema (DME) is a major cause of vision loss in diabetics that is currently mainly treated by antivascular endothelial growth factor (VEGF) agents. The effect of these agents on macular perfusion (MP) is a current concern. Optical coherence tomography angiography (OCTA) is an imaging modality that allows noninvasive high-resolution retinal microvasculature imaging. Several recent studies evaluated the effect of anti-VEGF agents on the MP of DME patients using OCTA. Our aim is to provide a systematic review of these studies.

Methods: Multiple databases were searched including PubMed, Ovid Medline, EMBASE, and Google Scholar for relevant studies published between January 2016 and November 2020 which were included in this review. Studies were compared regarding their design, the number of included patients, the machine and scanning protocol used, the inclusion and exclusion criteria, the number of injections given, the type of anti-VEGF agent used, the outcome measures assessed, and the effect of injections on different MP parameters.

Results: A total of 16 studies were included. The studies assessed various OCTA parameters that define MP including the foveal avascular zone area and superficial and deep vascular density and yielded conflicting results. Seven studies showed stable or improved MP following treatment, while 7 studies showed worsening MP following treatment, and 2 studies showed inconclusive results. This could have been due to differences in study design, inclusion criteria, type of anti-VEGF agents used, treatment duration, and methods of image analysis and vascular density quantification. All identified studies were noncomparative case series, and 14 of them (87.5%) used the RTVue XR Avanti OCTA machine. Only one study compared OCTA to fluorescein angiography findings.

Conclusion: Analysis of MP changes following VEGF inhibition for DME could benefit from a unified scanning protocol and analysis approach that uses similar study designs to eliminate potential sources of bias. This may provide more definitive conclusions regarding the effect of treatment on MP.
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http://dx.doi.org/10.1155/2021/6634637DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8169275PMC
May 2021

Optic Nerve Sheath Fenestration for Papilledema Due to Cerebral Venous Sinus Thrombosis Associated with Antiphospholipid Syndrome: A Case Report.

Am J Case Rep 2021 May 24;22:e930497. Epub 2021 May 24.

Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.

BACKGROUND Cerebral venous sinus thrombosis (CVST) is a serious life- and vision-threatening condition that can have a variable presentation according to the site of venous occlusion, including mimicking idiopathic intracranial hypertension. We report on a patient with primary antiphospholipid antibody syndrome (APS) who presented with papilledema due to CVST that was refractory to medical treatment but responded to optic nerve sheath fenestration (ONSF). CASE REPORT A 21-year-old man presented with blurred vision of gradual onset and a progressive course for 1 month, accompanied by fever, headache, and confusion. He had a history of lower-limb deep vein thrombosis. Examination revealed decreased vision with bilateral grade IV papilledema. Magnetic resonance venography showed evidence of CVST and laboratory investigations revealed lupus anticoagulant antibodies, antinuclear antibodies, and anti-double stranded DNA antibodies, with hyperhomocysteinemia. The patient did not meet the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus (SLE) nor the new European League Against Rheumatism and American College of Rheumatology SLE classification criteria. He was diagnosed with CVST secondary to APS and hyperhomocysteinemia and treated with acetazolamide, systemic anticoagulation, and vitamins for 1 month, but with no improvement in his ophthalmic condition. He subsequently underwent unilateral ONSF, which resulted in improvement in vision bilaterally that continued throughout a 6-month follow-up period. CONCLUSIONS Papilledema associated with CVST can be the first presentation of APS. When performed in a timely manner, ONSF can save useful vision and lead to improvement in vision in patients with papilledema due to CVST that is refractory to medical treatment.
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http://dx.doi.org/10.12659/AJCR.930497DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164882PMC
May 2021

Comment on: Imaging in inherited retinal disorders.

Authors:
Ayman G Elnahry

Eur J Ophthalmol 2021 Apr 5:11206721211008022. Epub 2021 Apr 5.

Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.

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http://dx.doi.org/10.1177/11206721211008022DOI Listing
April 2021

Automated Image Alignment for Comparing Microvascular Changes Detected by Fluorescein Angiography and Optical Coherence Tomography Angiography in Diabetic Retinopathy.

Semin Ophthalmol 2021 Mar 30:1-8. Epub 2021 Mar 30.

Department of Ophthalmology, Lahey Hospital & Medical Center, Beth Israel Lahey Health, Peabody, MA, USA.

Purpose: To quantitatively compare microvascular features in the macula of patients with diabetic retinopathy (DR) using fluorescein angiography (FA) and optical coherence tomography angiography (OCTA).

Methods: Patients with DR were recruited from the Cairo University Hospital. FA was performed using a Topcon TRC-50DX or Heidelberg Spectralis HRA+OCT. OCTA was performed using an Optovue RTVue-XR Avanti. FA images were cropped and aligned to the corresponding OCTA images using i2k Align Retina software. The foveal avascular zone (FAZ), area of ischemia, and microaneurysms (MAs) were manually quantified using ImageJ. The fractal dimension (FD) was calculated from each skeletonized image using the FracLac plugin of ImageJ after retinal vascular segmentation.

Results: Twenty-four eyes of 17 patients were evaluated, but only 18 eyes were successfully aligned. There was no difference in FAZ area measured for FA and OCTA images. Compared with OCTA images, FD was significantly less for FA images (1.66 ± 0.048 versus 1.72 ± 0.023, < .001). Significantly more MAs were identified on FA images (102 ± 27.5) compared with OCTA (47.5 ± 11.7, < .0001). The number of MAs on FA correlated with decreasing best corrected visual acuity (r = 0.315, = .015) and increasing central macular thickness (r = 0.492, = .001). No such associations were found with MAs detected on OCTA. Nevertheless, the area of ischemia in the FA images (8.5 ± 4.1%) was significantly smaller compared with the area measured in both the superficial (30.7 ± 9.5%) and deep capillary plexus (21.6 ± 10.9%) of the OCTA ( < .001). Interestingly, number of MAs in the FA images correlated with increasing area of ischemia in the FA (r = 0.568, < .001) but only the superficial segment of the depth-resolved OCTA scans (r = 0.539, < .001).

Conclusions: OCTA is a non-invasive tool capable of resolving the retinal vasculature in greater detail when compared with FA but detects significantly fewer MAs. Automatic alignment facilitates quantitative comparison of the microvascular features in DR.
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http://dx.doi.org/10.1080/08820538.2021.1901122DOI Listing
March 2021

Chandelier-assisted pneumatic retinopexy for rhegmatogenous retinal detachment repair in young adults.

Indian J Ophthalmol 2021 04;69(4):979-981

Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.

We describe the new technique of chandelier-assisted pneumatic retinopexy in repairing rhegmatogenous retinal detachments in a series of young adults. In the operating room, a 25-gauge trocar cannula is inserted at the pars plana 180° across the preoperatively detected retinal break followed by Chandelier light insertion, which is used in globe fixation and rotation. The retinal periphery is reexamined using scleral indentation and chandelier light endoillumination. Transconjunctival cryopexy is performed around the break followed by paracentesis and pure sulfur hexafluoride gas injection. Twelve eyes of 12 patients were repaired. Their mean (±SD) age was 29.4 (±3.4) years and preoperative corrected distance visual acuity (CDVA) was 0.36 (±0.32). Nine eyes had 1 break while 3 eyes had 2 breaks within 1 clock hour. Mean duration of operation was 11.7 (±1.8) min. No patient experienced major intraoperative complications, but one patient required reoperation. Mean CDVA 6 months postoperatively was 0.63 (± 0.21) (p < 0.05).
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http://dx.doi.org/10.4103/ijo.IJO_1798_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012970PMC
April 2021

A 47-Year-Old Woman Urgently Referred for Proliferative Diabetic Retinopathy Management.

JAMA Ophthalmol 2021 Apr;139(4):482-483

Scheie Eye Institute, University of Pennsylvania, Philadelphia.

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http://dx.doi.org/10.1001/jamaophthalmol.2020.4670DOI Listing
April 2021

Diagnostic and Therapeutic Challenge.

Retina 2020 Dec 17;Publish Ahead of Print. Epub 2020 Dec 17.

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http://dx.doi.org/10.1097/IAE.0000000000003084DOI Listing
December 2020

Treatment of Intraretinal Cystic Spaces Associated With Gyrate Atrophy of the Choroid and Retina With Intravitreal Bevacizumab.

J Pediatr Ophthalmol Strabismus 2020 Nov;57(6):400-406

Purpose: To evaluate the use of intravitreal bevacizumab injections for the treatment of intraretinal cystic spaces associated with gyrate atrophy of the choroid and retina.

Methods: Retrospective chart review of 5 eyes of 3 patients with intraretinal cystic spaces associated with gyrate atrophy and treated with intravitreal bevacizumab injections was performed. Information obtained included history, examination findings, optical coherence tomography (OCT), OCT angiography, fluorescein angiography, and microperimetric findings before and after the injections.

Results: The mean age of patients was 11 ± 4.6 years. All patients received three monthly bevacizumab injections. The mean corrected distance visual acuity was 0.27 ± 0.10 at baseline and improved to 0.36 ± 0.12 after the injections (P = .015). The mean central macular thickness was 569 ± 127 µm at baseline and improved to 422 ± 123 µm after the injections (P = .067). Microperimetry and OCT angiography performed in 1 patient before and after the three injections showed improved macular sensitivity and vascular density measurements following the injections.

Conclusions: Intravitreal bevacizumab is safe and effective in the treatment of intraretinal cystic spaces associated with gyrate atrophy. [J Pediatr Ophthalmol Strabismus. 2020;57(6):400-406.].
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http://dx.doi.org/10.3928/01913913-20200813-01DOI Listing
November 2020

Management of Idiopathic Intracranial Hypertension During the COVID-19 Pandemic.

Rev Recent Clin Trials 2021 ;16(2):122-125

Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Background: In the current coronavirus disease 2019 (COVID-19) pandemic, health systems are struggling to prioritize care for affected patients; however, physicians globally are also attempting to maintain care for other less-threatening medical conditions that may lead to permanent disabilities if untreated. Idiopathic intracranial hypertension (IIH) is a relatively common condition affecting young females that could lead to permanent blindness if not properly treated. In this article, we provide some insight and recommendations regarding the management of IIH during the pandemic.

Methods: The diagnosis, follow-up, and treatment methods of IIH during the COVID-19 pandemic period are reviewed. COVID-19, as a mimic of IIH, is also discussed.

Results: Diagnosis and follow-up of papilledema due to IIH during the COVID-19 pandemic can be facilitated by nonmydriatic fundus photography and optical coherence tomography. COVID-19 may mimic IIH by presenting as cerebral venous sinus thrombosis, papillophlebitis, or meningoencephalitis, so a high index of suspicion is required in these cases. When surgical treatment is indicated, optic nerve sheath fenestration may be the primary procedure of choice during the pandemic period.

Conclusion: IIH is a serious vision-threatening condition that could lead to permanent blindness and disability at a relatively young age if left untreated. It could be the first presentation of a COVID-19 infection. Certain precautions during the diagnosis and management of this condition could be taken that may allow appropriate care to be delivered to these patients while minimizing the risk of coronavirus infection.
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http://dx.doi.org/10.2174/1574887115666200917111413DOI Listing
June 2021

Peripapillary microperimetry for the diagnosis and follow-up of papilledema in cases treated for idiopathic intracranial hypertension.

Neurol Res 2021 Jan 11;43(1):61-70. Epub 2020 Sep 11.

Department of Ophthalmology, Faculty of Medicine, Cairo University , Cairo, Egypt.

Objectives: To evaluate the use of peripapillary microperimetry in the diagnosis and follow-up of medically and surgically treated cases of papilledema due to idiopathic intracranial hypertension (IIH).

Methods: This study was a prospective non-comparative observational case series of patients with IIH. All patients underwent full ophthalmological examination, radiological imaging, and lumbar puncture, as well as microperimetric measurements around the optic nerve head. Patients were classified into a medical group, treated by weight reduction and acetazolamide, and a surgical group, treated by optic nerve sheath fenestration. Peripapillary microperimetric examinations were done at presentation and after one-month of treatment. Findings were compared to values obtained from an age-matched healthy control group.

Results: The study included 78 eyes of 39 patients diagnosed with IIH and 32 eyes of 16 healthy control subjects. The average of the sum of the 12 peripapillary microperimetric thresholds for both eyes of IIH cases before treatment was 53.4±59.9 dB, while for controls it was 171±14.0 dB (p<0.001). After 1 month of treatment, it improved to 86.7±56.1 dB (p<0.001) in IIH cases. Analyzed separately, the medical group improved from 68.9±43.4 dB to 105.2±76.5 dB (p<0.001), while the surgical group improved from 13.5±21.9 dB to 54.9±35.5 dB (p<0.001). Several potential roles for peripapillary microperimetry use in IIH management were identified including confirming papilledema diagnosis, follow up of treatment, and selection of cases for surgery.

Conclusion: Microperimetry can accurately and quantitatively monitor changes in peripapillary retinal sensitivity in patients undergoing treatment for papilledema due to IIH.
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http://dx.doi.org/10.1080/01616412.2020.1820811DOI Listing
January 2021

Analysis of optical coherence angiography in cystoid macular oedema associated with gyrate atrophy.

Eye (Lond) 2021 Jun 1;35(6):1766-1774. Epub 2020 Sep 1.

Department of Ophthalmology Ospedale San Raffaele, University Vita-Salute Milan, Milano, Italy.

Background: To evaluate the relationship between superficial, deep foveal avascular zone (FAZ) and foveal cyst areas in eyes with cystoid macular oedema (CMO) associated with gyrate atrophy of the choroid and retina (GA).

Methods: This is a retrospective collaborative multicenter study of optical coherence tomography-angiography (OCTA) images in GA. Superficial and deep FAZ and foveal cyst were measured using Image J by two independent experts. Values were corrected for myopia magnification. These values were compared with age-matched controls from normative data.

Results: Twenty-three eyes from 12 patients with GA and CMO were included in the study. The mean ± standard deviation age was 22 ± 19.7 years, mean Snellen spectacle-corrected visual acuity of 20/70 with mean myopia of 5.7 ± 4.1 dioptres. Qualitatively, no focal occlusion of superficial and deep capillary plexus was noted. Mean superficial FAZ area (0.484 ± 0.317 mm), deep FAZ area (0.626 ± 0.452 mm), and foveal cyst area (0.630 ± 0.503 mm) were significantly larger than superficial and deep FAZ areas in controls of same age range (p < 0.001). Macular cyst area correlated with superficial FAZ area (R = 0.59; p = 0.0057) and more strongly with deep FAZ area (R = 0.69; p < 0.001).

Conclusions: The superficial and deep FAZ area in GA-associated CMO were noted to be significantly larger than in controls. It seems that RPE dysfunction leads to foveal cyst enlargement displacing the capillary plexus with resultant enlarged superficial and deep FAZ area.
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http://dx.doi.org/10.1038/s41433-020-01166-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8169820PMC
June 2021

Optical coherence tomography angiography imaging of the retinal microvasculature is unimpeded by macular xanthophyll pigment.

Clin Exp Ophthalmol 2020 09 4;48(7):1012-1014. Epub 2020 Aug 4.

Department of Ophthalmology, Lahey Hospital & Medical Center, Beth Israel Lahey Health, Peabody, Massachusetts, USA.

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http://dx.doi.org/10.1111/ceo.13824DOI Listing
September 2020

Acute idiopathic maculopathy during the treatment of intracranial tuberculomas masquerading as malignant glioma.

Acta Neurol Belg 2020 Oct 12;120(5):1251-1253. Epub 2020 Jun 12.

Department of Ophthalmology, Faculty of Medicine, Cairo University, Kasr Alainy street, Cairo, 11956, Egypt.

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http://dx.doi.org/10.1007/s13760-020-01406-2DOI Listing
October 2020

Review on Recent Trials Evaluating the Effect of Intravitreal Injections of Anti-VEGF Agents on the Macular Perfusion of Diabetic Patients with Diabetic Macular Edema.

Rev Recent Clin Trials 2020 ;15(3):188-198

Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Background: Diabetic macular edema (DME) is a major cause of vision loss in diabetics worldwide. Anti-vascular endothelial growth factor (anti-VEGF) agents have become the mainstay of treatment of vision loss due to DME. Long-term effects of these agents on the macular perfusion (MP) are a current concern.

Objective: To review recently published studies that evaluated the effect of intravitreal injection of anti-VEGF agents on the MP of diabetics with DME.

Methods: Different databases were searched including PubMed, Medline, Ovid, Science Direct, and Google Scholar for relevant studies published between 2010 and 2019. All studies found were compared regarding methodology and results and included in this review. Some studies relating to retinal perfusion in general and not strictly MP were also included for comprehensiveness.

Results: Several studies utilizing different anti-VEGF agents were identified. All the large randomized controlled clinical trials identified utilized primarily fluorescein angiography (FA) and human graders and found generally no worsening of MP associated with anti-VEGF agents use in diabetic patients with DME. Some of these studies, however, depended on post-hoc analysis. Several more recent, but smaller case series, have utilized the relatively new and non-invasive optical coherence tomography angiography (OCTA) in this evaluation and found more conflicting results.

Conclusion: The large clinical trials recently performed depended mainly on FA in the analysis of MP changes following injections and generally found no worsening of MP. More recently, smaller case series have utilized OCTA in this analysis, yielding more conflicting results. Large randomized controlled trials using OCTA are thus needed.
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http://dx.doi.org/10.2174/1574887115666200519073704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7536789PMC
January 2020

Evaluation of Changes in Macular Perfusion Detected by Optical Coherence Tomography Angiography following 3 Intravitreal Monthly Bevacizumab Injections for Diabetic Macular Edema in the IMPACT Study.

J Ophthalmol 2020 27;2020:5814165. Epub 2020 Apr 27.

Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Objective: To evaluate macular perfusion changes following intravitreal bevacizumab injections for diabetic macular edema (DME) using spectral domain optical coherence tomography angiography (SD-OCTA).

Methods: This study was a prospective noncomparative interventional case series. Treatment naïve patients with DME underwent full ophthalmological examination and SD-OCTA scanning at baseline and after 3 intravitreal bevacizumab injections. Both the 6 × 6 and 3 × 3 mm macular scan protocols were used. Pretreatment and posttreatment OCTA images were automatically aligned using a commercially available retina alignment software (i2k Align Retina software); then the fractal dimension (FD), vascular density (VD), and skeleton VD changes were obtained at the full retinal thickness (Full) and superficial (SCP) and deep (DCP) capillary plexuses after processing images using a semiautomated program. The foveal avascular zone (FAZ) was manually measured and FD was calculated using the FracLac plugin of ImageJ.

Results: Forty eyes of 26 patients were included. Following injections, there were an 8.1% increase in FAZ, 1.3% decrease in FD-Full and FD-SCP, 1.9% decrease in FD-DCP, 8% decrease in VD-Full, 9.1% decrease in VD-SCP, 10.6% decrease in VD-DCP, 13.3% decrease in skeleton VD-Full, 12.5% decrease in skeleton VD-SCP, and 16.3% decrease in skeleton VD-DCP in the 6 × 6 mm macular area and a 2.6% decrease in FD-Full, 3.4% decrease in FD-SCP, 11.5% decrease in VD-Full, 14.3% decrease in VD-SCP, and 25.1% decrease in skeleton VD-SCP in the 3 × 3 mm macular area which were all statistically significant ( < 0.05). Using univariate and multivariate analysis, the pretreatment FD, VD, and skeleton VD at each capillary layer significantly negatively correlated with the change in FD, VD, and skeleton VD at the corresponding capillary layer, respectively ( < 0.05).

Conclusion: OCTA is a useful noninvasive tool for quantitative evaluation of macular perfusion changes following DME treatment. This trial is registered with NCT03246152.
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http://dx.doi.org/10.1155/2020/5814165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201518PMC
April 2020

Optical coherence tomography of the optic nerve head before and after optic nerve sheath fenestration for idiopathic intracranial hypertension.

Acta Neurol Belg 2020 Jun 17;120(3):775-777. Epub 2020 Mar 17.

Department of Ophthalmology, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo, 11956, Egypt.

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http://dx.doi.org/10.1007/s13760-020-01331-4DOI Listing
June 2020

Response to: Optic neuritis induced by 5-fluorouracil chemotherapy: case report and review of the literature.

J Oncol Pharm Pract 2020 04 13;26(3):775. Epub 2020 Feb 13.

Department of Ophthalmology, Faculty of Medicine, Cairo University.

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http://dx.doi.org/10.1177/1078155220904414DOI Listing
April 2020

REVERSIBLE NEUROTROPHIC KERATOPATHY ASSOCIATED WITH ROSUVASTATIN THERAPY: A CASE REPORT.

J Popul Ther Clin Pharmacol 2019 08 16;26(2):e38-e42. Epub 2019 Aug 16.

Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Background: Rosuvastatin is a 3-hydroxy-3-methyl-glutaryl-CoA reductase enzyme inhibitor that is in wide use with few reported ocular adverse events.

Objectives: To report a case of bilateral neurotrophic keratopathy associated with rosuvastatin therapy that dramatically improved following drug discontinuation.

Case Presentation: A 65-year-old female presented with painless diminution of vision in both eyes of gradual onset and progressive course for 1 month. She had recently started rosuvastatin therapy for hyperlipidemia. Examination revealed bilateral stage 2 neurotrophic keratopathy with impaired corneal sensation which was previously resistant to conservative ulcer treatment. Following discontinuation of rosuvastatin therapy, there was dramatic bilateral improvement in corneal sensation, size of the corneal ulcers, and visual acuity.

Conclusion: Rosuvastatin may result in reversible trigeminal nerve impairment and neurotrophic keratopathy.
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http://dx.doi.org/10.15586/jptcp.v26i2.627DOI Listing
August 2019

Orbital and Subcutaneous Encephalocele 10 Days Following an Orbital Roof Fracture in a Child.

Ophthalmic Plast Reconstr Surg 2020 May/Jun;36(3):e79

Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt.

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http://dx.doi.org/10.1097/IOP.0000000000001431DOI Listing
March 2021

Anterior ischemic optic neuropathy in a patient with optic disc Drusen while on FOLFOX Chemotherapy for colon cancer: the value of Occam's Razor and Hickam's dictum.

Authors:
Ayman G Elnahry

Rom J Ophthalmol 2019 Apr-Jun;63(2):174-177

Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.

A 53-year-old male developed acute diminution of vision in his right eye while on FOLFOX chemotherapy for stage C colon cancer. Examination revealed bilateral optic nerve head swelling with flame shaped hemorrhages over the right optic disc and anomalous left retinal vasculature. Computed tomography scan of the brain and orbit revealed no cerebral pathology, however bilateral optic disc drusen (ODD) was suspected. B scan ultrasonography confirmed the presence of bilateral ODD. Fluorescein angiography showed early hypofluorescence of the right optic disc with bilateral late disc staining and a diagnosis of right anterior ischemic optic neuropathy (AION) with bilateral ODD was made. A literature review was performed and possible mechanisms for the development of AION in this case were discussed.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6626935PMC
July 2019

Vitrectomy for a secondary epiretinal membrane following treatment of adult-onset Coats' disease.

Am J Ophthalmol Case Rep 2019 Sep 9;15:100508. Epub 2019 Jul 9.

Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Purpose: To report a case of adult-onset Coats' disease that had worsening of macular edema and progressive macular traction following cryotherapy and repeated intravitreal bevacizumab injections due to formation of a secondary epiretinal membrane which only improved following pars plana vitrectomy and membrane peeling.

Observations: A 35-year-old male presented with diminution of vision in his left eye and was found to have localized telangiectatic retinal vessels and aneurysmal dilatations with massive exudation and cystoid macular edema. He was diagnosed as adult-onset Coats' disease and treated with cryotherapy and a concomitant intravitreal injection of 2.5 mg bevacizumab followed by 3 monthly intravitreal injections of 2.5 mg bevacizumab and a single injection of 4 mg triamcinolone acetonide. Partial obliteration of the telangiectatic vessels and aneurysmal dilatations with improvement in surrounding lipid and fluid exudate was achieved, however, this was associated with progressive worsening of macular edema and macular traction due to formation of an epiretinal membrane which only improved following vitrectomy and membrane peeling. Effect of therapy at each stage was evaluated using visual acuity testing, fundus examination, fundus fluorescein angiography, and optical coherence tomography.

Conclusion And Importance: A secondary epiretinal membrane can develop following treatment of adult-onset Coats' disease and cause traction especially when combining cryotherapy with bevacizumab injections. Vitrectomy in such cases with membrane peeling may result in improvement of anatomical and functional outcomes.
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http://dx.doi.org/10.1016/j.ajoc.2019.100508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6624194PMC
September 2019

Clinical and Imaging Findings One Year Following Traumatic Chiasm Transection.

Neuroophthalmology 2019 Jun 19;43(3):205-207. Epub 2018 Sep 19.

Elnahry Eye Clinics, Giza, Egypt.

Traumatic chiasm transection is a rare condition characterized by bitemporal hemianopsia following head trauma. In a study of visual complications following head trauma, only 4.4% of patients suffered from chiasmal injuries. Complete transection of the chiasm is even more rare and best visualized using magnetic resonance imaging (MRI). We report the one-year follow-up of clinical, visual field, and MRI findings of a patient with complete transection of the optic chiasm following head trauma.
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http://dx.doi.org/10.1080/01658107.2018.1521842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619945PMC
June 2019

Unilateral papilledema revealing an intracanalicular optic nerve sheath meningioma.

Neuroophthalmology 2019 Apr 26;43(2):123-125. Epub 2018 Jun 26.

Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.

A 43-year-old female is referred to our clinic for evaluation of an incidentally discovered unilateral papilledema in her right eye of unknown cause. She had no past ocular or medical history. Examination revealed a corrected-distance visual acuity of 20/20 in both eyes. Posterior segment examination showed an elevated right optic nerve head with blurred edges. Ultrasonography failed to reveal optic disc drusen. Visual field testing showed enlargement of the blind spot in the right eye. Magnetic resonance imaging of the brain and orbit was done and revealed enlargement of the intracanalicular and prechiasmatic part of the right optic nerve and a diagnosis of a presumed right intracanalicular optic nerve sheath meningioma was made. She was managed conservatively and several years later remains asymptomatic.
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http://dx.doi.org/10.1080/01658107.2018.1482359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619963PMC
April 2019

Abdominal sarcoidosis presenting as bilateral simultaneous optic disc granulomas.

Neuroophthalmology 2019 Apr 13;43(2):91-94. Epub 2018 Jun 13.

Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.

A 24-year-old male presents with diminution of vision in both eyes of acute onset with floaters. He has a history of fever of unknown origin. Examination revealed bilateral optic disc granulomas with mild vitritis. Serum angiotensin converting enzyme was found to be elevated and tuberculin skin test was negative. Computed tomography scan of the chest showed clear lung fields with no hilar lymphadenopathy but mildly enlarged pretracheal lymph nodes. Computed tomography scan of the abdomen revealed multiple enlarged abdominal lymph nodes with hepatosplenomegaly, and ultrasound-guided biopsy of one of these lymph nodes showed chronic granulomatous inflammation consistent with sarcoidosis. Immunosuppressive therapy resulted in resolution of ocular inflammation with no recurrence.
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http://dx.doi.org/10.1080/01658107.2018.1467935DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619928PMC
April 2019

Treatment of acquired Brown syndrome in a child with a single intramuscular systemic depot steroid injection.

J AAPOS 2019 10 27;23(5):292-293. Epub 2019 May 27.

Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt; Elnahry Eye Clinics, Giza, Egypt.

A 10-year-old girl presented with a complaint of diplopia and mild superomedial orbital pain in the left eye of 2 weeks' duration. She had limited elevation of the left eye, especially in adduction, moderate limitation of elevation in the primary position, mild limitation of elevation in abduction, downshoot in adduction, mild hypotropia in the primary position, and normal abduction. There was mild swelling and tenderness in the superomedial aspect of her left orbit. Fundus examination revealed intorsion of the left fundus on upgaze. She was diagnosed with acquired Brown syndrome, due presumably to a local inflammatory cause, and treated with a single intramuscular depot injection of betamethasone in her deltoid muscle. One week later, her symptoms were resolving, and there was marked improvement of elevation of the left eye in adduction, with near normal elevation in the primary position and in abduction. There was no recurrence 3 months later.
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http://dx.doi.org/10.1016/j.jaapos.2019.05.003DOI Listing
October 2019

Evaluation of the Effect of Repeated Intravitreal Bevacizumab Injections on the Macular Microvasculature of a Diabetic Patient Using Optical Coherence Tomography Angiography.

Case Rep Ophthalmol Med 2019 18;2019:3936168. Epub 2019 Apr 18.

Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.

A 53-year-old female patient with center-involving diabetic macular edema affecting the left eye was imaged using optical coherence tomography angiography (OCTA) in both eyes. She underwent three monthly intravitreal bevacizumab injections in the left eye only and OCTA was repeated in both eyes one month following the last injection and showed decreased vascular density (VD) in the treated left eye but not in the untreated right eye compared to baseline. No further injections were required in either eye, and OCTA was done in both eyes 4 months following the last injection which showed improved VD of the left eye with stable VD in the right. Three monthly intravitreal bevacizumab injections were then required in both eyes; then OCTA was repeated following the last injection and revealed decreased VD in both eyes compared to previous scan. OCTA could be a useful tool for detecting VD changes following bevacizumab injections in diabetics.
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http://dx.doi.org/10.1155/2019/3936168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500649PMC
April 2019
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