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   Table of Contents - Current issue
Coverpage
April-June 2020
Volume 113 | Issue 2
Page Nos. 33-76

Online since Friday, July 10, 2020

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ORIGINAL ARTICLES  

Clinicopathologic evaluation of primary vs secondary enucleated unilateral group D retinoblastoma eyes p. 33
Ahmed M Seddeek, Ashraf S Shaarawy, Nihal M El Shakankiri, Bassma M El Sabaa, Sameh E Soliman
DOI:10.4103/ejos.ejos_2_20  
Background The risk of tumor spread is the main concern while deciding primary treatment in advanced unilateral retinoblastoma, which presents later with an intact normal eye. Enucleation was recommended as a radical treatment but with newer treatment options such as systemic and intra-arterial chemotherapy. Ocular salvage could be tried in group D eyes with smaller tumors and visual potential. Aim The aim was to assess the histopathologic metastatic risk in primary vs secondary enucleated (trial salvage) unilateral group D eyes. Design Retrospective, noncomparative, single-institution observational case series. Patients and methods All primary and secondary enucleated unilateral group D eyes (June 2012 to December 2018) managed at the pediatric ocular oncology unit, Ophthalmology Department, University of Alexandria. Clinical, radiological, histopathologic, and treatment data were collected. Clinicopathologic correlation was performed to identify the frequency of high-risk histopathologic features (HRHF). Statistical analysis All analyses were performed using Microsoft Excel 2013 software and SPSS software version 17.0. Results Twenty-six eyes were included. Sixteen were primary enucleated and none showed HRHF while 10 were secondary enucleated after failed trial salvage. Timely enucleated secondary cases (6/10) showed no HRHF while delayed secondary enucleation (2/4) was significantly associated with HRHF (P=0.02). All cases are alive with no metastasis after a median follow-up of 5 years. Conclusion Primary and timely secondary enucleation for unilateral group D retinoblastoma eyes are comparable in low metastatic risk and effectivity of tumor control. Controlled discussed trial ocular salvage is safe conditioned by strict timely termination, if necessary.
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Intraocular lens Master optical biometry vs conventional ultrasonic biometry in intraocular lens power calculations in highly myopic vs emmetropic eyes p. 39
Mina N Gad, Mervat S Mourad, Rafaat A Rehan, Mouamen M Mustafa
DOI:10.4103/ejos.ejos_8_20  
Aim The aim was to compare between the preoperative intraocular lens (IOL) power calculations accuracy measured by IOL Master vs applanation ultrasonic biometry in highly myopic and emmetropic eyes regarding postoperative refractive error. Patients and methods The IOL powers of 32 eyes of 32 patients prepared for phacoemulsification with IOL implantation were calculated preoperatively by IOL Master and A-scan. Postoperative refractive outcomes and spherical equivalent were compared with the predicted refractive error of each method. Results The mean±SD age of the 32 recruited patients was 53.91±10.21 years. The mean axial length (AXL) measured by IOL Master was higher (25.8±2.65 mm) than that with A-scan (25.46±3.43 mm), with a mean difference of 0.34±1.04 mm (P=0.2112). The mean predicted IOL power was 13.50±7.80 D with IOL Master vs 13.63±9.05 D with A-scan (P=0.930). However, no statistically significant difference was found regarding average K readings and predicted postoperative refraction (P=0.05 and 0.564, respectively). Further subgroup analysis revealed a statistically significant difference in AXL between both devices only in emmetropic group, with mean difference of 0.99±0.485 mm (P=0.00068). The mean absolute errors measured by IOL Master was 0.19±0.1417, whereas that of A-scan was 0.561±0.623. The mean difference between the two methods was −0.371 (P=0.0385), which was statistically significant. Discussion and conclusion The IOL Master AXL measurements were accurate, allowing more accurate calculation of the (IOL) power. It is user friendly, fast, with no contact with the corneal surface and with no possibility of damage to the surface or transmitting a disease.
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Assessment of radial peripapillary capillary and macular vascular density in primary open angle glaucoma p. 46
Haitham Y Al-Nashar, Wael M El-Haig, Mohammed A Al-Naimy
DOI:10.4103/ejos.ejos_11_20  
Purpose The aim was to assess radial peripapillary capillary (RPC) and macular vascular density in eyes with primary open angle glaucoma (POAG). Patients and methods This observational cross-sectional study included 60 eyes of normal person and 67 eyes with POAG. Glaucomatous eyes were subdivided into three groups according to visual field findings; mild, moderate, and severe glaucoma (14, 27, and 26 eyes, respectively). Both RPC and macular vascular density were measured using optical coherence tomography angiography (OCTA). Visual field mean deviation was analyzed. Retinal nerve fiber layer (NFL) thickness and ganglion cell complex thickness were determined using OCT in all eyes. Results Peripapillary retinal NFL (thickness and ganglion cell complex thickness were significantly different between glaucomatous and normal eyes (P<0.001). In eyes with POAG, RPC vascular density was significantly less than normal ones (P<0.001) and was correlated with glaucoma severity (P=0.02). A significant correlation was found between RPC vascular density and visual field mean deviation and NFL thickness. Macular vascular density was significantly less in glaucomatous eyes (P<0.001) with significant correlation with the degree of glaucoma severity (P=0.01). Conclusion OCTA has the ability of visualization and quantification of RPC and macula vessel density and may be useful in measuring retinal ganglion cell damage in open angle glaucoma.
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The effect of pupillary dilatation on visual field testing in glaucoma p. 54
Doha G Salem, Mervat S Mourad, Mahmoud A Hamid
DOI:10.4103/ejos.ejos_15_20  
Introduction The concern on the effect of pupillary dilatation on visual field parameters in patients with glaucoma comes from the fact that patients usually seek field examination after their pupils have been dilated for fundus examination. Aim To investigate the influence of pupillary dilatation on visual field testing in patients with glaucoma, by using automated static perimetry. Patients and methods A prospective comparative noninterventional clinical study was conducted on 20 eyes (11 patients) with open-angle glaucoma. Two consecutive visual field examinations were performed on each eye of all participants. The first was done on the undilated normal pupil size, whereas the second was done after dilating the pupil to 6–8 mm. Results After pupillary dilatation, fixation losses were significantly higher. There was no significant difference in false-negative or false-positive results. There was improvement in the mean deviation with no statistical significance. Pattern standard deviation showed also improvement, which was statistically significant. Discussion and conclusion It was found that pupillary dilatation caused variability and difference in the visual field parameters, which emphasizes the importance of consistent pupillary size in performing the serial automated visual field tests, especially in patients with glaucoma to allow standardized judgment on the patient’s progression.
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Internal limiting membrane peeling effect on visual outcomes after diabetic vitrectomy p. 69
Ashraf S Shaarawy, Samir M Elbaha, Ehab M Ghoneim, Mohamed A Elmassry
DOI:10.4103/ejos.ejos_75_19  
Aim and Objectives To determine whether Internal Limiting Membrane (ILM) peeling has an effect on visual outcomes after vitrectomy for diabetic tractional retinal detachment. Settings and Design A prospective randomized interventional case series. Patients and Methods Pars Plana Vitrectomy (23-Gauge) was performed on 34 cases with diabetic epi-macular traction affecting the vision due to advanced proliferative diabetic retinopathy. The usual steps of vitrectomy were performed. The ILM was randomly chosen to be peeled in 16 cases (group I), or left not peeled in 18 cases (group II). Eventually, either air, Sulphur hexafluoride (SF6) gas or silicone oil tamponade was used. Final visual acuity results were tabulated six months after surgery, and compared between the two groups. Results The mean pre-operative visual acuity (VA) was 0.06 (decimals) and 0.03 in groups I and II respectively. The mean post-operative VA was significantly better: 0.26 and 0.27 in groups 1 and 2 respectively (P=0.001). There were no statistically significant differences between VA gains in both groups (P=0.721). Air tamponade was used in 18.8% and 33.3%, SF6 in 37.5% and 33.3%, and silicone oil in 43.8% and 33.3% in groups I and II respectively. Conclusions ILM peeling had no effect on the final visual outcome after vitrectomy for diabetic tractional retinal detachments.
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