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ORIGINAL ARTICLES
IOL master and A-scan biometry in axial length and intraocular lens power measurements
Soheir H Gaballa, Riham S. H. M Allam, Nahla B Abouhussein, Karim A Raafat
January-April 2017, 18(1):13-19
DOI:10.4103/1110-9173.201623  
Purpose The purpose of this paper is to evaluate differences between IOL master and A-scan regarding axial length (AXL) and predicted IOL power in different types of cataract. Patients and methods Forty eyes of 40 patients underwent examination by IOL master and A-scan, where average K-reading, AXL and predicted IOL power were compared. Results Forty eyes of 40 patients were included. The mean AXL measured by IOL master was higher (26.18±2.92 mm) than that with A-scan (26.02±2.99 mm) with a mean difference of 0.2±0.44 mm (P=0.07). The mean predicted IOL power was 11.61±8.33 D with IOL master versus 12.01±8.23 D with A-scan (P=0.03). However, no statistically significant difference was found regarding average K-readings and predicted postoperative refraction (P=0.4 and 0.7, respectively). Bland–Altman plots showed almost perfect agreement between both methods regarding AXL and predicted IOL power. Further subgroup analysis revealed a statistically significant difference in AXL between both devices only in nuclear cataract with no significant difference in cases with complicated cataract to myopia or silicone oil (P=0.013, 0.2 and 0.1, respectively). No statistically significant difference was found between the three groups regarding the calculated IOL power (P=0.34, 0.13 and 0.15, respectively). Bland–Altman analysis showed almost perfect agreement for the mean difference of AXL and IOL power in the three subgroups. Conclusion There is no significant difference between IOL master and A-scan biometry, with the noncontact IOL master being preferred by patients; however, there exists certain situations where A-scan is still mandatory.
  10,558 656 1
One-year results of the triple procedure for primary pterygia
Hisham A Saad, Ahmed M Ghoneim, Waleed A Allam
July-December 2015, 16(2):45-49
DOI:10.4103/1110-9173.168526  
Purpose The aim of this work was to study the effectiveness and potential complications of adjunctive intraoperative mitomycin-C (MMC) application combined with limbal-conjunctival autografting after primary pterygium excision. Patients and methods Fifty-seven eyes of 43 patients with primary pterygia were randomized to receive pterygium excision, followed by either a free conjunctival autograft (control group, n = 27) or an adjunctive intraoperative MMC 0.02% application for 2 min and limbal-conjunctival autograft (triple procedure group, n = 30). All patients were followed for 12 months. Results After 1 year, the recurrence rate was 14.81 and 0% in the control and the triple procedure groups, respectively (P < 0.05). Most complications were transient and mild. The duration of surgery was significantly shorter in the control group (P < 0.01). The surgery did not significantly alter the corrected distance visual acuity or the average absolute astigmatism in either group. Conclusion Simple excision of pterygium combined with adjunctive intraoperative MMC 0.02% application for 2 min and limbal-conjunctival autografting is a safe and effective way of treating primary pterygia.
  1,582 4,050 -
Scanning electron microscopy of human corneal lenticules at variable corneal depths in small incision lenticule extraction cases
Ihab M Osman, Amira Y Madwar
October 2016, 17(3):109-113
DOI:10.4103/1110-9173.195261  
Purpose The aim of this study was to evaluate the surface quality of corneal lenticules at variable corneal depths in cases of small incision lenticule extraction using scanning electron microscopy. Patients and methods Forty eyes of 20 myopic patients were included. One eye was randomly assigned for lenticules at 100 µm depth (group I), whereas the other eye was assigned for lenticules at 160 µm depth (group II). The VisuMax femtosecond laser system was used for the procedure. An established scoring system and a new scoring system at higher magnification levels for surface regularity were used. Results The mean overall diameter of the lenticules as seen on electron microscopy was 6.54±0.17 and 6.73±0.20 mm in group I and group II, respectively (P=0.003). In both groups, around 50% of cases showed a smooth surface at ×10 magnification. The mean score was 14.90+1.74 and 13.25+2.77 in group I and group II, respectively (P=0.031). Conclusion The VisuMax femtosecond laser system creates predictable good-quality surface refractive corneal lenticules at superficial depth. Deeper corneal lenticules showed more irregular surfaces, especially at higher magnification levels. Energy settings still need further adjustment to be able to create deeper predictable lenticules in small incision lenticule extraction cases.
  1,270 3,632 -
‘Wipe-out’ after subscleral trabeculectomy in advanced glaucoma patients
Ahmed M Abdelrahman, Heba M.A. ElSaied, Riham S.H.M. Allam, Moataz H Osman
May-August 2017, 18(2):94-98
DOI:10.4103/DJO.DJO_44_16  
Purpose The aim of this study was to evaluate the safety of trabeculectomy in advanced glaucoma patients in the Egyptian population, and to detect postoperative wipe-out syndrome in high-risk patients. Patients and methods Thirty-six eyes of 33 patients with advanced glaucoma were included in the study. All patients underwent subscleral trabeculectomy. The patients were followed up for 3 months during which intraocular pressure (IOP), best-corrected visual acuity (BCVA), slit lamp biomicroscopy, fundus examination, and perimetry were done. Results The mean age of the study group was 51.17±2.64 years. The study included 24 males and nine females. The mean preoperative BCVA was 0.36±0.33. the mean IOP was 31±8.75 mmHg and the mean number of medications was 3.08±0.1. In all cases, complete success was achieved except for two cases with qualified success. The BCVA at day 90 showed no change in 21 eyes, visual decline in three eyes and visual gain in 12 eyes. A negative linear correlation was noticed between the percent reduction in IOP and the reduction in BCVA in the first postoperative day (r=−0.239) which was not statistically significant (P=0.162). The color of the neuroretinal rim was not a significant determinant for the final BCVA (P=0.48). Visual field changes showed no statistically significant differences. Conclusion Wipe-out phenomenon is not an ultimate postoperative outcome for filtering surgery in patients with advanced glaucoma. Pale neuroretinal rim and postoperative hypotony are risk factors for postoperative visual deterioration.
  4,493 272 1
Various topographic patterns of post-LASIK ectasia and their treatment modalities
Sherif A Eissa
October 2016, 17(3):114-122
DOI:10.4103/1110-9173.195257  
Purpose The purpose of this study was to present different topographic presentations of keratectasia following laser in-situ keratomileusis (LASIK), and their management strategies. Settings The study was carried out in specialized eye hospital − Cornea and Refractive Unit. Design This is a retrospective case series. Patients and methods The study enrolled 44 eyes of 29 patients who presented with post-LASIK ectasia, between 2011 and 2014. Eight eyes (18.18%) had previous LASIK surgery at our center and 36 eyes (81.81%) had LASIK procedure by surgeons outside our hospital. Results Although 29 eyes (65.90%) presented early with crab-claw/pellucid-like pattern, only six eyes (13.63%) first presented with asymmetric bow tie with inferior steepening. Isolated inferior steep cone was the pattern in six eyes (13.63%), whereas three eyes (6.81%) presented early with superior steepness. Twenty-five eyes (56.81%) were managed by corneal collagen cross-linking (CXL) with riboflavin, followed 6 months later by toric implantable collamer lens in three eyes and implantable collamer lens in a single eye. Intracorneal ring segment implantation procedure was implemented in nine eyes (20.45%), whereas seven eyes (15.90%) had deep anterior lamellar keratoplasty done. Three patients − three eyes − (6.81%) refused treatment by cross-linking on early diagnosis, and they presented with progressive features of ectasia over 3 years, which finally required deep anterior lamellar keratoplasty. Conclusion Post-LASIK ectasia can manifest with various topographic patterns, at different onset points following LASIK, and unpredictable course of progression. Early diagnosis, proper discussion of the pros and cons of treatment modalities with the patient, and early intervention with the suitable corrective procedure is crucial.
  2,482 1,471 -
Outcome after cataract surgery in patients with traumatic cataract
Akshay J Bhandari, Shobhana A Jorvekar, Pranay Singh, Surekha V Bangal
June 2016, 17(2):56-58
DOI:10.4103/1110-9173.189074  
Purpose The aim of the study was to investigate visual outcome in patients with traumatic cataract after cataract surgery and to study the various etiological factors. Patients and methods A prospective study was carried out on all patients with traumatic cataract who underwent cataract extraction with primary intraocular lens implantation at a tertiary eye hospital between January 2012 and December 2014. Data were collected on age, sex, preoperative vision, postoperative vision at 3–6 months, and postoperative complications responsible for decreased visual acuity. Results Fifty eyes in 50 patients were studied. The study population comprised 36 male and 14 female patients. The preoperative visual acuity was less than 6/60 in all 50 eyes. The postoperative visual acuity in 28 eyes was 6/6–6/12, whereas 20 eyes had visual acuity of 6/18–6/36 and two eyes had visual acuity less than 6/60. The cause of poor visual acuity was mainly corneal opacity and posterior capsular opacity. Conclusion Our study shows that good visual results can be achieved with traumatic cataract surgery if the posterior segment is not involved and the corneal scar does not block the optical axis.
  2,975 370 -
N-butyl-2-cyanoacrylate tissue adhesive versus subcuticular skin closure in external dacryocystorhinostomy
Dikran G Hovaghimian, Khaled A Abou Sedira, Mohamed Y Farag
July-December 2015, 16(2):97-102
DOI:10.4103/1110-9173.165062  
Purpose The aim of this study was to compare the surgical efficacy and aesthetic outcome of using tissue adhesive N-butyl-2-cyanoacrylate 'Histoacryl' with subcuticular suture closure of skin incision in external dacryocystorhinostomy (DCR). Design The present study was conducted as an interventional study. Patients and methods A total of 60 chronic dacryocystitis patients undergoing DCR procedures at the Research Institute of Ophthalmology were included. The patients were randomly selected, irrespective of age, sex or race, and were divided into two groups of 30 patients each. A classic external DCR was done for all the patients. At the completion of the surgery, the skin incisions in group 'A' were closed with vicryl 6/0 subcuticular suture, whereas in group 'B' N-butyl-2-cyanoacrylate 'Histoacryl' (FDA approved) tissue adhesive was used to close the skin incisions. No subcutaneous sutures were placed to approximate the wound edges. After 20 s of drying time the adhesive was applied for the second time. All the patients were followed up on the first day, fourth day, first week, second week, first month, and then monthly thereafter for 6 months. The time of suturing the wound and the time of application of the tissue adhesive was recorded for all the patients in both groups. During follow-up the wound was examined for evidence of infection, pain and discharge, and an inquiry was carried out for patient satisfaction. Photographs of the wounds were taken at every visit. The photographs were then shown to a senior surgeon, who was oblivious of the method of closing the wound, and rated the quality of skin incision according to 'WES scale'. Results No intraoperative wound complications were encountered in any patient. Statistical analysis of the data available, at 1 month, showed no statistically significant differences between the two groups as regards duration of healing, inflammation or final incision appearance as rated by the senior surgeon. Skin closure time averaged 61 s in subcuticular suture and 52 s in N-butyl-2-cyanoacrylate skin glue, which was statistically insignificant. Conclusion Using N-butyl-2-cyanoacrylate glue is an effective and a reliable method for skin closure, yielding similar aesthetic results as skin closure with subcuticular sutures in clean incision for external DCR surgery. It is safe, quick, does not compromise wound integrity, is adequately tolerated by the patients and could be considered an excellent alternative and an improvement on the traditional method of wound closure, providing high level of satisfaction for both patient and surgeon.
  2,986 242 -
Comparison between sublingual immunotherapy and subcutaneous immunotherapy in the treatment of pollen-induced vernal keratoconjunctivitis in children
Basem M Ibrahim, Randa S Abdel-Latif
January-March 2018, 19(1):1-8
DOI:10.4103/DJO.DJO_50_17  
Purpose The aim of this study was to compare between sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT) in the treatment of pollen-induced vernal keratoconjunctivitis (VKC) in children. Patients and methods This was a prospective randomized case series. Forty-six patients with grass pollen-induced VKC were enrolled in this study. The cases were divided randomly into two groups: group A included 23 children treated by SLIT and group B included 23 children treated by SCIT. All cases were assessed for improvement by measurement of the level of specific immunoglobulin E (IgE)/6 months and by clinical scoring system/3 months. This system comprises the total subjective symptom scores (TSSS) and the total ocular sign score (TOSS). Data were collected, compared, and analyzed. Results Both routes, SLIT and SCIT, led to a statistically significant effect (P˂0.001) in the improvement of these cases of pollen-induced VKC, and this was evident from all of the follow-up variables including specific IgE test, TSSS, and TOSS. There was no statistically significant difference between the two routes of administration of immunotherapy in the specific IgE test, TSSS, and TOSS at all the follow-up visits (P<0.05). Conclusion SLIT had the same efficacy as SCIT in the treatment of children with grass pollen-induced VKC, but with less pain and a shorter and a more convenient schedule compared with that of SCIT.
  2,811 228 -
NSAIDs eye drops versus steroidal eye drops after phacoemulsification cataract surgery
Safaa A.M Aboud
April-June 2018, 19(2):99-105
DOI:10.4103/DJO.DJO_11_17  
Purpose The aim of this study was to evaluate the efficacy NSAID eye drops in comparison with topical steroids following phacoemulsification cataract surgery. Patients and methods This prospective study included 120 patients with senile cataract who were subjected to phacoemulsification cataract extraction with foldable posterior chamber intraocular lens implantation. Postoperatively, patients were assigned to two groups: NSAIDs group and steroids group. All patients were subjected to preoperative and postoperative investigations including autorefractometer, slit-lamp examination, indirect ophthalmoscopy, tonometry, and Nassar color plates. Optical coherence tomography was performed for all patients in the last visit. Results No statistically significant differences were found between both groups in visual acuity (0.20±0.15 in the NSAIDs group and 0.20±0.13 in the steroidal group), corneal edema, or anterior chamber reaction (P>0.05). The mean macular thickness for the steroidal patient group was significantly higher than their counterparts in the NSAIDs group (P<0.05). However, both medications proved their efficacy in preventing complications throughout the study. Intraocular pressure showed spikes in the steroidal group patients from the third week till the end of the study. Conclusion Both topical NSAIDs and steroids have the same efficacy in preventing inflammation and corneal edema. However, patients subjected to topical steroids were more likely to develop intraocular hypertension and cystoid macular edema.
  2,465 296 -
Posterior approach levator aponeurosis advancement in aponeurotic ptosis repair
Molham A Elbakary
January-June 2015, 16(1):32-36
DOI:10.4103/1110-9173.157787  
Purpose The aim of the study was to investigate the efficiency, advantages, and disadvantages of posterior approach advancement of the levator aponeurosis in the repair of aponeurotic ptosis. Patients and methods This is a prospective interventional study, which included 27 eyelids of 20 patients with aponeurotic ptosis. The study included only cases with good levator function of 11 mm or more. Patients with significant dermatochalasis were excluded from the study. All patients were treated by posterior approach levator aponeurosis advancement under local anesthesia. Patients were evaluated 1 week, 1 month, 3 months, and 6 months postoperatively for margin reflex distance 1 (MRD1), eyelid symmetry, and eyelid crease and contour. Results The study included 27 eyelids of 20 patients with aponeurotic ptosis. The patients' mean age was 44.36 ± 14.47 years. The mean preoperative MRD1 was 1.6 ± 0.5 mm, whereas the mean levator function was 12.6 ± 1.1 mm. The mean operative time was 32.6 ± 5.4 min. The postoperative MRD1 showed significant improvement to 3.7 ± 0.6 mm (P < 0.001). Eighty-five percent showed successful outcome with postoperative MRD1 within 1 mm symmetry with the other eye in unilateral cases or 3.5-4.5 mm in bilateral cases. All cases showed postoperative good natural-looking eyelid crease and contour. Success of the procedure showed no correlation to the results of the phenylephrine test (P = 0.762). Conjunctival granuloma was recorded in 3.7% of patients. Conclusion Posterior approach aponeurotic advancement is an effective procedure for correction of aponeurotic ptosis. It has the advantages of high success rate, good natural-looking eyelid contour, and short operative time, and the results are independent of the response to phenylephrine.
  2,488 243 -
Macular and retinal nerve fiber layer thickness changes after small-incision lenticule extraction and femto-LASIK
Asaad A Ghanem, Salah A Mady, Tarek N Attia, Tamer I Salem
July-December 2015, 16(2):50-57
DOI:10.4103/1110-9173.168528  
Introduction Femtosecond laser flap creation exerts less intraocular pressure (IOP) fluctuation but requires more procedural time compared with microkeratome flap creation. This IOP elevation during suction may affect the macular and retinal nerve fiber layer thickness that can be assessed with optical coherence tomography. Purpose The aim of this study was to compare the influence of the transient elevation of IOP during suction on the macular and retinal nerve fiber layer thickness after small-incision lenticule extraction (SMILE) and femtosecond laser-assisted in-situ keratomileusis (femto-LASIK). Patients and methods A total of 80 and 75 eyes that received SMILE and femto-LASIK procedures for myopia and myopic astigmatism, respectively, were enrolled in this study. Spectral-domain optical coherence tomography was used to measure macular and peripapillary retinal nerve fiber layer thickness preoperatively, at 1 week, and 1, 3, and 6 months postoperatively. Results The study included 155 eyes. In both the SMILE group and the femto-LASIK group, the mean foveal, parafoveal, and perifoveal retinal thickness did not change significantly from the preoperative to any postoperative timepoint (P > 0.05). The mean foveal retinal thickness was significantly greater in the femto-LASIK group than in the SMILE group (P<0.05). The retinal nerve fiber layer thickness did not change significantly from the preoperative to any postoperative timepoint in either group (P > 0.05). The differences in the retinal nerve fiber layer between the SMILE group and the femto-LASIK group were not statistically significant at any follow-up visit (P > 0.05). Conclusion Both SMILE and femto-LASIK procedures had no significant effects on the macular and retinal nerve fiber layer thickness postoperatively.
  1,443 1,234 -
REVIEW ARTICLE
Ophthalmic complications of targeted therapies: a review
Deepti Sharma
September-December 2017, 18(3):117-122
DOI:10.4103/DJO.DJO_23_17  
Recently, there has been an increase in the use of targeted therapies for cancer treatments. Nevertheless, the ocular side effects of the commonly used targeted agents are generally under-reported and not well studied in the literature. The aim of this study was to review common targeted therapies leading to ocular side effects and their management. A database search was conducted on Google scholar, PubMed and Medline using phrase words, ‘targeted therapy’, ‘ocular toxicity’, ‘antineoplastic agent’ and ‘management’. Ocular toxicity has been described with numerous approved targeted agents and also seems to be associated with several classes of agents currently being tested in early-phase clinical trials. It is important for oncologists to be aware of the potential for ocular toxicity, with prompt recognition of symptoms that require referral to an ophthalmologist. The ocular side effects of targeted therapy are clinically relevant and can be present in up to 70% of patients depending on the medication used. Because no screening protocol is recommended, ophthalmologists and oncologists should be vigilant; however, a dose reduction or cessation of therapy is only rarely necessary.
  1,345 1,178 -
ORIGINAL ARTICLES
Punctotomy augmented by the use of perforated punctal plugs for the management of canaliculitis
Ayman Abd El Ghafar, Hossam Al-Sharkawy
July-December 2015, 16(2):89-92
DOI:10.4103/1110-9173.168537  
Purpose The aim of this study was to evaluate the use of perforated punctal plugs with punctotomy for the management of canaliculitis with preservation of punctal and canalicular patency. Patients and methods This was a prospective interventional case series including 12 consecutive patients with unilateral canaliculitis. Punctotomy was performed for all cases with curettage of canalicular contents followed by application of a perforated punctal plug. Plugs were removed after 3 months and all patients were followed up for 6 months. Results This study included 12 cases of canaliculitis, eight female (66.7%) and four male (33.3%), with a mean age of 60.33 ± 4.6 years (ranging from 48 to 73 years). The lower canaliculus was affected in 83.33% of cases, whereas the upper canaliculus was affected in 16.67% of cases. Sulfur granules were present in six cases (50%) and six cases (50%) were negative. Gram staining of the expressed contents revealed the following: 50% Actinomyces israelii, 30% Staphylococcus aureus, and 20% mixed infection. Improvement in inflammation and epiphora occurred in 11 cases (91.67%), whereas persistence of epiphora occurred in one case (8.33%). One case (8.33%) showed inflammatory granuloma at the site of punctotomy and one case (8.33%) showed extrusion of the plug after 1 month of surgery. Conclusion This study showed that punctotomy combined with implantation of perforated punctal plug is an effective technique for the management of canaliculitis, with improvement in manifestations and preservation of punctal and canalicular patency.
  2,369 152 -
Spectralis optical coherence tomography normal macular thickness in Egyptians
Mohammad A.M. El-Hifnawy, Amir R Gomaa, Ahmed M Abd El-Hady, Hassan E Elkayal
October 2016, 17(3):143-150
DOI:10.4103/1110-9173.195269  
Purpose The aim of this study was to determine the normative data of macular thickness in the Egyptian population and to assess the effect of different demographic data and ocular parameters on it using spectral-domain optical coherence tomography (SD-OCT). Patients and methods This cross-sectional study included 105 healthy Egyptian patients who underwent a comprehensive ophthalmic examination, including Spectralis SD-OCT scanning, at Alexandria Main University Hospital. One eye from each patient was chosen randomly to be included in the study. Macular thickness was calculated based on center thickness and nine areas that corresponded to the Early Treatment Diabetes Retinopathy Study map using OCT mapping software. The relationships between macular thickness and sex, age, axial length (AL), spherical equivalent, keratometry readings, intraocular pressure, BMI, parity, and use of oral contraceptive pills were analyzed. Results The study included 49 male and 56 female patients. The mean age of the patients was 40.41±14.17 years. The mean central subfield thickness was 262.70±19.64 μm. The mean macular thickness values in all areas of the Early Treatment Diabetes Retinopathy Study map were significantly greater in men than in women. As age increased, outer macular thickness decreased significantly in the overall group and in female but not in male patients (partial correlation). The AL correlated negatively with inner and outer macular thickness (partial correlation). However, spherical equivalent had no significant influence on multiple linear regression analysis. Central subfield thickness did not correlate significantly with keratometry readings, intraocular pressure, BMI, parity, or use of oral contraceptive pill. Conclusion The mean macular thickness values in the Egyptian population were found to be less than those seen in the Spectralis SD-OCT studies published previously on Caucasians but more than those seen in Blacks. Sex had the most significant effect on macular thickness in all regions. Age and AL showed a significant negative correlation with outer macular thickness.
  2,267 157 1
Comparative study between smokers and nonsmokers regarding dry eye
Hosam Eldine Mohamed Khalil, Safaa Awadallah Aboud, Mostafa Amer Azzab
January-March 2018, 19(1):9-13
DOI:10.4103/DJO.DJO_25_17  
Purpose The purpose of this study was to evaluate the relationship between smoking and dry eye in the adult population. Patients and methods A total of 500 male patients, 250 smokers and 250 nonsmokers, were recruited for this study in the period between May 2015 and April 2016. In addition to history taking and general examination, all participants were asked about eye irritation symptoms and were subjected to slit lamp and fundus examination. Schirmer 2 test, using topical anesthesia, tear break-up time (TBUT), and rose bengal staining were done for all study participants. Results There was no statistically significant difference between the age of patients in both groups. The mean age of smokers was 41.44±7.55 years, whereas in nonsmokers it was 39.97±7.59 years. Schirmer 2 test values were significantly lower in smokers compared with nonsmokers (P=0.017). In smokers, the mean value of Schirmer 2 test was 13.91±6.81 mm, whereas in nonsmokers it was 16.58±7.41 mm. TBUT values of the smokers were significantly lower in smokers than in nonsmokers (P=0.035). It averaged 11.9±5.8 s in smokers and 14.9±5.5 s in nonsmokers. The rose bengal staining scores did not differ between the two groups (P=0.467). Additionally, a linear negative correlation was detected between smoking index of smokers and their Schirmer 2 test and TBUT values. The eye irritation indices of the smokers were statistically higher than those of the nonsmokers (P=0.0007). Conclusion The findings of this study suggest that smoking affects the tear film secretion and stability. In addition, it causes eye irritation symptoms, and so smokers are more likely to have dry eyes and severity of dry eye is more in smokers than in nonsmokers.
  2,116 274 -
Accuracy of corneal power measurements for intraocular lens power calculation after myopic laser in-situ keratomileusis
Mohammad A.M. El-Hifnawy, Mohamed Shafik Shaheen, Amr F Abou El-Kheir, Hany A Helaly
January-June 2015, 16(1):10-15
DOI:10.4103/1110-9173.157780  
Purpose The aim of the study was to evaluate the accuracy of corneal power measurements for intraocular lens (IOL) power calculation after myopic laser in-situ keratomileusis (LASIK). Setting The study was conducted at the Faculty of Medicine, Alexandria University, Egypt. Patients and methods The study was conducted on 45 eyes that had undergone myopic LASIK previously. Corneal power was measured using manual keratometry, automated keratometry, IOLMaster, and Pentacam. Different hypothetical IOL power calculation formulas were used in each case. Results The steepest mean K value with manual keratometry (37.48 ± 2.86 D) followed by automated keratometry (37.31 ± 2.83 D) and the IOLMaster mean K value (37.06 ± 2.98 D) were steeper than any other mean K value measured by Pentacam. Using 4 mm Holladay equivalent K reading (EKR) with the double-K SRK/T formula, the refractive outcome was good, with 97.8% of cases within ± 2 D, 80.0% of cases within ± 1 D, and 42.2% of cases within ± 0.5 D. The best combination of formulas was 'Shammas-PL+double-K SRK/T using EKR 4 mm'. Conclusion Pentacam Scheimpflug imaging using EKR at 4 mm improved the accuracy of IOL power calculation in post-LASIK eyes. The best option is a combination of formulas. It is recommended to use the mean of the combination of 'Shammas-PL+double-K SRK/T with EKR 4 mm'.
  2,093 223 -
Phacoemulsification versus manual small incision cataract surgery in hard nuclear cataracts
Hesham A Enany
April-June 2018, 19(2):92-98
DOI:10.4103/DJO.DJO_37_17  
Purpose The aim of this study was to compare the clinical outcomes of phacoemulsification with that of manual small incision cataract surgery (MSICS) in cases of hard nuclear cataract. Patients and methods Eighty eyes of 80 patients with gradual painless diminution of vision, diagnosed as senile nuclear cataract grade 4 or higher according to Lens Opacities Classification System III (brown cataract), were studied. These eyes were divided randomly into two groups: group A included 40 eyes treated by phacoemulsification by the vertical chopping technique and group B included 40 eyes treated by MSICS by the viscoexpression technique. Results One day postoperatively, the corrected distance visual acuity was at least 6/18 in 21 (52.5%) patients in the MSICS group and in nine (22.5%) patients in the phacoemulsification group. The difference was statistically significant (P=0.01). A postoperative increase in intraocular pressure was recorded in one (2.5%) case in the phacoemulsification group. On the first postoperative day, 11 (27.5%) cases in the MSICS group and 13 (32.5%) cases in the phacoemulsification group developed postoperative iritis, with no statistically significant difference between both the groups. Conclusion Both phacoemulsification and MSICS achieved comparable and excellent visual outcomes for treatment of hard brown cataract, with lower complications rates and earlier postoperative visual rehabilitation in small incision cataract surgery.
  2,005 225 -
Correlation of tear film-specific immunoglobulin E assay with the skin prick test in allergic conjunctivitis
Basem M Ibrahim, Randa S Abdel-Latif
September-December 2017, 18(3):123-132
DOI:10.4103/DJO.DJO_30_17  
Purpose The aim of this study was to investigate the correlation and validity of tear film allergen-specific immunoglobulin E (IgE) in relation to the skin prick test in diagnosing different types of allergic conjunctivitis. Design The study design was a prospective randomized case series. Patients and methods One hundred and twenty patients with allergic conjunctivitis were included in this study and were classified into four groups according to the type of allergy. Group 1 included 48 patients with perennial allergic conjunctivitis. Group 2 included 35 patients with seasonal allergic conjunctivitis. Group 3 included 30 patients with vernal keratoconjunctivitis (VKC), and group 4 included seven patients with atopic keratoconjunctivitis. All patients were subjected to the skin prick test, which was performed with aeroallergen panel using kits containing different inhalant allergens, positive control (histamine 1 mg/ml), and negative control (saline 0.9%). Tear samples were collected using the microcapillary method for the quantitative determination of specific IgE using immune blot assay. Data were evaluated and statistically analyzed. Results In this study, the skin prick test and specific IgE were performed to 11 different allergens and the results revealed that the most common mixed allergens were mixed pollen, mixed mould, and mixed mite. Validity of tear film-specific IgE in the detection of allergens was assessed against the skin prick test (gold standard). There was IgE specificity of 100%, whereas the sensitivity ranged from 50 to 100% to the three common allergens in the four groups. There was a statistically significant correlation between specific IgE and the skin prick test for the most common allergens in patients with perennial allergic conjunctivitis, seasonal allergic conjunctivitis, and VKC (except for mould allergens in the VKC group). There was only a statistically significant correlation between specific IgE and the skin prick test for mite allergen in patients with atopic keratoconjunctivitis. Conclusion Tear film-specific IgE has a statistically significant correlation and validity when compared with the skin prick test in diagnosing the causative allergen in different types of allergic conjunctivitis. It could be a good alternative to the skin prick test in the diagnosis of allergic conjunctivitis with high sensitivity and specificity and fewer complications and limitations.
  1,881 197 1
Minimally invasive pterygium surgery versus air-assisted dissection technique for excision of primary pterygium
Hesham A Enany
January-June 2015, 16(1):1-4
DOI:10.4103/1110-9173.157771  
Purpose The aim of this study was to assess and compare minimally invasive pterygium surgery with air-assisted dissection technique for excision of primary pterygium. Patients and methods This prospective randomized comparative study was carried out on 20 eyes of 16 patients with primary pterygium. The cases were randomly divided into two equal groups: group I included 10 eyes in which pterygia were excised with minimally invasive pterygium surgery, and group II included 10 eyes in which pterygia were excised with air-assisted dissection technique. Postoperative examination and follow-up for 3 months were carried out. Results The mean age of the patients was 46.1±3.8 years. Successful dissection was recorded in 80% of cases in group I and in 70% of cases in group II. Recurrence occurred in 10% of cases in each group, with a follow-up duration of 3 months. Conclusion The minimally invasive pterygium surgery is superior to air-assisted dissection of pterygium as it keeps the tenon capsule intact.
  1,788 271 -
Correlation between optical coherence tomographic patterns and visual acuity in eyes with diabetic macular edema
Hossam T Al-Sharkawy
February 2016, 17(1):35-41
DOI:10.4103/1110-9173.178773  
Purpose The aim of the present study was to investigate the correlation between different features of optical coherence tomography, macular thickness, and visual acuity (VA) in patients with diabetic macular edema. Patients and methods In total, 168 eyes with clinically significant diabetic macular edema were included in the study. Best-corrected VA was measured and converted to the logarithm of the minimum angle of resolution (logMAR). Optical coherence tomography was carried out and morphology at the presumed fovea was used to classify eyes into four groups: group I, in which the eyes had only noncystoid sponge-like diffuse retinal thickening (DRT); group II, in which the eyes had DRT with cystoid macular edema (CME); group III, in which the eyes had DRT with serous retinal detachment (SRD); and group IV, in which the eyes had DRT with CME and SRD in the same eye. Retinal thickness at the central fovea [center point thickness (CPT)], average macular thickness (AMT), and the height of the cystoid space and the SRD at the fovea were measured. Results DRT was found alone in 65% of the eyes, CME in 16%, SRD in 13%, and CME and SRD in 6%. Mean logMAR was 0.68 with DRT, 1.16 with CME, 0.89 with SRD, and 1.05 with CME and SRD. Mean CPT was 299 μm in DRT, 573 μm in CME, 354 μm in SRD, and 483 μm in CME and SRD, whereas mean AMT was 309 μm with DRT, 374 μm with CME, 344 μm with SRD, and 390 μm with CME and SRD. There was a positive significant correlation between logMAR and CPT in DRT (0.357, P = 0.001), whereas the correlation was less in CME, SRD, and CME and SRD (0.373, P = 0.087; 0.463, P = 0.053; and 0.082, P = 0.847; respectively). The positive correlation between logMAR and AMT was significant in DRT, CME, and SRD but not in CME and SRD (0.314, P = 0.002; 0.605, P = 0.003; 0.646, P = 0.004; and 0.327, P = 0.429, respectively). The height of the SRD was positively correlated with logMAR (0.516, P = 0.028), whereas the correlation between the height of the cystoid space in CME and logMAR was less (0.360, P = 0.099). Conclusion DRT was the most common feature. CME had worst visual outcome and greatest CPT and AMT. In DRT, worse VA correlated more with CPT than with AMT, whereas in CME and SRD, correlation of VA was more with AMT than with CPT. VA correlated with height of lesion in eyes with SRD but not with CME. The height of cystoid space correlated with CPT but not with AMT, whereas the height of SRD correlated with both CPT and AMT.
  1,762 282 -
Visual acuity, fundus changes, and electroretinographic findings in Egyptian children with Bardet-Biedl syndrome
Dina El-Fayoumi, Rasha Helmy, Marwa Nabhan, Nevien Soliman
February 2016, 17(1):29-34
DOI:10.4103/1110-9173.178769  
Purpose The aim of the present study was to assess visual acuity, measure the degree of visual impairment, and examine fundus changes in Egyptian children with Bardet-Biedl syndrome (BBS), and to correlate these findings with the results of flash electroretinography (ERG). Materials and methods A cross-sectional study was conducted on infants and children with BBS. Diagnosis was carried out by a specialized pediatrician. Full ophthalmological examination, including slit-lamp examination, refraction, and indirect ophthalmoscopy, was carried out. Best-corrected visual acuity was measured and full-field flash ERG was performed. Results This study included 20 patients with BBS. The median age was 9 years (ranged from 1 day to 18 years). The mean age of onset of symptoms in the whole group was 6.5 ± 4.3 years. Visual impairment, defined as a best-corrected visual acuity in the better seeing eye of 20/60 (6/18) or less, was present in 11 patients (55% of the cases), and night blindness as a symptom was present in nine patients (45%); pigmentary retinopathy was clinically detected in 35% of the patients and retinal dystrophy as an ERG finding was detected in 60% of the patients. Conclusion Visual impairment in BBS is mainly caused by rod-cone dystrophy, which is one of the major criterion of diagnosis, which manifests with age. Before the age of 6, children rarely present with ocular manifestations, and usually have normal fundus examination; on the other hand, retinitis pigmentosa-like picture is usually seen in children older than 6. However, the electrophysiological changes may precede the fundus changes.
  1,902 132 -
Micropulse laser for diabetic macular edema
Mahmoud A Abouhussein
October 2016, 17(3):167-171
DOI:10.4103/1110-9173.195258  
Aim The aim of this study was to evaluate the effects of subthreshold micropulse yellow 577-nm laser photocoagulation on eyes with diabetic macular edema (DME). Patients and methods In this prospective interventional case series, 20 eyes of 20 patients with previously treated centre involving DME received one single session of yellow micropulse 577-nm laser photocoagulation. Treatment was delivered using the IQ 577-nm laser system. Fixed treatment parameters were used in all cases: 200-µm spot size, 200-ms exposure duration, 400-mW powers, and a 5% duty cycle. Confluent applications with no spacing were administered over the entire edematous area including the fovea. Results The baseline best-corrected visual acuity was 0.42±0.15 logMAR, which improved to 0.3±0.26 logMAR at the final follow-up (P<0.043). The central subfield thickness was 354.3±32.96 μm at baseline and the final central subfield thickness was 310.7±52.62 μm (P<0.002). Conclusion Subthreshold micropulse yellow 577-nm laser photocoagulation is effective in treating DME.
  1,758 260 3
Effect of the volume of anesthetic solutions and patient’s age on the efficacy of retrobulbar anesthesia
Engy M Mostafa, Amr Mounir
April-June 2018, 19(2):87-91
DOI:10.4103/DJO.DJO_71_17  
Purpose The aim of this study was to monitor the effect of different anesthetic volumes and patients’ age on the efficacy of bulbar akinesia and analgesia induced by retrobulbar anesthesia (RBA). Patients and methods This was a prospective, comparative, and interventional study that enrolled 478 patients who had consecutive cataract surgery and received RBA. Patients were divided randomly into two groups according to the volume of anesthetic solutions used. In group 1, patients received 2.50 ml of RBA, whereas in group 2, patients received 4 ml of RBA. Each group was then subdivided according to the age of the patients less than 45 years and greater than or equal to 45 years (1a, 1b, 2a, and 2b, correspondingly). The efficacy of anesthesia was evaluated by the degree of ocular motility in both groups. Results The study included 478 eyes of 478 patients. Group 1a included 94 patients: 51 eyes showed no movement regarding globe akinesia, 27 eyes showed flicker movement, 10 eyes showed partial movement, and six eyes showed full movement. Group 1b included 131 patients: 84 eyes showed no movement, 30 eyes showed flicker movement, 10 eyes showed partial movement, and seven eyes showed full movement. Group 2a included 103 patients: 80 eyes showed no movement, 17 eyes showed flicker movement, four eyes showed partial movement, and two eyes showed full movement. Group 2b included 150 patients: 109 eyes showed no movement, 28 eyes showed flicker movement, eight eyes showed partial movement, and five eyes showed full movement. Conclusion This comparison of different injection anesthetic volumes showed significant differences regarding bulbar akinesia, where the larger volume of anesthetic solution (4 ml) yielded better ocular akinesia with no significant effect of age of the patient on the efficacy of RBA.
  1,852 164 -
Efficacy and safety of the use of freeze-dried (lyophilized) amniotic membrane transplantation with combined trabeculotomy-trabeculectomy for congenital glaucoma
Salah M Al-Mosallamy
July-December 2015, 16(2):58-64
DOI:10.4103/1110-9173.165060  
Purpose The aim of the study was to evaluate the outcome of the surgical technique that utilizes freeze-dried (lyophilized) amniotic membrane transplantation (AMT) with combined trabeculotomy-trabeculectomy in cases of primary congenital glaucoma with respect to its efficacy and complications. Patients and methods This was a prospective controlled study that included 25 eyes of 19 patients with primary congenital glaucoma. The patients were categorized into two groups: group I included 14 eyes that were treated with combined trabeculotomy-trabeculectomy with AMT and group II included 11 eyes that were treated with combined trabeculotomy-trabeculectomy without adjunctive (control group). Results Nineteen patients were included in the study: 13 were male and six were female. The mean age was 6.2 ± 3.5 months and 5.7 ± 2.9 months in groups I and II, respectively; there were no statistically significant differences between groups I and II regarding the patient demographics and preoperative characteristics. The surgical outcome of the two groups showed that absolute success was achieved in 71.4% and qualified success in 14.3% in group I, and in group II absolute success was achieved in 45.5% and qualified success in 27.2%. This difference was highly significant in terms of absolute success and significant in terms of total success between the two groups. The mean intraocular pressure (IOP) in this study was markedly decreased from preoperative values in both groups during postoperative follow-up visits, with statistically significantly lower IOP in group I than in group II at all postoperative visits. The complications encountered were hyphema in 28.6% of patients in group I and in 27.3% of patients in group II. Shallow anterior chamber associated with hypotony occurred in 21.4 and 18.2% of patients in groups I and II, respectively. One case in each group developed serous choroidal detachment. Flat nonfunctioning bleb with high IOP occurred in 14.3% of patients in group I and in 27.3% in group II. The complication rates were statistically insignificant between the two groups. Conclusion AMT-enhanced combined trabeculotomy-trabeculectomy appears to be an effective procedure for the treatment of primary congenital glaucoma with better long-term control of IOP and without added complications.
  1,455 521 -
Decapsulation versus valve reimplantation in cases with an encysted Ahmed valve in refractory glaucoma
Salah M Al-Mosallamy
January-June 2015, 16(1):22-26
DOI:10.4103/1110-9173.157784  
Purpose The aim of the study was to evaluate the efficacy and safety of decapsulation of the fibrous capsule around the valve body versus valve reimplantation in another site in refractory glaucoma cases. Patients and methods We studied 25 cases with refractory glaucoma that had been implanted with an Ahmed glaucoma valve; their intraocular pressure (IOP) was greater than 21 mmHg and had undergone additional maximum topical antiglaucoma therapy. Patients were divided into two groups according to the surgical treatment that had been performed: group I included 12 eyes that had been treated by surgical decapsulation of the cyst around the valve body without removal of the valve and group II included 13 eyes treated by removal of the valve and reimplantation in another quadrant of the eye. Results Of the 25 patients included in the study, 15 were male and 10 were female, with a mean age of 19.2 ± 9.2 years in group I and 22.1 ± 10.3 years in group II. Recurrent congenital glaucoma was the most common preoperative diagnosis in both groups (50 and 53.8% in groups I and II, respectively). There was no statistically significant difference between the two groups regarding preoperative patient demographic characteristics (P < 0.05). The surgical results revealed that the mean operation time was significantly lower in group I than in group II (30 ± 12 and 45 ± 13.5 min, respectively; P = 0.023). However, there were no statistically significant differences in the success (complete and partial) and failure rates between the two groups (P < 0.05). There was marked reduction in IOP from preoperative values in both groups but there were no significant differences in IOP levels between the two groups over the follow-up visits. Tube-related complications occurred in group II only and included corneal tube touch in one (7.7%) case and erosion of the tube covering in two (15.4%) cases. One of them developed endophthalmitis and then lost the perception of light (PL) and ended in phthisis bulbi. Recurrence of encapsulation occurred more in group I (three cases, 25%) than in group II (two cases, 15.4%), after a mean postoperative time of 23 ± 2 weeks. The incidence of valve re-encapsulation was statistically insignificant between the two groups (P = 0.09). Conclusion Both surgical techniques were effective in controlling IOP in cases with encapsulated Ahmed valve; however, the decapsulation technique was simpler with shorter operation time and no probability for tube-related complications. Although the other technique of valve reimplantation had a longer operation time and more tube-related complications, it was associated with less incidence of re-encapsulation. However, larger multicenter studies with longer follow-up are needed for validation of these treatment strategies.
  1,737 205 3