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   Table of Contents - Current issue
January-March 2017
Volume 110 | Issue 1
Page Nos. 1-30

Online since Wednesday, May 17, 2017

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Evaluation of intraocular inflammation after intracameral injection of triamcinolone acetonide during pediatric cataract surgery p. 1
Ahmed G Elmahdy
Purpose The aim of this study was to evaluate the efficacy and safety of intracameral triamcinolone acetonide (TA) to control inflammation in pediatric cataract eyes undergoing cataract extraction. Patients and methods This prospective clinical study included 60 eyes of 47 patients who underwent elective cataract extraction with irrigation–aspiration under general anesthesia and were randomized to three groups. Eyes in group A were injected with 0.1 ml of 2 mg TA into the anterior chamber. Eyes in group B were injected with 0.05 ml of 1 mg TA into the anterior chamber, and eyes in group C were not administered TA. Postoperatively, in group C, topical prednisolone acetate 1% eye drops were administered six times per day for 7 days, followed by four times per day for 3 weeks, to control postoperative inflammation. In groups A and B, topical corticosteroids were not used. To evaluate the efficacy of intracameral TA, anterior chamber cells were measured on postoperative days 1, 7, and 30 using slit-lamp biomicroscopy. Results Both treatments were equally effective in controlling postoperative inflammation following irrigation–aspiration in congenital cataract. No statistically significant differences between groups were observed. Conclusion This study concluded that the use of TA as an intracameral injection during pediatric cataract surgery reduces aqueous cells, the main clinical findings in postsurgical inflammation.
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Corneal collagen cross-linking in patients with keratoconus associated with dry eye p. 8
Tamer H El-Sersy
Purpose The aim of this study was to assess the safety and efficacy of corneal collagen cross-linking in keratoconus associated with dry eye. Patients and methods This study included 35 eyes of 29 patients diagnosed as having keratoconus associated with moderate dry eye manifestations (as measured by Schirmer 1 test result of 8-4 mm after 5 min). Moreover, 12 keratoconic eyes were also included in this study without any manifestations of dry eye as a control group (as measured by Schirmer 1 test result of ≥15 mm after 5 min). All eyes were subjected to preoperative and postoperative assessments including uncorrected visual acuity, best-corrected visual acuity, pachymetry, simulated keratometry, and corneal topography. The thinnest corneal thickness was at least 400 μm in all eyes. As mentioned before, the degree of preoperative dry eye was assessed using Schirmer 1 test. Epithelium-on cross-linking technique was used. All data were analyzed and recorded. Results The results of ‘epithelium-on’ collagen cross-linking are variable, but its noninvasive nature makes it potentially useful in cases when epithelium debridement is better to be avoided, such as in patients with dry eyes. In our study, there was a remarkable improvement regarding postoperative uncorrected visual acuity and best-corrected visual acuity (one line or more). There was no statistical significant difference between the results among dry eyes and nondry eyes. Average K readings showed a marked reduction reaching more than 2 D. The mean astigmatism showed unremarkable changes. The main central corneal thickness showed marked corneal thinning with reduction in the corneal thickness of ∼50 μm or more in many eyes. Conclusion This study showed no significant difference in efficacy and safety of corneal collagen cross-linking among eyes with keratoconus either associated with dry eye or not.
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Study of the effect of different designs of nasal mucosal and lacrimal sac flaps on the success rate of external dacryocystorhinostomy p. 14
Ali M El Sawy, Momen M Hamdi, Sherif S Elwan, Tarek M Abdalla
Purpose The aim of this study was to assess the effect of the designing of four types of mucosal flaps on the success rates of dacryocystorhinostomy. Patients and methods In this prospective randomized study, dacryocystorhinostomy was performed for 128 eyes with nasolacrimal duct obstruction in adults complaining of epiphora. Patients were subdivided into four groups: group 1included 32 eyes in which only anterior flaps were sutured; group 2 included 32 eyes in which anterior flaps were sutured together with excision of posterior flaps; group 3 included 32 eyes in which anterior and posterior flaps were sutured; and group 4 included 32 eyes in which no flaps were created. Patients of all groups were followed up for 6 months. Assessment of operative success depended on subjective patient satisfaction − that is, stoppage or reduction in epiphora. Objective patency of fistula was assessed by means of positive syringing and estimating the area of the fistula using ultrasound. All data of four groups were statistically compared to assess significance. Results The success rate in group 1 was 100% in the first week, 100% after 1 month, and 93.8% after 6 months. The success rate in groups 2 and 3 was 100% in the first week, 100% after 1 month, and 96.8% after 6 months. There was no statistical significance for this disparity. The success rate in group 4 was 87.5% in the first week owing to fibrosis, 81.2% after 1 month, and 65.6% after 6 months. Using B-mode ultrasonography, the mean osteotomy area was 400mm2 intraoperatively for all cases, 337.4 mm2 (84.3% of intraoperative size) for the successful cases on the second postoperative day, and 32.2 mm2 (8% of intraoperative size) 6 months after the operation. Osteotomy size in unsuccessful cases was 237 mm2 (59.2% of intraoperative size) on the second postoperative day and 3.3 mm2 (0.8% of intraoperative size) 6 months after the operation. Conclusion Suturing of anterior suspended flaps in daryocystorhinostomies increases the success rate as in groups 1, 2, and 3. The difference between suturing, removing, or leaving the posterior flaps was found statistically nonsignificant. Thus, it can be judged intraoperatively according to its redundancy, ease of access, and operation time. It is not recommended to remove anterior and posterior flaps as this decreases the success rate significantly. The use of B-mode ultrasonography for follow-up of the osteotomy size postoperatively is recommended as a safe, effective, and noninvasive procedure.
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Choroidal thickness in healthy Egyptians and its correlation with age p. 22
Mona K Abdellatif
Purpose The aim of this study was to investigate choroidal thickness in healthy Egyptians and its correlation with age. Patients and methods This cross-sectional study included 134 eyes of 89 healthy Egyptians who were divided into three age groups: group 1, 20–40 years old; group 2, 40–60 years old; and group 3, more than 60 years old. Spectral-domain optical coherence tomography using enhanced depth imaging was used to calculate choroidal thickness map in the macular area. Eyes with high myopia and hyperopia were excluded. Results The mean (±SD) central choroidal thickness was 337.23±37.51, 285.29±31.23, and 270.24±22.37 µm in groups 1, 2, and 3 consecutively (P<0.001). The choroidal thickness was highest in the central 1 mm zone, followed by the superior quadrant, and the thinnest quadrant was the nasal one in the three groups. Regression analysis showed significant choroidal thickening in group 1 (B=4.941, P=0.001), nonsignificant thinning in group 2 (B=−0.301, P=0.739), and significant thinning in group 3 (B=−3.774, P=0.001). Conclusion Choroidal thickness varies significantly with age. Significant choroidal thinning starts in the fifth decade of life, but is more statistically significant after the age of 60 years. This proves that choroidal thinning is not fixed in all age groups.
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Ocular surface changes after simultaneous cataract surgery and limbal relaxing incisions p. 28
Mohamed A Ali, Ahmed Shawkat Abdelhalim
Purpose The aim of this study was to assess time-course changes of the ocular surface after simultaneous phacoemulsification and limbal relaxing incisions (LRIs) in the early postoperative period. Patients and methods We prospectively examined 35 eyes of 22 consecutive patients who underwent simultaneous cataract surgery with LRIs both preoperatively and postoperatively (1 week, 1 month, and 3 months). Ocular surface quality was assessed in terms of corneal sensitivity, tear break-up time (BUT), and tear production, both preoperatively and postoperatively. Corneal sensitivity was measured using the Cochet–Bonnet corneal aesthesiometer, and tear volume was determined using Schirmer’s I test. Results Corneal sensitivity was 58.5±3.9 mm preoperatively and was 58.3±2.7, 58.9±2.5, and 59.8±0.6 mm at 1 week, 1 month, and 3 months postoperatively, respectively [analysis of variance (ANOVA), P=0.13]. The BUT was 9.7±5.6 s preoperatively and was 5.6±3.1, 5.9±4.7, and 4.5±2.6 s at 1 week, 1 month, and 3 months, postoperatively, respectively (ANOVA, P=0.002). Tear volume was 15.2±8.8 mm preoperatively and was 12.2±6.9, 12.5±7.3, and 11.8±8.0 mm at 1 week, 1 month, and 3 months postoperatively, respectively (ANOVA, P=0.26). Conclusion Simultaneous phacoemulsification with LRIs induced a significant decrease in BUT postoperatively without significantly affecting tear volume or corneal sensitivity.
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