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Misdirection (aberrant regeneration) of the third cranial nerve
Sayed A Sayed, Mahmoud Rabea
July-September 2013, 106(3):150-152
Purpose Head trauma can lead to aberrant regeneration of the third cranial nerve (oculomotor nerve). Background Aberrant regeneration of the third cranial nerve is most commonly due to its damage by trauma. Case report We report here the case of a patient who, following severe head injury, suffered from diplopia, abnormal deviation of the right eye (exotropia, moderate limitation in elevation and adduction), and overaction of the left lateral rectus. Neither ptosis nor limitation of sursumduction was seen in the right eye. Surgery was carried out for relieving diplopia due to aberrant regeneration of the third cranial nerve affecting the right eye. Right medial rectus resection (7 mm) and left lateral rectus recession (9 mm) were performed. Diplopia disappeared in the sixth week after operation. Conclusion Traumatic third nerve palsy may result in aberrant regeneration of the third cranial nerve. The full-blown features of this syndrome may or may not be present. Diplopia was relieved by performing surgery in both the affected eye (right medial rectus resection) and the healthy eye (left lateral rectus muscle recession).
  10,176 383 1
Effect of fasting on intraocular pressure in glaucomatous patients
Walid Abdelghaffar, Marwa Abdelshafy, Mohamed N Elmohamady
July-September 2020, 113(3):77-82
Purpose The aim of this study was to assess the effect of intermittent fasting and dehydration on intraocular pressure (IOP) in patients under glaucoma treatment. Patients and methods The present study was conducted on 36 glaucoma cases and 30 healthy controls of matched age and sex. IOP measurements with Goldmann applanation tonometer were taken 1 week before fasting (at 8.00 a.m.), during Ramadan fasting (first, second, third, and fourth week) (at 8.00 a.m. and 4.00 p.m.), and 1 week after Ramadan during the nonfasting period (at 8.00 a.m.). Results The study was conducted on 36 glaucoma cases; their mean age was 47.3 years. There were 12 (33.3%) men and 24 (66.7%) women and 30 healthy participants, their mean age was 47.7 years. There were 11 (36.7%) men and 19 (63.3%) women. There was gradual decrease in IOP with fasting, in both glaucomatous cases and control groups, with no significant differences in IOP between groups during fasting. Glaucoma cases showed significantly higher percentage change in IOP (either improvement or deterioration) when compared with the control group. Conclusion Our results showed that fasting during Ramadan has a lowering effect on IOP values in healthy controls and glaucomatous patients. Glaucoma cases showed significantly higher percentage change in IOP when compared with the control group.
  8,285 216 -
Retropupillary fixation of iris-claw intraocular lens versus trans-scleral suturing fixation for aphakic eyes without capsular support
Dina Mohammad Rashad, Omar Mohammad M Afifi, Gamal A.M. Elmotie, Hatem Amin Khattab
October-December 2015, 108(4):157-166
Purpose The aim of this work was to compare retropupillary fixation of an iris-claw intraocular lens (IOL) (Verisyse) with trans-scleral suturing fixation for aphakic eyes without sufficient capsular support as regards the safety and complications of the procedure. Design This study was an interventional comparative prospective one. Patients and methods A total of 42 aphakic eyes of 40 patients were divided into two equal groups: 21 eyes were offered iris-claw IOL and 21 eyes were implanted with scleral-fixed IOL. Intraoperative data (mainly surgical time and intraoperative bleeding) and postoperative data [mainly corrected distance visual acuity (CDVA), intraocular pressure, and postoperative complications] were compared between the two groups during the follow-up period (first day,1 week, 2 weeks,1 month, and after 3 months). Results The mean surgical time in the iris-claw group was 24.77 ± 4.8 min, whereas the mean surgical time in the scleral fixation group was 67.09 ± 8.1 min, with a statistically significant difference between the two groups. On the first postoperative day, the CDVA ranged from 0.06 to 0.5 in the iris-claw group, with a mean of 0.22 ± 0.116, and it ranged from 0.05 to 0.15 in the scleral fixation group, with a mean of 0.10 ± 0.032; there was a statistically significant difference between the groups (P = 0.00021). However, after the first 3 months postoperatively, the CDVA ranged from 0.25 to 1.0 in the iris-claw group, with a mean of 0.51 ± 0.25, and it ranged from 0.15 to 0.6 in the scleral fixation group, with a mean of 0.42 ± 0.16; there was no statistically significant difference between the two groups (P = 0.152). On the first postoperative day, the mean intraocular pressure in the iris-claw group was 15.62 ± 2.59 mmHg, whereas in the scleral fixation group it was 19.62 ± 3.94 mmHg, with a statistically significant difference between the two groups (P = 0.00038). The iris-claw group showed higher rates of anterior chamber reaction, pupillary distortion, and cystoid macular edema postoperatively. In contrast, the rates of corneal edema, vitreous hemorrhage, and conjunctival erosion were higher in the scleral fixation group. Conclusion From our results, it is evident that iris-claw IOLs have now matured to a stage when they can be used with considerable safety and efficacy. The new designs, as well as the evolution of surgical techniques and instrumentation, have made them the best option for primary or secondary implantation in aphakic eyes. The surgical procedure is easier, shorter, and safer than those used for scleral-sutured IOLs.
  3,911 4,517 5
Preperiosteal suborbicularis oculi fat lift blepharoplasty
Sherif Elwan, Saad Rashad, Thanaa H Mohammed, Yousra A Farweez
October-December 2013, 106(4):223-225
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.
  3,937 4,167 -
Comparison between effects of Ringer's and Ringer's lactate irrigating solutions on corneal endothelium during phacoemulsfication
Hossam T Al-Sharkawy
April-June 2015, 108(2):67-73
Purpose The aim of this study was to compare the effect of phacoemulsification on the corneal endothelium using Ringer's and Ringer's lactate as the intraocular irrigating solution. Setting Mansoura Ophthalmic Centre, Faculty of Medicine, Mansoura University, Egypt. Design Prospective randomized comparative study. Materials and methods A total of 102 eyes of 102 patients with senile cataract were randomized to have phacoemulsification with foldable intraocular lens implantation performed using Ringer's (group 1) or Ringer's lactate (group 2) as the intraocular irrigating solution. Specular microscopy was done preoperatively, 1 week and 3 months postoperatively to evaluate endothelial cell density (ECD), coefficient of variation (CV), and central corneal thickness. Data were analyzed using the t-test, the Mann-Whitney U-test, and the Pearson correlation coefficient. Results Mean ECD was 2532 cells/mm 2 preoperatively, 2345 cells/mm 2 1 week, and 2284 cells/mm 2 3 months postoperatively in group 1, and 2526, 2374, and 2322 cells/mm 2 , respectively, in group 2. There was a statistically significant difference between preoperative ECD and each of 1 week and 3 months postoperative ECD in each group. No significant difference was found between 1-week mean ECD reduction in group 1 (7.35%) and group 2 (6.05%) or between 3-month mean ECD reduction in group 1 (9.69%) and group 2 (8.07%). Conclusion Ringer's and Ringer's lactate solutions are associated with minimal changes in corneal ECD, morphology, and function during uncomplicated phacoemulsification with foldable intraocular lens implantation in patients with normal endothelial cell counts. There is no clinically significant difference in endothelial cell preservation and polymegathism and corneal swelling between Ringer's and Ringer's lactate solutions.
  7,791 304 -
Analysis of 2-year corneal cross-linking results in keratoconus patients
Mohammed I Hafez
October-December 2014, 107(4):226-231
Purpose To analyze the results of 2 years of corneal collagen cross-linking (CXL) for the treatment of keratoconus and to detect the efficiency of this procedure. Design This was a retrospective noncomparative study. Patients and methods A total of 58 eyes of 40 keratoconus patients were subjected to CXL. Epithelium-off CXL was the only procedure performed for all cases. The preoperative and postoperative measures included uncorrected visual acuity, best-corrected visual acuity (BCVA), fundus examination, slit-lamp examination, pachymetry, keratometry, refractometry, and corneal topography. All eyes included in this study were followed up at 1, 3, 6, 12, and 24 postoperative months. All preoperative and postoperative data of all eyes were collected, revised, and analyzed. Results This study showed that uncorrected visual acuity improved by at least one line in 70.7% of the eyes in the study, but remained stable in 22.4% of the eyes in the study. BCVA improved by at least one line in 53.4% of the eyes in the study, but remained stable in 36.2% of the eyes in the study. Astigmatism remained stable in 86.2% of the eyes in the study and decreased by a mean of 1.20 D in 13.8% of the eyes in the study. The average keratometry (K) decreased by more than 1 D in 74.1% of the eyes in the study, but remained stable in 13.7% of the eyes in the study. The maximum K value decreased by a mean of 2.47 D in 55.1% of the eyes in the study, but remained stable in 38% of the eyes in the study. The K value of the apex decreased by a mean of 2.73 D in 65.5% of the eyes in the study, but remained stable in 25.9% of the eyes in the study. Conclusion This study proved that corneal cross-linking is beneficial both as a visual-preserving and as a visual-improving procedure. K readings are the main indicator of the success or the failure of the procedure. Central corneal thickness can be an indicator of improvement; there is a reciprocal relationship between the central corneal thickness and the BCVA. The best chance is for patients with corneal thickness more than 400 μm. It is advised that the refractive surgeon should store the riboflavin in the refrigerator from +4°C to +8°C and discard it immediately after surgery. The use of steroid from the first postoperative day was helpful. Most postoperative visual improvements resulted from a decrease in myopia, whereas there was no remarkable improvement in astigmatism.
  7,567 419 -
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
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.
  7,570 415 -
Prevalence of dry eye disease in southern Egypt: a hospital-based outpatient clinic study
Engy M Mostafa
January-March 2016, 109(1):32-40
Purpose The aim of this study was to determine the prevalence of dry eye disease (DED) in a tertiary ophthalmic outpatient hospital-based clinic in southern Egypt. Patients and methods A cross-sectional, observational, hospital-based study of 3128 patients was conducted at the Ophthalmology Outpatient Clinic of the Sohag University Hospital, Egypt, between January 2011 and August 2013. The participants comprised adult ophthalmic outpatients aged 18 years or older. DED was assessed subjectively with the Ocular Surface Disease Index (OSDI) questionnaire and objectively with Schirmer's test, tear film breakup time (TBUT), and conjunctival/corneal staining. An OSDI score of 22 or more with a TBUT of less than 10 s or Schirmer's test reading of less than 10 mm was considered diagnostic of definite DED. Descriptive and analytical statistics were performed. In all comparisons, P value less than 0.05 was considered to be statistically significant. Results Dry eye disease prevalence was 22.8% in the 3128 patients. DED was significantly more prevalent in patients 45 years or older and in females. An OSDI score more than 22 was found in 55%, TBUT less than 10 s in 44.7%, and Schirmer's test score less than 10 mm in 39.3%. DED symptoms are significantly associated with meibomian gland dysfunction, previous refractive surgery, and diabetes. Definite DED was significantly associated with previous cataract surgery, ocular allergy, pterygium, and diabetes. Conclusion This is the first observational study of DED in southern Egypt on a large sample population. The prevalence of DED among ophthalmic outpatients at Sohag University Hospital, Egypt, was 22.8% depending on both symptoms and signs. Older age patients and females were more susceptible to DED. DED is an existing entity that can compound any eye condition causing incomplete recovery, and therefore high index of suspicion is greatly advised.
  6,973 434 7
Prevalence of dry eye in diabetics
Silviana S Kamel, Thanaa H Mohammed, Yasser A El Zankalony, Ali H Saad
July-September 2017, 110(3):77-82
Purpose The aim of this work is to study the prevalence of dry eye in type II diabetic patients and to correlate the dry eye with the duration of the diabetes and the level of Glycosylated Hemoglobin (Hb 1 Ac). Patients and methods It is a prospective randomized study in which 100 eyes (50 diabetics, 50 control) with type II diabetes mellitus is included in the study attending in department of ophthalmology Ain Shams University. Dry eye was confirmed by tear film break up time (TBUT) and Schirmer I test. Results Schirmer and tear film BUT values were lower among the uncontrolled diabetic patients. There is highly statistically significant relation between severity of dry eye by Schirmer test with duration of diabetes, hypertension, Debris in tear film, degree of diabetic retinopathy, Glycosylated Hemoglobin (HbA1C), with P value 0.003, 0.044, 0.000, 0.000, 0.000 respectively. There is highly statistically significant relation between severity of dry eye by BUT test with duration of DM, HTN, Debris in tear film, DR, HbA1C, with P value 0.002, 0.032, 0.000, 0.001, 0.000 respectively. Conclusion Diabetic patients are more prone to suffering from dry eye than normal subjects. These abnormalities can result in severe complications. Early examination of the diabetic patients for the detection of the ocular surface disorders is indicated.
  6,707 682 6
Role of pterygium in ocular dryness
Tamer H El-Sersy
October-December 2014, 107(4):205-208
Aim of the work The aim of this study was to find out the relation between tear film function and pterygium. Patients and methods This study included 60 patients with unilateral pterygium from the outpatient clinic of October 6 University, with age ranging between 25 and 70 years. Pterygium was treated by simple excision in 20 eyes, by excision with B irradiation in 20 eyes, and with conjunctival autograft technique in the remaining 20 eyes. The results of tear break-up time (TBUT) and Schirmer-1 test were evaluated before and 6 months after surgery. We also included 25 healthy individuals as controls. Results This study included 60 patients (32 male and 28 female patients) with a mean age of 44.17 ± 9.25 years. Age and sex were not statistically different between the patients and controls (P = 0.24 and 0.96, respectively). The mean TBUT was 11.70 ± 2.16 s in control eyes (ranged from 8.5 to 16.0 s). However, in eyes with pterygium this value was markedly reduced to 5.91 ± 1.95 s. TBUT was statistically lower among patients compared with controls (P < 0.0001). The mean Schirmer-1 test result was 13.76 ± 2.06 mm (range 11-17 mm/5 min) in normal healthy eyes and 5.85 ± 1.86 mm (range 3-9.5 mm/5 min) in the eyes of patients with pterygium. The difference was statistically different between the patients and controls (P < 0.0001). Before surgery, the average TBUT was 5.90 ± 1.87 s. This was significantly prolonged to 7.95 ± 1.33 ± 6 months postoperatively (t = 9.97, P < 0.0001) in all our cases. Moreover, Schirmer-1 test was 6.29 ± 1.90 mm/5 min preoperatively and significantly prolonged to 9.67 ± 1.57 postoperatively (t = 27.23, P < 0.0001). Conclusion Ocular dryness in the presence of pterygium and its improvement after surgery favor the hypothesis that pterygium itself contributes to the phenomenon of disturbed tear film functions in such patients.
  3,572 3,768 3
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
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.
  6,915 388 4
Efficacy of topical cyclosporine 0.05% eye drops in the treatment of dry eyes
Haitham Y Al-Nashar
October-December 2015, 108(4):233-236
Purpose The aim of the present study was to evaluate the effectiveness of cyclosporine 0.05% in the treatment of dry-eye disease. Patients and methods A total of 35 eyes of 20 patients with dry-eye disease were included in the present study. Ten patients (20 eyes) had dry eyes associated with systemic rheumatologic disease (Sjögren's syndrome), five patients (10 eyes) had dry eyes after undergoing laser in-situ keratomileusis, and five patients (five eyes) had dry eyes after cataract surgery. Detailed history taking along with full ophthalmic examination was carried out for all patients. In addition, Schirmer's test and break-up time (BUT) test were conducted for all patients. The patients were examined for ocular symptoms of dry eyes (ocular pain, burning, and foreign body sensation). Cyclosporine 0.05% eye drops were prescribed twice daily for 3 months. The patients were followed up after 1, 2, and 3 months. Results In total, 35 eyes of 20 patients diagnosed with dry-eye syndrome were included in this study. The mean age of the patients was 37.3 years (range: 26-65 years).The patients were evaluated for ocular symptoms (burning, pain, and foreign body sensation). Schirmer's paper test and BUT test were conducted for all patients. The score of ocular symptoms before the beginning of the treatment was 2.50 ± 0.46, and this score improved to 0.9 ± 0.52 after 3 months with a statistically significant difference (P = 0.01). Schirmer's paper test was performed before the beginning of the treatment, and showed a wetting of 1.15 ± 0.58 mm of the paper, and improved after 3 months to 5.86 ± 0.29 mm (P = 0.001). BUT improved from 5.57 ± 1.36 s before the treatment to 9.9 ± 0.92 s after 3 months of treatment (P = 0.001). Conclusion Topical cyclosporine 0.05% is effective in the treatment of dry-eye syndrome, which has an inflammatory cause.
  6,543 428 4
Evaluation of large cupping in children with anemia
Mohamed Yasser S Saif, Ahmed Tamer S Saif, Passant S Saif, Hany S El Saftawy, Ola A Dabbous, Mohamed N Salem
October-December 2015, 108(4):167-172
Introduction In adults, large optic disc cups are often a sign of glaucoma. Children, however, show a lower prevalence of glaucoma than adults, but may present with optic disc cupping of nonglaucomatous origin. Aim of the work The purpose of this study is to evaluate with large cupping in children having anemia. Patients and methods This is a prospective analysis of patients attending the ophthalmology outpatient clinic in Beni Suef, Fayoum, and Misr universities. All patients were subjected to standard ophthalmological examination, optical coherence tomography (OCT), fundus photography, complete blood count (CBC), and stool analysis to diagnose the cause of anemia. Results In this study examination cupping of greater than 0.4 was detected in 236 patients out of 3361 patients examined within the same age. The mean age of the selected patients (236 patients) was 11.48 ± 3.2 ranging from 6 to 18 years of which 137 (58.05%) were girls and 99 (41.95%) boys. The mean best corrected visual acuity converted to logMAR is 0.093 ± 0.109 ranging from 0.301 (6/12) in 53 eyes to 0 (6/6) in 260, whereas the rest best-corrected visual acuity 0.176 (6/9). The mean intraocular pressure was 11.75 ± 1.539.The mean cup disc ratio was 0.498 ± 0.0934 (0.497 ± 0.095 for females and 0.501 ± 0.090 for males). The majority of patients (females more than males) had C/D ratio similarity between both eyes, whereas very few had 0.2 differences (males more than females). The mean Hb concentration was 10.79 ± 0.89 g/dl in females and 11.04 ± 1.09 g/dl in males. It was as low as 7.2 in males and 7.8 in females. The stool analysis for the patients showed that 126 patients (74 females, 52 males) were infected with Entamoeba histolytica, whereas 31 patients (22 females, nine males) were infected with Giardia lamblia and 79 patients did not have parasitic manifestations. Conclusion In conclusion to our work we found that functional optic nerve damage is a possibility in children with anemia and cupping and with normal intraocular pressure and that there is very high incidence of parasitic infestation in those children and young adolescents that warns for state intervention to deal with this problem. A larger scanning by the ministry of health may be needed to verify these results.
  4,984 1,882 -
The use of adaptive optics for retinal imaging with microscopic resolution
Mortada A Abozaid
October-December 2016, 109(4):145-152
Adaptive optics (AO) is a technology used to improve the performance of optical systems by reducing the effects of optical aberrations. Adding AO to retinal imaging tools allows noninvasive direct visualization of the photoreceptor cells, capillaries, and nerve fiber bundles by correcting the eye’s monochromatic aberrations. AO can provide new information on the early pathological changes of the retinal microstructures in various retinal diseases, can also monitor response to novel treatments at the cellular level, and can help better select candidates for such treatments. This review discusses the basics, clinical applications, and challenges of AO retinal imaging.
  2,844 3,669 -
Classification and management of ectropion with medial canthal tendon laxity
Hesham A Ibrahim, Heba N Sabry
October-December 2014, 107(4):263-267
Purpose Lower eyelid ectropion is usually accompanied by a variable degree of medial and lateral eyelid laxity. This work investigates a clinical evaluation scheme and a surgical plan to repair ectropion associated with different stages of such associated laxity. Patients and methods Forty-two procedures on 30 patients with lower eyelid ectropion associated with variable degree of medial palpebral ligament laxity were performed on the basis of the ectropion classification and management protocol described in this work. Patients were followed up for at least 6 months postoperatively. Results Firm medial eyelid fixation against lateral traction and correction of ectropion were achieved in all cases. Epiphora was cured in 26 eyes. The planned cosmetic outcome was achieved in 28 cases. Conclusion Individualizing the surgical repair for involutional ectropion on the basis of the clinical findings is cosmetically and functionally rewarding.
  6,076 410 2
Primary versus secondary intraocular lens implantation in the management of congenital cataract
Thanaa H Mohamed, Rania G Eldin Zaki, Mohamed H Hashem
April-June 2016, 109(2):54-59
Aim This study aimed to compare the efficacy of primary intraocular lens (IOL) implantation following removal of congenital cataract in patients with aphakia younger than 2 years of age, followed by secondary implantation after the age of 2 years. Patients and methods This was a comparative prospective study that included patients with congenital cataract (28 eyes) who underwent lensectomy and anterior vitrectomy in the first year of life; 14 eyes were subjected to primary IOL implantation. Fourteen eyes with left aphakia were subjected to visual rehabilitation until the age of 2 years. Secondary implantation was performed and the two groups were followed for 2 years after implantation by a full ophthalmological examination. Results Postoperative significant uveitis occurred in 14.2% of patients in group A and 35.7% of patients in group B; the difference between the two groups was statistically insignificant. Fixation was good in 71% of patients in group A and in 57% of patients in group B; this difference was nonsignificant. Increasing intraocular pressure was noted in four cases in group B that was statistically significant and the diagnosis of glaucoma was confirmed and managed, whereas in group A, none of the cases had an intraocular pressure higher than 18 mmHg. Conclusion Primary IOL implantation was found to be safe and effective in the management of congenital cataract; it leads to lower incidence of complications and better visual outcomes compared with aphakia and secondary IOL implantation.
  5,975 387 1
Nonincisional (threading) levator plication in mild and moderate blepharoptosis: a novel technique
Mohsen S Badawy, Osama M El Nahrawy, Ahmed A Abdelghany, Heba M Khalaf
July-September 2014, 107(3):191-199
Purpose The aim of this study was to evaluate our technique of nonincisional (threading) levator plication operation in cases of mild to moderate blepharoptosis. Setting Ophthalmology Department, Suez Canal University Hospital, Ismailia, Egypt. Design This study was interventional in design. Patients and methods We perform nylon threading 7/0 through the skin using a guiding syringe needle gauge no. 21 and the superior levator palpebral muscle and Mόller's muscle are tucked in by sutures guided to the tarsus surface; then, threads are tightened till the lid margin is elevated to the correct level, and the thread is knotted and inserted under the skin and orbicularis muscle. A total of 21 eyelids of 18 patients were subjected to this procedure. Results A total of 18 patients (12 male and six female, mean age 40 years) were studied. Nineteen eyelids were normally corrected or within 0.5 mm of normal, yielding a success rate of 90.5%. One (4.8%) patient was elevated within 1 mm of normal, and it was accepted. One (4.8%) eyelid was undercorrected and it wasn't accepted. An excellent lid contour was noted in all cases, except one, in whom a slight irregularity of the lid margin was observed, which was corrected spontaneously within 1 month. Conclusion The nonincisional (threading) levator plication technique is a safe and effective surgery for the treatment of mild to moderate blepharoptosis. It has a high success rate and good cosmetic outcome.
  5,917 371 -
Possible changes in intraocular pressure measurements after corneal collagen cross-linking with riboflavin and ultraviolet A in eyes with keratoconus
Iman M Eissa, Mostafa A El-Husseiny, Ahmad Ismail
July-September 2013, 106(3):168-171
Purpose The aim of the study was to determine the possible effect of corneal collagen cross-linking (CXL) with riboflavin and ultraviolet A on intraocular pressure (IOP) measurements using Goldmann applanation tonometry (GAT) in eyes with keratoconus. Design The study was designed as a prospective case series and conducted in Al Haram Eye Center and RCC Hospital, Giza, Egypt. Materials and methods This noncomparative study measured IOP using GAT before CXL and at 3, 6, and 12 months after CXL. Results The study evaluated 49 eyes (40 patients). There was a statistically significant increase in the measured IOP at 3, 6, and 12 months after CXL (P<0.001). The mean preoperative IOP was 11.2 mmHg (1.29 SD), whereas the mean postoperative IOP was 12.24 mmHg (1.13 SD) at 3 months, 12.37 mmHg (1.13 SD) at 6 months, and 12.55 mmHg (1.12 SD) at 12 months. We also found a direct correlation between preoperative central corneal thickness and IOP measurements at postoperative examinations. However, postoperative IOP measurements were not correlated with patient age, sex, or preoperative keratometric readings. Conclusion After riboflavin-ultraviolet A CXL in eyes with keratoconus, there was a significant increase in IOP measured using GAT, which was probably caused by an increase in corneal rigidity and not a true increase.
  5,939 316 -
Quantitative assessment of optic disc edema using spectral domain optical coherence tomography
Ahmed Mohamed Kamal Elshafei, Raafat Mohyeldeen Abdelrahman, Heba Radi AttaAllah
April-June 2014, 107(2):49-54
Introduction Optic disc edema (ODE) can be caused by a variety of conditions including pseudotumor cerebri, hypertension, diabetes, uveitis, anemia, lymphoma, and papillitis. Improvement in the quality of optical coherence tomography (OCT) can support the diagnosis and management of ODE. OCT may help in this diagnosis by showing peripapillary retinal nerve fiber layer (RNFL) thickening. Aim of the work To evaluate quantitative assessment of optic disc edema by measuring peripapillary nerve fiber layer (RNFL) thickness, and peripapillary maximum neurosensory retinal (MNSR) thickness in the four quadrants using spectral domain OCT. Patients and methods The study was done in El-Minya Investigation Eye Center between May 2012 and May 2013. The study included 21 eyes of 16 patients with optic disc edema and 20 eyes of 11 normal control persons. Both patients and normal control were examined by spectral domain OCT, two sets of measurements were evaluated and compared: Peripapillary RNFL thickness measurement in four quadrants using the standard optic disc cube 200 × 200 acquisition protocol, spectral domain OCT, Peripapillary maximum neurosensory retinal thickness (MNSR) in four quadrants using high definition 5 line images. Results In ODE group, 21 eyes of 16 patients were evaluated. The control group included 20 eyes of 11 normal subjects. The Mean average peripapillary RNFL was 93.1 ± 8.2 in control group 132.3 ± 46 µ in mild ODE, 139.4 ± 29.2 µ in moderate ODE and 264.2 ± 116.9 µ in severe ODE. The mean average peripapillary MNSR in the four quadrants was 350.1 ± 36.3 µm in control group, 458.7 ± 37.3 µm in mild ODE, 634.4 ± 35.01 µm in moderate ODE and 968.3 ± 245 µm in severe ODE. Conclusion There was a statistically significant increase in mean RNFL thickness and mean MNSR in four quadrants in all grades of ODE group compared with the control group (P = 0.001). There was a strong positive correlation (r = 0.89, P = 0.001) between the mean MNSR and the mean RNFL in eyes with ODE.
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The visual outcome of anisometropic amblyopia after laser-assisted in-situ keratomileusis surgery
Hussien S El-Nahas, Mervat E Elgharieb, Yasser M Khalifa, Sarah A Abou El-Ela
July-September 2013, 106(3):123-128
Purpose To evaluate the visual outcomes of patients with anisometropic amblyopia after laser in-situ keratomileusis (LASIK) surgery. Patients and methods LASIK was performed in 24 anisometropic amblyopic eyes of 24 patients. All eyes were amblyopic and received the standard amblyopia treatment (occlusion and/or optical penalization). The mean age of the patients was 21.62 ± 9.55 SD years, ranging from 6 to 42 years. The mean myopic error ± SD was -5.7 ± 2.25 (range from −11.5 to −3.25) and the mean hypermetropic ± SD was +3.5 ± 0.95. Results The preoperative mean uncorrected visual acuity ± SD was 0.11 ± 0.06 and became 0.56 ± 0.18, whereas the preoperative mean best corrected visual acuity was 0.39 ± 0.13 and became 0.57 ± 0.17 6 months postoperatively. Uncorrected visual acuity of all patients improved significantly about three or more lines in Snellen's chart. The best corrected visual acuity of about 79% of the patients improved by one or more lines in Snellen's chart. Conclusion LASIK is an effective option for the correction of high myopic or hypermetropic anisometropia. Recommendations LASIK surgery could be recommended in all types of anisometropic amblyopic patients in whom traditional management failed and who were intolerable to glasses or contact lenses. Amblypoia management should be continued postoperatively. Further studies are recommended to assess factors affecting anisometropic amblyopia management by LASIK, such as age, refraction, depth of amblyopia and response to conventional therapy.
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Correlation of retinal nerve fiber layer thickness and perimetric changes in primary open-angle glaucoma
Ahmed E.Abd El-Naby, Hossam Y Abouelkheir, Hossam T Al-Sharkawy, Tharwat H Mokbel
January-March 2018, 111(1):7-14
Purpose This study aims at evaluating the relation between retinal nerve fiber layer (RNFL) thickness evaluated by spectral-domain optical coherence tomography (OCT) in primary open-angle glaucoma and visual field sensitivity. Patients and methods A total of 20 normal and 60 glaucomatous eyes were included in this study. Glaucomatous eyes were graded into early, moderate and severe stages according to Hodapp, Parrish, and Anderson classification. Complete ophthalmic examination, white-on-white perimetry and spectral-domain OCT were done for all patients. RNFL thickness of quadrants and average thickness were recorded. Area under receiver operating characteristic curves were used to assess the performance of OCT parameters. Results Average RNFL thickness was the best parameter to discriminate normal from early glaucoma, early from moderate and moderate from severe. Average RNFL loss was 14.9% in early glaucoma, 25.1% in moderate glaucoma and 37.2% in severe glaucoma. A significant correlation was detected between mean deviation and average RNFL thickness. Conclusion The present study found that average RNFL thickness has a good diagnostic value for diagnosis of glaucoma and for differentiating between glaucoma stages according to its severity.
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Retrospective study of ocular trauma in Mansoura Ophthalmic Center
Abd-Elmonem Elhesy
October-December 2016, 109(4):153-160
Aim The aim of the study was to conduct an epidemiological study of ocular trauma cases presented to the Mansoura Ophthalmic Center, Mansoura College, regarding patient age, sex, and job, the reason for trauma, and kind of ocular injuries. Patients and methods This research is dependent on hospital discharge sheets, studies from the emergency room setting or population-based interviews. It is a retrospective epidemiological study that includes all patients presenting with ocular injuries to the Mansoura Ophthalmic Center (Mansoura College) throughout the period from January 2012 to June 2015. Within this study, we examined retrospectively 1134 patients presenting with eye injuries. Patient’s collected data included age, sex, address, occupation, duration of presentation, reason for trauma, site to trauma, and kind of injuries. The reason for injuries was differentiated into blunt or sharp. Based on the site of eye injuries, the data were classified into three groups: work-related injuries, home-related injuries, and street-related injuries. The examination sheet for the hurt eye was acquired, and information was recorded based on the standardized classification of ocular trauma. Results The study incorporated 1134 patients presenting with eye injuries within a period of 3.5 years (from January 2012 to June 2015). Most instances (80.4%) of ocular trauma occurred in male patients, who had an average chronological age of 25 years (varying from 1 to 80 years). Factory employees represent 36.2% of the total injury cases. Farmers represented 2.5% of hurt individuals. Students represented 18.5% of hurt individuals. Motorists constituted 1.4%. Housewives constituted 7.2% of injury cases. Individuals without any jobs constituted 34.2% of cases. Within this study, there was no delay in presentation to the hospital in 788 (69.5%) cases. However, 268 (23.6%) patients demonstrated delay greater than 24 h to 1 week, and 78 (6.9%) patients demonstrated delay in excess of 7 days. Workplace injuries constituted 36.7% of cases, road-related injuries 31.9% of cases, and home injuries 31.4% of cases. Blunt objects represented 36.3% of eye injury cases. Sharp objects represented 63.7% of eye injury cases. There have been 852 (75.1%) closed-globe injuries and 282 (24.9%) open-globe injuries. Conclusion In Egypt, ocular trauma is an issue, as it is a significant reason for blindness. This research was targeted at determining factors that are characteristics of ocular trauma, so that they can aid in reducing its prevalence in Egypt.
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Prevalence of amblyopia among children attending primary schools during the amblyogenic period in Minia county
Sahar T Abdelrazik, Mohamed F Khalil
October-December 2014, 107(4):220-225
Introduction Amblyopia is one of the most important causes of visual impairments in young children; its incidence varies between 0.14 and 4.7%. An early diagnosis can enable optimal treatment. Illiteracy and poverty play a major role in preventing individuals from seeking medical advice, and we lack data on the prevalence of amblyopia in Upper Egypt, especially Minia county. Objective This study aimed to screen for amblyopia in students attending the governmental primary schools in Minia County during the amblyogenic period. Design A prospective observational cross sectional study was carried out between March and April 2010. Patients and methods Visual acuity and pen light ophthalmic examinations were performed for 1608 students (age range 7-9 years). Overall, 864 students were from urban areas and 744 were from rural areas. Children with defective vision were subjected to a full ophthalmic examination including slit lamp, orthoptic, and fundus examination in addition to cycloplegic refraction to detect the cause of reduced vision. Results Of the total number of participants, 14.49% had defective vision; 0.75% had organic causes (5.2% of the patients with defective vision), 12.25% had refractive errors (84.5% of the patients with defective vision), and 1.49% had amblyopia (10.3% of the patients with defective vision). The main cause of amblyopia was anisometropia (54.16%), followed by strabismus (25%), ametropia (12.5%), and finally deprivation (8.33%). Conclusion The prevalence of amblyopia in our study is 1.49%, which is higher in rural areas than in urban areas.
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Hydroxychloroquine retinopathy in a cohort of patients from upper Egypt
Mortada A Abozaid, Esam Aboelfadl, Mohammed A Ismail
October-December 2017, 110(4):110-113
Purpose To identify risk factors and state demographics of a cohort of patients from upper Egypt experiencing hydroxychloroquine (HCQ) retinopathy. This was an observational study. This study was conducted in Sohag University Hospital, Egypt. Patients and methods The medical records of the rheumatology department were retrospectively reviewed to identify patients who stopped taking HCQ owing to its induced visual troubles. Ten patients were identified and were subjected to complete ophthalmological examination in addition to automated perimetry and optical coherence tomography of the macula. Results All patients (nine females and one male) had received HCQ 200 mg twice daily for years. The mean age was 59.1 years, mean real weight was 83.3 kg, mean height was 1.63 m, mean ideal body weight was 56.72 kg, and the mean daily dose per kg of ideal weight was 7.14 mg/kg/day, whereas the mean daily dose per kg of real weight was 4.85 mg/kg/day. Conclusion Calculation of HCQ dose according to the ideal weight is a better predector of retinal toxicity than real body weight.
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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
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.
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