Isolated orbital fractures constitute 4% to 6% of facial fractures and the incidence reaches up to 30% to 55% when combined with other facial bone fractures (1). Blow–out fractures are caused by direct trauma to the globe which causes an increase in intraorbital pressure and decompression via fracture of the orbital floor (2). Orbital trauma is largely the result of motor vehicle accidents, industrial accidents, sports-related facial trauma, and assaults. Motor vehicle accidents, particularly those in which seatbelts are not worn, are usually the most common cause of maxillofacial trauma, as shown in large series in developed nations.In the adult female population, nonaccidental injury in the form of domestic violence should be specifically assessed during history-taking, because this is a common cause of orbital fractures in this group (3). The patient commonly complaining of ecchymosis , black eyes ,limitation of eye movements, diplopia, enophthalmos and very rarely severe pain and nausea immediately after the injury (4). Computed tomography, plane radiology and magnetic resonance imaging may be used in the evaluation of the orbital trauma (5). Timing of and method used for reconstruction of orbital floor is controversial. Surgical repair is indicated in diplopia, severe enophthalmos (>2mm), and large fractures (50% or more of floor) (6). The goal of reconstruction in the orbital blow-out fractures are to restore floor continuity, provide support of orbital contents and prevent fibrosis of soft tissues (7). Reconstruction of orbital blow-out fractures can be carried out with alloplastic or autogenous graft. Autogenous grafts include bones (calvarium, rib and iliac crest) and cartilages (nasoseptal, conchal and rib). Autogenous bone is an ideal material for grafting (8). Alloplastic materials include porous polyethelene (medpore surgical implant), high density polyethelene (marlex), and silicone (silastic).The popularity of these synthetic materials is largely owing to their availability and convenience with long-term satisfactory results. However, some complications including extrusion, infection and dacryocystitis have been reported (9). Autogenous grafts provide better biocompatibility. However they cause donor site morbidity, additional operative time and potential problems of graft resorption (10).

Isolated orbital fractures constitute 4% to 6% of facial fractures and the incidence reaches up to 30% to 55% when combined with other facial bone fractures (1). Blow–out fractures are caused by direct trauma to the globe which causes an increase in intraorbital pressure and decompression via fracture of the orbital floor (2). Orbital trauma is largely the result of motor vehicle accidents, industrial accidents, sports-related facial trauma, and assaults. Motor vehicle accidents, particularly those in which seatbelts are not worn, are usually the most common cause of maxillofacial trauma, as shown in large series in developed nations.In the adult female population, nonaccidental injury in the form of domestic violence should be specifically assessed during history-taking, because this is a common cause of orbital fractures in this group (3). The patient commonly complaining of ecchymosis , black eyes ,limitation of eye movements, diplopia, enophthalmos and very rarely severe pain and nausea immediately after the injury (4). Computed tomography, plane radiology and magnetic resonance imaging may be used in the evaluation of the orbital trauma (5). Timing of and method used for reconstruction of orbital floor is controversial. Surgical repair is indicated in diplopia, severe enophthalmos (>2mm), and large fractures (50% or more of floor) (6). The goal of reconstruction in the orbital blow-out fractures are to restore floor continuity, provide support of orbital contents and prevent fibrosis of soft tissues (7). Reconstruction of orbital blow-out fractures can be carried out with alloplastic or autogenous graft. Autogenous grafts include bones (calvarium, rib and iliac crest) and cartilages (nasoseptal, conchal and rib). Autogenous bone is an ideal material for grafting (8). Alloplastic materials include porous polyethelene (medpore surgical implant), high density polyethelene (marlex), and silicone (silastic).The popularity of these synthetic materials is largely owing to their availability and convenience with long-term satisfactory results. However, some complications including extrusion, infection and dacryocystitis have been reported (9). Autogenous grafts provide better biocompatibility. However they cause donor site morbidity, additional operative time and potential problems of graft resorption (10).

Abstract Vascular endothelial dysfunction, accelerated thickening of arterial intima, and changes in ventricular functions contribute to increased cardiovascular morbidity in type 1 diabetes mellitus (T1DM). This study aimed to investigate the functional-structural changes in the arteries and myocardium together with affection of highly sensitive C-reactive protein (hsCRP), circulating endothelial cells (CECs), and vitamin C levels in children with T1DM. Also, to test the association with early atherosclerotic changes. The study included 30 children with a diagnosis of T1DMand 30 healthy subjects matched by sex, age, and body mass index. Serum lipids, HbA1c, hsCRP, vitamin C, and CECs were detected. Corrected QT interval (QTc), cardiac dimensions, and left ventricular (LV) functions were assessed using conventional echocardiography. Noninvasive ultrasound was used to measure brachial artery flow-mediated dilation (FMD) responses and carotid intima-media thickness (IMT). The QTc interval was significantly higher in the diabetic patients than in the control subjects (P�.001). The findings showed LV diastolic dysfunction as reflected by significantly lower early peak flow velocity, decreased E/ A ratio, increased early filling deceleration time (DcT), and prolonged isovolumic relaxation time (IVRT) (P�.001for each). The children with diabetes had a significantly lower FMD response, increased IMT, lower vitamin C level, higher hsCRP, and higher CEC compared with the control subjects (P�.001 for each). A positive correlation between CEC and HbA1c was found (P = 0.004). An alteration in myocardial function and endothelial dysfunction may begin early with the association of early atherosclerotic changes. These changes are accelerated when glycemic control is poor. The authors recommend early and close observation of children with diabetes for any alterations in cardiac and vascular endothelial function. Vitamin C supplementation may reduce the risk of complications.

Abstract Vascular endothelial dysfunction, accelerated thickening of arterial intima, and changes in ventricular functions contribute to increased cardiovascular morbidity in type 1 diabetes mellitus (T1DM). This study aimed to investigate the functional-structural changes in the arteries and myocardium together with affection of highly sensitive C-reactive protein (hsCRP), circulating endothelial cells (CECs), and vitamin C levels in children with T1DM. Also, to test the association with early atherosclerotic changes. The study included 30 children with a diagnosis of T1DMand 30 healthy subjects matched by sex, age, and body mass index. Serum lipids, HbA1c, hsCRP, vitamin C, and CECs were detected. Corrected QT interval (QTc), cardiac dimensions, and left ventricular (LV) functions were assessed using conventional echocardiography. Noninvasive ultrasound was used to measure brachial artery flow-mediated dilation (FMD) responses and carotid intima-media thickness (IMT). The QTc interval was significantly higher in the diabetic patients than in the control subjects (P�.001). The findings showed LV diastolic dysfunction as reflected by significantly lower early peak flow velocity, decreased E/ A ratio, increased early filling deceleration time (DcT), and prolonged isovolumic relaxation time (IVRT) (P�.001for each). The children with diabetes had a significantly lower FMD response, increased IMT, lower vitamin C level, higher hsCRP, and higher CEC compared with the control subjects (P�.001 for each). A positive correlation between CEC and HbA1c was found (P = 0.004). An alteration in myocardial function and endothelial dysfunction may begin early with the association of early atherosclerotic changes. These changes are accelerated when glycemic control is poor. The authors recommend early and close observation of children with diabetes for any alterations in cardiac and vascular endothelial function. Vitamin C supplementation may reduce the risk of complications.

Purpose To describe the pattern of ophthalmic medicolegal cases with emphasis on cases of assault, and to acquaint ophthalmologists with rules pertaining to expert testimony and medical reports. Methods A retrospective study was carried out to review files of 247 medicolegal cases from Upper Egypt seen by the senior author in 8 years. These were classified categorically and were analyzed from various characteristics and aspects. The scheme for examination of subjects and for formulating the medicolegal report is described. Results The different categories were assault in 224 cases (90.5%), military recruitment evasion in 8 cases (3.25%), occupational disability claims in 8 cases (3.25%) and medical malpractice in 7 cases (3%). Thirty two cases (13%) presented with alleged functional visual loss, of them 25 cases (10%) were malingering. Traumatic lens subluxation or dislocation was seen in 37 (13.5%) cases and phthisis and atrophia bulbi was the presenting sign in 55 (22.3%) cases. Twenty percent of assault cases were females. There were no differences in incidence between the provinces in Upper Egypt. Assault tools inflicted injuries are described, as well as the outcome of these cases. Claims against military recruits could not be substantiated. Occupational claims for damages were false. Alleged medical negligence cases were rejected based on accepted standards of care and not on unexpected complications. Conclusion Medical reports have to be structured, detailed, accurate and unbiased. Data in this work are useful for statistical and planning purposes in the medicolegal domain.

Purpose To describe the pattern of ophthalmic medicolegal cases with emphasis on cases of assault, and to acquaint ophthalmologists with rules pertaining to expert testimony and medical reports. Methods A retrospective study was carried out to review files of 247 medicolegal cases from Upper Egypt seen by the senior author in 8 years. These were classified categorically and were analyzed from various characteristics and aspects. The scheme for examination of subjects and for formulating the medicolegal report is described. Results The different categories were assault in 224 cases (90.5%), military recruitment evasion in 8 cases (3.25%), occupational disability claims in 8 cases (3.25%) and medical malpractice in 7 cases (3%). Thirty two cases (13%) presented with alleged functional visual loss, of them 25 cases (10%) were malingering. Traumatic lens subluxation or dislocation was seen in 37 (13.5%) cases and phthisis and atrophia bulbi was the presenting sign in 55 (22.3%) cases. Twenty percent of assault cases were females. There were no differences in incidence between the provinces in Upper Egypt. Assault tools inflicted injuries are described, as well as the outcome of these cases. Claims against military recruits could not be substantiated. Occupational claims for damages were false. Alleged medical negligence cases were rejected based on accepted standards of care and not on unexpected complications. Conclusion Medical reports have to be structured, detailed, accurate and unbiased. Data in this work are useful for statistical and planning purposes in the medicolegal domain.

Purpose To describe the pattern of ophthalmic medicolegal cases with emphasis on cases of assault, and to acquaint ophthalmologists with rules pertaining to expert testimony and medical reports. Methods A retrospective study was carried out to review files of 247 medicolegal cases from Upper Egypt seen by the senior author in 8 years. These were classified categorically and were analyzed from various characteristics and aspects. The scheme for examination of subjects and for formulating the medicolegal report is described. Results The different categories were assault in 224 cases (90.5%), military recruitment evasion in 8 cases (3.25%), occupational disability claims in 8 cases (3.25%) and medical malpractice in 7 cases (3%). Thirty two cases (13%) presented with alleged functional visual loss, of them 25 cases (10%) were malingering. Traumatic lens subluxation or dislocation was seen in 37 (13.5%) cases and phthisis and atrophia bulbi was the presenting sign in 55 (22.3%) cases. Twenty percent of assault cases were females. There were no differences in incidence between the provinces in Upper Egypt. Assault tools inflicted injuries are described, as well as the outcome of these cases. Claims against military recruits could not be substantiated. Occupational claims for damages were false. Alleged medical negligence cases were rejected based on accepted standards of care and not on unexpected complications. Conclusion Medical reports have to be structured, detailed, accurate and unbiased. Data in this work are useful for statistical and planning purposes in the medicolegal domain.

Abstract PURPOSE: To study the morphological patterns of pterygia and pingueculae using high-resolution anterior segment spectral domain optical coherence tomography (SD-OCT). METHODS: Prospective cross-sectional study of 25 eyes presented with pterygia and pingueculae was conducted, and the eyes were examined by anterior segment SD-OCT. RESULTS: We examined 25 eyes, including 13 eyes with primary pterygia, six eyes with recurrent pterygia, one case with a pseudopterygium and five eyes with pingueculae. Primary pterygia revealed elevation of the corneal epithelium by a wedge-shaped mass of tissue separating the corneal epithelium from the underlying Bowman's membrane, which became wavy and interrupted. We found satellite masses of pterygium tissue advanced under the epithelium beyond the clinically seen pterygium margins. In recurrent pterygia, we detected that the central tip of the pterygium was more advanced and creeping beneath the basal corneal epithelium than the primary pterygium. In pseudopterygium, the SD-OCT images showed that the overgrowing membrane was not really attached to the underlying cornea. In cases of pingueculae, SD-OCT revealed a wedge-shaped mass that was nearly similar in pattern to that of the pterygia but stopped at the limbal region. Immediately after removal of pterygia, we noticed many remnants of the pterygia masses over the corneal stroma in spite of the clinically clear appearance of cornea. CONCLUSIONS: SD-OCT provided us with high-resolution images of the pterygium and the pinguecula and showed clearly the anatomical relationship between the corneal tissues and these lesions. The use of this new modality of imaging may help to decrease the current recurrence rates after pterygium excision through using the anterior segment SD-OCT in the evaluation of these lesions.

Abstract PURPOSE: To study the morphological patterns of pterygia and pingueculae using high-resolution anterior segment spectral domain optical coherence tomography (SD-OCT). METHODS: Prospective cross-sectional study of 25 eyes presented with pterygia and pingueculae was conducted, and the eyes were examined by anterior segment SD-OCT. RESULTS: We examined 25 eyes, including 13 eyes with primary pterygia, six eyes with recurrent pterygia, one case with a pseudopterygium and five eyes with pingueculae. Primary pterygia revealed elevation of the corneal epithelium by a wedge-shaped mass of tissue separating the corneal epithelium from the underlying Bowman's membrane, which became wavy and interrupted. We found satellite masses of pterygium tissue advanced under the epithelium beyond the clinically seen pterygium margins. In recurrent pterygia, we detected that the central tip of the pterygium was more advanced and creeping beneath the basal corneal epithelium than the primary pterygium. In pseudopterygium, the SD-OCT images showed that the overgrowing membrane was not really attached to the underlying cornea. In cases of pingueculae, SD-OCT revealed a wedge-shaped mass that was nearly similar in pattern to that of the pterygia but stopped at the limbal region. Immediately after removal of pterygia, we noticed many remnants of the pterygia masses over the corneal stroma in spite of the clinically clear appearance of cornea. CONCLUSIONS: SD-OCT provided us with high-resolution images of the pterygium and the pinguecula and showed clearly the anatomical relationship between the corneal tissues and these lesions. The use of this new modality of imaging may help to decrease the current recurrence rates after pterygium excision through using the anterior segment SD-OCT in the evaluation of these lesions.

Abstract AIM: To study plasma levels of vascular endothelial growth factor (VEGF), endothelin-1(ET-1) and nitric oxide (NO) in patients with proliferative diabetic retinopathy (PDR) before and after pan-retinal photocoagulation (PRP). METHODS: Forty patients (23 females and 17 males, mean age 48.5±12.2 years) with PDR without previous PRP therapy were studied. Blood samples were obtained before and 3 months after the last PRP session. Baseline (prelaser) plasma levels of VEGF, ET-1 and NO were compared with their levels in 30 healthy age- and sex- matched controls and also with plasma levels 3 months post-PRP. RESULTS: Patients with PDR had significantly raised plasma VEGF (375±89ng/L), ET-1(20±5ng/L) and NO (135±53µmol/L) when compared with healthy control group (P0.01). After PRP, there was a significant reduction in plasma VEGF (179±66ng/L), ET-1 (11±5ng/L) and NO (91±49µmol/L) levels at 3 months' follow-up but still significantly higher than healthy controls. CONCLUSION: Patients with PDR demonstrate elevated VEGF, ET-1 and NO, which decrease after successful laser treatment.