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   2019| April-June  | Volume 20 | Issue 2  
    Online since July 24, 2019

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Surgical outcomes of inferior oblique muscle weakening procedures for eliminating inferior oblique muscle overaction: a prospective randomized study
Ahmad Abdel Karim Mohamed, Hassan Shamselden Yousef, Amr Mounir
April-June 2019, 20(2):88-94
Purpose The aim of this study was to evaluate the outcomes of weakening surgical procedures for eliminating inferior oblique muscle overaction (IOOA). Patients and methods A prospective randomized interventional study was performed on 20 eyes of 12 patients with IOOA. The eyes were classified randomly into three groups. The first group included six eyes treated with inferior oblique (IO) myotomy. The second group included eight eyes treated with IO myectomy. The third group included six eyes treated with IO muscle recession. The ductions, versions, and degree of IOOA were analyzed in all patients before and after surgery. Patients were included in the study only if they achieved a minimal follow-up period of 3 months. Results Orthotropia was achieved in 13 (65%) eyes: three (15%) eyes in IO myotomy group, five (25%) eyes in IO myectomy group, and five (25%) eyes in IO recession group. One (5%) eye of IO myotomy group showed residual degree of IOOA. Underaction of IO occurred in one (5%) eye of IO myectomy and recurrence occurred in five (25%) eyes of all groups. Conclusion Recession is the most effective procedure to eliminate IOOA, whereas myectomy at insertion is the second most effective procedure and myotomy is the least effective procedure.
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Optical coherence tomography-based comparison of retinal nerve fiber layer thickness and macular thickness in amblyopic and fellow eyes
Abdulghaffar T.T Abdulghaffar, Abdelkhalek Al-Saadany, Asmaa M Ibrahim
April-June 2019, 20(2):74-81
Objectives The aim of the present study was to compare the retinal nerve fiber layer thickness (RNFLT), macular thickness, and ganglion cell layer thickness between amblyopic and fellow eyes using spectral domain optical coherence tomography (OCT). Patients and methods Seventy-six patients were included in the study (32 males and 44 females; age range, 18–40 years; mean age, 27.21±8.25 years). Detailed medical history of all patients was obtained. All patients underwent detailed ophthalmologic and fundoscopic examination by slit-lamp biomicroscopy, visual acuity by Landolt’s chart, cycloplegic refraction, ocular alignment, applanation tonometry, and OCT imaging by spectral domain OCT (Cirrus-5000 OCT). Results There was no significant difference between the amblyopic and fellow eyes regarding central macular thickness, average macular thickness, or ganglion cell complex thickness. By further secondary analysis aiming to compare subgroups according to the refractive status, only the RNFLT was significantly lower in the amblyopic eyes compared with the fellow eyes in the myopic amblyopic subgroup only. Other OCT values were not significantly different in other amblyopic eyes versus fellow eyes in different subgroups. Conclusion There was no significant correlation between amblyopia and OCT parameters. However, OCT revealed a significant reduction in the mean RNFLT in myopic amblyopic eyes only compared with their fellow eyes. Axial length may be more influential than amblyopia.
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Correlation between central corneal thickness and retinal nerve fiber layer thickness in open-angle glaucoma
Esraa Y Mohamed, Ahmed I Basiony, Asmaa Ibrahim
April-June 2019, 20(2):55-62
Background Central corneal thickness (CCT) is an important risk factor in the development and progression of primary open-angle glaucoma (POAG). The retinal nerve fibers respond to high intraocular pressure (IOP) with irreversible loss. So, there is a great interest to study the correlation between these two factors: CCT and retinal nerve fiber layer thickness (RNFLT) using the spectral-domain optical coherence tomography (SD-OCT). Aim The aim of this study was to correlate the CCT and the RNFLT in POAG patients by using SD-OCT. Patients and methods This study was conducted in Menoufia University Hospitals, Egypt, from October 2017 to October 2018. The study included 116 eyes of 61 patients with POAG receiving antiglaucomatous eye drops with controlled IOP. CCT and peripapillary RNFLT were measured by using SD-OCT (Optovue RTVue-100). Then, we performed a correlation between them. Results The study included 61 (40 males and 21 females) patients. The mean age was 51.5±6 years. A significant positive relationship was found between the CCT and the RNFLT (r=0.6). This means that patients with thick cornea have thicker nerve fiber layer than those with thinner corneas. Conclusion CCT is an important risk factor and predictive factor for both diagnosis and prognosis of POAG. So, it is mandatory to be measured to modify the IOP measurements and to correlate with the nerve fiber layer thickness. This helps us to tailor the plan of treatment.
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Predictability of intraocular lens power calculation in eyes with average axial lengths: optical versus ultrasonic biometry
Amin F Ellakwa, Mohammed S Abd Elaziz, Marwa A Zaky, Waleed M Nagy
April-June 2019, 20(2):68-73
Objective The aim of this study was to compare the partial coherence interferometry to ultrasound (US)-based biometry in intraocular lens (IOL) power calculation in eyes with average axial length (AL). Patients and methods One hundred eyes with AL of 21–24 mm having cataract as the only ocular pathology were included in the study from November 2016 to October 2018. Fifty eyes were subjected to US biometry and 50 eyes were subjected to Zeiss IOL-Master optical biometry followed by IOL power calculation. All patients underwent phacoemulsification by experienced surgeons with intra-bagal implantation of one-piece soft hydrophilic intraocular lens. AL, keratometric reading, anterior chamber depth, and intraocular lens power were compared. Actual postoperative spherical equivalent (SE), mean absolute error, and predicted error were calculated. Results No statistically significant difference was found between the two groups regarding the AL, keratometric reading, anterior chamber depth, IOLs power, predicted postoperative SE, and actual postoperative SE (P=0.36, 0.20, 0.57, 0.39, 0.31, and 0.09, respectively). The US group had significantly higher predicted error and mean absolute error than IOL-Master group (P=0.03 and 0.01, respectively). Conclusion IOL-Master optical biometry is slightly more accurate than US biometry for intraocular lens power calculation in eyes with average AL, whereas A-scan biometry is still a cost-effective method.
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Evaluation of corneal and lens density changes after cross-linking in keratoconus
Lamyaa S Soliman, Mohamed S Abdel-Aziz, Marwa A Zaky, Hatem M Marey
April-June 2019, 20(2):47-54
Background Corneal cross-linking (CXL) is an important modality for keratoconus therapy. Lens and corneal density are reported to change in keratoconus and with CXL. However, these changes are not well studied. Aim The aim of this study was to evaluate the changes in corneal and lens density in patients with keratoconus after corneal CXL. Patients and methods This is a prospective case series study that was conducted in a private Eye Laser Center, Menoufia Governorate, Egypt. The study consisted of patients with bilateral clinical keratoconus whose age ranging between 15 and 40 years with clear lenses. Bilateral minimum corneal thickness of 400 µm, measured with Pentacam, was essential. All study patients were examined preoperatively and 1, 3, and 6 months postoperatively. Ophthalmic examination included uncorrected distance visual acuity, corrected distance visual acuity, and manifest refraction as well as corneal thickness, thinnest location, maximal keratometric reading (Kmax), and corneal and lens densitometry measured by Pentacam. Results The preoperative mean corneal density on the axis 0–180 was 17.3±1.8, which changed to 20.7±2.01 after 6 months postoperatively (P=0.001). Although the preoperative mean corneal density on the axis of 90–270 was 17.4±2.06, it changed to 19.9±2.4 after 6 months postoperatively (P=0.04). No significant changes were encountered in lens density after CXL. Conclusion Corneal CXL significantly increased the corneal but not the lens density. This increase was maximal after 1 month and gradually returned toward the baseline. CXL is considered as a safe procedure for the lens.
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Corneal endothelial changes after subscleral trabeculectomy with mitomycin-C
Faried M Wagdy, Adel G Zaky, Sara N.A Gohar
April-June 2019, 20(2):63-67
Background Antimetabolites have been proposed to increase the success rate and reduce fibrosis associated with filtering surgery. However, they have cytotoxic effect on corneal endothelial cells. Noncontact specular microscopy was used for measuring the endothelial cell changes after subscleral trabeculectomy (Trab) with antimetabolites. Purpose The aim of this study was to evaluate the changes that occur in corneal endothelial cells after subscleral Trab with mitomycin-C (MMC). Patients and methods This is a prospective interventional study that was carried out on 30 eyes of 26 patients attending the Ophthalmology Department of Menoufia University Hospitals. They were prepared for subscleral Trab with MMC in the period between April 2017 and April 2018. Follow-up for those patients was done by specular microscopy preoperatively and 1 week, 3, and 6 months postoperatively to evaluate corneal endothelial changes. Specular microscopy was performed at the Memorial Institute of Ophthalmology in Giza. Results There was a significant decrease in cell density but nonsignificant difference in central corneal thickness and cell size 6 months after surgery compared with preoperative values. Intraocular pressure was controlled after surgery and remained low during the follow-up period. Conclusion Subscleral Trab with MMC caused a significant but nonclinically remarkable loss of endothelial cells which occurred only intraoperatively or at the early postoperative period. However, prolonged toxic effect of MMC and progressive cell loss were not a major concern.
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Electrophysiological study of thyroid ocular disorders
Mona Abdel Kader, Naglaa Abass
April-June 2019, 20(2):82-87
Purpose The aims of this study were to evaluate the visual evoked potential (VEP) changes in thyroid ocular disorders and to correlate between VEP latencies and thyroid hormones. Patients and methods The study participants were divided into four groups. Group 1 comprised 50 patients (100 eyes) with subclinical hypothyroidism (29 patients had recent hypothyroidism without treatment, and 21 patients had controlled hypothyroidism with treatment). Group 2 comprised 35 patients (70 eyes) with overt hypothyroidism (20 patients had recent hypothyroidism without treatment, and 15 patients had controlled hypothyroidism with treatment). Group 3 comprised 35 patients (70 eyes) with hyperthyroidism (18 patients had recent hyperthyroidism without treatment, and 17 patients were under treatment). Group 4 comprised 70 patients (140 eyes) with normal thyroid functions as a control group. Flash and pattern VEP and thyroid hormone assay were performed for all patients. Results There was an increase in the latencies of VEP without statistically significant change in amplitudes in thyroid disorders (groups 1, 2, and 3) compared with the normal control group (group 4). The increase in latencies in group 1 was statistically insignificant (P>0.1), while, in groups 2 and 3, it was statistically significant (P<0.005 and 0.001, respectively). In group 3, there was a positive correlation between latencies and tri-iodothyronine (T3) and thyroxine (T4). The increase in p100 was accompanied with an increase in T3 and T4. Conclusion VEP can detect the early optic nerve defects in the absence of any neurological or ophthalmological symptoms in thyroid disorders.
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