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   Table of Contents - Current issue
Coverpage
October-December 2018
Volume 19 | Issue 4
Page Nos. 211-273

Online since Thursday, December 20, 2018

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ORIGINAL ARTICLES  

Supratarsal injections versus topical steroids in resistant vernal keratoconjunctivitis p. 211
Nermeen M Badawi
DOI:10.4103/DJO.DJO_41_18  
Purpose The aim of this study was to compare the safety and efficacy of supratarsal triamcinolone acetonide injection versus supratarsal dexamethasone sodium phosphate injection versus topical prednisolone acetate 1% eye drops in the treatment of resistant cases of vernal keratoconjunctivitis (VKC). Patients and methods This is a comparative, prospective randomized study that was done on 120 eyes (60 patients) having resistant VKC. The eyes included in the study were divided into three groups. Group 1 included 40 eyes (20 patients) that received supratarsal injection of 20 mg of triamcinolone acetonide; group 2 included 40 eyes (20 patients) that received supratarsal injection of 2 mg of dexamethasone sodium phosphate; and group 3 included 40 eyes (20 patients) that received topical prednisolone acetate 1% eye drops. Results Supratarsal steroid injections provided more effective resolution of symptoms and signs in comparison to topical steroid eye drops. No statistically significant difference was found between triamcinolone acetonide and dexamethasone sodium phosphate supratarsal injections (P>0.05). However, the supratarsal injections showed a statistically significant higher resolution of symptoms and signs than those of topical steroids. Eyes in groups 1 and 2 (supratarsal injections) had a lower recurrence rate and a delayed recurrence in comparison to group 3 (topical steroid eye drops) (P<0.05). No complications related to the drugs or to the technique of injection were reported in all groups. Conclusion Supratarsal injection of steroids is an effective, easy, well-tolerated, and safe technique in the treatment of resistant VKC, which provides an effective and longer relief of symptoms and signs with a delayed and lower rate of recurrence.
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Assessment of corneal thickness in soft contact lens users using anterior segment optical coherence tomography p. 216
Nehal A Hasan, Ahmed H Aldghaimy, Mohamed A Hamed, Doaa A Ahmed
DOI:10.4103/DJO.DJO_33_18  
Purpose The aim of this study was to evaluate the effect of soft contact lens (SCL) use on corneal thickness measured by anterior segment optical coherence tomography (AS-OCT). Patients and methods The epithelial and overall thicknesses of both the central cornea and the nasal and temporal cornea of SCL wearers (25 patients) were obtained by AS-OCT and compared with those of refraction‐matched controls (25 individuals) and patients with emmetropia (25 patients). Results The mean corneal epithelial thickness in SCL-wearing, spectacle-wearing, and emmetropic groups was 48.13±2.39, 51.92±2.81, and 53.13±2.11 μm, respectively. The corneal epithelium of members of the SCL group was significantly thinner than both the spectacle-wearing and emmetropic groups (P=0.000 and 0.006, respectively). The central corneal thickness in SCL-wearing, spectacle-wearing, and emmetropic groups was 517.67±21.95, 562.53±20.58, and 547.83±26.71 μm, respectively. The corneal thickness of the SCL group was significantly thinner than both the spectacle-wearing and emmetropic groups (P=0.0395 and 0.0255, respectively). Conclusion Contact lens wear is related to thinning of both corneal thickness and epithelium. AS-OCT is a noninvasive and clinically applicable technique used to assess assessing the involvement of the cornea in contact lens wearers.
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The effect of topical 1% nalbuphine versus 0.1% nepafenac on corneal epithelial wound healing and pain after photorefractive keratectomy p. 221
Basem M Ibrahim, Mohamed S Ahmad
DOI:10.4103/DJO.DJO_18_18  
Purpose To compare nalbuphine 1% (opioid analgesic) eye drops and nepafenac 0.1% (NSAID) eye drops in terms of their effects on corneal re-epithelialization and pain after photorefractive keratectomy (PRK). Design A randomized prospective double-masked contralateral eye study was conducted. Patients and methods Thirty adult healthy patients who were undergoing bilateral PRK received nepafenac 0.1% eye drops in one eye and nalbuphine 1% eye drops in the contralateral eye, every 2 h on the day of surgery and then four times daily on postoperative days 1 through 5 after bandage contact lens insertion. Patients were asked to fill out pain assessment questionnaires every 2 h (general pain and after-drop pain) starting right away after surgery and continuing through postoperative day 5. Postoperative follow-up visits were daily until the epithelial defect completely healed in both eyes. The patients were then examined weekly for 4 weeks. At each visit, the patients provided rating of the general pain and the after-drop pain, and the epithelial defect size was assessed until complete healing of the corneal epithelium. Results The general pain scores were less and the after-drop pain scores were more in the nalbuphine group when compared with the nepafenac group, but with no statistically significant difference between them (P>0.05). The mean epithelial defect size was similar between nepafenac 0.1% and nalbuphine 1% eye drops at the procedure day, but there were statistically significant differences between them with more fast healing in the nalbuphine group from the first postoperative day until complete epithelial defect healing (P<0.05). Conclusion Nalbuphine 1% eye drops may provide a new choice in controlling pain after PRK surgery with comparable efficacy and better epithelial healing when compared with nepafenac 0.1% eye drops.
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Standard versus transepithelial collagen cross-linking in the management of keratoconus p. 228
Abd El-Magid M Tag El-Din, Magdy E.E Tawakol, Amr M.M Sheta
DOI:10.4103/DJO.DJO_32_18  
Objective The aim of this study was to compare corneal collagen cross-linking (CXL) using either standard or transepithelial CXL. Patients and methods The study included 30 eyes of 18 patients with a mean age of 27.08 years. They were seven women and 11 men. Eyes were divided into two groups. Group I: included 15 eyes that underwent standard CXL after removal of the epithelium. Group II: included 15 eyes that underwent CXL with the epithelium intact. The patients were followed up postoperatively at 1 week, 1 month, 3 months, and 6 months for their uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), pentacam, ocular response analyzer, and specular microscopy. Results The preoperative mean keratometry (K) max was 47.9 diopters (D). Preoperative mean astigmatism was −3.75 D and mean pachymetry of the corneal center was 467.1 µm. The mean preoperative UCVA for group I was 0.118±0.05 and the mean postoperative UCVA at the 6-month visit was 0.26±0.18. In group II the mean preoperative UCVA was 0.278±0.14 and the postoperative UCVA at 6 months was 0.408±0.3. The mean preoperative BSCVA for group I was 0.218±0.204, while the mean postoperative BSCVA at the 6-month visit was 0.48±0.18. The mean preoperative BSCVA for group II was 0.6±0.305 while the mean postoperative BSCVA at 6 months was 0.745±0.21, There was a statistically significant difference between the two groups regarding UCVA improvement. However, there was a statistically nonsignificant difference between the two groups regarding BSCVA improvement. Comparing the change in mean spherical equivalent between the two groups, it was found statistically significant (P=0.04). On the other hand, comparing that of corneal astigmatism, it was statistically nonsignificant. Pentacam revealed a mean preoperative Kmax of 48.06±5.05 D. The mean postoperative Kmax at 1 month was 47.1±5.6 D. The mean postoperative Kmax at 3 months was 45.75±5.1 D and at 6 months was 45.725±4.49 D. There was a statistically significant difference between mean preoperative and mean postoperative Kmax. A nonsignificant corneal thinning with a mean pachymetry of 433.78±46.71 µm was observed. Conclusion There was significant difference between standard and transepithelial cross-linking with better results with the standard cross-linking, but with satisfactory results of both methods.
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Evaluation of patients with keratoplasty in Tanta University Hospital using anterior segment optical coherence tomography p. 237
Zahraa M Elskhawy, Moataz M Sabry, Mohammed S Alshorbagy, Adel A Selima
DOI:10.4103/DJO.DJO_8_18  
Purpose This study aimed to evaluate patients with keratoplasty in Tanta University Hospital using anterior segment optical coherence tomography (AS-OCT). Patients and methods This was a cross-sectional study that included 30 eyes of 22 patients who underwent keratoplasty in Tanta University Hospital from January 2016 till December 2016. The AS-OCT imaging using Topcon 3D optical coherence tomography; 3D OCT 2000(FA) was done. The preoperative pathology was corneal scarring in 16 (53.33%) eyes and advanced keratoconus in 14 (46.67%) eyes. Penetrating keratoplasty was done in 27 eyes, whereas deep anterior lamellar keratoplasty was performed in three eyes. Results Comparing the base line characteristics between the keratoconus and the corneal scar groups, statistically significant differences were detected in age (P<0.001), best corrected visual acuity (decimal) (P=0.001), spherical equivalent in diopters (D) (P=0.018), and thickness disparity at the wound interface (μm) (P=0.026). The keratoconus group was younger and had better best corrected visual acuity than the corneal scar group. The total number of graft–host interface images from 30 eyes obtained by the AS-OCT was 120 cross sections. Of these, 22 (18.33%) cross sections had well-apposed junction and 98 cross sections had malapposed junction (81.67%). Protrusion (50 cross sections; 41.67%) was the most frequent misalignment type. When classifying the eyes according to the most frequent alignment pattern among the four cross sections, five eyes had well-apposed junction state (16.67%) (all were keratoconus cases) and 25 eyes had the malapposed junction state (83.33%) (corneal scar: 16 eyes, keratoconus: nine eyes). Among the 25 eyes with malapposed junction state, 12 eyes had protrusion, seven eyes had gap, and six eyes had step. Conclusion The AS-OCT is a valuable tool for postoperative follow up of patients with keratoplasty. It helps in visualization of the internal surface of the graft–host interface. Thus, it can help in detecting the malapposition and so the cause of postoperative astigmatism can be recognized and can be managed early.
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Visual performance after trifocal versus extended range of vision presbyopia-correcting intraocular lenses p. 243
Ahmed Abd El Kareem El-Massry, Ahmed E Shama, Hazem W Kandil, Mohammed H Ghoneem
DOI:10.4103/DJO.DJO_43_18  
Purpose The purpose of this article is to compare visual outcomes after cataract surgery with implantation of two intraocular lenses (IOLs): extended range of vision and trifocal. Patients and methods A prospective study comprising 14 patients (26 eyes) was conducted. Phaco-emulsification followed by implantation of Finevision IOL was performed in eight patients (15 eyes) and Symfony IOL in six patients (11 eyes). The following outcomes were assessed after 3 months from surgery: uncorrected and best-corrected monocular distance, intermediate and near visual acuities and spherical equivalent refraction. Results The mean values for the Finevision group and the Symfony group, respectively, were uncorrected visual acuity (UCVA) for far 0.05±0.08 logMAR and 0.02±0.04 logMAR; UCVA for intermediate 0.23±0.05 logMAR and 0.4±0.06 logMAR; UCVA for near 0.19±0.10 logMAR and 0.42±0.06 logMAR; best-corrected visual acuity (BCVA) for far −0.03±0.08 logMAR and −0.03±0.05 logMAR; BCVA for intermediate 0.22±0.04 logMAR and 0.4±0.06 logMAR; BCVA for near 0.19±0.07 logMAR and 0.41±0.05 logMAR. Finevision group was statistically significant (P<0.05) better than Symfony group in UCVA and BCVA for near and intermediate. Conclusion Both the Finevision IOL and the Symfony IOL are excellent presbyopia-correcting IOLs. In our study, they provided excellent visual acuities at all distances. The Finevision group had better near and intermediate visual acuities.
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Prevention of posterior capsular opacity after pediatric cataract surgery p. 246
Ahmed H Aldghaimy, Mohamed A Hamed, Wael Elshazly Eta
DOI:10.4103/DJO.DJO_27_18  
Objective The objective of this article is to evaluate the effect of triamcinolone acetonide and enoxaparin on prevention of posterior capsule opacification (PCO) after pediatric cataract surgery Patients and methods A total of 44 eyes of 34 patients were recruited for the study; 24 (70.6%) were boys and 10 (29.4%) were girls. All eyes had automated posterior capsulotomy with anterior vitrectomy via pars plana approach using 23-G vitrectomy and a square edge hydrophobic acrylic lens implantation. The 44 eyes were divided into two groups: group A received enoxaparin and group B received triamcinolone acetonide. Results The percentage of PCO was 40.9% in group A and 36.4% in group B. This difference was not statistically significant (P=0.757). Conclusion These results suggest that the effect of triamcinolone acetonide and enoxaparin is approximately equal in the incidence of PCO in children.
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Evaluation of En Face optical coherence tomography in the assessment of vitreoretinal interface disorders p. 251
Mohammad R Aboulfotouh, Nermeen M Bahagt, Nihal A Hassan, Mohammad W Nagaty
DOI:10.4103/DJO.DJO_26_18  
Purpose The aim of this study was to assess the clinical value of En Face optical coherence tomography (OCT) in vitreoretinal (VR) interface disorders and how can we benefit from it when combined with B-scan OCT. Patients and methods This cross-sectional study included 20 eyes of 18 patients having VR interface disorders who attended Kasr El-Ainy Ophthalmology Outpatient Clinic during the period from January to December 2015. All patients were subjected to full ophthalmological examination followed by SD-OCT imaging using Optovue Rtvue machine. Results In this study, 20 eyes of 18 patients, including 10 females and eight males, were examined. Age ranged from 20 to 60 years. Unilateral pathology was present in 16 cases and bilateral pathology in two cases. Of the 20 eyes, eight had epiretinal membrane, four had full-thickness macular holes (one atrophic and three traumatic), and two had lamellar macular holes. En Face C-scan images when combined with B-scan images gave three-dimensional view of the retinal segment from superficial to deep as well as cross-sectional view allowing better diagnosis and management of the VR interface disorder. Conclusion En Face OCT can detect epicenters in epiretinal membranes and can detect full-thickness and lamellar macular holes. C-scan images are very useful when combined with B-scan images in viewing VR interface disorders.
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Does cycloplegia have a role in accurate estimation of refraction in highly myopic children p. 256
Ali A Ghali, Mohamed Altaher A AbdelAtty
DOI:10.4103/DJO.DJO_21_18  
Aim The aim of this study was to determine whether there is any difference between manifest and cycloplegic refractions in highly myopic children. Patients and methods This prospective study was carried out on 250 children aged 6–14 years with a refractive error higher than −6D. Both manifest and cycloplegic refractions were measured and compared for the difference in spherical equivalent. Results Our study showed no statistically significant difference in the spherical equivalent between manifest and cycloplegic refraction in highly myopic children. Conclusion This study suggests that cycloplegia has no significant value in accurate estimation of refraction in children with high myopia.
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To study the epidemiological and clinical profile of ocular trauma at a tertiary health-care facility p. 259
Ekta Syal, Munish Dhawan, Surinder Pal Singh
DOI:10.4103/DJO.DJO_14_18  
Aim To study the profile of ocular trauma and to find out its risk factors. Settings and design This is a prospective hospital-based study that included patients of ocular trauma presenting to the Department of Ophthalmology and Emergency, Guru Gobind Singh Medical College and Hospital, Faridkot, India during the period from May 2015 to November 2016. Patients and methods The study included patients with recent history of trauma (<7 days). Complete demographic data, history of trauma, and detailed ocular examination were done. Statistical analysis used the statistical package for the social sciences software. Results A total of 200 patients were studied. Men had twofold higher rates of injury than women. The predominant age group was between 21 and 30 years with a mean age of 29.87±12.46 years. Daily laborers were most frequently involved in trauma (n=64; 32%). The workplace trauma was the most common mode accounting for 27.5% of the cases and was most commonly sustained by laborers (50.90%). Metallic objects were responsible in 28.5% followed by vegetative matter (11%). Mechanical trauma was present in 94.5% while 5.5% suffered from chemical trauma. In 94.5% cases with mechanical trauma, 60.5% sustained closed globe injuries and 26% had open globe injuries. Contusions and penetrating injuries were the most common in closed and open globe injuries, respectively. Corneoscleral perforation was the most common clinical presentation in 50 patients. Forty-two percent of patients required only medical management and 58% required surgical management with the most frequent being corneal/scleral perforation repair. Conclusion Workplace-related eye injuries were noted in a significant number of cases. Strict implementation of health education and preventive strategies especially at the workplace will help to decrease the occurrence of ocular injuries.
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CASE REPORT Top

An unusual Erdheim–Chester disease with bilateral orbital involvement and diabetes insipidus: a case report p. 268
Mohamed A.I Eldesouky
DOI:10.4103/DJO.DJO_16_18  
Case report A 39-year-old man presented with proptosis, disk edema, and extraocular muscle restrictions. He was suspected of having systemic lymphoma and had already been submitted to retroperitoneal biopsy; however, the diagnosis was still uncertain. The patient was evaluated by computed tomography and MRI of the orbit. Orbital pseudotumor was suspected and a biopsy of the orbital lesion initially failed to provide the correct diagnosis which was only made after detailed analysis of the clinical and imaging findings and review of the histopathologic studies. The systemic diagnosis was made after the orbital diagnosis although the patient had been extensively investigated for more than 1 year. Erdheim–Chester disease is a rare idiopathic systemic condition characterized by a xanthogranulomatous process involving the retroperitoneum, heart, lungs, bone, and other tissues. The condition is often fatal due to renal or cardiovascular complications. Ocular findings are rare but may be very helpful for the diagnosis. Therefore, ophthalmologists should be aware about the clinical manifestations and imaging findings of this rare disease in order to establish an early diagnosis.
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LETTER TO THE EDITOR Top

Cavernous hemangioma of the optic disc p. 272
Mahmood D Al-Mendalawi
DOI:10.4103/DJO.DJO_24_18  
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