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   Table of Contents - Current issue
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October-December 2017
Volume 110 | Issue 4
Page Nos. 110-142

Online since Thursday, March 8, 2018

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ORIGINAL ARTICLES  

Hydroxychloroquine retinopathy in a cohort of patients from upper Egypt Highly accessed article p. 110
Mortada A Abozaid, Esam Aboelfadl, Mohammed A Ismail
DOI:10.4103/ejos.ejos_39_17  
Purpose To identify risk factors and state demographics of a cohort of patients from upper Egypt experiencing hydroxychloroquine (HCQ) retinopathy. This was an observational study. This study was conducted in Sohag University Hospital, Egypt. Patients and methods The medical records of the rheumatology department were retrospectively reviewed to identify patients who stopped taking HCQ owing to its induced visual troubles. Ten patients were identified and were subjected to complete ophthalmological examination in addition to automated perimetry and optical coherence tomography of the macula. Results All patients (nine females and one male) had received HCQ 200 mg twice daily for years. The mean age was 59.1 years, mean real weight was 83.3 kg, mean height was 1.63 m, mean ideal body weight was 56.72 kg, and the mean daily dose per kg of ideal weight was 7.14 mg/kg/day, whereas the mean daily dose per kg of real weight was 4.85 mg/kg/day. Conclusion Calculation of HCQ dose according to the ideal weight is a better predector of retinal toxicity than real body weight.
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Measurement of central corneal thickness by different techniques p. 114
Reem Hassan Ibrahim Azzam, Manal Ali Kasem, Abeer Khattab, Hossam Mohamed Ali El-Fallal
DOI:10.4103/ejos.ejos_41_17  
Purpose The aim of this study was to compare the central corneal thickness (CCT) measurements by three different techniques: pentacam, noncontact specular microscopy, and ultrasound biomicroscopy (UBM) devices. Patients and methods This prospective observational cross-sectional study was performed on patients seeking medical care at the outpatient clinic of Ophthalmology Center at Mansoura University. They were consecutively recruited and selected, and measurement of CCT by pentacam, UBM, and specular microscopy was done. Thereafter, the results were compared as an evaluation study of all techniques. Results This study included 200 eyes of 100 patients. The age of the included patients in the study ranged from 20 to 50 years. The mean age was 34.56±9.94 years. The CCT ranged from 465 to 630 µm, with a mean of 532.88±34.15 µm when measured by pentacam. When measured by specular microscopy, it ranged from 456 to 601 µm, with a mean 531.92±33.64 µm, and when measured by UBM, it ranged from 463 to 602 µm, with a mean 533.97±31.10 µm, with P value of 0.824 (nonsignificant). Conclusion CCT measurements obtained by UBM tend to be thicker than those obtained by pentacam and noncontact specular microscopy, but the measurements of all three are strongly positively correlated with each other. So, any of these devices can be easily substituted by the other for the measurement of CCT.
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Internal limiting membrane dsytrophy: a case series study of a rarely reported retinal dystrophy p. 118
Hanem M Kishk
DOI:10.4103/ejos.ejos_43_17  
Purpose The purpose of this study was to describe the clinical features of 10 cases of a rarely reported internal limiting membrane dystrophy with glistening retinal reflex and peculiar fundus mottling. Patients and methods This is a retrospective review of 10 patients attending the outpatient clinic of Mansoura Ophthalmic Center in the period between 2000 and 2014. For all cases, measuring BCVA, fundus examination and fundus fluorescein angiography were done. Optical coherence tomography (OCT) was done for nine patients, with one patient missed (was not accessible for the investigation). Results The study included 10 unrelated patients − three female and seven male. The age ranged from 21 to 36 years (mean: 27±0.5 years). The mean visual acuity was 0.3±0.04. In all cases, fundus examination revealed the presence of a peculiar reddish mottling, with glistening retinal reflex and areas of epiretinal membranes and distortion of retinal blood vessels. Fundus fluorescein angiography revealed capillary dye leakage all over the retina with cystoid macular edema in five eyes. In one patient, abrupt cessation of retinal blood vessels was evident in the temporal retina. OCT revealed the presence of epiretinal membranes and schisis cavities in all retinal layers. Secondary choroidal neovascular membrane was evident in one eye. Conclusion Internal limiting membrane dystrophy is an extremely rare hereditary disorder that presents early in life (second-third decade) with early drop of vision. Clinically, it presents with glistening retinal surface, epimacular membranes and peculiar reddish mottling of the whole retina extending from the central retina to the far periphery. Fluorescein angiography shows capillary leakage all over the retina and cystoid macular edema. OCT shows schiscis cavities in all retinal layers. Some cases are complicated by choroidal neovascular membrane.
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Early ophthalmic findings in joubert syndrome p. 127
Amira A Abdelazeem, Olfat A Hassanin, Amal A Elgohary, Maha S Zaki, Amany H Galal, Joseph G Gleeson
DOI:10.4103/ejos.ejos_46_17  
Aim The aim of this study was to determine the early ophthalmic and electrophysiological features of Joubert syndrome (JS) in young Egyptian children and compare them with other studies. Patients and methods A prospective study was conducted of 10 children who initially presented with neurologic deficits and diagnosed clinically, with radiologic confirmation and secondary molecular diagnostic testing. A comprehensive paediatric, neurologic and ophthalmic evaluation was performed, including visual electrophysiology and ocular examination in conjunction with confirmed determination of probable and known causative variants in Joubert-associated genes. Structural and functional deficits were observed among the individuals within the cohort and compared with reported frequencies of these defects in prior reports. Results Patients’ ages ranged from 14 months to 4 years. Known causative mutations were found in eight of them and five (genes) with confirmation of separate alleles by parental testing. In two cases, molecular confirmation of the diagnosis was not obtained. The spectrum of observed abnormalities includes epicanthic folds, hypertelorism, ptosis, nystagmus, strabismus, lid retraction and chorioretinal degeneration. There were also delayed flash visual evoked potential (VEP) in all 10 cases. The electroretinogram responses (both scotopic and photopic responses) were greatly varied from normal to severely reduced responses, which have been previously reported. These abnormalities allow for subcategorization of the JS, which may correlate with the observed mutations. Conclusion Association of these findings with an expanded clinical definition of Joubert is warranted. The clinical subtypes of JS may be associated with specific types of mutations in the causative genes. This report, which evaluates the findings in a relatively young cohort, provides a unique opportunity to consider the earliest manifestations of JS that may lead to early recognition and appropriate genetic testing to confirm the diagnosis. Clinical findings beyond those identified in this report and by prior publications should be evaluated as potentially independent of the primary genetic condition rather than assuming that each new finding is part of the same syndrome.
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Light microscopic examination of the anterior chamber cells in uveitis p. 134
Eiman Abd El-Latif
DOI:10.4103/ejos.ejos_45_17  
Background Uveitis is a serious ocular condition with potentially blinding complications. It can be a sign of a large number of disorders with diverse etiologies, both infectious and noninfectious. Methods A prospective study was done on patients who presented with uveitis and grade 4 anterior chamber cells. A 0.1 ml aqueous sample was withdrawn under aseptic conditions in the operation theatre. All samples were prepared and examined by the same pathologist. Results Light microscopic examination of the aqueous sample from the 16 eyes with a hypopyon revealed predominant neutrophils. On the other hand, light microscopic examination of the aqueous sample from the 22 eyes without a hypopyon revealed predominant lymphocytes. Discussion The convection currents of the aqueous can be regarded as a vertically oriented centrifuge. Some centrifugal force is exerted on the particles suspended in the aqueous humor, and examples of these particles are inflammatory cells in anterior uveitis. Conclusion The predominant type of inflammatory cells is not the same in all cases of anterior uveitis.
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CASE REPORT Top

Fish-hook removal in a child from eyelid by modified retrograde technique: a case report p. 138
Pradnya Kamat, Swathi Mailankody, Pratik Doshi
DOI:10.4103/ejos.ejos_2_15  
Fishing is one of the most common activities in coastal areas. Improperly disposed fishing hooks are often used by children to play with and are potential sources of ocular injuries, ranging from simple to grievous damage. Here we report a case of a 6-year-old boy who presented with a rusted fish-hook embedded in his left upper eyelid. It was removed under local anaesthesia by modified retrograde technique. We concluded that in an otherwise unharmed eye, modified retrograde technique is a safe method of removing a small barbed fish-hook from the eyelid.
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Delayed retrobulbar hemorrhage after reconstruction of inferior orbital wall fracture: a case report p. 141
Bahram Eshraghi, Ali Torkashvand, Ramon Katoozpour, Pasha Anvari
DOI:10.4103/ejos.ejos_34_16  
A 25-year-old man presented with enophthalmos and hypophthalmos in the left eye, underwent orbital floor reconstruction. Three days after the initial surgery, the patient’s visual acuity (VA) reduced to finger counting at 3 m, intraocular pressure increased to 32 mmHg, and relative afferent pupillary defect was detected. Further, spiral computed tomography demonstrated retrobulbar hemorrhage. After cantholysis and canthotomy, the VA was 20/200, 4 h postoperatively. Within 3 days, VA improved to 10/10. Physicians should have a heightened index of suspicion and awareness of this uncommon complication.
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