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  Citation statistics : Table of Contents
   2014| January-March  | Volume 107 | Issue 1  
    Online since June 21, 2014

 
 
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ORIGINAL ARTICLES
Transepithelial photorefractive keratectomy versus conventional alcohol-assisted photorefractive keratectomy for correction of mild and moderate myopia
Waleed A Ghobashy, Mohamed E Shahin, Karem A Kolkailah
January-March 2014, 107(1):1-4
DOI:10.4103/2090-0686.134922  
Purpose The aim of the study was to compare both transepithelial photorefractive keratectomy (trans-PRK) and PRK for correction of mild and moderate myopia with respect to effectiveness, visual recovery pain, and safety. Materials and methods In this prospective case-control series, group I with 24 myopic eyes (12 patients) with spherical equivalent -1.00 to -6.00 D underwent trans-PRK using Schwind Amaris 500E excimer laser, with trans-PRK plate form. A case-adjusted group II (the control group) with 24 myopic eyes (12 patients) with spherical equivalent -1.00 to -6.00 D underwent alcohol-assisted PRK using Visx S4 excimer laser. Uncorrected visual acuity (UCVA) was measured on the first day, at first week, 1 month, and 6 months along with manifest refraction. Postoperative pain was assessed using visual analog scale. Occurrence of complications was documented. Results Patients in group I showed faster visual recovery with a mean UCVA of 0.3 on the first postoperative day compared with those in group II (0.2); however, both groups reached a mean UCVA of 0.9 by the end of sixth month. Manifest refraction was comparable in both groups. Pain was significant in group II with a score of 4 on the first day declining to 0 by the end of the first week compared with group I with a mean pain score of 3 on the first day and 0 by the end of day 4. No complications were recorded in either of the two groups along the study time. Conclusion Trans-PRK may offer a safe, less painful, and effective alternative to alcohol-assisted PRK in the treatment of mild and moderate myopia, especially in cases of thin cornea.
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Efficacy of gabapentin versus pregabalin in pain control during and after panretinal laser photocoagulation
Hazem A Hazem, Jehan A Sayed
January-March 2014, 107(1):28-32
DOI:10.4103/2090-0686.134940  
Purpose The aim of the study was to compare the analgesic efficacy and safety of pretreatment with oral gabapentin and its newer analog pregabalin for pain control during and after panretinal laser photocoagulation (PRP). Patients and methods The study included 60 eyes of 60 patients with proliferative diabetic retinopathy who were aged between 18 and 60 years and were candidates for PRP. Thirty patients (group A) received gabapentin 600 mg orally and group B received pregabalin 150 mg orally 2 h before PRP. Before sessions, all patients were instructed how to assess their pain level using the visual analog scale (VAS), and sessions were performed by the same ophthalmologist using as similar parameters as possible for each treatment plan. Blood pressure and heart rate were recorded just before, during, and immediately after each treatment session, and the VAS rates during (VAS I), 15 min after (VAS II), and 2 h after PRP session (VAS III) were collected; side effects for the study drugs were recorded for the same amount of time. Results The mean age was 49.47 ± 7 years in group A and 50.33 ± 10 years in group B. The mean duration of session was 12 ± 1.8 min in group A and 11 ± 1.3 min in group B. Systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure were significantly increased during sessions compared with baseline values in group A, whereas the increase in these parameters was not significant in group B. The median VAS both during the session (VAS I) and 15 min after the session (VAS II) was significantly lower in group B compared with group A, with no significant difference in the median pain score 2 h after session (VAS III) between both groups. The incidence of sedation and dizziness was significantly lower in group A compared with group B. More frequent nausea and vomiting were observed in group A compared with group B; however, this was not statistically significant. Conclusion In patients undergoing PRP, lower degree of pain associated with a better hemodynamic response was reported in those treated with preemptive 150 mg pregabalin compared with 600 mg gabapentin, suggesting that pregabalin may be better recommended for pain control during and immediately after PRP sessions.
  1 3,040 229
Sensory heterotropia: Which eye should be the main site of surgery, sound or amblyopic eye?
Sahar Torky Abdelrazik, Mohamed Farag Khalil
January-March 2014, 107(1):33-36
DOI:10.4103/2090-0686.134943  
Introduction The altered tonic vergence movement in sensory heterotropia may make the preoperative measured angle of deviation inconstant, and the surgical results are less predictable than when visual acuity is normal in each eye. Maintaining the postoperatively corrected position of the amblyopic eyes is considered difficult because the brain has lost interest in those eyes' position. Objective The aim of this study was to compare the postoperative results and their stability in patients undergoing surgery mainly on the sound eyes with those undergoing surgery mainly in the amblyopic eyes in case of sensory heterotropia. Design This prospective nonrandomized comparative study was carried out in the Ophthalmology Department, Minia University Hospital during the period from March 2011 to October 2012. Patients and methods Sixty patients were included in this study and were divided into two equal groups according to the type of horizontal deviations. In each group, half of the patients underwent surgery mainly on the sound eyes and the others underwent surgery mainly on the amblyopic eyes, and the results were compared. Results In patients of group 1 (esotropia) who underwent surgery mainly on the sound eyes, there were significantly higher and stable results than those who underwent surgery mainly on the amblyopic eyes after 1 and 6 months. Patients of group 2 (exotropia) who underwent surgery on the sound eyes had significantly higher and stable results than those who underwent surgery on the amblyopic eyes after 6 months only. Conclusion Surgery on the sound eyes mainly in horizontal sensory heterotropia had better and more stable results than surgery on the amblyopic eyes.
  - 1,576 119
Posterior lens capsule delineation during pars plana vitrectomy
Mohamad A. S. Eddin Abdelhakim
January-March 2014, 107(1):37-40
DOI:10.4103/2090-0686.134944  
Introduction A known complication of cataract surgery, during combined phacoemulsification and vitrectomy, is rupture of the posterior capsule, which occurs at a rate of 0.82-2.1%. Objective The aim of the study was to optimize the visualization of the posterior lens capsule during pars plana vitrectomy to prevent its injury during the procedure. Design This investigation was designed as a case-control study. Settings Patients visiting the Kasr Al-Aini Cairo University Hospitals Outpatient Clinic of Ophthalmology during the period from January 2012 to June 2013 were selected for the study. Participants and methods This study was conducted on two groups of patients. In group I (49 eyes), a few small air bubbles were allowed to pass through the infusion cannula and into the eye where they adhered to the posterior lens capsule, whereas in group II (control, 52 eyes) phacovitrectomy was carried out without air bubbles. Primary outcome measure The integrity of the posterior lens capsule during vitrectomy was considered the primary outcome measure. Results In group I comprising 49 (100%) vitrectomized eyes, the posterior lens capsule was perfectly visualized and avoided during detachment of the anterior hyaloid face, during total vitrectomy and during vitreous base shaving. In group II, there was one eye with posterior capsule rupture and intraocular lens drop (1.9%). Conclusion and relevance Small air bubbles help perfect delineation of the posterior lens capsule during vitrectomy, avoiding its injury.
  - 1,401 88
Transepithelial photorefractive keratectomy with adjunctive mitomycin-C for correction of residual myopia after LASIK
Waleed A Ghobashy, Ahmad A Abdel Ghani
January-March 2014, 107(1):41-44
DOI:10.4103/2090-0686.134949  
Purpose The aim of the study was to evaluate the efficacy and safety of transepithelial photorefractive keratectomy (trans-PRK) with adjunctive mitomycin-C (MMC) over laser in-situ keratomileusis (LASIK) flaps for the treatment of residual myopia following LASIK. Materials and methods In this single-center, retrospective clinical study, 12 eyes of nine patients (mean age 32.67 ± 2.8 years) who were administered MMC (0.02%, 20 s) during trans-PRK for the treatment of residual myopic error with a mean spherical equivalent of -1.00 ± 0.69 D following myopic LASIK were evaluated. The retreatment procedures were performed after an average of 13.67 ± 1.15 months of primary LASIK using Schwind Amaris 500E excimer laser, with trans-PRK plate form. All patients underwent slit-lamp microscopy, manifest and cycloplegic refraction, Sirius 3D corneal analysis, merging Scheimpflug technology with Placido topography, pachymetry, pupillometry, and wavefront analysis preoperatively and postoperatively. All patients underwent follow-up on day 1, at 1 week, and at 1, 3, and 6 months. Results Mean time between LASIK and PRK retreatment was 19.2 months (range 13-39 months). No intraoperative or postoperative complications occurred during primary LASIK or trans-PRK retreatment. Mean spherical equivalent refraction of attempted correction with PRK was -1.58 D (range -0.50 to -2.25 D). By the end of sixth postoperative month, the average uncorrected visual acuity improved from 0.48 (range 0.15-0.7) to 0.7 (range 0.3-1.0). All eyes showed improvement in uncorrected visual acuity. Four eyes had subjective improvement of glare symptoms. None of the eyes in the cohort developed postoperative haze or any complications. Conclusion Trans-PRK with adjunctive MMC is a safe and effective option for correction of residual myopia following LASIK.
  - 2,140 137
Clinical outcome of preoperative and intraoperative intravitreal injection of bevacizumab as an adjunct to vitrectomy in the treatment of proliferative diabetic retinopathy
Mohamed Farouk Sayed Othman, Hossam M Moharram, Raafat Mohy Eldin
January-March 2014, 107(1):5-9
DOI:10.4103/2090-0686.134924  
Objective The aim of this study was to evaluate the safety and clinical efficacy of an intravitreal injection of bevacizumab in pars plana vitrectomy (PPV) for complicated proliferative diabetic retinopathy (PDR). Patients and methods The study included 20 eyes of 20 patients (25-68 years old) with complicated PDR. All patients underwent 23-G PPV, and all of them received an intravitreal injection of 1.25 mg bevacizumab 1 week before planned vitrectomy and at the end of surgery. Results The mean surgical time was 60.5 ± 20.2 min (range 40-95 min). Iatrogenic breaks were reported in four eyes (20%) and silicone oil was used in these cases (20%). Final visual acuity showed improvement in 17 eyes (85%), whereas postoperative best-corrected visual acuity remained unchanged in three eyes (15%). The mean preoperative corrected visual acuity was 1.47 ± 0.73 logMAR units. A statistically significant increase in the mean corrected visual acuity was observed in all study eyes at 3 months after surgery (0.60 ± 0.48 logMAR units; P < 0.001). There were no cases with postoperative bleeding. Conclusion Injection of bevacizumab, 1.25 mg (0.05 ml), 1 week before PPV and at the end of operation is safe and effective, resulting in a decrease in the operation time, iatrogenic retinal breaks, intraoperative and postoperative bleeding, and improved visual acuity in PDR patients.
  - 2,091 185
Assessment of the posterior corneal surface changes after LASIK treatment of myopia using Pentacam
Yehia Khyrat, Ahmed Elshafei, Raafat M Abdelrahman, Noha H Abdelmalk
January-March 2014, 107(1):10-15
DOI:10.4103/2090-0686.134935  
Aim of the work The aim of this work is to study the changes that occur in the posterior corneal surface after laser-assisted in-situ keratomileusis (LASIK) for correction of myopia using Pentacam. Patients and methods In a prospective interventional case-series study, 50 myopic eyes of 27 patients were subjected to the LASIK procedure. Preoperative, 1 week, and 3 months postoperatively, Pentacam examination was performed at the Elminia Roaa Refractive Center between January and October 2011. Pentacam was used for the assessment of preoperative and postoperative pachymetry, anterior and posterior corneal curvatures, anterior and posterior corneal elevations, and asphericity of the posterior corneal surface. Results This study included 50 eyes of 27 patients, 19 women (70.3%) and eight men (29.7%). Patients' age ranged from 20 to 44 years, mean 27.3 ± 7.03 years. No statistically significant changes were found in the posterior horizontal corneal curvature (Rh). A statistically significant change in the posterior vertical corneal curvature (RV) from 6.1 ± 0.3 to 6.06 ± 0.2 mm 1 week after LASIK was found, but increased after 3 months to 6.2 ± 0.3S mm. No statistically significant changes in the posterior mean corneal curvature (Rm) were observed either at 1 week or 3 months after LASIK. A significant change in the Q-value (asphericity) was found both at 1 week and 3 months postoperatively. There were significant changes in the posterior corneal elevation both at 4 and at 7 mm from the center both at 1 week and 3 months after LASIK. Conclusion Post-LASIK changes of the posterior corneal surface affect mainly the vertical curvature, asphericity, and posterior corneal elevation. Fortunately, no case of post-LASIK ectasia was observed during the follow-up period of this study. Further studies are needed to document posterior corneal surface changes in patients with suspected post-LASIK ectasia.
  - 2,059 194
Comparative measurement of central corneal thickness using Pentacam, ocular response analyzer, and ultrasound pachymetry devices for normal, glaucomatous, and keratoconic eyes
Mohamed A El-Malah, Nahla Abo-Hussein
January-March 2014, 107(1):16-19
DOI:10.4103/2090-0686.134936  
Purpose The aim of the study was to compare central corneal thickness (CCT) measurements using Scheimpflug imaging (Pentacam), ocular response analyzer (ORA), and ultrasound pachymetry (USP) devices for normal, glaucomatous, and keratoconic eyes. Patients and methods This was a prospective study that enrolled 170 eyes of 85 patients: 86 normal eyes, 50 eyes diagnosed as primary open angle glaucoma (POAG), and 34 eyes with keratoconus (KC). The CCT was measured using three machines - USP, Pentacam, and ORA - at the same time by two expert operators. Microsoft Excel, the Student t-test, and analysis of variance test were used for statistical analyses. Results The mean age of the three groups, normal, POAG and KC patients were 45 ± 17.7, 48 ± 7.8 and 26 ± 15.6 years respectively. CCT measurements using USP, Pentacam, ORA revealed: 552 ± 26.2 μ, 562 ± 23.3 μ and 569 ± 29.7 μ for normal eyes, 559 ± 13.4 μ, 570 ± 22.6 μ, and 587 ± 27.6 μ for POAG eyes, and 482 ± 17.7 μ, 505 ± 7.8 μ and 516 ± 8.5 μ for KC eyes respectively. It was noticed that, readings using USP shows reduced values in comparison to two other machines. USP and Pentacam were relatively comparable machines. Conclusion The measurements of CCT using ultrasound and Pentacam instruments had significant linear correlations with one another. Both methods had highly satisfactory measurement repeatability. Reading using ORA gives higher values.
  - 2,113 174
Botulinum toxin A-induced ptosis: A safe and effective alternative to surgical tarsorrhaphy for corneal protection
Hany A Khairy
January-March 2014, 107(1):20-22
DOI:10.4103/2090-0686.134937  
Aim The aim of the study was to evaluate the corneal protective effect of botulinum toxin A-induced ptosis in the treatment of various corneal pathological conditions in which surgical tarsorrhaphy was indicated. Patients and methods This prospective study included 25 eyes (25 patients) with various ocular conditions in which surgical tarsorrhaphy was indicated, and it was replaced by botulinum toxin A injection. Corneal pathology included 16 patients with resistant fungal ulcers, four with persistent corneal epithelial defect, one with central corneal melt due to rheumatoid arthritis, and four with Bell's palsy. Patients were injected with a dose of 5 U of Botox A using a 26-G insulin syringe. Patients were followed up daily during the first week, and if they did not achieve complete closure of the lid aperture repeat injection of 5 U was given. Results All patients had complete ptosis; however, six (24%) required repeat injection after 1 week. Superior rectus underaction was not recorded in any patient. Corneal pathology was improved in all, but one patient had corneal melt secondary to rheumatoid arthritis and required a tectonic corneal graft. The main duration for complete ptosis to develop was 6.8 ± 1.96 days (range 5-12 days). The duration for induced ptosis to recover was 55.64 ± 10.24 days (range 44-66 days). Conclusion Botulinum toxin A-induced ptosis is a good alternative to surgical tarsorrhaphy as a means of corneal protection in various forms of corneal pathology.
  - 4,541 310
Evaluation of internal limiting membrane peeling for idiopathic full-thickness macular hole by optical coherence tomography and multifocal electroretinography
Kamal Enam, Amr El-Kannishy
January-March 2014, 107(1):23-27
DOI:10.4103/2090-0686.134938  
Purpose The aim of the study was to evaluate the anatomical and functional success of idiopathic macular hole surgery using optical coherence tomography (OCT) and multifocal electroretinography (mfERG). Design The study was designed as a prospective interventional case series. Patients and methods Fourteen eyes with idiopathic full-thickness macular hole were treated with pars plana vitrectomy and internal limiting membrane peeling. OCT and mfERG were performed in all patients preoperatively and during a follow-up period of 6 months to elicit anatomical and functional changes of the macula. Results OCT images revealed closure of macular holes in all patients after 3 months of follow-up, whereas mfERG showed improvement of retinal responses. These changes were associated with a significant improvement in visual acuity (P = 0.0001). Conclusion Pars plana vitrectomy with internal limiting membrane peeling successfully restored the normal architecture of the fovea, with improvement in retinal function.
  - 1,562 105