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   Table of Contents - Current issue
Coverpage
October-December 2018
Volume 111 | Issue 4
Page Nos. 127-163

Online since Wednesday, February 13, 2019

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ORIGINAL ARTICLES  

Comparative study of specular microscopy in type І diabetes with and without diabetic retinopathy compared with normal persons p. 127
Mohamed H.A Mohamed, Abd El Rahman G Salman, Thanaa H Mohamed, Yousra A.T Farweez
DOI:10.4103/ejos.ejos_43_18  
Purpose This study compared corneal endothelial changes in morphology and corneal thickness by specular microscopy in two groups of type I diabetes with and without diabetic retinopathy and were compared with a normal control. Patients and methods The study included 45 participants aged 19–29 years as follow: 15 eyes of 15 patients with type I diabetes without retinopathy (group I), 15 eyes of 15 patients with type I diabetes with retinopathy (group II), and 15 eyes of 15 normal persons matched for age and sex with the case groups (group III). Noncontact specular microscope (CEM-530; NIDEK) was used to assess the corneal endothelium for endothelial density, coefficient of variation in cell size, percentage of hexagonal cells, and central thickness of the cornea. Results There was a highly significant decrease in endothelial density (P=0.002) and hexagonal cell percentage (P=0.001) in diabetics compared with normal control. A highly significant increased variation in cell size (P=0.001) and corneal thickness (P=0.001) was reported in diabetics rather than control. Diabetic retinopathy tends to have no effect on corneal endothelial morphology such as endothelial density, variation in cell size, percentage of hexagonal cells, and corneal thickness. Conclusion Type I diabetes mellitus was found to affect corneal endothelial morphology such as decreased endothelial cell density and hexagonal cell percentage and increased cell size variability impairing the endothelial function leading to increased central corneal thickness.
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Lower lid retractors tucking with gray-line splitting procedure in the management of lower eyelid involutional entropion with misdirected lashes p. 132
Mahmoud A El-Samkary
DOI:10.4103/ejos.ejos_36_18  
Purpose The aim was to assess the outcome of a surgical technique of lower lid retractors tucking with gray-line splitting procedure in the management of patients with unilateral lower eyelid involutional entropion with misdirected lashes. Patients and methods This prospective case series included 60 patients with unilateral lower eyelid involutional entropion with misdirected lashes and no previous history of entropion correction surgery. Patients with cicatricial and traumatic lower lid entropion were excluded. Eyelid margin splitting was done first along the gray line, then lower lid retractors tucking was done through a transcutaneous incision using three horizontal 5-0 vicryl sutures and redundant skin was excised. All patients were followed up at 1 day, 1 week, and 3, 6, and 12 months postoperatively. Results Success rate after 1 year was 92.6% (n=50/54) and recurrence occurred in 7.4% (n=4/54). Overall, six patients were excluded owing to incomplete follow-up and excluded from statistics. Postoperative temporary ectropion occurred in 85% in the first 3 weeks. Patient opinion and satisfactions reached up to 92% at the end of the year. Conclusion Lower lid retractors tucking with gray-line splitting is a highly effective, simple surgical technique that is less traumatizing to conjunctiva and has good cosmetic results.
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Evaluation of the anterior chamber angle and filtering bleb morphology after phacotrabeculectomy by using anterior segment optical coherence tomography p. 137
Omnia Mohamed Osama AbdElHakam, Raafat Mohyeldeen Abdelrahman, Sahar Torky Abdelrazek, Ahmed Mostafa Eid
DOI:10.4103/ejos.ejos_22_18  
Purpose Evaluating the anterior chamber angle (ACA) and filtering bleb following phacotrabeculectomy by using anterior segment optical coherence tomography (AS-OCT). Patients and methods This is a retrospective study that included 30 eyes of 30 patients with cataract and glaucoma of both sexes and aged from 42 to 72 years. Patients attended the Ophthalmology Department of Minia University Hospital between June 2016 and November 2017. The duration of follow-up was 6 months. The patient’s underwent preoperative clinical and AS-OCT examination, followed by phacotrabeculectomy, and then postoperative AS-OCT to evaluate the angle and the filtering bleb. Results A total of eight patients were diagnosed with primary open-angle glaucoma and 22 with primary closed-angle glaucoma. Overall, eight (26.7%) eyes had closed angle in two quadrants: six (20%) eyes with closed superior and inferior quadrants and two (6.7%) eyes with closed nasal and temporal quadrants. Closed ACAs in three quadrants of the eye, the superior, nasal, and temporal quadrants, were found in six (20%) eyes. Closed ACAs in the four quadrants of the eyes were observed in eight (26.7%) eyes. Cystic blebs are highly elevated and hyporeflective (30% of cases). Diffuse blebs are moderately elevated with moderate reflectivity (50% of cases). Flat blebs are low with hyperreflectivity (20% of cases). Conclusion AS-OCT is an optimistic tool to investigate the filtering blebs. It was able to detect angle changes preoperatively and postoperatively and show the features of the bleb that are not properly detected by the slit lamp examination. It has the advantage over ultrasound biomicroscopy in being a noncontact, noninvasive procedure, allowing early postoperative examination.
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The efficacy of adjunct therapy by intravitreal aflibercept and laser versus triamcinolone and laser in the treatment of diabetic macular edema: a 6-month study p. 144
Ashraf H Soliman
DOI:10.4103/ejos.ejos_59_18  
Aim The aim was to compare visual and central macular thickness (CMT) improvement and complications of adjunct intravitreal aflibercept (IAI) (2 mg) 0.05 ml followed by argon laser photocoagulation with adjunct intravitreal triamcinolone 4 mg/0.1 ml followed by argon laser photocoagulation in treating diabetic macular edema. Patients and methods A total of 30 eyes of 26 patients with type II diabetes having visual loss owing to clinically significant macular oedema (CSME) and confirmed by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were included. Patients were randomly assigned into two groups: group 1 was treated by IAI (0.05 ml) 2 mg/4 weeks (2q4) for a total of five doses, and group 2 by intravitreal triamcinolone acetonide 4 mg/0.1 ml. Best corrected visual acuity (BCVA) and clinical examination were done monthly. OCT was done at 2, 4, and 5 months. At 5 months, and CMT allowing, FFA was done and laser photocoagulation was performed on distinct leakers. OCT and FFA were done at 6 months, and results were compared between the two groups. Results At 6 months, there was a statistically significant improvement (P<0.05) of CMT in the IAI group compared with IVTA group (P=0.04 and 0.469, respectively). The IVTA group showed an ill-sustained effect, where four cases required reinjection. BCVA for the IAI group continued to improve throughout the study period, with statistically significant values until the end point (P=0.033). IVTA group showed statistically significant improvement in BCVA at the 2-month and 4-month visits, but insignificant changes thereafter (P=0.76 at 6 months). These changes were similar to CMT. Overall, five (33%) eyes in the IVTA group had an increase in intraocular pressure (IOP), with the highest at 12th week, and were treated by topical timolol 0.5% bid. Moreover, one patient had a visually significant posterior subcapsular cataract, and phacoemulsification with intraocular lens (IOL) implantation was performed after the study. One case in each group developed self-limited vitreous hemorrhage, which resolved spontaneously. Conclusion IAI/laser provides superior and more sustained anatomical CMT and BCVA results with fewer complications compared with the intravitreal triamcinolone/laser.
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Adjustable strabismus surgery versus conventional surgery in esotropia p. 153
Karim Gaballah
DOI:10.4103/ejos.ejos_64_18  
Purpose The aim of this study is to compare the adjustable strabismus surgery with the conventional strabismus surgery. Patients and methods This is a randomized prospective study that was carried out by studying and comparing two groups of esotropia. The first group included 15 patients, in whom adjustable surgery was performed, and the second group included 15 patients, who were operated by conventional strabismus surgery, depending on the measured angle of deviation. The postoperative results were compared in the two groups on the postoperative day, and then after 1, 2, and 6 months. Results cases of the first group, had the suture attaching the muscle and tied intraoperatively by a suture, that can be advanced modified according to the resulting ocular alignment, these cases entered into the operating theatre, the second day of operation, and had the muscle suture advanced or released and tied finally so as to bring the eyes in the desired orthotropic position, but within 6 months, two patients had a residual angle of less than 10 prisms. Among the patients in the second group, in three cases, there was undercorrection as detected at the end of the follow-up period. Conclusion The results seemed comparable, the adjustable and the conventional surgery, and since the conventional surgery is requiring less manipulations and less exposure to anaesthesia, we recommend the conventional surgery in the cases when the results are predictable, and leave the choice of the adjustable suture technique in cases where the postoperative results cannot be predicted as in surgery of longstanding strabismus with known anatomical changes and to unexpected anatomical changes found during surgery.
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Medial rectus plication versus resection in adults with exotropia p. 158
Karim A Gaballah
DOI:10.4103/ejos.ejos_56_18  
Purpose The aim of this study is to evaluate the medial rectus (MR) plication as an alternative to MR muscle resection in adults with exotropia. Patients and methods This prospective study was performed in the period from January 2015 till end of June 2016, on 40 adult patients with constant exotropia, who were divided into two groups: group A including 20 patients who were operated by plication of the MR in one or two eyes, and group B included 20 patients operated by MR resection in one or two eyes. Cases were followed for a period of 1 year till end of June 2017. Results The postoperative correction was comparable in the two groups. There were no significant differences in postoperative correction and stability, but the plication technique could be safer in prevention of muscle loss and prevention of anterior segment ischaemia. Conclusion MR muscle plication technique can be adapted in the surgery of exotropia as a safer technique avoiding the risk of muscle loss and anterior segment ischemia.
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