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   Table of Contents - Current issue
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April-June 2017
Volume 110 | Issue 2
Page Nos. 31-70

Online since Thursday, July 20, 2017

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ORIGINAL ARTICLES  

Study of the different ocular manifestations in children with juvenile idiopathic arthritis p. 31
Eiman M Abd El Latif, Ghada F El Derini
DOI:10.4103/ejos.ejos_15_17  
Purpose The aim of this study was to describe the features of uveitis in children with juvenile idiopathic arthritis (JIA). Patients and methods The present study was an observational study of 132 eyes of 75 children with JIA and uveitis, who were examined with a slit-lamp biomicroscope and a noncontact fundus lens. The features of uveitis are described. Results Among the 75 patients with JIA-associated uveitis, 132 eyes were affected by uveitis. At least one ocular complication was present in 64% of patients and in 67% of eyes affected with uveitis at presentation. In the 132 affected eyes, band keratopathy was the most frequent complication observed (32%), followed by posterior synechiae (28%), cataract (22%), and ocular hypertension (15%). Conclusion In summary, poor vision and ocular complications still occur commonly among children with JIA-related uveitis, particularly if there is a long delay in referral to a tertiary-care center.
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Evaluation of corneal collagen cross-linking with femtosecond laser-assisted intrastromal corneal ring segments in keratoconus p. 35
Mohamed Farouk Sayed Othman Abdelkader, Ezz El-Din Galal Mohamed, Hesham Fathallah El-Sheikh, Ahmed Maher Khalafallah
DOI:10.4103/ejos.ejos_24_17  
Purpose The purpose of this article is to evaluate and compare the outcomes of simultaneous and successive femtosecond laser-assisted intrastromal corneal kera-ring segments insertion and corneal collagen cross-linking in the treatment of keratoconus.
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Evaluation of transconjunctival levator tucking for congenital ptosis p. 41
Mohamed F.S. Othman Abdelkader, Raafat M Abdelrahman Abdallah
DOI:10.4103/ejos.ejos_22_17  
Purpose The purpose of this paper is to evaluate the efficacy, cosmetic results, and safety of transconjunctival tucking of the levator aponeurosis for correction of simple congenital ptosis. Patients and methods This was a prospective interventional noncomparative case-series study. This study was carried out at the Ophthalmology Department of Minia University Hospital. Thirty eyelids of 24 patients with simple congenital ptosis with fair to good levator muscle function (≥5 mm lid elevation) were subjected to transconjunctival tucking of levator aponeurosis. All patients were subjected to an assessment of history and a full ophthalmological examination. The degree of ptosis was evaluated using marginal reflex distance 1. Levator muscle function was evaluated while fixing the eyebrow. Preoperative and postoperative digital photographs were used for documentation. Results Anatomical success was achieved in 26 (86.7%) eyelids. Undercorrection was present in four (13.3%) eyelids. No case of overcorrection was encountered. Undercorrection was associated with more severe ptosis and less levator muscle function. Good cosmetic outcomes were obtained in the majority of cases. Apart from undercorrection, no significant postoperative complications occurred during the study. Conclusion Levator aponeurosis tucking using the posterior transconjunctival approach is safe and effective for correcting simple congenital blepharoptosis, with good cosmetic outcomes. This technique is especially useful for mild and moderate cases of congenital ptosis associated with fair to good levator muscle function.
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Asteroid hyalosis removal during phacoemulsification: an anterior approach p. 46
Mohamed Anbar
DOI:10.4103/ejos.ejos_21_17  
Purpose The aim of this study was to evaluate the safety and efficacy of asteroid hyalosis (AH) removal by means of anterior vitrectomy through posterior capsulorhexis during phacoemulsification. Patients and methods The study was conducted on 16 eyes of 16 cataractous patients associated with AH. Phacoemulsification was performed, followed by removal of the AH through posterior capsulorhexis by means of anterior vitrectomy and before intraocular lens implantation. Patients were examined at 1 day, 1 week, 1, 3, and 6 months postoperatively. Data were analyzed using paired t-tests to compare the preoperative and postoperative uncorrected visual acuity and corrected visual acuity. The basic postoperative parameters at each follow-up visit were assessment of uncorrected visual acuity and corrected visual acuity and slit-lamp examination to evaluate the corneal condition and to detect any postoperative inflammation. The disappearance of AH was confirmed clinically using slit-lamp examination. Results All patients in this study showed a statistically significant improvement in postoperative visual acuity (P=0.001) at the last follow-up visit. One patient who had diabetic retinopathy and maculopathy showed deteriorated visual acuity at the last postoperative visit (P=0.2). Two patients had suboptimal best-corrected visual acuity after 6 months due to the presence of cellophane maculopathy detected clinically and using ocular coherence tomography (OCT) examination (P=0.01). Conclusion Removal of AH by means of anterior vitrectomy during phacoemulsification through a posterior capsulorhexis is safe and effective and enables the surgeon to treat undiagnosed missed retinal lesions that were not obvious preoperatively.
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A prospective comparative study between trabeculectomy versus trabeculectomy with Ologen for patients with primary open-angle glaucoma at 3-year follow-up p. 51
Ahmed G Elmahdy
DOI:10.4103/ejos.ejos_20_17  
Background The aim of this study was to compare the outcomes of trabeculectomy with collagen implant versus conventional trabeculectomy for uncontrolled intraocular pressure (IOP). Patients and methods Sixty-eight eyes of 58 patients were randomly selected for trabeculectomy either with Ologen implant (the study group) or without implant (the control group). Preoperative history taking and examinations were carried out. Data including age, sex, glaucoma type, IOP, and numbers of postoperative glaucoma medications were collected. Postoperative IOP, number of postoperative glaucoma medications, and postoperative complications were recorded. Each patient was followed up for 3 years. Results No significant differences were observed between the two groups in terms of preoperative IOP and number of preoperative antiglaucoma medications. Postoperative IOP in the Ologen group was significantly lower than that in the control group at all follow-up visits; the mean IOP in the Ologen group was 12.88±2.37 mmHg and that in the control group was 17.26±2.72 mmHg (P=0.006). The mean number of antiglaucoma medications (0.61±0.15) in the Ologen group was significantly lower than that in the control group (1.48±0.19) at last visit (P<0.001). There were no statistically significant differences between the two groups as regards postoperative complications as observed in this study. Conclusion Trabeculectomy with Ologen showed significant advantages over trabeculectomy alone in terms of IOP. Large sample size is needed to confirm the safety and long-term outcome of trabeculectomy with Ologen.
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Retreatment of residual error after femtosecond laser-assisted in-situ keratomileusis in correcting high hyperopia p. 59
Amr A Gab-Alla
DOI:10.4103/ejos.ejos_17_17  
Purpose The aim of the present study was to evaluate the results of femtosecond laser-assisted in-situ keratomileusis (LASIK) in correcting high hyperopia. Patients and methods The study was carried out at El-Gowhara Eye Center, Ismailia, Egypt. A prospective case series study was carried out. Hyperopic eyes with a spherical equivalent (SE) greater than or equal to +3.00 D were corrected by LASIK. The flaps were created with the VisuMax femtosecond laser. The refractive ablations were performed with the 500-kHz Amaris excimer laser. Full cycloplegic refraction was the target refraction. Patients were divided into two groups. Group A included patients with residual refractive errors less than or equal to +0.50 D of the target refractions and had no further LASIK retreatment, and group B included patients with residual refractive errors greater than +0.50 D of the target refractions along with retreatment 1 month after the primary LASIK. The refractive predictability and stability of the treated and retreated eyes were followed-up for 6 months after LASIK. Results Sixty-four patients (115 eyes) received primary hyperopic femtosecond LASIK. The mean±SD age of all patients was 40.30±13.4 years with a range of 21–64 years. The preoperative mean±SD cycloplegic SE refraction was +4.29±1.5 D with a range from +3.00 to +9.00 D. One month after the primary LASIK treatment, 79.1% (91 eyes) of the treated patients had a mean cycloplegic SE refraction of +0.36±0.13 D (group A). After 6 months of follow-up, 62.6% of eyes (n=72) had an uncorrected distance visual acuity of 0.3±0.21 log MAR. Four (3.5%) eyes lost one line of corrected distance visual acuity (CDVA) (Snellen). Five (4.3%) eyes lost two lines of CDVA (Snellen). Seven (6.1%) eyes gained one line of CDVA (Snellen). Twenty-one (18.3%) eyes gained two lines of CDVA (Snellen). The mean±SD cycloplegic SE refraction was +0.41±0.32 D. In group B (20.9%) (24 eyes), patients had a mean±SD cycloplegic SE refraction of +2.41±0.96 D at the first month after primary LASIK. These patients required a second-stage LASIK retreatment by lifting the original flap. After 6 months of follow-up, 83.3% of eyes (n=20) had an uncorrected distance visual acuity of 0.6±0.13 log MAR. Seven (29.2%) eyes gained one line of CDVA (Snellen). Two (8.3%) eyes lost one line of CDVA, and two (8.3%) eyes lost two lines of CDVA (Snellen). The mean±SD cycloplegic SE refraction was +0.25±0.21 D. No epithelial ingrowth was recorded in both groups. Conclusion Femtosecond LASIK for the correction of high hyperopia is predictable and safe; 79.1% of the patients underwent correction during the primary treatments, and 20.9% were totally corrected after retreatments. No cases of epithelial ingrowth were recorded over the 6-month follow-up period.
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The effect of behavior disorders on ocular trauma and visual outcome in children in Middle Delta, Egypt p. 65
Rabab Elseht, Mohamed A Seleem
DOI:10.4103/ejos.ejos_16_17  
Purpose We sought to study the potential effects of child behavior disorders as well as the psychological profile and parenting style in children with ocular trauma and evaluate their effects with other traumatic associates on the visual outcome. Setting This study was conducted at Tanta University Eye Hospital, Middle Delta. Study design This was a nonrandomized cohort study. Patients and methods This study included all children at least 6 years with ocular trauma admitted to the Ophthalmology Department, Tanta University, from June 2015 to January 2016. Children were evaluated with regard to age, sex, time of seeking treatment, type, site of injury, and causative agent of trauma. Psychological assessment was carried out at the child psychiatry unit objectively using Western Psychological Services programs after trauma. Best-corrected visual acuity was detected at the last follow-up visit after trauma and was correlated to the behavioral disorders of children and the traumatic associates. Results In this study, we included 62 children aged 6–16 with an average±SD of 9.45±2.8 years. Among them, 71% were boys and 29% were girls (P<0.0001). Open globe injury was found in 37 eyes (59.7%), closed in 22 eyes (35.5%), and adnexal in three (4.8%). Single entry was a significant type of injury (P=0.0001), and sharp causative agents were many and variable. Certain psychiatric and parenting style problems were significantly associated with moderate and severe vision loss such as inattention, aggressive behaviors, attention deficit hyperactivity disorder (P=0.01), and oppositional defiant disorder with P=0.03. Conclusion Child behavior disorders and abnormal parenting style were significantly associated with ocular trauma in children. In addition, certain types and characters of trauma were effective in the visual outcome.
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