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   Table of Contents - Current issue
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April-June 2020
Volume 21 | Issue 2
Page Nos. 75-138

Online since Friday, June 26, 2020

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ORIGINAL ARTICLES  

Evaluation of ocular surface in type 2 diabetic patients Highly accessed article p. 75
Reham S Badr, Alaa M Fadel, Ibrahim Y Allam, Ihab M Osman
DOI:10.4103/DJO.DJO_12_20  
Purpose The aim of this study was to evaluate the tear film and the changes in ocular surface in type 2 diabetic patients. Patients and methods This is a prospective, cross-sectional, observational, hospital-based study of 100 participants (200 eyes). They included 50 diabetic patients (100 eyes) and 50 healthy controls (100 eyes), of either sex above 40 years old, who were evaluated at Alexandria General Eye Hospital, Alexandria, Egypt. History was taken from all participants including ocular surface disease index questionnaire. All participants underwent full ophthalmological examination, Schirmer’s test, tear film breakup time, corneal staining, and rose Bengal staining tests. Results When compared with the healthy controls, diabetic patients showed significantly reduced Schirmer’s test, tear breakup time measurements, and higher grades of corneal and rose Bengal staining (P<0.001). Ocular surface disease index was severe in 70% of diabetics. There was a significant difference between the two groups regarding the dry eye severity grade according to Dry Eye Workshop, as most of diabetic patients were grades 3 and 2 (37 and 53%, respectively), whereas 64% of the controls were grade 1. Conclusion Tear film abnormality was a significant feature of diabetic ocular surface disease, which suggests that diabetic patients are more prone to experience dry eye than normal participants. Therefore, all diabetic patients should undergo routine early examination and follow-up of tear function and ocular surface parameters.
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Effects of chalazion on corneal astigmatism and wave-front aberrations in Egyptian patients p. 82
Islam Y.S Swaify, Omar M El Zawahry, Amr A Khafagy, Shaymaa H Salah
DOI:10.4103/DJO.DJO_59_19  
Aim This study investigated the correlation between chalazion, regarding its size, site and location, and different types of refractive errors, as well as high-order aberrations in Egyptian patients. Patients and methods This is a cross-sectional study which compared 53 eyes from 48 patients having eyelid chalazion with 43 eyes of age-matched control group. Chalazion was classified according to size, site, and location. Refraction was done using an autorefractokeratometer. Corneal topography and aberrations were done using a Scheimpflug topographer. Results The third-order aberration (coma Z31) and fourth-order aberration (secondary astigmatism Z42) were higher in the chalazion group compared with the control group (P=0.035 and 0.035, respectively). Lower lid chalazia showed higher Esafoil aberration Z66 than both upper lid and control group (P=0.015 and 0.001, respectively). In addition, the large-sized chalazion group showed a significant increase in Esafoil aberration Z66 than the small-sized group and the control group (P=0.004 and 0.003, respectively). No difference was observed between the chalazion group and the control group regarding autorefractokeratometer data or topographic data. Conclusion Although the presence of chalazion may not be associated with changes in refraction or corneal astigmatism, it still can cause increase in some high-order aberrations and hence, in the quality of vision. Besides, it is a threat as a source of infection before any surgical procedure. Therefore, it is important to exclude and treat any chalazion before proceeding with any refractive surgery especially wave-front-guided and wave-front-optimized corneal refractive procedures.
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Supracor LASIK treatment of hyperopic and myopic presbyopes: a comparative study p. 90
Basem M Ibrahim
DOI:10.4103/DJO.DJO_70_19  
Background Supracor is a relatively new technique that has been approved for hyperopic presbyopia correction; however, till now, no published studies have evaluated the performance of supracor in myopic patients with presbyopia. Objective The aim of this study was to compare the results of supracor treatment of presbyopia between hyperopic and myopic patients. Patients and methods The study included two groups: hyperopic group and myopic group. Complete preoperative examination consisted of cycloplegic and manifest refraction, spherical equivalent (SE), binocular uncorrected and corrected distant visual acuity (UCDVA and CDVA), binocular uncorrected and corrected near visual acuity (UCNVA and CNVA), measurement of higher order aberrations, and the determination of the dominant eye using hole-in-the card test. Patients were examined at the first day, third day, 1 month, 3 months, and 6 months postoperatively. UCDVA, CDVA, UCNVA, CNVA, higher order aberrations, and SE were measured, and all complications were recorded. Furthermore, patient’s satisfaction was documented by a detailed questionnaire. All data were collected, analyzed, and compared between the two groups. Results The study included 20 hyperopic and 19 myopic patients. There were no statistically significant differences (P>0.05) between the two groups regarding postoperative UCDVA, CDVA, UCNVA, CNVA, SE, spherical aberrations, and complications. However, there was a statistically significant difference (P<0.05) between the studied groups regarding patient satisfaction at 1 month, 3 months, and 6 months postoperatively (which was higher in patients with hyperopia), with a significant increase in patient satisfaction in those with hyperopia over time. Conclusion Supracor was found to be effective, predictable, and stable technique in the management of presbyopia in both patients with myopia and those with hyperopia, with similar results in the two groups except for patient satisfaction, which was higher in those with hyperopia.
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Visual and corneal biomechanical changes after femtosecond laser-assisted intracorneal ring segment implantation in patients with keratoconus p. 101
Paula S Abdel Malek, Alaa A El-Dorghamy, Ahmed M Ghoneim, Hazem A Elbedewy
DOI:10.4103/DJO.DJO_4_20  
Purpose The aim of this study was to evaluate the effect of femtosecond laser-assisted intrastromal corneal ring segment (ICRS) implantation in patients with keratoconus on the visual outcome and corneal biomechanics using CORVIS ST. Patients and methods This is a prospective interventional study that was carried out on 30 keratoconic eyes which underwent femtosecond laser-assisted ICRS implantation. All the included eyes were assessed before ICRS implantation for uncorrected/best-corrected visual acuity, Pentacam and Corvis ST imaging. They were assessed again at 1 and 3 months after the implantation for the same parameters. Results The mean age of the studied group was 24.00±3.80 years. The uncorrected corrected visual acuity improved significantly at the first (0.36±0.04, P<0.001) and third month (0.53±0.09, P<0.001) after ICRS implantation compared with the preoperative level (0.22±0.05), whereas the best-corrected visual acuity at the third postoperative month (0.73±0.12) was significantly better than the preoperative value (0.60±0.29, P=0.082) and the first postoperative month value (0.60±0.08, P<0.001). The corneal biomechanical index measured by CORVIS ST remained stable from the preoperative level (1.0) till the first month after ICRS implantation but decreased significantly at the third postoperative month to 0.86. There were no significant changes regarding Applanation 1 (A1) or Applanation 2 (A2) times but A1 and A2 lengths and biomechanically corrected intraocular pressure decreased significantly at the first and third month after ICRS implantation than the preoperative level. Conclusion Implantation of ICRS in eyes with keratoconus improved visual acuity and changed significantly the corneal biomechanical parameters measured by CORVIS ST. Corneal biomechanical index, A1, and A2 were significantly decreased with no changes in A1 or A2 times. ICRS implantation can be considered safe, as the complications were almost nil.
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Femtosecond laser-assisted anterior lamellar keratoplasty for treatment of herpetic corneal scars p. 108
Mohamed Anis, Mohamed Hosny, Sarah Azzam
DOI:10.4103/DJO.DJO_9_20  
Purpose The aim of this study was to report the results of femtosecond laser-assisted anterior lamellar keratoplasty (FS-ALK) for treatment of herpetic corneal scars in a small group of cases. Patients and methods A noncomparative case series of eight eyes with postherpetic stromal corneal scars underwent FS-ALK using the Alcon WaveLight FS-200. The donor and recipient corneas were cut using the same parameters at 70% depth from the thinnest location of the recipient cornea. The donor cornea was sutured using eight interrupted sutures. The main outcome measures included preoperative and postoperative uncorrected visual acuity and best-corrected visual acuity (BCVA, LogMar). Anterior segment optical coherence tomography was done preoperatively and 1 month after suture removal. Complications were documented. Results The procedure was uneventful in all eyes with easy separation of the precut lenticule with no intraoperative complications. The BCVA improved significantly in 7/8 (87.5%) eyes. The mean preoperative BCVA was 0.88±0.15 LogMar and improved 1 month after suture removal to 0.36±0.15 LogMar (P=0.00001). Conclusion The FS-ALK is a safe, easy, and effective procedure for the treatment of herpetic corneal scars.
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Pars-plana vitreous aspiration during combined trabeculectomy, phacoemulsification, and intraocular lens implantation in eyes with very shallow anterior chamber p. 113
Mohamed N Elmohamady, Marwa Abdelshafy, Ashraf Elhabbak, Elham A Gad
DOI:10.4103/DJO.DJO_63_19  
Aim The aim of this study was to evaluate the outcome of pars-plana vitreous aspiration during combined trabeculectomy, phacoemulsification, and intraocular lens (IOL) implantation in eyes with shallow anterior chamber (AC) to prevent its associated complications. Patients and methods Fifty-four eyes of 46 patients were included in this study. All eyes were indicated for combined trabeculectomy, phacoemulsification and IOL implantation. All eyes had very shallow AC and injection of a viscoelastic substance through AC paracentesis failed to deepen the AC. Vitreous aspiration was performed with a 27 G needle on a 3 ml syringe over the pars plana 3.5 mm posterior to the limbus in the superotemporal quadrant. The cases were followed up for 12 months. The main outcome measures were the volume of aspirated vitreous, and intraoperative and postoperative complications. Results Intraoperative deepening of the AC occurred in all cases after vitreous aspiration. Aspirated vitreous volume varied from 0.3 to 0.7 ml (average 0.47 ml). There was no evidence of positive vitreous pressure during surgery in any case. No intraoperative complications occurred in all cases. Postoperative complications were detected in the form of shallow AC with hypotony in 5.5% of the cases (3 out of 54 cases) and shallow AC with high intraocular pressure was reported in 3.7% of the cases (2 out of 54 cases). All cases were managed without the need for a second surgery. Complications related to vitreous aspiration like vitreous hemorrhage, retinal tear, or detachment were not observed in any case. Conclusion Pars-plana vitreous aspiration is a safe procedure to prevent intraoperative shallow AC and its associated complications during combined trabeculectomy, phacoemulsification, and IOL implantation.
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Management of refractory glaucoma using fixed-energy diode laser cyclophotocoagulation p. 117
Ahmed F Gabr, Mohamed A Nassef, Tag El Din M Othman, Tarek R Hussein
DOI:10.4103/DJO.DJO_60_19  
Purpose The aim of this study was to evaluate the efficacy and safety of trans-scleral diode laser cyclophotocoagulation (TSCPC) using the fixed-energy technique in the management of patients with refractory glaucoma. Patients and methods In this prospective study, 22 eyes of 22 adult patients with refractory glaucoma and visual acuity of less than or equal to 3/60 (≥1.3 logMAR) were included. Following complete ophthalmological examination, patients were treated with TSCPC using the slow coagulation technique. Follow-up of patients was done at 1 week, 1 month, 3 months, and 6 months, postoperatively. Postoperative complications were monitored and reported. Results The mean age of patients was 57.1±10.6 years. There was no significant change in visual acuity or optic disk appearance between preoperative and postoperative visits in all cases. There was a significant reduction in mean intraocular pressure after 6 months of follow-up from 42.41±8.8 mmHg, preoperatively to 18.5±8.8 mmHg, postoperatively (P=0.02). The mean number of antiglaucoma medications was reduced significantly from 2.45±1.1, preoperatively, to 1.0±0.5, postoperatively (P=0.0001). Mild to moderate anterior chamber reaction was reported in 16 (72.7%) patients while hyphema was found in two (9%) patients and vitreous hemorrhage and transient hypotony due to choroidal detachment were encountered in one patient each. Six (27.27%) patients reported smooth postoperative course without any complications or pain. Conclusion Fixed energy method of TSCPC represents an effective technique for the management of refractory glaucoma with low potential for serious complications.
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Anatomical and functional significance of choroidal thickness changes after anti-vascular endothelial growth factors injection in diabetic macular edema p. 122
Mai N Abd-Elmohsen, Ahmed A Dahab, Shaimaa A Arfeen, Karim A Raafat, Khaled Elrakhawy
DOI:10.4103/DJO.DJO_57_19  
Purpose The aim of this study was to evaluate the choroidal thickness (CT) changes and its effect on the early functional and anatomic outcome in eyes with diabetic macular edema (DME) following intravitreal injection of bevacizumab by using enhanced depth imaging optical coherence tomography. Design This is a prospective interventional study. Patients and methods A total of 40 eyes (of 27 patients) with clinically significant DME were included in the present study. Evaluation of CT at different points before and after three intravitreal injections of bevacizumab was done by using enhanced depth imaging optical coherence tomography. Patients were classified according to the anatomic and functional outcome to responder and nonresponder groups. Results There was a significant decrease in the mean subfoveal CT from 425.47±96.61 to 374.75±99.71 μm following the three intravitreal injections (P<0.001). All examined quadrants of the choroid (nasal, temporal, superior, and inferior) showed significant decrease in thickness from 306.29±66.29, 313.85±65.01, 322.14±66.03, and 314.64± 62.93 μm, respectively, to 267.85±69.49, 273.00±71.76, 279.75±64.36, and 275.91±57.89 μm, respectively. There was a significant decrease in CT in the anatomic responder group (mean change was 49.68 μm compared with 21.43 μm in the nonresponder group; P=0.023), as well as in the functional responder group (mean change was 49.68 μm compared with 21.43 μm in the nonresponder group; P=0.023). Conclusion Over a 3-month period, the use of intravitreal bevacizumab was associated with significant thinning of the choroid in DME which did not correlate with visual acuity changes. The responder groups showed significant reduction in CT as compared with the nonresponder groups. CT changes following bevacizumab injection might represent secondary nonspecific changes with no definite predictive value on the outcome.
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Prevalence, risk factors, and morbidity of eyelid laxity in elderly Egyptian population p. 127
Shymaa I Saad, Mohamed A Ragab, Ihab M Osman
DOI:10.4103/DJO.DJO_1_20  
Purpose The aim of this study was to evaluate the age and its relation to lid laxity and ocular surface disorders as well as the lid laxity prevalence in an elderly Egyptian population. Setting The study was conducted at the Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt. Patients and methods The study included 400 patients presenting to the Outpatient Eye Clinic of Alexandria Main University Hospital, Alexandria, Egypt, from April 2018 to April 2019. A cross-sectional survey of patients above 55 years old was done. Clinical data were gathered from a questionnaire. Upper and lower eyelid laxity was clinically graded. In addition, tear breakup time test was done to evaluate dryness. Results The study was conducted on 799 eyes. The prevalence of lid laxity in the right lower and upper lids was 51.1 and 14.8%, respectively, whereas in left lower and upper lids, it was 50 and 14.7%, respectively. There was a negative significant correlation between tear breakup time and lid laxity in the right lower and upper lids and in the left lower lid (P<0.001). Conclusion Eyelid laxity was prevalent in this elderly Egyptian population. Its presence was associated with ocular surface morbidity. This suggests that dynamic eyelid testing should be incorporated into the ophthalmic examination in patients with ocular surface discomfort.
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Comparative study of unilateral lateral rectus hang-back recession versus bilateral rectus hang-back recession for management of small-angle basic intermittent exotropia in Egyptians children p. 133
Nermeen M Badawi
DOI:10.4103/DJO.DJO_69_19  
Purpose The aim of this study was to evaluate the efficacy of unilateral lateral rectus hang-back recession (ULR) compared with bilateral rectus hang-back recession (BLR) for management of small-angle basic intermittent exotropia in Egyptian children. Patients and methods The study included 50 patients with basic intermittent exotropia. They were divided into two groups: group A underwent ULR, and group B underwent BLR. All patients underwent a complete ophthalmological examination including measuring the angles of deviation at distant and near. They were followed up at 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year postoperatively. Results The final postoperative distant angle of deviation was 4.9±4.4 prism diopter (PD) for the ULR group and 3.2±6.9 PD for the BLR group, whereas the final postoperative near angle of deviation was 4.4±2.3 PD for the ULR group and 2.88±8.2 PD for the BLR group, with no statistically significant difference between the two group regarding both angles by the end of the follow-up period (P>0.05). Conclusion The ULR technique is comparable to the BLR technique regarding the efficacy and long-term angle stability.
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