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   Table of Contents - Current issue
Coverpage
July-September 2017
Volume 110 | Issue 3
Page Nos. 71-108

Online since Monday, November 6, 2017

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ORIGINAL ARTICLES  

Incidence and risk factors of retinopathy of prematurity in neonatal intensive care units: Mansoura, Egypt p. 71
Rania M.R. Bassiouny, Rasheed S Ellakkany, Samy A Aboelkhair, Tarek A Mohsen, Ihab S Othman
DOI:10.4103/ejos.ejos_25_17  
Background Retinopathy of prematurity ROP is a leading cause of blindness affecting ∼50 000 children worldwide. The incidence of the disease varies among different countries, it is influenced by the level of perinatal care, the existence of screening programs for early diagnosis. Low birth weight BW, small gestational age GA, other antenatal, postnatal risk factors have been identified with their relation to the severity of the disease. Aim The aim of this research was to study the incidence and risk factors of ROP in preterm babies at neonatal intensive care units, Mansoura city. Patients and methods This study included 402 preterm infants admitted to neonatal intensive care units in Mansoura city in the period from March 2013 to March 2015. Fundus examination was done using indirect ophthalmoscopy and a 28 D lens, and fundus images were captured using wide-field digital fundus camera (Retcam 3). Results Out of the 402 screened preterm babies, 237 (59%) cases had ROP, among whom 101 (42.6%) had stage 1, 114 (48.1%) had stage 2, 12 (5.1%) had stage 3, 10 (4.2%) had aggressive posterior retinopathy, and 24 (10.1%) presented with plus disease. GA, BW, oxygen therapy, sepsis, multiple birth, and cesarean section were factors found to be significantly associated with the disease. Conclusion ROP occurred in 59% of all screened preterm babies. The main risk factors for the development of ROP were GA, BW, oxygen therapy, sepsis, multiple birth, and cesarean section.
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Prevalence of dry eye in diabetics p. 77
Silviana S Kamel, Thanaa H Mohammed, Yasser A El Zankalony, Ali H Saad
DOI:10.4103/ejos.ejos_19_17  
Purpose The aim of this work is to study the prevalence of dry eye in type II diabetic patients and to correlate the dry eye with the duration of the diabetes and the level of Glycosylated Hemoglobin (Hb 1 Ac). Patients and methods It is a prospective randomized study in which 100 eyes (50 diabetics, 50 control) with type II diabetes mellitus is included in the study attending in department of ophthalmology Ain Shams University. Dry eye was confirmed by tear film break up time (TBUT) and Schirmer I test. Results Schirmer and tear film BUT values were lower among the uncontrolled diabetic patients. There is highly statistically significant relation between severity of dry eye by Schirmer test with duration of diabetes, hypertension, Debris in tear film, degree of diabetic retinopathy, Glycosylated Hemoglobin (HbA1C), with P value 0.003, 0.044, 0.000, 0.000, 0.000 respectively. There is highly statistically significant relation between severity of dry eye by BUT test with duration of DM, HTN, Debris in tear film, DR, HbA1C, with P value 0.002, 0.032, 0.000, 0.001, 0.000 respectively. Conclusion Diabetic patients are more prone to suffering from dry eye than normal subjects. These abnormalities can result in severe complications. Early examination of the diabetic patients for the detection of the ocular surface disorders is indicated.
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Evaluation of anterior segment changes using ultrasound biomicroscopy following phacoemulsification and implantation of one-piece and three-piece intraocular lenses in high myopia p. 83
Reham Mohamed Samy, Ayser Abd El-Hameed Fayed, Tarek Tawfik Aboulnasr, Yousry Fekry Abdoh
DOI:10.4103/ejos.ejos_29_17  
Aim The aim of this research was to study the performance of the implanted one-piece and three-piece intraocular lenses (IOLs) in relation to the enlarged diameters of the capsular bags of the highly myopic eyes. Patients and methods Patients were randomly divided into two groups: group A included 15 eyes that underwent phacoemulsification with implantation of one-piece IOLs, and group B included 15 eyes that underwent phacoemulsification with implantation of three-piece IOLs. All patients included in this study were high myopes with axial length greater than 26.5 mm. All eyes were planned for clear lens extraction or cataract extraction. Results In group A, a statistically significant negative correlation was found between the diameters of the capsular bags and the diameters of the implanted one-piece IOLs. The correlation coefficient (r) is −0.56. In group B, a statistically significant positive correlation was found between the diameters of the capsular bags and the diameters of the implanted three-piece IOLs. The correlation coefficient (r) is 0.86. Conclusion The study of this correlation is to help in answering an important question − that is, does one diameter IOL fit all capsular bags? The statistical analyses in both groups point to a statistically significant correlation between the diameters of the capsular bags and the diameters of the implanted IOLs in both groups A and B, which demonstrates the absence of fitting of both sorts of IOLs in relation to the enlarged capsular bags of the highly myopic eyes − i.e. it focuses on the divergence between the size of the IOLs and that of the capsular bag.
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Correlation between the axial length and the effect of recession of horizontal rectus muscles p. 89
Manar A Ghali
DOI:10.4103/ejos.ejos_31_17  
Purpose The aim of this study is to determine whether the axial length (AxL) measurement would be useful in predicting the effect of horizontal rectus muscles recession. Patients and methods This study retrospectively reviewed 94 patients (52 with intermittent exotropia and 42 with infantile esotropia and partially accommodative esotropia), with age ranging from 4 to 15 years (7.63±3.2). All cases underwent bilateral lateral rectus recession for exotropia and bilateral medial recession for esotropia; there were no cases of combined vertical strabismus. There was no history of any ocular trauma or previous strabismus surgery. Preoperative angle of deviation, AxL (IOL Master), and postoperative angle of deviation at 6 months were recorded; effect of recession was calculated in all cases. Results The mean AxL for all cases was 23.39±1.73. The patients were divided into two groups: exotropia group (n=52) and esotropia group (n=42). Each group was subdivided into two subgroups: subgroup I (AxL<23.39) and subgroup II (AxL≥23.39). The effect of recession in exotropic group was 2.27±0.29; in short AxL subgroup, it was 2.42±0.17, and in long AxL subgroup, it was 1.98±0.25. In esotropic group, the effect of recession was 3.36±0.53; in subgroup I, it was 3.67±0.31, and in subgroup II, it was 2.87±0.44. Conclusion The results showed a negative correlation between AxL and effect of recession in both esotropia and exotropia groups. It is recommended to increase the amount of recession in longer AxL.
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Subfoveal choroidal thickness versus foveal thickness in patients with myopia p. 94
Walid Mohamed El-Zawahry
DOI:10.4103/ejos.ejos_32_17  
Purpose The aim of this study was to explore the influence of myopia on the foveal thickness and its correlation with subfoveal choroidal thickness (SFCT), the axial length (AL), and spherical equivalent (SD) in patients with myopia. Patients and methods We included 120 patients with myopia, and their ages ranged from 25 to 35 years. Moreover, 30 age-matched and sex-matched healthy emmetropic individuals were included as a control group. All participants underwent a complete ophthalmologic examination which included best-corrected visual acuity test, slit-lamp examination, Goldman applanation tonometry, indirect ophthalmoscopy, Axial length (AL) measurement (PacScan 300A, Sonomedescalon Inc., New York, USA), and spectral domain optical coherence tomography (Retinascan RS-3000 Advance, NIDEK, Gamagori, Japan). Results Foveal thickness was statistically higher in patients with myopia than that of healthy emmetropic participants, whereas SFCT was statistically lower in the patients with myopia than that of emmetropic individuals. Foveal thickness showed positive correlation with SD and AL, but it showed negative correlation with visual acuity (VA) and SFCT. SFCT showed significant positive correlation with the VA, but it showed negative correlation with SD, AL, and foveal thickness. Multiregression analysis showed that the most important determinant of foveal thickness in this study was AL and SFCT (β=0.35 and −0.66, respectively, and P<0.001 and <0.001, respectively). Conclusion With the increase in myopia degree and AL, the average foveal thickness increased and SFCT decreased. SFCT and AL are the most important predictive factors of VA in myopic eyes.
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Refractive error changes after bilateral medial rectus muscle recession surgery in congenital esotropia p. 100
Walid Mohamed El-Zawahry
DOI:10.4103/ejos.ejos_33_17  
Purpose The aim of this study was to evaluate the changes in refractive errors after bilateral medial rectus muscle recession surgery in children with congenital esotropia. Patients and methods Medical reports of 75 children with congenital esotropia were retrospectively reviewed. All included patients attended the Ain Shams University hospitals for undergoing bilateral medial rectus muscle recession surgery from January 2013 till January 2016. Cycloplegic refraction was done preoperatively and 3 months and 1 year postoperatively. Spherical equivalent (SE) was calculated to determine the amount of change in refractive error especially astigmatism and its axis. Patients were excluded if neurological abnormalities or developmental delays were documented and if structural eye abnormalities were present. Results Significant myopic shift and astigmatic change were determined in the SE refraction in the early postoperative period (3 months); however, these changes disappeared in the long term (at the postoperative first year). Conclusion Only the early postoperative period showed significant change in the SE value with myopic shift that necessitates early postoperative visual rehabilitation for fear of recurrence of the deviation or development of amblyopia.
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Adult divergence insufficiency esotropia: a comparison of lateral rectus resection, medial rectus recession, and miniplication of lateral rectus p. 105
Manar A Ghali
DOI:10.4103/ejos.ejos_34_17  
Purpose The aim of this study was to compare the outcomes and efficacy of three surgical procedures for correction of adult divergence insufficiency esotropia: lateral rectus resection (LRR), medial rectus recession (MRR), and Wright lateral rectus miniplication (LRMP). Patients and methods A retrospective study was conducted on 22 patients with adult divergence insufficiency esotropia who were operated between 2012 and 2016; eight of them underwent LRR, six underwent MRR, and eight underwent LRMP. Their age ranged from 45 to 68 years. Esotropia was at least 10Δ greater at distance than at near. All patients did not have significant esotropia at near [0–6 prism diopter (PD)] with fusion at near; all of them complained of diplopia for far with no underlying neurological diseases. The mean follow-up period was 24 (12–40) months. Achieving single vision at far and postoperative deviation of up to 5 PD was considered a successful result. Results Age at presentation was 45–68 years, with mean age of 56.8±7.7 years. All the cases underwent bilateral surgeries. In group LRR, the preoperative angle of deviation at far was 20.5±5.8 prism diopter(PD) and for near was 2.9±2.4 PD. In group MRR, the preoperative angle of deviation at far was 21.7±6.1 PD and for near was 3.5±2.8 PD. In group LRMP, the preoperative angle of deviation at far was 21.4±8.5 PD and for near was 3.1±2.7 PD. Postoperative, no cases of diplopia were reported along the follow-up period in groups MRR and LRMP, whereas one case of the eight cases of group LRR showed diplopia. The postoperative angles for far in LRR, MRR, and LRMP groups were 2.38±2.1, 2.5±2.3, and 2.25±1.8 PD, respectively. Conclusion The three procedures had excellent outcomes in eliminating diplopia and postoperative alignment, but LRMP has the advantage to be vessel sparing, less invasive, reversible, and being able to be done with topical anesthesia.
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