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  Citation statistics : Table of Contents
   2013| October-December  | Volume 106 | Issue 4  
    Online since April 28, 2014

 
 
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ORIGINAL ARTICLES
Inferior rectus tucking versus combined superior rectus recession with posterior fixation suture (faden) for the treatment of dissociated vertical deviation without inferior oblique overaction
Mohamed Mostafa K Diab
October-December 2013, 106(4):239-244
DOI:10.4103/2090-0686.131573  
Purpose To compare the efficiency of inferior rectus tucking versus combined superior rectus recession with posterior fixation suture (Faden) for the treatment of dissociated vertical deviation (DVD) without inferior oblique overaction. Patients and methods In this prospective study, 50 consecutive patients with DVD and without inferior oblique overaction were allocated randomly in their order of presentation to two groups; each group included 25 patients. The patients in group I were subjected to combined bilateral superior rectus recession and the Faden procedure (posterior fixation) and the patients in group II were treated by bilateral inferior rectus tucking (plication). Results DVD improved significantly (P < 0.05) in the two groups of the study. In group I, the mean vertical deviation improved from 18.21 ± 4.73 prism diopter (PD) preoperatively to 7.82 ± 5.61 PD 9 months after surgery (P < 0.05), with a mean correction of vertical deviation of 10.21 ± 3.52 PD and a mean correction of asymmetry of 2.1 ± 1.6 PD. Four patients needed inferior rectus tucking for residual or recurrent manifest DVD. In group II, the mean vertical deviation improved from 17.97 ± 6.89 PD preoperatively to 6.97 ± 5.46 PD 9 months after surgery (P < 0.05), with a mean correction of vertical deviation of 11.34 ± 2.71 PD and a mean correction of asymmetry of 2.5 ± 1.3 PD. Five patients needed inferior rectus retucking for residual manifest DVD. Conclusion Inferior rectus tucking is as effective as superior rectus recession with posterior fixation sutures for the primary treatment of DVD without inferior oblique overaction. Inferior rectus tucking can also be used effectively for the treatment of residual and recurrent DVD; further studies are recommended in this field.
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Evaluation of the role of apelin in diabetic retinopathy
Waleed Mahdy Nada, Doaa Attia Abdel Moety, Mahmoud M Abo Almeaty, Khaled M Hadhoud
October-December 2013, 106(4):245-248
DOI:10.4103/2090-0686.131587  
Purpose The study was designed to evaluate the role of apelin in diabetic retinopathy by measuring the concentration of plasma apelin and correlating the results between the control group, diabetic patients without and with retinopathy, and diabetic patients after treatment with panretinal photocoagulation (PRP). Methods The study included four groups: group A consisted of 20 normal individuals as the control group, group B consisted of 20 diabetic patients without retinopathy, group C consisted of 20 diabetic patients with untreated proliferative diabetic retinopathy (PDR), and group D consisted of the same patients of group C after treatment with PRP. Plasma apelin was measured in all groups and interpretation of the results was carried out. Results The study revealed that plasma apelin increased significantly in diabetic patients with PDR (mean 1.6 ng/ml) compared with the control group (mean 0.98 ng/ml) and with diabetic patients without retinopathy (mean 0.97 ng/ml). Plasma apelin decreased nonsignificantly in diabetic patient with PDR after treatment with PRP (mean 1.2 ng/ml). Conclusion Apelin plays an important role in retinal angiogenesis in diabetic patients; measurement of plasma apelin may be a good indicator for ischemic retinal condition, especially in the absence of other ischemic manifestations in the body.
  1 1,309 164
Evaluation of corneal biomechanics using ocular response analyzer for normal and primary open angle glaucoma eyes
Mohamed A El-Malah
October-December 2013, 106(4):249-252
DOI:10.4103/2090-0686.131594  
Purpose The aim of the study was to evaluate the differences in intraocular pressure measurements using the applanation Goldmann method (IOPg), in intraocular pressure after compensation of the cornea (IOPcc), in corneal hysteresis (CH), and in corneal resistance factor (CRF) between healthy individuals and patients diagnosed as primary open angle glaucoma (POAG) using ocular response analyzer (ORA). Patients and methods Ninety-four eyes of 94 individuals, 45 male individuals and 49 female individuals, were classified into two equal groups: the POAG (47 eyes) group and the normal (47 eyes) control group. Their mean age was 54 ± 7.1 years and 55 ± 7.8 years, respectively. All measures for the four selected parameters (IOPg, IOPcc, CH, and CRF) were performed using an ORA machine for all eyes. Statistical analysis was made using the Student t-test to search for any significant difference between the two groups. Results All parameters including IOPg, IOPcc, CH, and CRF were measured and their mean values were calculated. In normal eyes, the mean of IOPg was 15.8 ± 1.3 mmHg, that of IOPcc was 14.7 ± 0.2 mmHg, that of CH was 11.6 ± 1.2 mmHg, and that of CRF was 12.4 ± 1.8 mmHg, whereas in eyes presented with POAG, the mean of IOPg was 23.6 ± 2.6 mmHg, that of IOPcc was 26.8 ± 2.4 mmHg, that of CH was 8.4 ± 2.3 mmHg, and that of CRF was 9.4 ± 0.6 mmHg; there was a significant difference between the two groups. Conclusion In this study, the selected parameters such as IOPg and IOPcc had higher readings and CH and CRF had lower readings in glaucomatous eyes and vice versa in normal eyes. The low readings of intraocular pressure in POAG eyes were most probably because of low readings of CH and CRF. Studies with larger sample size are needed to support the results and more accurately evaluate the ORA machine and its role in early detection of glaucoma patients.
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Retinal nerve fiber layer versus optic nerve head evaluation in the diagnosis of glaucoma and glaucoma suspect patients
Tharwat H Mokbel, Amal M Elbendary, Hossam T El Sharkawy, Wael M El Desouky
October-December 2013, 106(4):253-258
DOI:10.4103/2090-0686.131608  
Purpose To evaluate the role of retinal nerve fiber layer (RNFL) versus optic disc parameters in the diagnosis of glaucoma and glaucoma suspect using spectral domain optical coherence tomography (SD-OCT). Patients and methods Forty-five normal, 51 glaucoma suspect, and 54 glaucomatous eyes were examined. Complete ophthalmic examination, white-on-white perimetry, and SD-OCT were performed for all patients. RNFL thickness of quadrants and clock hours and optic disc parameters were recorded. Area under receiver operating characteristic curves (AUC) were used to assess the performance of OCT. Results RNFL thickness and optic head parameters were used discriminate the three groups for all comparisons. Inferior, average, and superior RNFL thickness were the best parameters that discriminated normal from glaucoma (AUC: 0.96-0.99), suspect from glaucoma (AUC: 0.84-0.91), and normal from suspect (AUC: 0.71-85). Rim area and vertical cup/disc ratio were the best parameters that discriminated normal from glaucoma (0.87-0.90), suspect from glaucoma (AUC: 0.82-0.83), and normal from suspect (0.76). Conclusion The ability of SD-OCT to differentiate between normal and glaucoma suspect eyes from glaucomatous eyes is better for RNFL thickness than optic nerve head parameters. The ability of both RNFL thickness and optic disc parameters is less in differentiating normal from glaucoma suspect eyes.
  - 1,527 178
Ocular cyclovertical deviations among strabismic patients attending Ophthalmology Department in Minia University Hospital
Sahar T Abdelrazik, Mohamed F Khalil
October-December 2013, 106(4):259-262
DOI:10.4103/2090-0686.131618  
Introduction Small residual hyperdeviations following surgical alignment of horizontal strabismus are of special clinical significance as they cause permanent problem in patient's binocular function. Once the correct diagnosis has been made, medical and surgical management of these deviations does not present any problems. Objective This study was designed to detect the prevalence of vertical deviation among patients suffering from strabismus, attending Minia University Hospital. Design This retrospective study was conducted in the Ophthalmology Department, Minia University Hospital during the period from January 2008 to January 2013. Patients and methods We reviewed our medical records at the Paediatric Ophthalmology Unit to evaluate the data of 1456 patients who attended the clinic from January 2008 to January 2013 and who were suffering from strabismus. They were subjected to complete history taking about birth history, trauma, abnormal head positions, and examination of old images. Complete ophthalmologic and orthoptic examination were performed. Detected cases of vertical strabismus were recorded and all data of the patients were subjected to statistical analysis. Results We reported that 87.5% of strabismus patients in the study had only horizontal deviation and 12.5% had vertical deviations either pure vertical or in association with horizontal deviations; 58.8% of these vertical deviations were inferior oblique overaction. Conclusion Vertical deviations had a considerable prevalence in strabismic patients and they should be in mind for good diagnosis and management of strabismus patients.
  - 1,221 101
Transepithelial photorefractive keratectomy versus LASIK in correction of mild and moderate myopia
Waleed A Ghobashy, Mohammed E Helmy, Ahmad A Abdel Ghani
October-December 2013, 106(4):263-266
DOI:10.4103/2090-0686.131623  
Purpose The aim of this study was to compare both transepithelial photorefractive keratectomy (trans-PRK) and LASIK in correction of mild and moderate myopia in terms of effectiveness, visual recovery, and safety. Materials and methods This was a prospective case - control series. Group I included 30 myopic eyes (16 patients) with spherical equivalent -1.00 to -6.00 D that were subjected to trans-PRK using a Schwind Amaris 500E excimer laser, with a trans-PRK platform. A case-adjusted group II (control group) included 30 myopic eyes (18 patients) with spherical equivalent -1.00 to -6.00 D that were subjected to LASIK using a Schwind Amaris 500E excimer laser, with a LASIK platform. Uncorrected visual acuity (UCVA) was measured on the first day, first week, 1 month, and at 6 months, together with manifest refraction. Postoperative pain was assessed using a visual analog scale. The occurrence of complications was documented. Results Patients in group I showed slower visual recovery, with a mean of UCVA 0.34 ± 0.19 on the first postoperative day compared with group II (0.76 ± 0.42). However, both groups achieved a mean UCVA of 1.00 by the end of the sixth month. Manifest refraction was comparable in both groups, with a mean of −0.60 ± 1.07 D in group I and −0.15 ± 0.06 D in group II, by the end of the study. Pain was significant in group I, with an average score of 3.2 ± 1.09 in the first day decreasing to zero by the end of the first week in comparison with group II with no pain in the first day until the end of the first week. No complications were recorded in either of the two groups during the study period. Conclusion Trans-PRK may offer a safe and effective alternative to LASIK in the treatment of mild and moderate myopia, especially in cases of thin cornea.
  - 1,965 148
Preperiosteal suborbicularis oculi fat lift blepharoplasty
Sherif Elwan, Saad Rashad, Thanaa H Mohammed, Yousra A Farweez
October-December 2013, 106(4):223-225
DOI:10.4103/2090-0686.131560  
Aim The aim of this study was to determine the effect of preperiosteal suborbicularis oculi fat (SOOF) lift blepharoplasty in the treatment of tear-trough (nasojugal) deformity. Patients and methods A prospective interventional case study was carried out on 10 eyelids (five patients; four women and one man), age range 40-70 years (mean ± SD, 58.0 ± 11.0); all of them had tear-trough deformity as a part of midfacial aged appearance with prolapsed orbital fat. A preperiosteal SOOF lift blepharoplasty was performed under local or general anaesthesia, adding a preseptal orbicularis oculi muscle sling and lateral canthal resuspension in cases of lower lid laxity. The tear-trough deformity was observed objectively and subjectively, and reported over the following 6 months. Results All patients showed improvement in the tear-trough deformity 1 month postoperatively. None of the patients required repeat surgery at the end of the follow-up period (6 months). Early postoperative complications (1 day postoperative) included periorbital oedema, ecchymosis and conjunctival chemosis (10 eyes, 100%), subconjunctival haemorrhage (two eyes, 20%), brownish skin pigmentation (four eyes, 40%) and epiphora (four eyes, 40%). Lid retraction was observed in one eyelid (10%, 1 month postoperative) and numbness of the ipsilateral cheek in six eyelids (60%). Conclusion SOOF elevation can be used as a part of a routine lower lid blepharoplasty for the treatment of the tear-trough deformity. It may be considered a safe addition to other techniques of midfacial rejuvenation.
  - 2,458 3,979
Demographics and epidemiology of open globe injuries in children in the age group of 2-16 years
Dina Elfayoumi, Mouchira Zayed
October-December 2013, 106(4):226-229
DOI:10.4103/2090-0686.131561  
Purpose The aim of the study was to review demographic, etiologic, and clinical characteristics of globe injuries in children in the age group of 2-16 years. Materials and methods The medical records of 376 patients below the age of 16 years who presented to the Casualty Department in Kasr El-Ainy Hospital, Cairo University with open globe injuries during the period between June 2011 and June 2012 were examined retrospectively. Patients were analyzed with respect to age, sex, place of injury, cause of injury, and clinical signs at the time of presentation. Results A total number of 1345 patients with open globe injuries was recorded in 1 year from June 2011 to June 2012; of them, 376 children were in the age group of 2-16 years, this means that children below the age of 16 represented around 28% of the total number of casualty patients. Our study showed that most of the open globe injuries below the age of 16 years occurred in boys (276 boys vs. 100 girls). The mean age was 8.8 ± 4.3 years. The children were classified into three groups: (a) preschoolers including children from 2 years to those below 7 years; (b) school-age children including children from 7 years to those below 11 years; and (c) adolescents including children from 11 years to 16 years. Most patients (44.9%) were in the 2-6-year age group followed by the adolescent age group (11-16 years) (32.4%), then the school-age children (7-10 years) (22.6%). Pointed and sharp objects were found to be the main causative agents. Injuries occurred most frequently in streets (61.9%) followed by homes (31.9%), and then schools (6%). Conclusion Open globe injuries in children occur most frequently in preschool boys. The injuries occurred mainly in the streets followed by homes and the least common place for injury was recorded to be the schools.
  - 1,321 1,716
A novel technique to improve the results of conventional dacryocystorhinostomy
Salah M El-Sayed Al-Mosallamy
October-December 2013, 106(4):230-234
DOI:10.4103/2090-0686.131562  
Purpose The objective of this study was to evaluate the results of the use of dried lyophilized amniotic membrane to increase the survival of external dacryocystorhinostomy (EX-DCR) with respect to the efficacy and complications. Patients and methods This was a prospective controlled study that included 22 eyes of 20 patients. All had nasolacrimal duct obstruction and were selected from the outpatient clinic; they were classified into two groups, 11 patients each. The first group patients were treated by EX-DCR using dried lyophilized amniotic membrane (group I) that was wrapped around the silicon tube after its implantation in the lacrimal passage (between the lacrimal passage and nasal cavity). The second group (II) patients were treated by the standard EX-DCR only, which served as the control group. Results The study included 22 eyes of 20 patients: 13 were female patients (65%) and seven (35%) were male patients, with mean age of 50.8 ± 6.5 and 48.2 ± 7.1 for groups I and II, respectively. Demographic characteristics showed insignificant difference between both groups. With respect to the success rate, all patients in both groups showed 100% subjective (symptomatic relief) and objective success rate (on examination) at 3-month follow-up (at the time of removal of silicon tube), but at the end of follow-up (8 months) the success rate decreased to 90.9% in the first group and 72.7% in the second group, and this difference was statistically significant (P = 0.0288). One of the complications encountered in this study was epistaxis in five patients (45.4%) in group I and in six patients (54.5%) in group II. Other complication was periorbital ecchymosis in two patients in each group. In one patient in group I, the lower punctum was slit and opened (cheese wiring) using a silicon tube. The complication rate was statistically insignificant between the two groups (P = 0.897). Conclusion The use of amniotic membrane with EX-DCR was effective in improving the results and increasing the survival of the ostium between the sac and the nasal cavity, with no added complications. However, larger multicenter studies with longer follow-up are needed before establishment of this treatment strategy.
  - 1,356 311
Evacuation of dermoid cysts before excision
Ayman A El-Ghafar, Hosam A ElKhair
October-December 2013, 106(4):235-238
DOI:10.4103/2090-0686.131563  
Purpose The aim of this work is to evaluate safety and efficacy of evacuation of dermoid cysts before excision. Patients and methods Twenty patients with orbital dermoid, 10 patients with external angular dermoid, seven patients with internal angular dermoid, and three patients with deep orbital dermoid were included in this study. The patients attended the outpatient clinic of Mansoura Ophthalmic Center from January 2011 to September 2011. All patients were operated by puncture of the cyst wall, aspiration of the contents with a suction device, and then complete removal of the cyst wall. Results Twenty patients were operated, 11 males (55%) and nine females (45%), mean age 6.8 (ranged from 2.5 to 27 years). There were three patients (15%) with deep orbital dermoid, 10 patients (50%) with external angular dermoid, and seven patients (35%) with internal angular dermoid. Patients with external and internal angular dermoid were operated through external and internal sub-brow incisions (85%); however, in patients with deep orbital dermoid (15%), they were located in the lacrimal fossa and were operated through lateral orbitotomy without a bone flap. All cases were excised successfully without postoperative recurrence. In one patient (5%), rupture had already occurred before surgery, and this patient developed postoperative recurrent orbital inflammation that responded to a local triamcinolone injection. Conclusion Evacuation of dermoid cyst before excision represents a safe and efficient technique.
  - 2,523 154