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   Table of Contents - Current issue
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April-June 2018
Volume 111 | Issue 2
Page Nos. 43-89

Online since Thursday, August 30, 2018

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ORIGINAL ARTICLES  

Ocular motility disorders: unusual presentation of pituitary adenoma p. 43
Manal A Kasem, Mohamed Kassem, Ahmed N Taha, Al-Sharawy Kamal
DOI:10.4103/ejos.ejos_16_18  
Background The aim of this study was to describe ocular palsies as a rare presentation of pituitary adenomas and their relation to the size, type, and extension of tumor. Patients and methods Patients who presented with acquired onset of diplopia or ptosis during the period from February 2014 to January 2017 were included. Patients were referred to the neurology unit for transphenoidal removal of the gland. Full ophthalmologic and neurologic examinations were performed preoperatively and postoperatively. Results This study included 15 (12 men and three women) patients. Nine (60%) patients had isolated third nerve palsy; four (26.6%) patients had isolated sixth nerve affection; and two (13.3%) patients had total external ophthalmoplegia. Ocular motor disorders occurred more in nonfunctioning macroadenomas (73.3%) with grade 3 paraseller extension (60%). Apoplexy occurred in 46.7% of the cases. After surgical removal of the tumor, ocular motor improvement started within 3 weeks postoperatively. Full recovery occurred in seven (46.6%) patients within 6 months; five (33.3%) patients showed partial recovery; and three (20%) patients showed no improvement. Conclusions Acquired ocular motility disorders should raise the possibility of pituitary adenoma. The third nerve is the most affected, followed by the sixth nerve. The majority of the cases occurred in nonfunctioning macroadenoma. Transphenoidal tumor excision has a favorable outcome regarding the improvement of ocular motility.
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Risk factors for consecutive esotropia p. 49
Manal A Kasem
DOI:10.4103/ejos.ejos_15_18  
Purpose The aim of this retrospective study was to investigate the different factors predisposing to consecutive esotropia (CET) after surgical management of intermittent exotropia (IXT). Patients and methods This study included the medical records of patients who had surgery for IXT from March 2016 to March 2017. Postoperatively, the patients were divided into two groups: A group who developed CET and another group who became orthotropic within 6 months of follow-up. Possible risk factors for the development of CET were recorded and analyzed. Results Eighteen patients developed CET, while the orthotropic group consisted of 78 cases. CET occurred in 61% of patients of less than 6 years old. There was no significant correlation between preoperative angle of IXT and development of CET, but there was significant correlation with the angle of initial CET (postoperatively). CET was found in 16.7% of preoperative tenacious proximal convergence exotropia. CET was developed in 66.7% of cases of asymmetrical surgery (recession–resection), and more common with the development of lateral incomitance (27.8%). Amblyopia, suppression, and absence of stereopsis were considered risk factors in 50% of the cases. No correlation between errors of refraction and development of CET. Conclusion This study concluded that many risk factors may predispose to CET, the more significant factors were the age of the patients (<6 years old), large angle of initial postoperative CET, type of IXT, asymmetric surgery (recession–resection procedure), development of lateral incomitance, and presence of amblyopia or suppression.
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Wave front aberrations and patient satisfaction of aspheric intraocular lenses p. 53
Ismail A.N Omar
DOI:10.4103/ejos.ejos_2_18  
Aim The aim was to study postoperative wave front higher order aberrations of eyes implanted with aspheric intraocular lens (IOL) in comparison with those with standard spherical IOL and to assess the subjective satisfaction in relation to both IOL designs. Patients and methods The study included 40 patients with bilateral cataract. Patients were enrolled in a prospective comparative case series from December 2013 till January 2015. All patients underwent a complete preoperative assessment. Phacoemulsification was done for all patients in both eyes. Aspheric IOL (Acrysof IQ SN60WF) was implanted in the right eye and standard spherical IOL (AcrySof SA60AT) in the left eye. Wave front examination was done at 3 months postoperatively to measure the higher order aberrations. A questionnaire was used to record the patients’ satisfaction regarding the two IOL designs. Results There were no significant differences between the two IOLs regarding the postoperative visual acuity or the mean refractive spherical equivalent. Spherical aberrations were significantly lower in the aspheric IOL group, with only 35% of the patients reported that it was the best eye. There were no significant differences in other aberrations. Conclusion Aspheric IOLs and standard IOLs have the same visual outcome regarding visual acuity. However, aspheric IOLs induced significantly less spherical aberrations. Aspheric IOL gave better qualitative visual functions in some patients especially during night.
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Choroidal thickness map variations in patients with retinitis pigmentosa using enhanced depth imaging optical coherence tomography p. 57
Mona K Abdellatif, Weam M Ebeid
DOI:10.4103/ejos.ejos_23_18  
Objective The aim was to investigate changes in retinal and choroidal thickness (CT) maps in patients with retinitis pigmentosa (RP) in comparison to controls using enhanced depth imaging optical coherence tomography (OCT). Participants and methods A cross-sectional study was done on a consecutive sample of 32 eyes of 22 patients with RP. Control group included 30 eyes of 15 age-matched healthy participants. Full ophthalmological examination was done for every participant. Enhanced depth imaging OCT was performed measuring retinal and CT at the nine early treatment diabetic retinopathy study (ETDRS) subfields. Results The mean central CT was statistically significantly thinner (269.73±48.48 µm) in the patients’ group compared with 291.90±29.33 µm in the control group (P=0.023). On comparing the four choroidal quadrants between the two groups, patients with RP had significantly thinner choroid only in the nasal quadrant (P<0.001). The mean central macular thickness was statistically significantly thinner (226.45±61.35 µm) in the RP group than in controls (247.80±33.74 µm; P=0.009). The four macular quadrants were also significantly thinner in the RP group (P<0.001). Significant positive correlation was found between central macular thickness and central CT (r=0.511, P=0.003) and also at the upper and nasal quadrants (P=0.011 and <0.000,‏ ‏respectively). Conclusion Our study demonstrated that CT is thinned significantly in patients with RP in the central 1 mm and in the nasal quadrant. Evaluation of choroidal vasculature in future studies using OCT angiography may provide further insight into the involvement of choroid in the pathogenesis of RP.
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Comparing the outcome of intraocular lens implantation with or without posterior optic capture in pediatric cataract surgery p. 63
Nervine M El-Meshad, Mohamed G Aly, Amr S Galal, Akmal A Risk, Zafer F Ismail
DOI:10.4103/ejos.ejos_25_18  
Purpose To evaluate the outcome of intraocular lens (IOL) implantation with posterior optic capture versus in-the-bag implantation in pediatric cataract surgery. Setting Ain Shams University Hospital and Research Institute of Ophthalmology. Design It is a prospective, comparative clinical study. Patients and methods Thirty eyes with developmental cataract underwent primary cataract extraction and IOL implantation of hydrophobic acrylic multipiece Sensar IOL AR40e. In all cases, anterior and posterior continuous curvilinear capsulorrhexis, lens aspiration, and anterior vitrectomy were performed. IOL was implanted in the ciliary sulcus, and the optic was captured in both anterior and posterior capsulorrhexis in group A (15 eyes) and implanted in the bag without capture in group B (15 eyes). Visual acuity, visual axis opacification, red reflex, intraocular pressure, centration, and complications were all assessed. Results The mean age of children was 5.3±2.93 years. At 6 months of follow-up, the mean postoperative corrected distant visual acuity was 0.69±0.19 and 0.65±0.23 in groups A and B, respectively. The mean clear central zone was 4.29±0.24 and 3.6±0.55 mm in groups A and B, respectively (P=0.001). The mean IOL decentration measured in mm was 1.61±1.17 and 0.86±0.28 SD in groups A and B, respectively (P=0.003). There were no postoperative complications in all cases. Conclusion Placement of IOL haptics in the ciliary sulcus while capturing the optic through the posterior continuous curvilinear capsulorrhexis provides more central clarity of the visual axis, however IOL decentration was more common.
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Direct brow lift versus transblepharoplasty browpexy for correction of brow ptosis p. 70
Mahmoud M.M Genaidy, Ahmed M.K Elshafei, Raafat M.A Abdallah, Mahmoud M Shetawy
DOI:10.4103/ejos.ejos_44_17  
Purpose The aim of this study was to compare direct brow lift and transblepharoplasty browpexy for the management of brow ptosis in terms of cosmetic results, complications, and patient satisfaction. Patients and methods It is a surgical intervention prospective comparative study, 40 brows of 24 patients with brow ptosis were divided into two groups. Group A included 20 brows that were subjected to direct brow lift and group B included 20 brows that were subjected to transblepharoplasty browpexy. Preoperative evaluation included assessment of general and ophthalmological history, brow evaluation, any associated dermatochalasis, ocular examination, cranial nerve examination, visual field assessment, and photographic documentation. Results Bilateral brow ptosis was present in 16 patients, whereas eight patients had unilateral brow ptosis. There were 16 female patients and eight male patients. Their age ranged between 53 and 75 years. The cosmetic complaint of an undesirable appearance was the presenting symptom in 18 patients, whereas functional issues with heaviness and temporal visual field defects were the presenting symptoms in four patients. In group A (direct brow lift), 16 brows were corrected with the brow level at or slightly above the superior orbital margin, whereas four brows were undercorrected. In group B (transblepharoplasty browpexy), 12 brows were fully corrected, whereas eight brows were undercorrected. Conclusion Both direct brow lift and transblepharoplasty browpexy are effective and safe techniques for the correction of brow ptosis. Each procedure has its own advantages.
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A pilot randomized trial evaluating overminus spectacles versus part-time occlusion for control of intermittent exotropia among children 2–10 years of age p. 76
Merna G Abdelfatah, Ahmed T.I Mahmoud, Abdelrahman G Salman, Marwa E Elsebaay
DOI:10.4103/ejos.ejos_8_18  
Purpose The aim was to compare the short-term effectiveness of overminus spectacles versus part-time occlusion (PTO) in improving control of intermittent exotropia [X(T)]. Patients and methods A total of 60 children with X(T), from 2 to 10 years of age, were included in the study. Their distance office control score started from 2 or worse. This is a clinical, randomized, prospective, pilot study. Children were randomly assigned to overminus spectacles, PTO therapy, and observation for 4 months followed by 2 months without treatment. Results The mean distance exotropia control score after 4 months of treatment improved significantly in the overminus spectacle and the PTO groups from 3.9 vs. 3.9 to 2.0 vs. 2.7, respectively. After stoppage of treatment for 2 months, the score deteriorated significantly to 3.3 and 3, respectively. The observation group’s score showed nonsignificant change all throughout the study period. There was a significant improvement in both mean near and distance angles only in the overminus spectacle group after 4 months of treatment and a significant deterioration after 2 months without treatment. Both near and distance angles showed nonsignificant change in both PTO and observation groups all throughout the study period. There was also a significant correlation between the poor compliance of the patients and their deterioration in the PTO group. Conclusion Overminus spectacle therapy has proved to be more effective in control of X(T) than PTO therapy. Poor compliance in PTO therapy affects the treatment effectiveness. It is suggested to work on a protocol of treatment cessation in further studies.
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Outcomes of bimanual microincision cataract surgery and 2.2-mm coaxial phacoemulsification p. 82
Tarek R El-Lakkany, Ashraf M Swellam, Hamza Abd El-Hameed, Hossam T Al-Sharkawy, Rania K Farag
DOI:10.4103/ejos.ejos_47_17  
Purpose To compare the efficacy and safety outcomes of bimanual microincision cataract surgery (B-MICS) versus 2.2-mm coaxial phacoemulsification (C-MICS). Patients and methods This prospective, interventional, randomized, comparative clinical study was carried out on 60 cataractous eyes. Thirty patients were managed surgically by C-MICS through a 2.2 mm mean incision and 30 patients were managed surgically by B-MICS through a 1.2–1.4 mm trapezoidal incision. The main outcomes measures were postoperative best-corrected distant visual acuity, postoperative spherical equivalent, higher-order aberrations, corneal thickness, corneal endothelial cell loss (ECL), and complications during and after surgery. Both groups were compared for all variables preoperatively. Results The visual rehabilitation in group B was faster than that in group A (nonsignificant). There were nonstatistically significant differences, in the best-corrected visual acuity, between both groups throughout the postoperative period. The mean ECL was statistically significantly higher in group A (221.2±44.1) compared with group B (167.5±67.9) (P<0.001). The mean central corneal thickness change was significantly greater in group A than group B (P=0.01). The surgically induced astigmatism was statistically significantly improved in B-MICS (group B) than C-MICS (group A) (P=0.001). For the other corneal aberrations, there were nonsignificant differences between the two groups. No differences were found in the complications during surgeries between the two groups of cataract surgery. Conclusion The two techniques are reliable, functional, effective, and yield good visual outcomes and low complication rates. B-MICS with the smallest incision induces less astigmatism (surgically induced astigmatism), less ECL, fewer central corneal thickness changes, and enables earlier visual rehabilitation.
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