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   Table of Contents - Current issue
Coverpage
July-September 2018
Volume 111 | Issue 3
Page Nos. 91-126

Online since Thursday, November 22, 2018

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ORIGINAL ARTICLES  

Outcome of strabismus surgery in patients of type 3 gaucher’s disease p. 91
Manal A Kasem, Mona A.L Alsayed
DOI:10.4103/ejos.ejos_28_18  
Purpose Surgical correction of esotropia in patients of neuronopathic Gaucher’s disease (GD) type 3 aiming to improve the cosmetic appearance with the evaluation of the success rate, presence of residual angle, or recurrence during the follow-up period. Study design A retrospective, descriptive study. Patients and methods Ten patients with type 3 neuronopathic GD were referred from the Pediatric Gastroenterology and Neurology Units of Mansoura Children’s Hospital. All patients suffered from systemic, neurological, and ophthalmological manifestations such as hepatosplenomegaly, horizontal gaze palsy and esotropia, respectively. They received enzyme replacement therapy, and showed a stationary course for at least 1 year before strabismus surgery. Patients were admitted and operated for cosmetic correction of esotropia. They were followed up regularly every month for 1 year. Postoperative data were recorded at the end of 1, 3, 6, and 12 months. Results In all, 80% of cases showed improvement of the angle. Orthotropia (within 10 pd) was obtained at the end of 6 months and maintained till the end of 1 year postoperatively; 20% of the cases showed residual esotropia. Conclusion Surgical correction of strabismus in type 3 GD can achieve good cosmetic results with low risk of residual angle or recurrence.
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The ablation depth effect on dry eye after LASIK treatment for myopia p. 96
Mostafa Abo Elfadl, Hosny A Zein, Ahmed Mostafa Eid, Abd Elaleem A Tolba
DOI:10.4103/ejos.ejos_21_18  
Purpose The aim was to investigate the effect of ablation depth on the incidence and severity of the dry eye after laser-assisted in-situ keratomileusis (LASIK) treatment of myopia. Patients and methods This was a prospective, noncomparative, interventional case series study that included myopic patients who underwent LASIK treatment for myopia ranging from −1.75 to −12.00 D. All patients had a comprehensive preoperative ophthalmologic evaluation. Tear breakup time (TBUT) and Schirmer 1 tests were undertaken for all patients preoperatively and at 1, 3, and 6 months postoperatively. The main outcome measures included the incidence and severity of the dry eye and their correlation with ablation depth at 1, 3, and 6 months postoperatively. Results 104 eyes of 53 myopic patients (14 males and 39 females) with a mean age of 27.4±6.06 years (range: 21–45 years). At the baseline, the mean spherical equivalent was −6.38±2.82 D (range: −1.5 to −12 D), mean TBUT was 12.93±1.60 s (range: 10–17 s), and the mean Schirmer 1 score was 17.9±62.52 mm (range: 14–30 mm). Mean post-LASIK TBUT was 7.58±4.32, 10.22±5.38, and 12.07±4.02 s at 1, 3, and 6 months, respectively (P<0.001). The mean post-LASIK Schirmer 1 score was 8.50±5.01, 11.4±5.54, and 14.24±3.77 mm at 1, 3, and 6 months, respectively (P<0.001). There was a strong negative correlation between ablation depth and both TBUT and Schirmer 1 values at 1 and 3 follow-up months, but a moderate negative correlation at 6 months. Conclusions There was moderate to strong negative correlation between ablation depth and the degree of post myopic LASIK dryness assessed objectively by TBUT and Schirmer 1 tests.
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The relation between inner segment/outer segment junction and visual acuity before and after ranibizumab in diabetic macular edema p. 102
Noha H Hareedy, Ayman A Gaafar, Hisham K. Abd El-Dayem, Reham F. Abd El-Razek El-Shinawy
DOI:10.4103/ejos.ejos_26_18  
Purpose The aim of the study was to evaluate the relation between the photoreceptor inner segment/outer segment (IS/OS) junction integrity and the best corrected visual acuity (BCVA) and color vision after intravitreal injection of antivascular endothelial growth factor, ranibizumab in patients with diabetic macular edema (DME). Patients and methods This prospective observational interventional study was conducted on 50 eyes of patients with DME. All patients received three doses of intravitreal injection of antivascular endothelial growth factor (ranibizumab) 1 month apart. The photoreceptor IS/OS was evaluated by spectral domain optical coherence tomography and correlated to both BCVA and color vision by the Ishihara pseudoisochromatic 38 plates test. Results There was highly statistically significant improvement of photoreceptor IS/OS integrity after the second (P=0.003) and third injections (P=0.000). There were increases in the percentage of cases that read the color test correctly after each injection, but this increase was found to be not statistically significant when compared to color vision before the first injection. The mean BCVA was 0.96±0.09 SD (logarithm of the minimum angle of resolution) before the first injection. There was a highly statistically significant improvement in the BCVA after first (0.78±0.15), second (0.70±0.15), and third injections (0.64±0.16) (P=0.000). There was a statistically significant relation between color vision and IS/OS after the first injection (P=0.047), but it was a highly statistically significant relation after the second and third injections (P=0.000). BCVA was significantly related to IS/OS after the second and third injection (P=0.017 and 0.000, respectively). Conclusion The continuity of the foveal photoreceptor IS/OS layer evaluated by means of spectral domain optical coherence tomography is a valuble prognostic indicator of visual acuity and color vision outcome in patients with DME.
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Evaluation of small-volume (3 ml) ophthalmic anaesthesia for both subtenon anaesthesia using blunt-tipped curved needle and single medial canthal injection with sharp needle for phacoemulsification surgery p. 108
Tamer A Refai, Rehab S Khattab
DOI:10.4103/ejos.ejos_29_18  
Introduction Medial canthus injection as well as subtenon anaesthesia has been used in anterior segment surgery. In this research, we compared the effectiveness and safety of small volume (3 ml) for either technique. Patients and methods Forty eyes of 40 patients undergoing phacoemulsification surgery at the Research Institute of Ophthalmology, Giza, Egypt, were divided into two groups: group A (20 eyes) included eyes of patients who received subtenon injection with blunt-tipped curved needle and group B (20 eyes) included eyes of patients who received single injection at medial canthus with sharp needle. Following either injection, the akinesia score and surgeon and patient satisfaction scores were reported as well as any related complications. The studied data were subjected to statistical analysis and results emphasized. Results In our study, the akinesia score had a mean value of 6±2.43 for subtenon group and 3.25±2.61 for the single injection medial canthus group, with a highly significant difference (P<0.01). A total of 17 (85%) patients were satisfied from anaesthesia in group A versus 12 (60%) patients in group B, with a highly significant difference (P<0.001). Moreover, 12 (60%) cases needed facial supplementation in group A versus zero (0%) cases in group B, with a highly significant difference (P<0.01). There was no statistically significant difference among both groups regarding surgeon satisfaction as well as rate of complications related to anaesthesia injection (P>0.05). Conclusion For phacoemulsification, subtenon anaesthesia using small volume of 3 ml was more effective regarding better akinesia score compared with a similar volume of medial canthus injection, with lower rate of supplemental injection as well as better patient and comparable surgeon satisfaction. The main disadvantage was a higher rate of pain to injection as well as more need for facial supplementation.
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Reoperation of strabismus, points to be considered p. 116
Karim A Gaballah
DOI:10.4103/ejos.ejos_44_18  
Purpose The aim was to obtain the best results when dealing with previously operated cases of strabismus, as regards the restoration of ocular alignment, regaining ocular motility at least in the central field and at the same time aiming at preserving equal vertical width of the palpebral fissure in both the eyes. Participants and methods Effective strategies for strabismus reoperations are controversial, and should be tailored to each patient, depending on the specific history and findings. The first decision is to operate on previously operated muscles or fresh muscles. This should be influenced by many factors, in part by whether we are treating an undercorrection or an overcorrection, limitations of rotations, and incomitance, and by the vertical width of the palpebral fissure in the two eyes. Also many important decisions should be made intraoperatively based on the muscles integrity, whether slipped, lost, tight, hypertrophied, and also according to forced duction test. Results The total number of cases included in this study were 175 patients. Most of them were exotropic, 102 (58.3) cases, 67 women and 35 men, most of them (80 cases, 78.5%) were residual or recurrent. Esotropia constituted 59 (33.7%) cases, most of them were residual (46 cases). New types of deviation presented in 8% of cases. Management decision depended on the presenting deviation, its angle, ocular motility and any limitation, forced duction test, vertical width of the palpebral fissure, and modified according to the anatomical findings during the surgery. Conclusion A proper plan for a strabismus reoperation takes into consideration a number of factors preoperatively, and the surgeon should be prepared to modify his plans in each patient according to the intraoperative findings.
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Hang-back technique versus conventional rectus recession in strabismus surgery p. 123
Karim A Gaballah
DOI:10.4103/ejos.ejos_45_18  
Purpose The aim of this work was to study a new technique of rectus muscle weakening and compare it with the conventional method of muscle recession. Patients and methods This was a prospective study performed between February 2015 and June 2016, and follow-up was carried out until June 2017. A total of 54 patients presenting with esotropia underwent medial rectus recession with the hang-back technique, and 30 patients underwent recession with the conventional method. The results of strabismus surgery in these two groups of esotropia, one of them treated with the hang-back technique and the other with conventional recession, are compared. Results Surgical outcomes were not significantly different in the two treatment groups. The hang-back was found to be technically safer, avoiding the scleral pass, by attaching the muscle into the stump of the tendon. Conclusion It seems that the modified recession by the hang-back technique can reduce the complications and risks involved in conventional recession, and it is safer and effective for muscle recession. It can decrease the risk of globe perforation, as the sclera behind the insertion of the medial recti is the thinnest part of the sclera.
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