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   Table of Contents - Current issue
October-December 2020
Volume 113 | Issue 4
Page Nos. 125-159

Online since Monday, January 4, 2021

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Evaluating peripheral retinal vascularization and rate of recurrence after intravitreal injection of ranibizumab as a primary treatment for retinopathy of prematurity p. 125
Mostafa M El Manhaly, Ossama A El Hadad, Hesham F Goweini, Ahmed A Souka
Context Retinopathy of prematurity (ROP) is a vascular proliferative disease affecting premature infants. Aims The aim was to assess the extent of peripheral retinal vascular growth and recurrence rate in patients with type 1 ROP treated with ranibizumab. Settings and design Patients with ROP attending the pediatric eye clinic in the main university hospital in Alexandria Faculty of Medicine were recruited. Participants and methods This prospective study included 20 eyes of 10 patients showing type 1 ROP, treated with 0.25 mg ranibizumab intravitreal injection only. Patients were followed for 6 months, where peripheral vascularization and rate of recurrence were assessed through indirect ophthalmoscopy and RetCam imaging. Statistical analysis Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. The tests used were χ2 test, Fisher’s exact test, and Student t test. Results A total of 16 (80%) eyes showed good peripheral vascularization and favorable anatomical outcome. The average timing for temporal zone III retinal vascularization was 15.71±2.09 weeks, with three eyes not reaching zone III after 6 months of injection. One eye showed retinal folding and macular ectopia. Three (15%) eyes showed signs of recurrence, with two eyes showing neovascularization at the initial vascular ridge by the fifth week after intravitreal ranibizumab injection (IVR), and one eye showing the recurrence of thick temporal ridge by the fourth months. Conclusions Ranibizumab is a potential effective treatment for patients with type 1 ROP. Delayed peripheral vascularization and disease recurrence mandate tailored long-term follow-up period according to individual response.
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Prevalence of dry eye disease among healthy Egyptian population p. 133
Bassem F Aziz, Caroline A Tawfik
Purpose The aim was to study the prevalence and related risk factors of dry eye disease (DED) in a random population sample from Cairo and upper Egypt. Materials and methods A clinic-based, cross-sectional, observational, multicenter study was conducted on eyes of healthy individuals accompanying ophthalmological patients coming for ocular examination in outpatient clinics of Ain Shams University Hospital and Al Watany Eye Hospital, Cairo; Saint Mary Hospital, Qena; and Aswan Eye center, Aswan, Egypt. Eyes were selected by systematic random sampling. Two questionnaires were used: the Ocular Surface Disease Index and another one covering medical history and risk factors for DED. External ocular examination, tear film break-up time, and Schirmer’s tests were done. Diagnosis of DED was established on an Ocular Surface Disease Index score of 50 or above associated with at least one of DED symptoms together with either tear film break-up time of less than or equal to 5 s or Schirmer’s test measurement of less than or equal to 10 mm. Results A total of 603 eyes were included; 290 of which were of male participants and 313 were of female ones. The age range was 18–94 years, with a mean age of 50.06±19.06 years. The prevalence of DED was 77.6% (468 eyes). There was a statistically highly significant difference in DED prevalence among all age groups (P<0.0001), with higher prevalence in age group of 41–50 years old, but the trend between consecutive age groups was not statistically significant (P=0.4747). Moreover, DED was statistically more common in females [86.9% of female participants versus 67.6% of male participants (P<0.0001)]. Blepharitis was found in 81% (379 eyes) and smoking in 43.8% (205 eyes). Moreover, 29.7% (139 eyes) of detected DED cases had associated dry mouth. Conclusion DED was quite common among our studied subjects, and most of them had associated blepharitis. Smoking was also a major risk factor. Moreover, DED was more common in female sex. There was a statistically significant difference in DED prevalence among the age groups.
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Evaluation of fenestration technique of the medial recuts muscle with resection of ipsilateral lateral rectus muscle in patients with sensory esotropia p. 142
Mohamed H Elkhawaga, Nehal M Elshakankiri, Hany A Helaly, Amr A Elkamshoushy
Background There is an ongoing need to move toward sutureless surgery with less surgical manipulations, while maintaining the same results achieved by conventional surgery. Aim The aim was to evaluate the safety and the effectiveness of fenestration technique of the medial recuts muscle with resection of ipsilateral lateral rectus muscle in patients with sensory esotropia. Design A prospective, noncomparative, single-institution interventional study was conducted. Patients and methods This is a prospective study conducted on 16 children with sensory esotropia. Fenestration of the medial rectus muscle is a novel technique of weakening of the medial rectus by excising a rectangular wide central part extending from the insertion to a point back 5–8 mm depending on the angle of the esotropia leaving superior and inferior longitudinal muscle sleeves with no muscle sutures needed. Postoperative angle was reported at 3 months and at final follow-up. Results The procedure reduced the angle of esotropia from mean preoperative angle of 36.6±9 (20–50) to 5.3±5.9 (0–20) PD. Satisfactory horizontal alignment, defined as postoperative alignment within 8 PD of orthotropia at distance, was achieved in 81.25% of the cases at 3 months of follow-up. There were no overcorrections. The procedure was well tolerated by patients. Conclusion Fenestration technique is a safe and effective weakening procedure for medial rectus in cases of sensory esotropia.
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Combined femtosecond laser-assisted intrastromal corneal ring segments implantation and corneal collagen cross-linking for treatment of pellucid-like keratoconus p. 147
Mortada A Abozaid
Purpose To evaluate the safety and efficacy of combined femtosecond laser-assisted intrastromal corneal ring segments implantation plus accelerated transepithelial corneal collagen cross-linking (ATE-CXL) in cases of pellucid-like keratoconus (PLK). Patients and methods This retrospective study included 25 eyes of 13 patients with PLK. Cases were divided into two groups: group 1 consisted of 13 eyes (seven patients) that had been treated by femtosecond laser-assisted Kerarings implantation and ATE-CXL in the same session, whereas group 2 included 12 eyes (six patients) that had been treated with ATE-CXL alone. Results After 1 year of surgery, the mean uncorrected visual acuity (UCVA) of group 1 improved from 0.94±23 (logMAR) to 0.73±18, whereas the mean best-corrected visual acuity improved from 0.75±16 to 0.49±0.22. The mean preoperative maximum keratometry (Kmax) was 65.23±5.03 D, whereas the mean postoperative Kmax was 53.92±4.21 D. However, in group 2, the preoperative mean UCVA was 0.63±0.31 and the postoperative UCVA was 0.55±0.29, whereas the mean best-corrected visual acuity changed from 0.31±0.26 to 0.23±0.19. The mean preoperative Kmax was 51.38±3.73 D, whereas the mean postoperative Kmax was 48.43±2.98 D. Conclusion Combined femtosecond laser-assisted Kerarings implantation and ATE-CXL is safe and effective in the treatment of PLK.
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Effect of macular optical coherence tomography on decision making before silicone oil removal p. 153
Mohamed M Elwan, Tharwat H Mokbel, Amani E Badawi, Waleed A Abou Samra, Sherein M Hagras
Purpose To evaluate the role of spectral domain optical coherence tomography (SD-OCT) in affecting the decision making in eyes prepared for silicon oil removal (SOR) and to identify the cases that should have an obligatory preoperative SD-OCT. Patients and methods This prospective nonrandomized study involved patients with silicone-filled eyes recruited over the period from 2015 to 2018. Data from preoperative clinical examination and SD-OCT imaging and proposed modifications on SOR surgery based on both ways of examinations were recorded and compared. Cohen’s Kappa test was used to study the agreement between the clinical and OCT results. Results A total of 146 eyes of 138 patients were included in the study. Before SOR, clinical examination revealed normal macula in 108 (74%) eyes compared with 62 (42%) by OCT. OCT was able to detect significantly higher macular pathologies than did the clinical examination alone (P<0.0005). The number of eyes with macular edema (ME) and epiretinal membrane detected by OCT was significantly higher than that detected clinically (P<0.0005). There was a weak agreement between the results of clinical and OCT examination regarding ME (weighted K=0.426). Modifications added to the routine SOR based on clinical findings were suggested in 25 (17%) eyes compared with 65 (45%) eyes on adding OCT findings in decision making. Superadded modifications based on SD-OCT alone were significantly more in diabetic than nondiabetic patients regarding management of ME and macular retinal detachment (P=0.003). Conclusion SD-OCT was proved to be a helpful tool for following silicone-filled eyes, especially in diabetic patients. Preoperative OCT findings influenced the surgical plans of the routine SOR, thus aided in managing treatable macular lesions such as epiretinal membrane, ME, macular holes, and macular detachment.
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