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   Table of Contents - Current issue
July-September 2019
Volume 112 | Issue 3
Page Nos. 67-115

Online since Wednesday, September 25, 2019

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Assessment of corneal endothelial cell changes caused by mitomycin-C application during pterygium surgery p. 67
Tarek M Radwan, Ahmed A Abdelghany, Amr A.F Ali, Ahmed A.B Abdel Aal
Background Topical Mitomycin-C (MMC) can have a deleterious effect onto corneal endothelium in some ophthalmic surgeries. Aim To evaluate safety of intraoperative topical MMC in pterygium surgeries onto corneal endothelium. Design Prospective comparative cohort study. Subjects and methods Forty-six patients were included in this study. Twenty-three patients underwent pterygium surgery with intraoperative MMC application (trial group) and equal number of patients underwent pterygium excision without MMC (control group) at the Suez Canal University Hospital. Corneal endothelial images were acquired with a specular microscope before surgery and at one week, one month, and three months following surgery. Results Mean preoperative endothelial cell counts were 2364±220 cells/mm2 in the pterygium excision without MMC group and 2411±227 cells/mm2 in the pterygium excision with MMC group (P=0.7). One week, one month and three months after surgery, the pterygium with MMC group showed a statistically insignificant endothelial cell loss (P=0.06) whereas the other group didn’t encounter any decrease in ECD (P=0.349), similar insignificant changes were found between the different measurements in the follow-up periods as compared to the preoperative measurements of central corneal thickness (CCT), cellular hexagonality, coefficient of variation and standard deviation of cell area as well as between patients of both groups. Conclusions A single intraoperative 0.02% MMC topical application using MMC solution-moistened cellulose sponges, onto the scleral bed under the conjunctiva with care not to touch the cornea has not resulted in a statistically-significant deleterious effect onto corneal endothelium.
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Prevalence of ectatic corneal conditions among keratorefractive candidates p. 78
Tarek M Abdullah, Amr I ElAwamry, Ossama T Nada, Walaa M Hamed
Background Noninflammatory corneal ectasias is a group of diseases including keratoconus (KC), pellucid marginal degeneration (PMD), and keratoglobus. KC is the most common form of corneal ectasia characterized by progressive thinning of the central or inferior cornea, causing corneal steepening and cone formation. The disease typically presents during the second decade of life and is bilateral, but often one eye precedes the other. Detecting the cases of subclinical KC had always been a challenge for refractive surgeons especially when the suggestive clinical signs and symptoms to differentiate subclinical KC from the normal are not observed. Aim The aim of the study is to determine the prevalence of ectatic corneal conditions among keratorefractive population admitted for refractive surgery at Al-Mashreq Eye Centre, during the period from June 2017 till December 2017, using data from the Scheimpflug tomographer imaging system. Patients and methods Our study was conducted on patients seeking consultation for refractive surgery at Al-Mashreq Eye Centre during the period from June 2017 to December 2017. We used the Pentacam device to screen 1439 refractive surgery candidates after being subjected to precise ocular examination and full general and ocular history taking. Results In our study, a total of 42 patients (84 eyes) showed topographic signs of manifest and subclinical KC, making a total prevalence of 3.0%. No cases with PMD or keratoglobus were found, but cases with KC having a topographic pattern mimicking PMD called pellucid-like KC were found in five eyes (three patients). Compound myopic astigmatism was the commonest refractive error in keratoconic eyes (71.4%). Conclusion Prevalence of KC in refractive population may reflect an approximate idea of its prevalence in general population. Meticulous examination before refractive surgery can forbid bad consequences in patients at high risk of developing post-laser-assisted in situ keratomileusis ectasia and may save patients discovered at mild or moderate KC stages from the ultimate fate of keratoplasty. Moreover, surgeons should be aware that hypermetropia and mixed astigmatism do not eliminate the possibility of an associated ectatic corneal disease.
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Twenty-three-gauge pars plana approach versus limbal approach for removal of congenital cataracts p. 90
Sara A Gawad, Eman A Awad, Sameh Saleh, Adel Ellayeh
Purpose To compare the 23-G vitrectomy system via pars plana approach with the limbal approach for the management of congenital cataract in Egyptian infants attending Mansoura Ophthalmic Center, Delta, Egypt. Patients and methods A total of 30 eyes of 21 infants with congenital cataract who attended Mansoura Ophthalmic Center, Egypt, were included. They were sorted out into two groups; each included 15 eyes. Group I underwent pars plana approach and group II underwent anterior limbal approach for phacoaspiration, posterior capsulorhexis, and anterior vitrectomy. Postoperative examination and follow-up results were recorded. Results There was significant statistical increase in mean duration of surgery in group I (59.27±12.69) than group II (39.93±9.04), with P value less than or equal to 0.001. There was no significant statistical difference in intraocular pressure values at preoperative period, at 1 week, 2 weeks, 1 month, 3 months, and 6 months postoperatively in the studied groups .There was no significant statistical difference in the incidence of visual axis opacification, secondary glaucoma, anterior chamber reaction, capsular phimosis, and wound leak between the two groups. However, there was a significant statistical increase in the incidence of preretinal hemorrhage in group I (26.7%, n=4) when compared with group II (0%, n=0), with P value of 0.032. There was no significant statistical difference in the incidence of secondary glaucoma during a 6-month follow-up period. Conclusion Posterior approach and anterior approach can be used safely for infantile cataract, and the application of the technique depends on surgeon experience and skills.
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Photorefraction vision screening: value, constancy and credibility p. 99
Ahmed F Gabr, Mohamed A Nassef, Shaimaa S Soliman
Background The purpose of this study was to compare photorefraction using Plusoptix vision screening with that of standard cycloplegic refraction, to detect variability between different observers. Patients and methods In this prospective comparative study, the right eyes of 203 children were included. Refraction was performed for each child using Plusoptix photorefraction screener by two separate observers. Under the effect of cyclopentolate eye drops, retinoscopic cyclorefraction was performed for those under 4 years of age, and cyclorefraction using autorefractometer was performed for those 4 years or older. Results In this study, 203 patients with 203 eyes were included, 110 (54.2%) of them were boys and 93 (45.8%) were girls. The mean age of the children was 6.61±4.49 years (range from 4 months to 16 years), and 74 (36.5%) of them were less than 4 years of age and 129 (63.5%) at least 4 years of age. There was no significant difference between the two observers, as regards mean spherical equivalent (+0.52±1.54 D with range of −3.8 to +5.38 for observer 1 and 0.540±1.63 D with range of −3.8 to +4.8 for observer 2). In all age groups, there was no significant difference between photorefraction results and the final objective refraction, as regards mean spherical equivalent (0.540±1.62 and 0.549±1.62 D, respectively). Myopic shift was noted with higher refractive errors. Conclusion Compared with standard cycloplegic refraction, photorefraction using Plusoptix screener was found to be a valuable and reproducible method in spite of the tendency to myopic shift at higher refractive errors in children.
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Trabeculectomy with Ologen matrix implant versus trabeculectomy with mitomycin-C in primary open-angle glaucoma p. 104
Tarek Mohsen
Background The purpose of this study was to compare the efficacy and the safety of trabeculectomy augmented with Ologen matrix implant versus mitomycin-C (MMC) in cases with primary open-angle glaucoma (POAG). Patients and methods This retrospective comparative study included patients with POAG who presented to the Ophthalmic Center, Mansoura University, from January 2016 to January 2017. Patients were allocated into two groups: group A patients underwent trabeculectomy with Ologen implant and group B included patients who underwent trabeculectomy with MMC. The primary outcome was the change in the intraocular pressure (IOP), with the recorded complications considered as the secondary outcomes. All the patients were followed up for at least 1 year postoperatively. Results A total of 30 eyes of 17 patients were included in the study. There was no statistically significant difference between the two groups in the baseline demographic or clinical data. The IOP dropped from 43.07±6.23 to 16.03±4.2 mmHg at the twelfth month in group A (P<0.0001) and from 41.41±5.11 to 15.13±2.75 mmHg in group B (P<0.0001). The mean IOP was continuously higher in group A than in group B along the follow-up points, but the difference was statistically insignificant (P>0.05). Hypotony with thin blebs was statistically higher in the MMC group. Conclusion Trabeculectomy augmented with Ologen implant seems to provide the same efficacy as MMC, with fewer complications in cases with POAG.
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Optical coherence tomography angiography in the diagnosis of choroidal neovascular membrane p. 108
Tarek A Mohsen, Hanem M Kishk
Aim To evaluate the ability to diagnose and identify the morphologic features of choroidal neovascular membranes by optical coherence tomography angiography. Patients and methods Prospective, observational study of patients with Choroidal neovascularization (CNV) attending the outpatient clinic of Mansoura Ophthalmic Center. For all patients fluorescein angiography (FA), spectral domain optical coherence tomography (SD-OCT), and swept source optical coherence tomography angiography were done. The results were analyzed and compared. Results This study included 23 eyes of 23 patients. Seven eyes had age-related CNV and 16 eyes had myopic CNV. Activity was evident in 20 cases with dye leakage in FA and fluid accumulation in SD-OCT, while in the other three cases, no active dye leakage was present in FA in one of them with minimal fluid in structural OCT; in the other cases, structural OCT showed minimal intraretinal fluid in one case and absent intraretinal fluid in the other case. Regarding cases with evident activity in fundus fluorescein angiography (FFA) and OCT, in two cases neovascular network was evident with glomerular appearance. In 18 cases, densely interlaced network of vessels was evident. In three cases without evident activity in other imaging modalities, the membrane appeared as a tangled network with filamentous vessels and loss of small branches. Conclusion OCT angiography is a noninvasive, safe imaging tool for the diagnosis of CNV which gives information about the accurate size and localization of the membrane. It is a nonexpensive and rapid method that can be used for the diagnosis, screening of patients at risk, differentiate between active and inactive membranes, and follow-up.
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