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   Table of Contents - Current issue
January-March 2018
Volume 111 | Issue 1
Page Nos. 1-42

Online since Thursday, July 26, 2018

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Ocular effects of hepatitis c virus antiviral drugs p. 1
Thanaa H Mohammed, Ali H Saad, Tarek M Yosef, Remon G Lamee
Purpose The goal of this research is to find out the incidence of any ophthalmic adverse effects associated with sofosbuvir − ribavirin combination therapy in comparison with sofosbuvir − ribavirin − interferon combination therapy in patients having chronic hepatitis C. Patients and methods A prospective nonrandomized comparative study was carried on 80 eyes of 40 patients with a documented diagnosis of chronic hepatitis C referred by the Internal Medicine and Hepatogastroenterology Department. Study group 1 (20 patients; 40 eyes) patients enrolled in the dual-therapy delineation (a 24-week regimen of 400 mg/day sofosbuvir and a 600 mg/day ribavirin) and study group 2 (20 patients; 40 eyes) patients registered in the triple-therapy planning (12-week regimen of sofosbuvir and ribavirin plus 180-µg peginterferon α-2a subcutaneously weekly). All recorded patients were subjected to entire ophthalmic examination before the medicaments strategy inauguration with periodic examination at 3 and 6 months during the treatment plan using Schirmer test and tear film breakup time test. Results Retinopathy has been evidenced at 3 months after treatment onset in 15% of group 2 candidates and receded at 6 months, which dates 3 months after treatment termination, with no cases of retinopathy in group 1 patients; the difference was statistically insignificant. Schirmer test and tear film breakup time results changed significantly over the 6-month study period. In study group 1, values of both tests decreased at 3 months after the start of sofosbuvir antiviral drug therapy and continued to dwindle throughout the period of follow-up. On the contrary, in study group 2, they decreased at 3 months after treatment onset but came to the common standard values 3 months after treatment discontinuation. Conclusion In our research, both study groups show that the drug-induced dry eye effects were in any event reasonably mild and had trivial effect on one’s daily performance. The retinal lesions in our patients were peacefully asymptomatic, as there were no effects on the best corrected visual acuity (BCVA) in all patients throughout the 6-month study period.
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Correlation of retinal nerve fiber layer thickness and perimetric changes in primary open-angle glaucoma p. 7
Ahmed E.Abd El-Naby, Hossam Y Abouelkheir, Hossam T Al-Sharkawy, Tharwat H Mokbel
Purpose This study aims at evaluating the relation between retinal nerve fiber layer (RNFL) thickness evaluated by spectral-domain optical coherence tomography (OCT) in primary open-angle glaucoma and visual field sensitivity. Patients and methods A total of 20 normal and 60 glaucomatous eyes were included in this study. Glaucomatous eyes were graded into early, moderate and severe stages according to Hodapp, Parrish, and Anderson classification. Complete ophthalmic examination, white-on-white perimetry and spectral-domain OCT were done for all patients. RNFL thickness of quadrants and average thickness were recorded. Area under receiver operating characteristic curves were used to assess the performance of OCT parameters. Results Average RNFL thickness was the best parameter to discriminate normal from early glaucoma, early from moderate and moderate from severe. Average RNFL loss was 14.9% in early glaucoma, 25.1% in moderate glaucoma and 37.2% in severe glaucoma. A significant correlation was detected between mean deviation and average RNFL thickness. Conclusion The present study found that average RNFL thickness has a good diagnostic value for diagnosis of glaucoma and for differentiating between glaucoma stages according to its severity.
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Ocular infections after penetrating keratoplasty p. 15
S.K. Prabhakar, Raghavender R Arra
Context Early diagnosis of ocular infections following penetrating keratoplasty (PK) depending on clinical presentation in addition to ancillary laboratory investigations facilitates preservation of useful vision and prevention of further intraocular spread. Aim The aim of this research was to study donor and recipient risk factors in post-PK ocular infections. Patients and methods This is an interventional prospective study. This prospective study was conducted in 34 patients who underwent PK under peribulbar anaesthesia from 2014 to 2016 in a tertiary hospital. Six patients developed signs and symptoms suspicious of postoperative infections. Inclusion and exclusion criteria are mentioned. MS excel was used for statistical analyses. Results The mean age was 53±18.04 years, ranging from 12 to 86 years with 24 (70.59%) male and 10 (29.41) female individuals studied. There were 24 (70.59%) right eyes and 10 left eyes (29.41). The mean age was 63.97±16.8 years among the donors. Six (17.64%) patients developed postoperative infections that included one patient with Pseudomonas aeroginosa keratoconjunctivitis, two patients with fusarium fungal keratitis and growth could not be established in the remaining three cases. Positive microbial identification by culture was possible in three (8.82%) patients. Conclusion Microbial identification was confirmed in three cases, and three cases were negative for growth. The risk factor found among recipients were vegetative injury, dust fall and eye rubbing, as well as taking a very hot bath. Graft clarity restoration significantly improved after topical management with fortified antibiotics and antifungal agents.
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Ultrasonic evaluation of eyes with blunt trauma p. 20
Mohamed A Elshafie, Hossam Y Abouelkheir, Maha M Othman, Eman M Elhefny
Purpose The aim was to present the common A-B scan ultrasonography (US) and ultrasound biomicroscopy (UBM) signs in Egyptian patients with blunt ocular trauma and compare them with the clinical findings. Materials and methods This prospective study included consecutive patients with blunt ocular injury attending the outpatient clinic of Mansoura Ophthalmic Center during the period from October 2013 to October 2014. All patients were subjected to thorough ophthalmic examination. All patients underwent US to assess the posterior segment of the globe and UBM for evaluation of the anterior segment. Results A total of 95 eyes of 95 patients were recruited in the study. Overall, 68% of them were males, and 73.7% were younger than 40 years. Stick and stone injuries were the causes of blunt ocular injury in 27.4 and 23.2%, respectively, and 42.1% of the patients had visual acuity between hand motion (HM) and perception of light (PL). Using UBM, traumatic hyphema was detected in 47.4% of patients whereas iridodialysis was seen in 26.3% of patients. The commonest findings in B-scan US were vitreous hemorrhage and retinal detachment (21.1% each). B-scan US and UBM detected structural changes that were missed or could not be detected by clinical examination especially with opaque media, which was statistically significant in cases of angle recession. Conclusion The findings of this study support the combined use of B-scan US and UBM in the evaluation of eye with blunt trauma.
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Ganglion cell complex changes with long-standing diabetic macular oedema among Egyptian diabetic patients: an optical coherence tomography study p. 25
Tamer A Refai, Amre A.H Hassan
Introduction Optical coherence tomography (OCT) is a valuable tool for imaging retinal thickness and structure as well as performing good evaluation for the ganglion cell complex (GCC) parameters, reflecting the status of retinal nerve fiber layer, the ganglion cell layer and the inner-plexiform layers. In this study, these parameters were evaluated in eyes with long-standing diabetic macular oedema, thus emphasising the importance of seriously treating macular oedema. Patients and methods Sixty eyes of 38 patients were included in the study. There were 38 eyes of 25 male patients and 22 eyes of 13 female patients. These 60 eyes were divided into two groups: group A (30 eyes) included eyes of patients with long-standing diabetic macular oedema (>1 year duration) and group B (30 eyes) included eyes of patients without apparent ocular pathology as a control. The age range was 23–73 years (mean 56.57±11.42) in group A and 30–74 years (mean 53.33±12.10) in group B. The duration of diabetes ranged from 1 to 25 years (mean 15.2±5.97) in group A. The patients were examined by an ocular response analyser (OCT-Optovue) that performs different GCC studies in addition to macular map analysis (EMM5). Best-corrected visual acuity in Snellen lines was also reported. Collected data were arranged and subjected to analysis using suitable statistical methods. Results In this study, a highly significant difference (P<0.01) was found with higher mean values for the diabetic macular oedema group for the GCC average (116.95±21.14 μm), GGC superior (121.80±28.36 μm), GCC inferior (116.16±25.52 μm) and focal loss volume (FLV=5.55±2.50%) compared with the control group, with GCC average of 97.29±6.32 μm, GCC superior of 96.49±7.90 μm, GCC inferior of 97.77±6.44 μm and the FLV of 1.26±0.90%. In addition, a statistically significant difference (P<0.05) was found with higher mean values for the global loss volume in diabetic macular oedema group [global loss volume (GLV=7.40±3.90%)] versus control group (GLV=5.49±3.27%). For the diabetic macular oedema group, the central macular thickness (μm) showed a highly significant correlation (<0.01) with the thickness (μm) of GCC average, GCC superior and GCC inferior and a statistically significant correlation (<0.05) with both of the GLV% and FLV%. For the diabetic macular oedema group, the duration of diabetes mellitus showed a statistically significant correlation (<0.05) with the FLV%, with a nonsignificant correlation (>0.05) with the other studied GCC parameters. Compared with normative data, FLV% was abnormal in 70% of eyes, borderline in 6.67% of eyes and normal in 23.33% of eyes in diabetic macular oedema group compared with the control group, which showed values of 0, 6.67 and 93.33% for abnormal, borderline and normal values respectively, with χ2-test showing a highly significant difference (χ2=30.718 P<0.001) between both the groups. Conclusion Compared with normal group, patients with long-standing diabetic macular oedema showed higher mean values for all GCC parameters, which were strongly correlated with the central macular thickness. The FLV% values in particular was abnormal in ∼70% of eyes with diabetic macular oedema in comparison with normative data, and it correlated strongly with the duration of diabetes, so we recommend considering this parameter (FLV%) for seriously treating diabetic macular oedema before permanent GCC damage occurs.
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Reoperation of strabismus in Mansoura Ophthalmic Center p. 33
Mona A Abd El-Ghaffar, Manal A Kasem, Amr M.H Alkannishy, Ibrahim T El-Adawe
Purpose This prospective study included 30 patients attending the outpatient clinic of Mansoura Ophthalmic Center during the period from November 2013 to November 2014. Patients and methods A total of 16 patients presented with residual deviations, five patients with consecutive deviation, one patient with new vertical deviation, and eight patients with mixed, new with either all cases residual and consecuitive. Reoperation was done for all cases, and all cases were followed up for 6 months postoperatively. Results Postoperative results, early follow-up and 6-month follow-up showed that 18 patients became orthotropic after reoperation, five patients became orthotropic on glasses after reoperation and seven patients needed re-reoperation. Conclusion There are many risk factors that may increase the incidence of postoperative unsatisfactory alignment after strabismus surgery, such as improper diagnosis, improper surgical decision making or improper surgical procedure. These factors can be avoided as much as possible, but even with accurate diagnosis, proper surgical plan and perfectly done surgery, reoperation may still be needed.
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Evaluation of central corneal thickness as measured by pentacam and retinal and choroidal thickness as measured by optical coherence tomography before and after uneventful cataract phacoemulsification in normal and diabetic patients without retinopathy p. 37
Bahaa El Din A Ali, Abd El Rahman G Salman, Ahmed A Mohamad, Michael Waheed F Shaker
Introduction Cataract phacoemulsification surgery is the commonest ophthalmological surgical procedure performed worldwide. In spite of the relative short duration, small incision, and relative low power used during the procedure, it causes an inflammatory reaction, compression, and hypoxia to the tissues. Every step of this maneuver can cause direct effects on tissue and ocular pressure fluctuation, which may lead to disruption of the corneal endothelium, blood–aqueous barrier, and blood–retinal barrier, leading to postoperative corneal edema, increased macular, and choroidal thickness. Purpose The purpose of this study was to evaluate central foveal thickness (CFT) changes and subfoveal choroidal thickness (SFCT) changes using spectral domain optical coherence tomography and central corneal thickness (CCT) changes using Pentacam, before and after cataract surgery, and to compare the results between two groups, that is, normal and diabetic patients without retinopathy. Patients and methods A prospective study was conducted, in which 40 eyes of 40 patients, 20 nondiabetic and 20 diabetic without retinopathy, who underwent cataract phacoemulsification were examined preoperatively, 1 week postoperatively, and 1 month postoperatively. The study was done in Kobri El-Kobba Military Hospital during the period from May to November 2017. Results Preoperative CCT was significantly higher in diabetic group than the nondiabetic group. There was also a significant increase in CCT 1 week postoperatively in both group, reaching its peak, and then gradual decrease to near preoperative values 1 month postoperatively. There was no significant difference in preoperative and postoperative CFT values between the two groups. CFT continued to increase till 1 month postoperatively reaching values significantly higher than preoperative values at 1 week and 1 month postoperatively. The preoperative SFCT was significantly higher in diabetic group than the nondiabetic group with no significant differences in the postoperative values between the two groups; it also continued to increase till 1 month postoperatively, reaching values significantly higher than preoperative values at 1 week and 1 month postoperatively. Conclusion Cataract phacoemulsification leads to temporary increase in CCT and long-term increases in CFT and SFCT in both diabetic and nondiabetic patients. Diabetic patients have higher central corneal thickness and higher SFCT than nondiabetics.
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