Haitham Al-Nashar | Zagazig University (original) (raw)

Papers by Haitham Al-Nashar

Delta Journal of Ophthalmology

DOAJ (DOAJ: Directory of Open Access Journals), 2022

Purpose: To evaluate different pre-operative variables on the success of combined trabeculotomy-t... more Purpose: To evaluate different pre-operative variables on the success of combined trabeculotomy-trabeculectomy (CTT) surgery in patients with primary congenital glaucoma (PCG) to predict those at higher risk for surgical failure and for proper parent counseling. Patients and Methods: Sixty-three eyes of patients with PCG were treated either with CTT without augmentation, or CTT augmented with mitomycin-C (0.2 mg/mL) in both subconjunctival space and under scleral flap for 3 minutes, or with CTT augmented with a collagen implant under both the scleral flap and the conjunctiva. Cases showed surgical failure was reported and evaluated in relation to different pre-operative variables. Results: Complete success (IOP ≤21 mmHg) was achieved in 52 cases (82.5%). Cumulative success probability was calculated using Kaplan-Meier survival analysis, proving that higher pre-operative intraocular pressure (IOP) was associated with higher failure rates (28.6% for pre-operative IOP ≥30 mmHg versus 4.8% for IOP <30 mmHg), with P value = 0.007. Conclusion: CTT is an effective surgical intervention in PCG patients without sight threatening complications. Univariate survival analysis showed higher rates of surgical failure in patients with higher pre-operative IOP, while other pre-operative variables were irrelevant.

Delta Journal of Ophthalmology, 2016

Purpose The purpose of this study was to evaluate the changes in subfoveal choroidal thickness (S... more Purpose The purpose of this study was to evaluate the changes in subfoveal choroidal thickness (SFCT) in eyes with diabetic macular edema (DME) after intravitreal bevacizumab (IVB) injection. Patients and methods Thirty eyes diagnosed as nonproliferative diabetic retinopathy with DME were included in this prospective study. All eyes received an intravitreal injection of 1.25 mg/0.05 ml bevacizumab. Best-corrected visual acuity, SFCT, and central macular thickness were measured and recorded before the IVB injection and 1 month after the injection. The choroidal thickness was measured using enhanced depth imaging technique of Heidelberg Spectralis-optical coherence tomography. Results The mean age of the patients was 55.63±4.6 years, with a mean duration of diabetes of 8.26±1.96 years. The mean preinjection SFCT was 214.3±7.9 μm. The mean SFCT after 1 month of IVB injection was 215.5±6.8 μm, with no significant difference from the preinjection value (P=0.56). The mean change in the SFCT 1 month after intravitreal injection was 1.1±9.5 μm, with 0.5% change ratio. The correlation between change in SFCT and changes in central macular thickness and best-corrected visual acuity were 0.24 and −0.3, respectively, which were insignificant (P=0.2 and 0.09, respectively). Conclusion The IVB injection has no effect on the SFCT in eyes with DME.

Delta Journal of Ophthalmology (Print), 2022

The Egyptian Journal of Chest Diseases and Tuberculosis

Background and objective Obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) common... more Background and objective Obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) commonly coexist. Both could be associated with a number of pathophysiological derangements involved in the development of diabetic retinopathy (DR). So, the aim of this study was to assess the possible association between OSA and DR. Patients and methods This is a cross-sectional observational study that was conducted on patients with T2DM. Two-field 45°-digital retinal images for each eye were used to evaluate DR and graded according to the English National Screening Program guidelines. OSA was evaluated on the basis of an inpatient overnight sleep study (polysomnography) using a computerized polysomnogram device. Results This work recruited 110 patients. OSA was observed in 60% (66 patients). OSA was found to be independently associated with both advanced DR [preprolifrative (R2) or proliferative (R3)] (odds ratio=6.29; 95% confidence interval: 1.08–6.65; P=0.04) and maculopathy (odds ratio=12.92; 95% confidence interval: 3.97–4.79; P<0.001). Moreover, OSA severity was directly related to DR grade (r=0.5, P<0.001). Conclusion OSA was independently associated with advanced DR and maculopathy in T2DM patients. Moreover, severity of OSA was directly related to DR grade.

Delta Journal of Ophthalmology, 2019

Purpose The aim of this study was to compare subconjunctival bevacizumab injection and mitomycin ... more Purpose The aim of this study was to compare subconjunctival bevacizumab injection and mitomycin C (MMC) application after primary pterygium surgery in terms of recurrence rates and complications. Patients and methods This prospective comparative clinical study included 90 eyes of 90 patients with primary pterygium who underwent excision with bare sclera technique. Patients were randomized into three groups: group A (30 eyes), in which MMC 0.02% was applied to the bare scleral area for 3 min; group B (30 eyes), which received 2.5 mg/0.1 ml subconjunctival bevacizumab injection at the end of surgery; and group C (30 eyes), which was used as a control group and did not receive any adjuvant medications after pterygium excision. Patients were followed up for 6 months, and the recurrence rates of pterygium and any complications were reported. Results At 6 months after surgery, the recurrence rates in the three groups were as follows: two (6.7%) eyes in the MMC group A, two (6.7%) eyes in the bevacizumab group B, and 11 (36.7%) eyes in the control group C, with a significant difference among groups (P=0.01). No serious complications, except subconjunctival hemorrhage, were observed in all groups. Conclusion Groups receiving topical 0.02% MMC and 2.5 mg/0.1 ml subconjunctival bevacizumab injections after surgery showed lower recurrence rates than the control group. However, no difference in the recurrence rate was observed between both groups.

Journal of cataract and refractive surgery, Nov 1, 2016

To evaluate the efficacy and safety of primary posterior continuous curvilinear capsulorhexis (PC... more To evaluate the efficacy and safety of primary posterior continuous curvilinear capsulorhexis (PCCC) in adult patients with cataract. Zagazig University Hospital, Ash-Sharkya, Egypt. Prospective nonrandomized case series. This study comprised patients with senile cataract who had phacoemulsification. All patients had a dense posterior capsule opacification (PCO) discovered intraoperatively. Primary PCCC was performed to remove the residual opacification after posterior capsule polishing. All patients were followed for 3 months postoperatively. The outcome measures were corrected distance visual acuity (CDVA), macular edema detected by optical coherence tomography, and the occurrence of intraoperative or postoperative complications. Twenty-five eyes of 25 cataract patients had phacoemulsification. The mean age was 61.9 years ± 7.5 (SD). The mean CDVA preoperatively was 0.14 ± 0.08 and postoperatively it was 0.86 ± 0.15 at 1 week, 0.93 ± 0.08 at 1 month, and 0.94 ± 0.08 at 3 months (P...

Journal of the Egyptian Ophthalmological Society, 2015

Purpose The aim of the present study was to evaluate the effectiveness of cyclosporine 0.05% in t... more Purpose The aim of the present study was to evaluate the effectiveness of cyclosporine 0.05% in the treatment of dry-eye disease. Patients and methods A total of 35 eyes of 20 patients with dry-eye disease were included in the present study. Ten patients (20 eyes) had dry eyes associated with systemic rheumatologic disease (Sjögren′s syndrome), five patients (10 eyes) had dry eyes after undergoing laser in-situ keratomileusis, and five patients (five eyes) had dry eyes after cataract surgery. Detailed history taking along with full ophthalmic examination was carried out for all patients. In addition, Schirmer′s test and break-up time (BUT) test were conducted for all patients. The patients were examined for ocular symptoms of dry eyes (ocular pain, burning, and foreign body sensation). Cyclosporine 0.05% eye drops were prescribed twice daily for 3 months. The patients were followed up after 1, 2, and 3 months. Results In total, 35 eyes of 20 patients diagnosed with dry-eye syndrome were included in this study. The mean age of the patients was 37.3 years (range: 26-65 years).The patients were evaluated for ocular symptoms (burning, pain, and foreign body sensation). Schirmer′s paper test and BUT test were conducted for all patients. The score of ocular symptoms before the beginning of the treatment was 2.50 ± 0.46, and this score improved to 0.9 ± 0.52 after 3 months with a statistically significant difference (P = 0.01). Schirmer′s paper test was performed before the beginning of the treatment, and showed a wetting of 1.15 ± 0.58 mm of the paper, and improved after 3 months to 5.86 ± 0.29 mm (P = 0.001). BUT improved from 5.57 ± 1.36 s before the treatment to 9.9 ± 0.92 s after 3 months of treatment (P = 0.001). Conclusion Topical cyclosporine 0.05% is effective in the treatment of dry-eye syndrome, which has an inflammatory cause.

Journal of the Egyptian Ophthalmological Society, 2013

Purpose The aim of the study was to evaluate the efficacy of autologous serum eyedrops for the tr... more Purpose The aim of the study was to evaluate the efficacy of autologous serum eyedrops for the treatment of recurrent corneal erosion when compared with systemic doxycycline and topical steroids. Patients and methods In this prospective study, 27 eyes of 20 patients with recurrent corneal erosion were divided into two groups. In group A (14 eyes), the patients were treated with autologous serum eyedrops and in group B (13 eyes), the patients were treated with systemic doxycycline and topical steroids. In group A, autologous serum eyedrops were administered five times daily. Serum eyedrops were prepared by obtaining 50 ml of patient's blood and allowing it to clot, and the serum was obtained by centrifugation for 15 min. Detailed informed consent was obtained from all patients before the study. Patients in group B received oral doxycycline (50 mg) twice daily and topical fluoromethalone (0.1%) three times daily. The two groups were followed up for 6 months and were compared for the signs of relapse or recurrence of corneal symptoms and for any ocular complications. Results The study included 27 eyes of 20 patients (age range: 10-45 years). Eleven eyes in group A (78.5%) had complete healing of erosions with no relapse of the disease during the follow-up period. Two eyes (14.3%) presented with a recurrence after the end of the treatment and one eye (7.1%) failed to heal. No ocular complications were detected during the follow-up. In group B, eight eyes (61.5%) showed complete healing with no relapse of the disease during the follow-up period and one eye (7.7%) failed to heal. Four eyes (30.7%) presented with a recurrence after the end of the treatment, with a significant difference compared with group A ( P = 0.02). One patient in group B showed an increase in intraocular pressure in the follow-up period. Conclusion This study suggests that the treatment of recurrent corneal erosion with autologous serum eyedrops gives the same results as with the treatment with systemic doxycycline and topical steroids, with low recurrence rate and less complication.

The Egyptian Journal of Hospital Medicine

Background: The most prevalent form of exotropia is intermittent exotropia. The effect of muscle ... more Background: The most prevalent form of exotropia is intermittent exotropia. The effect of muscle recession can be predicted using the limbal insertion distance (LID). Objective: This study aimed to assess the treatment of intermittent exotropia (IXT) among both children as well as adults assembled on lateral rectus muscle LID using bilateral lateral rectus (LR) recession. Patients and methods: 46 participants ranged in age from 5 to 30 years old. Patients were separated into groups based on age. Group I included 35 patients (76.1%) with a mean age of 10.26 ± 4.11 years and group II included 11 patients (23.9%) older than 17 years (23.55 ± 4.8). All patients were operated either bilateral or unilateral LR recession to alleviate exotropia under general anesthesia based on preoperative angle of deviation. Results: Mean dose-response differed significantly between groups which was significantly lower among patients older than 17 years. The mean dose-response was 4.73 and 4.4 in group I and group II respectively. Preoperative angle deviation, limbus insertion distance, and amount of recession all exhibited a strong positive significant correlation with the mean dosage response. Both preoperative angle deviation, LID, and amount of recession were found to exhibit a strong positive significant correlation with the mean dose-response. Conclusion: For intermittent exotropia treatment, preoperative lateral rectus muscle weakness, angle deviation, limbus insertion distance, and recession amount are all positively correlated with the mean dose-response in both eyes and in one eye separately.

Delta Journal of Ophthalmology, 2020

Purpose The aim of this study was to evaluate the choroidal thickness in eyes with diabetic macul... more Purpose The aim of this study was to evaluate the choroidal thickness in eyes with diabetic macular edema (DME) with the use of swept source optical coherence tomography (SS-OCT). Patients and methods A total of 240 eyes were included in this prospective nonrandomized study. They were divided into three groups, each including 80 eyes. Group I included patients with DME, group II included diabetic patients without retinopathy, and group III were normal persons. Fluorescein angiography was done for all diabetic patients. Macular and choroidal thicknesses were measured by SS-OCT in all eyes. Forty-five eyes from group I received two intravitreal injections of 0.5 mg/0.05 ml ranibizumab with 1-month interval. Correlation between choroidal and macular thickness was evaluated in eyes with DME. Results The mean choroidal thickness in the central subfield area was 129.7±12.5 μm in group I (eyes with DME), 200.4±2.8 μm in group II (diabetic patients without DME), and 208.3±9.7 μm in group III (normal eyes). There was a statistically significant difference in choroidal thickness between eyes with DME (group I) and both groups II and III (P<0.001), whereas there was no statistically significant difference between diabetic patients without macular edema (group II) and normal participants (group III) (P=0.2). There was no statistically significant difference among the three groups regarding age, refractive errors, and intraocular pressure. The mean best-corrected visual acuity was 0.31±0.09, 0.78±1.1, and 0.84±1.2 in groups I, II, and III, respectively (P=0.001). Negative correlation between macular and choroidal thickness was observed in eyes with DME (r=−0.7, P<0.001). There was no significant difference between choroidal thickness before and after intravitreal injection of ranibizumab (P=0.4). Conclusion Choroidal thickness measured with SS-OCT was decreased in eyes with DME in comparison with normal participants. A negative correlation was observed between choroidal and macular thickness in eyes having DME.

International Ophthalmology, 2021

To compare between the effect of early (3 months) and late (6 months) silicone removal on the ele... more To compare between the effect of early (3 months) and late (6 months) silicone removal on the electroretinogram records. Thirty-four eyes with complex primary rhegmatogenous macula off retinal detachment undergone vitrectomy. Silicone oil was removed after 3 months in group I and after 6 months in group II. Scotopic and photopic ERGs, pattern electroretinogram (PERG) and multifocal ERG (mfERG) and best-corrected visual acuity (BCVA) were recorded for all eyes Preoperative mean best corrected visual acuity (BCVA) measured was 0.93 ± 0.05 in group I and 0.9 ± 0.08 in group II. One month after silicone removal, mean BCVA was 0.20 ± 0.04 and 0.18 ± 0.02 in groups I and II respectively. Before silicone oil removal the electroretinographic a- and b-waves were greatly reduced in both groups with no significant difference between them. One month after removal of silicone oil, the electroretinographic a- and b-waves increased in both groups with no significant difference between the two groups (p = 0.46 and 0.23 respectively). The amplitudes of the ERGs increase after removal of silicone oil tamponade with no difference between early (3 months) and late (6 months) removal.

The Egyptian Journal of Hospital Medicine, 2021

Background: Papilledema is a common clinical problem where the ophthalmologist plays an important... more Background: Papilledema is a common clinical problem where the ophthalmologist plays an important role in its diagnosis. Optical coherence tomography (OCT) provides high resolution images of the retina and the retinal nerve fiber layer (RNFL). Objective: The aim of the work was early and non-invasive diagnosis of papilledema and differentiating it from pseudopapilledema using optical coherence tomography (OCT). Patients and methods: This observational case control study included a total of 45 eyes stratified into 3 equally groups, 15 each, (Group-1): eyes of healthy normal subjects, (Group-2) eyes with papilledema and (Group-3) eyes with pseudopapilledema. Patients presented at Ophthalmology Outpatient Clinic, Zagazig University Hospitals. Follow-up visits included an interview with the patient for assessing the presence of ocular symptoms, and for ophthalmologic examination to register all the clinical findings. Results: There is statistically significant difference between the studied groups regarding result of fundus examination. Normal control group had normal appearance of fundus. Concerning pseudo papilledema, 73.3% had crowded disc and 26.7% had dusen. Concerning papilledema, 40% had mild lesion, 20% had moderate and remaining 40% had severe lesion. There is statistically significant difference between the studied groups regarding morphological changes. Crowded disc and buried optic disc drusen occurred in 73.3% and 26.7% of pseudopapilledema group respectively). There is statistically significant difference between the studied groups regarding superior RNFL. On LSD comparison, the difference is significant between each individual groups. There is statistically significant difference between the studied groups regarding inferior RNFL. Conclusion: It could be concluded that spectral domain optical coherence tomography can differentiate between papilledema, pseudopapilledema, and a normal disc.

Clinical Ophthalmology, 2022

Clinical Ophthalmology (Auckland, N.Z.), 2021

Purpose To report the outcomes of using topical mitomycin-C (MMC) after reconstructive surgery fo... more Purpose To report the outcomes of using topical mitomycin-C (MMC) after reconstructive surgery for contracted socket and to compare the results with those of the conventional postoperative treatment. Patients and Methods The medical records of patients who underwent reconstructive surgery for contracted anophthalmic socket were retrospectively reviewed. Based on the postoperative treatment protocol, two groups of patients were identified; group I (15 patients) who received topical MMC drops (0.02%) 4 times daily for 6 weeks and group II (15 patients) who received the conventional treatment (topical antibiotic-steroid combination). Preoperative data were extracted for age, gender, cause and timing of anophthalmia, history of previous surgeries, preoperative forniceal depth and socket volume (SV). The main postoperative outcome measures were superior fornix depth (SFD), inferior fornix depth (IFD) and SV at the end of 6th postoperative month. Prosthesis fitting and complications were ...

Delta Journal of Ophthalmology, 2018

Purpose To evaluate the efficacy of topical α-2 agonist (brimonidine) in the treatment of mixed d... more Purpose To evaluate the efficacy of topical α-2 agonist (brimonidine) in the treatment of mixed diabetic maculopathy (with edema and ischemia). Design This is a prospective randomized case series. Patients and methods Thirty eyes of 30 patients were included in this study. All eyes had mixed diabetic maculopathy as diagnosed by fluorescein angiography and spectral domain optical coherence tomography. The cases were divided into two groups: group I (15 eyes) was treated by intravitreal triamcinolone injection and topical brimonidine twice daily for 3 months, and group II (15 eyes) was treated only by intravitreal triamcinolone injection. Visual acuity, fluorescein angiography, and optical coherence tomography were done for all patients before the beginning of the treatment and every month for 3 months to detect the changes in logarithm of minimal angle of resolution (logMAR) visual acuity and the changes in the size of the foveal avascular zone and macular thickness. Results The mean...

$Research paper thumbnail of Predictability of Sirius dual-scanning corneal tomography in the measurement of corneal power after photorefractive surgery$

International Ophthalmology, 2015

Determining an accurate central corneal power (K) measurement is crucial for calculating the intr... more Determining an accurate central corneal power (K) measurement is crucial for calculating the intraocular lens power in patients who are undergoing cataract extraction. The ideal method for measuring K is to use a device that works independently of the refractive surgery information. The Scheimpflug camera system offers a promising means of measuring the true corneal power after keratorefractive surgery. In this study, we investigated the accuracy of this system in measuring central corneal power after photorefractive corneal surgery by comparing it to the theoretically derived central corneal power by history method. A total of 120 eyes of 65 (35 females and 30 males) patients were included in this study. The mean change of refraction at the spectacle plane was 3.75 D, whereas the mean change of refraction at the corneal plane was 3.37 D. Using the Sirius dual-scanning corneal tomography, the mean change in corneal power was 3.96 D. No significant differences were detected between the mean post-operative corneal power measured by the Sirius tomographer and the mean change in refraction at the corneal plane calculated clinically (P = 0.076) and the correlation was found to be high (0.913). This study suggests that Sirius dual-scanning corneal tomography offers high predictability when measuring the central 5 mm corneal power in patients who have had myopic corneal photorefractive surgery.

Egyptian Retina Journal, 2017

Purpose: The objective of this study is to detect the changes in subfoveal choroidal thickness (S... more Purpose: The objective of this study is to detect the changes in subfoveal choroidal thickness (SFCT) in eyes with diabetic macular edema (DME) with the use of enhanced depth imaging optical coherence tomography (EDI-OCT). Patients and Methods: One hundred and eighty eyes were included in this prospective nonrandomized study. They were divided into three groups, each including sixty eyes; Group I with patients with DME, Group II included diabetic patients without maculopathy, and Group III were normal persons. All eyes were examined with fluorescein angiography to detect the retinopathy stage, and all eyes were examined by EDI spectral domain-OCT to measure the thickness of the choroid. Central macular thickness (CMT) and best-corrected visual acuity (BCVA) were measured in all groups to find the correlation between them and SFCT. Results: The SFCT was significantly decreased in DME group (215.12 ± 5.6 μm) compared with the other two groups (in Group II, it was 253.1 ± 9.3 μm and in Group III, it was 255.93 ± 9.2 μm) (P < 0.001). A negative correlation (r = −0.6) was detected between CMT and SFCT in patients with DME while no correlation between them was found in other two groups (in Group II, r = 0.17 and Group III, r = 0.2). A significant correlation (r = 0.5) was observed between BCVA and SFCT in Group I, while in other two groups, no correlation between the two measures was detected (in Group II, r = −0.1 and Group III, r = −0.1). Conclusion: In eyes with DME, there is a choroidal thinning on EDI OCT. There is a negative correlation between SFCT and CMT in eyes with DME.