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   Table of Contents - Current issue
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July-September 2018
Volume 19 | Issue 3
Page Nos. 163-210

Online since Monday, September 24, 2018

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ORIGINAL ARTICLES  

Management options for Meibomian gland dysfunction p. 163
Sally E Salloom, Molham A ElBakary, Amr M Awara, Osama E Shalaby
DOI:10.4103/DJO.DJO_2_18  
Background Meibomian gland (MG) dysfunction is a chronic, diffuse abnormality of the MGs. At the end stage, it is characterized by terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretions. This may result in alterations of the tear film. Patients and methods This is a prospective randomized study that included two groups of patients;, with 40 eyes in each group. The first group (group I) received oral azithromycin for 5 days (500 mg in the first day and then 250 mg/day for 4 days), whereas the second group (group II) received oral doxycycline for 1 month (100 mg/twice daily). The patients were evaluated by the symptoms, signs, and special tests (Schirmer’s and tear break-up time tests) of dry eye. The patients were followed up at two main visits: at day 12 and at day 36 from the start of therapy. Results There was no significant difference between group I and group II regarding age, sex, or presence of diabetes mellitus. At the first post-treatment visit, group I had significant improvement in itching (P=0.002), foreign body sensation (P=0.001), and ocular surface staining (P=0.01) compared with group II. At the second post-treatment visit, group I had significantly better results regarding foreign body sensation (P=0.05), eyelid swelling (P=0.04), and ocular surface staining (P=0.03). Conclusion Both oral azithromycin and oral doxycycline had beneficial effects in patients with MG dysfunction. Azithromycin group was proved to have better results regarding symptoms, signs, and special tests with lower rates of adverse effects.
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Tear film changes after cataract surgery: manual small-incision cataract surgery versus phacoemulsification p. 170
Saurabh Shrivastava, Brijesha Dudhat, Reshma Ramakrishnan, Varshav Gore
DOI:10.4103/DJO.DJO_6_18  
Aim The aim was to identify if the type of surgical procedure has any bearing on dry eye syndrome and to find out the duration of postsurgical recovery of dryness in small-incision cataract surgery and phacoemulsification. Patients and methods A prospective randomized study was conducted on 100 patients of cataract. Group A had 50 patients who underwent small-incision cataract surgery, and group B included 50 patients who underwent phacoemulsification. Patients with pre-existing ocular surface disease, for example, known case of glaucoma; taking topical antiglaucoma drugs; lid disorders; and grade 5 cataract (hard cataract in which it is difficult to do phacoemulsification) were excluded. Dry eye workup included Schirmer’s I, basic secretion test, tear film breakup time, and corneal sensation. The workup was done preoperatively and then on seventh, 21st, and 90th day postoperatively. The values were compared in the group itself and in-between the two groups. Results In groups A and B, there was significant difference in the preoperative values of Schirmer’s I test, basic secretion test, and tear breakup time (TBUT) as compared with day 7 and day 21 postoperative values (P<0.05). However, the day 90 postoperative values were comparable to preoperative values, and there was no significant difference (P>0.05). There was significant difference in the Schirmer’s I test and basic secretion test values after 21 days of surgery between the groups (P<0.05), whereas there was no significant difference in TBUT and presence of corneal sensation values between the groups (P>0.05). Conclusion Cataract surgery can cause or aggravate dry eye and affect the dry eye test values in the postoperative period up to 3 months. This holds true for both manual small-incision cataract surgery and phacoemulsification surgery. Therefore before surgery, patients must be informed about the possible aggravation of dry eye symptoms, and artificial tears should be prescribed for attenuating corneal damage and dry eye symptoms.
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Corneal collagen cross-linking as an additional step in laser in-situ keratomileusis surgery for preventing post-laser in-situ keratomileusis regression p. 174
Ahmed A Alhagaa, Nermeen M Badawi
DOI:10.4103/DJO.DJO_3_18  
Aim The aim of this study was to evaluate the safety, stability, and efficacy of corneal collagen cross-linking as an additional step in laser in-situ keratomileusis (LASIK) surgery for prevention of post-LASIK regression. Patients and methods Eyes included in this study were classified into two groups: group A consisted of 30 myopic eyes (spherical equivalent between −6.00 and −10.00 D) that underwent LASIK surgery with riboflavin application and ultraviolet light irradiation in the same sitting and group B as the control group which consisted of 30 myopic eyes (spherical equivalent between −6.00 and −10.00 D) that underwent LASIK surgery only without riboflavin application or ultraviolet light irradiation. Postoperative follow-up was at 1 day, 1 week, 1, 3, 6 months, 1, 2, and 3 years postoperatively. Results The mean spherical equivalent at 3 years postoperatively was −0.75 D in group A in comparison with −2.75 D in group B in which the regression started significantly after 1 year postoperatively (from −0.50 to −2.75 D) with less regression (from −0.50 to −0.75 D) in group A by the end of follow-up period (P=0.002). No significant changes in topography or pachymetry were reported in the present study. In addition, no complications related to corneal collagen cross-linking were reported in comparison with the second group. Conclusion Adjuvant use of corneal collagen cross-linking as an additional step in LASIK procedure is safe and effective in decreasing post-LASIK regression.
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Myoring and Ferrara ring segment implantation using femtosecond laser for treatment of keratoconus p. 178
Mohamed I EL-Kasaby
DOI:10.4103/DJO.DJO_85_17  
Purpose To compare visual acuity, refraction, and topographic corneal changes after implantation of a MyoRing versus Ferrara ring segment for management of keratoconus. Patients and methods This is a prospective nonrandomized clinical comparative study. Forty eyes of 25 patients with keratoconus grades 2–4 were included in the study and were divided into two groups: group A (MyoRing group) included 20 eyes of patients with keratoconus subjected to femtosecond laser-assisted MyoRing implantation and group B included 20 eyes of patients with keratoconus subjected to femtosecond laser-assisted Ferrara ring segment implantation. Results Forty eyes of 25 patients (12 males and 13 females) with keratoconus grades 2–4 were enrolled in this study. The mean age of the patients in group A was 26.62±6.18 years and in group B was 24.72±5.06 years. The mean central corneal thickness improved from 440.25 to 476.57 µm in group A and from 441.35 to 470.63 μm in group B. The mean keratometric (K) reading decreased from 49.97±14.26 to 44.55±2.16 D in group A and from 48.69+4.26 to 44.85±1.92 D in group B. There was a statistically significant improvement in the postoperative uncorrected distance visual acuity, corrected distance visual acuity, K readings, manifest spherical and cylindrical refractive errors, and spherical equivalent in both groups. No serious intraoperative complications were reported. Conclusion Both MyoRing and Ferrara ring segments are effective modalities for treatment of grades 2–4 keratoconus, but MyoRing had a superior capability in improving the keratoconus parameters as well as in halting the progression of the disease.
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Assessment of quality and quantity of vision in astigmatic patients with tilted disc: a comparative study p. 191
Nehal M Samy El Gendy
DOI:10.4103/DJO.DJO_83_17  
Purpose The purpose of this article was to compare the quality and quantity of vision in cases with corneal astigmatism with and without tilted disc. Patients and methods Cases with astigmatic error between 1 and 3 D with and without tilted disc were included in the present study. Quantity of vision, in the form of uncorrected and corrected distance visual acuities, was compared. Quality of vision questionnaire, designed by McAlinden et al. in 2010, was used, and the results compared between the two groups. Higher order aberrations were also compared. Results Sixty eyes of 60 patients were included (30 eyes in each group). Uncorrected distance visual acuity was significantly lower in tilted disc group (Log MAR: 0.8±0.2) versus 0.5±0.2 in the group without tilted disc (P=0.04). Coma and trefoil values were also significantly higher in tilted disc group (0.4±0.1 vs. 0.2±0.1, P=0.03, respectively, and 0.3±0.1 vs. 0.1±0.1, P=0.04, respectively). Quality of vision test for uncorrected patients showed that patients with tilted disc suffered more from distortion, multiple image formation, and focus difficulty (frequency, severity, and bothersome were all affected) and starbursts (frequency only was affected). With spectacle correction, multiple images and focus difficulty (severity and bothersome) were improved. In addition, starbursts frequency was improved. Conclusion A significant difference in certain aspects of quality and quantity of vision between astigmatic patients with and without tilted disc was shown in this study. This should be put into consideration in certain job applicants and in refractive surgery candidates.
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Prevalence of diabetic retinopathy among children with type 1 diabetes mellitus treated by insulin p. 196
Emad E.M Elgemai, Nema H Zeriban, Shaimaa S Soliman
DOI:10.4103/DJO.DJO_15_18  
Purpose Among children and young adults, type 1 diabetes mellitus (DM) is the commonest type to occur as a result of defects in insulin secretion and/or insulin action. It is usually treated by insulin or insulin analogs. This work was done to study the prevalence of diabetic retinopathy (DR) among diabetic children with type 1 DM treated with insulin. Patients and methods This is a cross-sectional study that was carried out in Damnhour Teaching Hospital. It included 115 children with type 1 DM from 6 to 14 years of age. All patients were subjected to full fundus examination and were then classified according to its results into patients with DR and patients without DR. Risk factors associated with retinopathy were assessed in those patients. Results The mean age of the patients was 9.70±1.94 years and 55.7% were males. DR was found in 12 (10.4%) patients, eight of whom had retinopathy in one eye and four had retinopathy in both eyes. Mild nonproliferative DR was found in 11/230 (4.8%) eyes and moderate nonproliferative DR was found in 5/230 (2.2%) eyes. A significant positive correlation was found between the grade of retinopathy and the duration of diabetes (r=0.37; P<0.01), fasting blood glucose (r=0.36; P<0.01), and glycosylated hemoglobin (r=0.38; P<0.01). Conclusion The prevalence of DR was 10.4% among all studied patients and 7.0% among all studied eyes. The grade of retinopathy was directly related to the duration of DM, fasting blood glucose, and glycosylated hemoglobin levels.
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Correlation between choroidal thickness and central macular thickness measured by optical coherence tomography in nonproliferative diabetic retinopathy p. 201
Nehal Adel Hasan, Ahmed H Aldghaimy, Mohamed A Hamed, Alshaimaa M Eltaher
DOI:10.4103/DJO.DJO_12_18  
Purpose To investigate the correlation between central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) measured by spectral-domain optical coherence tomography in nonproliferative diabetic retinopathy (NPDR). Patients and methods This is a prospective observational randomized study (case series) that was performed on 48 eyes of 29 patients having NPDR. The 48 eyes were divided into two groups: group I comprised 28 eyes of diabetic patients having NPDR without macular edema [NPDR without diabetic macular edema (DME)] and group II included 20 eyes of diabetic patients having NPDR with macular edema (NPDR with DME). The patients underwent spectral-domain optical coherence tomography to measure the central subfoveal and parafoveal retinal and choroidal thicknesses. Results The age for group I was 56.18±11.27 years and for group II was 60.35±7.67 years. In group I, the CMT was 297.57±40.66 µm and the central subfoveal choroidal thickness (C-SFCT) was 221.21±40.49 µm. In group II, the CMT was 425.1±136.4 µm and the C-SFCT was 209.65±27.92 µm. In group I, no statistically significant correlation between CMT and C-SFCT was found (r=0.211, P=0.282), suggesting that retinal thickness may not be directly related to the choroidal thickness in this study group. In group II, a weak negative correlation was observed (r=−0.518, P=0.019), indicating that the choroidal thickness may decrease as the central retinal thickness increases in this group. Conclusion There was a statistically significant negative correlation between CMT and C-SFCT in patients with NPDR and DME. The SFCT decreased as the CMT increased. In addition, the subfoveal choroid was thinner in eyes with NPDR and DME than in eyes with NPDR without DME.
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Retinopathy of prematurity: screening and management p. 205
Hani A Albialy, Anwar A Rass
DOI:10.4103/DJO.DJO_4_18  
Purpose To screen neonates for retinopathy of prematurity (ROP) and to evaluate the use of antivascular endothelial growth factor in its treatment. Patients and methods This prospective study included 128 preterm infants with a birth weight (BW) less than 2000 g or estimated gestational age (GA) less than 32 weeks who were subjected to ophthalmological screening. Screening was done by fundus examination once the preemie completed his/her fourth week after birth or reached a GA of 32 weeks. The presence or absence of ROP and the staging and grading of the disease were noted. Severe cases that were selected as high-risk cases especially those with pre-plus or plus disease were subjected to intravitreal bevacizumab (IVB) injection. Results One hundred and twenty-eight premature infants were enrolled in the study. Thirty-six infants were identified to have ROP in different stages (28.1%); 26 (72.2%) were with mild ROP and 10 (27.7%) with severe ROP, who were treated with IVB injection. Regarding the preterm babies with no ROP, there was a significant difference between their mean BW and GA in comparison with those with ROP. Stages of ROP were directly related to GA as most of the ROP cases were younger than 31 (83.3%) weeks of age, with a significant correlation with total screening cases. A highly significant correlation of different stages of ROP with BW was observed as all cases were under 1800 g. The results of ROP treated cases with IVB injection revealed highly significant success in stage III and IV ROP with regression of neovascularization and no reported significant complications. Conclusion Screening of the neonates for ROP should be performed as early as possible. Antivascular endothelial growth factor therapy is a safe and effective primary treatment option for ROP.
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