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   2016| February  | Volume 17 | Issue 1  
    Online since March 16, 2016

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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
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.
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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
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.
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Combined cross-linking with femtosecond laser Myoring implantation versus combined cross-linking with femtosecond laser Keraring implantation for treatment of keratoconus
Mohammed I Hafez
February 2016, 17(1):1-8
Purpose The aim of this study was to compare the results with regard to efficacy, safety, and patient satisfaction between two combined procedures: combined femtosecond laser Myoring implantation with cross-linking (CXL) and combined femtosecond laser Keraring implantation with CXL for treatment of keratoconus. Setting This study was conducted in Sohag University Hospital, Sohag University, Egypt, in association with Sohag Future Femtosecond Laser Center. Design This was a prospective nonrandomized clinical comparative study. Patients and methods A total of 46 eyes of 30 patients with keratoconus were included in this study. Group A included 27 eyes of 17 patients who were subjected to combined CXL with femtosecond laser Myoring implantation, and group B included 19 eyes of 13 patients who were subjected to combined CXL with femtosecond laser Keraring implantation. All eyes were subjected to preoperative and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest refraction, slit lamp examination of anterior segment, intraocular pressure, fundus examination, and keratometry and pachymetry assessment with Pentacam corneal topographies at 3 and 6 months of follow-up. Results In group A, the preoperative mean ± SD UCVA was 1.30 ± 0.28 (logMAR), whereas the postoperative mean UCVA was 0.90 ± 0.12. The preoperative mean BCVA was 0.70 ± 0.23, whereas the postoperative mean BCVA was 0.30 ± 0.17. The preoperative keratometric average ± SD was 53.27 ± 0.62 D, whereas the postoperative keratometric average was 45.83 ± 0.64 D. The postoperative astigmatic correction was 1.51 ± 0.42 D. In group B, the preoperative mean UCVA was 1.30 ± 0.33, whereas the postoperative mean UCVA was 1 ± 0.16. The preoperative mean BCVA was 0.90 ± 0.46, whereas the postoperative mean BCVA was 0.60 ± 0.32. The preoperative keratometric average was 50.97 ± 0.48, whereas the postoperative keratometric average was 49.01 ± 0.32. The postoperative astigmatic correction was 3.07 ± 0.15. Conclusion This study proved that combined CXL with Myoring implantation is effective in the correction of the myopic component of keratoconus. Combined CXL with Keraring implantation is effective in the correction of the astigmatic component in keratoconus. The type and the site of keratoconus cone together with the K readings can help in the preoperative decision of which type of ring is best in each keratoconus case. This study proved that there is a synergistic action when CXL is combined with intracorneal rings (Myoring or Keraring).
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Secondary Artisan iris-fixated intraocular lens implantation for correction of aphakia
Ahmed H Mohamed
February 2016, 17(1):9-13
Purpose The aim of this study was to assess the visual and refractive outcome after Artisan lens secondary implantation for correction of aphakia and to report the incidence of complications. Patients and methods A total of 24 eyes of 24 patients rendered aphakic after complicated phacoemulsification and extracapsular cataract extraction were implanted with Artisan aphakia lens in Qena University Hospital. All patients underwent complete ophthalmic examination including uncorrected visual acuity, best-corrected visual acuity (BCVA), and manifest refraction both preoperatively and at 1 day, 1 week, 1 month, 2 months, and 6 months after surgery. Any intraoperative or postoperative complications were recorded. Results A total of 24 eyes of 24 patients were included, 16 of whom were men and eight were women. The mean follow-up was 7.2 ± 1.1 months (range = 6-9 months). The cause of aphakia was a complicated phacoemulsification (13 cases) and extracapsular cataract extraction (11 cases). At the final follow-up, the mean postoperative BCVA improved from 0.55 ± 0.19 preoperatively to 0.68 ± 0.20 postoperatively. Analysis of the final BCVA compared with that measured preoperatively demonstrated that 13 eyes (54%) improved, 12 eyes (50%) matched preoperative BCVA, and one eye (4%) decreased due to the occurrence of cystoid macular edema. The mean postoperative spherical equivalent was 1.00 ± 0.67 D, whereas it was 9.50 ± 1.7 D preoperatively. Of the 24 eyes, two developed high intraocular pressure in the early postoperative period. Conclusion Secondary implantation of Artisan iris-claw fixated lens is an effective and safe modality for correction of aphakia in eyes lacking sufficient capsular support.
  1,541 169 1
A comparison between the diagnostic results of short wavelength automated perimetry and standard automated perimetry in glaucoma patients
Ahmed H Mohamed
February 2016, 17(1):18-23
Purpose The aim of this study was to compare the diagnostic results of short wavelength automated perimetry (SWAP) and standard automated perimetry (SAP) in glaucoma patients. Patients and methods This study was held in Qena University Hospital from March 2012 to December 2012 and included 60 individuals who underwent full ophthalmological examination by means of slit-lamp biomicroscopy, gonioscopy, best-corrected visual acuity testing on Landolt's chart, fundus and optic nerve head examination using a +90 D lens, intraocular pressure (IOP) measurement by means of applanation tonometry, and finally optic nerve head photography using a Zeiss Visucam 500 fundus camera. The participants were divided into three groups: a normal age-matched control group (group A); a group with primary open-angle glaucoma POAG (group B); and a group with ocular hypertension OHT and glaucoma suspects (group C). Informed consent was obtained from all controls and patients after the nature and possible consequences of the procedure had been fully explained to them. All statistical analyses were performed by using IBM SPSS statistics. Results Thirty randomly selected eyes of 30 volunteers made up group A, 20 eyes of 20 POAG patients comprised group B, and 10 eyes of 10 ocular hypertension patients and glaucoma suspects comprised group C. The mean age of the 60 individuals included in the present study was 70.18 years (range: 60-82 years, SD: ±8.068); 29 were female and 31 were male. The prevalence of SWAP and SAP in glaucoma patients showed deficits in groups B and C, as defined by the presence of a glaucoma hemifield test 'outside normal limits'. According to this criterion, three of 10 (33.3%) group C eyes demonstrated a SWAP deficit at the second visit, whereas no (0%) eyes showed a deficit in SAP at the same time point. All 20 patients of group B manifested abnormal SWAP. The level of agreement in terms of the severity of field loss between SWAP and SAP for groups B and C, based on the pattern SD, was studied. In the present study we found that visual field loss was greater and more diffuse in SWAP than in SAP, but no patient exhibited new scotomata. Conclusion SWAP is superior to SAP in identifying patients with early glaucoma, ocular hypertension, glaucoma suspects, and patients with progressive optic disc cupping and may therefore be quite useful for determining early and progressive changes in glaucoma.
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A comparative study between trabeculotomy with deroofing of Schlemm's canal augmented with Ologen implant and conventional trabeculotomy in primary congenital glaucoma
Mohamed A.H. Elmallah, Thanaa H Mohamed, Ahmed G Elmahdy
February 2016, 17(1):24-28
Purpose The aim of the study was to evaluate the efficacy and safety of Schlemm's canal deroofing augmented by Ologen to enhance the success of trabeculotomy for primary congenital glaucoma (PCG). Patients and methods Thirty-two eyes of 21 patients were included in this prospective study, classified into two equal groups: the study group and the control group. The study group underwent trabeculotomy with Schlemm's canal deroofing and subconjunctival Ologen implantation, and the control group underwent trabeculotomy alone for infants affected by PCG. The participants were followed up for 6 months. Results According to the definitions for success, qualified success, and failure, the study group had 13/16 (81.25%) cases of success and 3/16 (18.75%) cases of qualified success. The control group reported 10/16 cases (62.50%) of success, 2/16 cases (12.50%) of qualified success, and 4/16 cases (25%) of failure. Conclusion Success and qualified success were higher in the study group (trabeculotomy augmented with deroofing of Schlemm's canal and Ologen implant) than in the control group after 6 months of follow-up for cases of PCG.
  1,296 161 1
Comparison between 20-, 23-, and 25-G transconjunctival sutureless vitrectomy in the surgical treatment of idiopathic macular hole and idiopathic epiretinal membrane
Ahmed M Bedda, Hesham F Elgoweini, Ahmed M Abdel-Hady, Osama R El-Naggar
February 2016, 17(1):42-46
Aim The aim of the present study was to compare 20, 23, and 25-G transconjunctival sutureless vitrectomy (TSV) systems in the management of idiopathic macular hole and idiopathic epiretinal membrane (EMM) as regards the operative time and postoperative complications such as hypotony (as shown by intraocular pressure<8 mmHg), retinal detachment, or endophthalmitis. Patients and methods This prospective, comparative, randomized clinical study was carried out on 60 consecutive patients undergoing TSV at a single center and by the same surgeon. Included patients were with preoperative diagnoses of idiopathic macular hole (group A) and idiopathic EMM (group B). Ten patients of each group were randomly allocated to 25-, 23-, or 20-G TSV subgroups using a table of random numbers. Three-port pars plana vitrectomy with internal limiting membrane peeling in group A with gas tamponade and EMM peeling in group B was carried out. Results In group A, the mean duration of surgery in the 20-G TSV subgroup was 43.7 ± 1.89 min compared with 42.5 ± 2.01 min in the 23-G subgroup and 43.5 ± 1.84 min in the 25-G subgroup. There was no statistically significant difference between the three subgroups. In group B, there was no statistically significant difference between the three subgroups, with a mean time of surgery of 35.8 ± 1.81 min in the 20-G subgroup versus a mean time of 37.9 ± 2.33 and 37.3 ± 1.98 min in the 23-G and the 25-G subgroups, respectively. In group A, the intraocular pressure was within the normal range in all follow-up periods in the three subgroups and no reported cases of hypotony either in the early or late follow-up periods. In group B, there was a statistically significant difference only in the first follow-up period between the three subgroups, as two cases of hypotony in the 20-G subgroup and two cases in the 25-G subgroup were reported, all of which resolved without sequelae. There were no cases of postoperative endophthalmitis in any case of either group A or group B. There were no cases of postoperative retinal detachment in any case of either group A or group B in all follow-up periods. Conclusion The current study indicated no increased risk of postoperative complications such as hypotony, endophthalmitis, or retinal detachment during sutureless vitrectomy.
  1,341 105 -
Ocular perfusion pressure and anticardiolipin antibodies in glaucomatous Egyptian patients
Maha Shahin, Hossam T Al-Sharkawy, Amany M El-Diasty
February 2016, 17(1):14-17
Aim The aim of the present study was to investigate the association of antiphospholipid antibodies and ocular perfusion pressure (OPP) with primary open-angle glaucoma (POAG) in an Egyptian population. Patients and methods A total of 44 patients were enrolled in the study: 22 with POAG and 22 controls. All patients underwent blood pressure measurement, ophthalmic examination, and blood tests. OPP was defined as 2/3΄[diastolic BP+1/3΄(systolic BP-diastolic BP)]-IOP. Blood was examined for the level of immunoglobulin G and immunoglobulin M anticardiolipin (aCL) antibodies using the enzyme-linked immunosorbent assay technique. Results There was no statistically significant difference between the two groups regarding age, sex, immunoglobulin G aCL antibodies, or immunoglobulin M aCL antibodies. OPP was statistically lower in patients with POAG compared with control. Conclusion The results of the present study do not confirm the hypothesis that POAG coexists with elevated blood levels of aCL antibodies. High OPP offers relative protection from glaucoma development.
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A choroidal neovascular membrane hidden under a pigment epithelial detachment
Alaa M Fadel, Moemen S Elnawawy
February 2016, 17(1):47-48
Pigment epithelial detachment occurs mainly in age-related macular degeneration and central serous chorioretinopathy and in other inflammatory, neoplastic and iatrogenic, retinal, and systemic disorders. A tomographic notch is an optical coherence tomography finding that might indicate the presence of an occult choroidal neovascularization.
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