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2015| January-March | Volume 108 | Issue 1
July 9, 2015
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Femtosecond laser intracorneal ring segment implantation based on a nomogram modification in type 1 and type 2 ectasia
Mouamen M Seleet, Ashraf H Soliman, Ola M Alaaeldin
January-March 2015, 108(1):1-5
The aim of the study was to evaluate the refractive, topometric and aberrometric changes in corneas with keratoconus treated with femtosecond laser intracorneal ring segment (ICRS) implantation following a proposed modified nomogram.
Settings and design
This is a retrospective, consecutive case series.
Materials and methods
ICRS implantation using the new proposed nomogram was performed in 10 eyes of seven patients with type 1 and type 2 keratoconus. Corneal tunnels were created using femtosecond laser, and KeraRings were inserted in all eyes. All cases were followed up every 3 months for 6 months using the Pentacam Phoenix system.
All analyses were performed with SPSS for windows 2007.
None of our patients developed complications related to ring placement, such as migration, extrusion or infection. In this limited case series an improvement was seen in uncorrected visual acuity (
P 0≤ 0.05), best spectacle corrected visual acuity (P
≤ 0.001) and refraction at 6 months (
< 0.001). Keratometric readings improved (
< 0.001), with flattening of the cornea. Corneal aberrations showed significant reduction when analysed by Zernike (
< 0.001) and Fourier analysis (
≤ 0.001). Corneal asphericity (Q value) also showed improvement (P < 0.05).
Femtolaser ICRS implantation using the proposed modified nomogram showed promising results in improving refraction, visual acuity, corneal topography and aberrations in patients with keratoconus.
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Incidence of retinal redetachment after silicone oil removal in cases of severe eye injuries operated during the 25th of January Egyptian Revolution
Ahmed M Abdel Hadi
January-March 2015, 108(1):15-20
This study aimed to evaluate the frequency of retinal redetachment after silicone oil removal (SOR) in cases of severe eye injuries operated during the 25th of January Egyptian Revolution; we also attempted to evaluate the causes behind the redetachment.
Patients and methods
This retrospective, noncomparative, interventional case series included patients who had undergone both vitrectomy and SOR. The cause for the primary intervention was penetrating posterior segment trauma with and without intraocular foreign body (IOFB). Indications for performing SOR were classified as increased intraocular pressure, decreasing best-corrected visual acuity because of incorrectable refractive error, and oil emulsification changes with a preceding adequate duration of silicone oil tamponade (at least 4 months) in the absence of any complication. After SOR, patients were followed up for a minimum duration of 3 months. Retinal redetachment was managed with a repeat vitrectomy and silicone oil infusion. Preoperative and intraoperative factors that might be related to the recurrent detachment were identified. We attempted to relate these factors to the redetachment.
The age of the patients ranged from 15 to 46 years, with a mean age of 31.07 8.3 years. The sample studied included 21 (70%) males. Preoperative retinal detachment (RD) was recorded before the first intervention in 17 (56.7%) eyes. IOFBs were found in 13 (43.3%) eyes. In nine (30%) cases, intraoperative retinotomy or retinectomy was performed to successfully flatten the retina. In the eyes with preoperative RD (17 eyes, 56.7%), an encircling band was fixed. The cause of SOR was found to be increased intraocular pressure in six (20%) eyes, decreasing best-corrected visual acuity because of incorrectable refractive error in 16 (53.3%) eyes, and oil emulsification changes in eight (26.7%) eyes. Before SOR all eyes showed an attached stable retina for a least 4 months. After 3 months of follow-up, seven (23.3%) eyes were found to have a recurrent RD. The cause for this recurrence was surmised to be because of proliferative vitreoretinopathy in two (6.7%) cases, reopening of an old break in another two (6.7%) eyes, and new breaks created because of aggressive proliferative vitreoretinopathy in three (10%) eyes. The recurrence of RD was not affected by the duration of silicone oil tamponade, preoperative RD, intraoperative retinotomy, an IOFB, the presence of vitreous remnants, and C3F8 fill with endolaser barrage at the conclusion of surgery (
= 0.76, 0.07, 0.64, 0.66, 0.54, 0.113, respectively). The only statistically significant correlation that we found was between the fixing of a tamponade and the rate of recurrence (
The routine use of silicone tamponade in complicated cases such as those with penetrating trauma, even if RD was not identified beforehand and the usage of an encircling bands in difficult cases with RD, may increase the success rate after SOR.
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Short-term outcome after artisan phakic intraocular lens implantation for treatment of high myopia
Hassan Mohamed Aly Adghaimy
January-March 2015, 108(1):6-9
The aim of this study was to evaluate the efficiency and safety after artisan phakic intraocular lens (IOL) implantation for treatment of high myopia.
The study was conducted in Qena University Hospital.
This was a prospective nonrandomized interventional case study. A total of 28 eyes in 24 patients having myopia ranging from −13 to −21 D underwent implantation of artisan phakic IOL (Ophtec; polymethylmethacrylate lens). Eyes were examined at day 1, 1 week, 1, 2, and 4 months after surgery. At each visit, the following data were recorded: manifest refraction, uncorrected visual acuity, best spectacle corrected visual acuity (BSCVA), change in BSCVA, slit lamp examination, applanation tonometry, as well as any adverse effects.
At 4 months postoperatively, the mean spherical equivalent was −1.5 D ± 0.6. The mean uncorrected visual acuity was 0.33 ± 0.17 and mean BSCVA was 0.48 ± 0.15. As regards the safety of artisan phakic IOL, the BSCVA remained the same or improved for all eyes; an average gain of 1.8 ± 0.62 lines of improvement was observed in 15 cases compared with preoperative BSCVA. Night glare/halos were noted in 10% of the eyes. Corneal edema was observed in one eye during the immediate postoperative period.
Artisan phakic IOL is a safe (short-term), efficient, and predictable modality for the treatment of high myopia. Improvement of postoperative vision is a valuable outcome.
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Evaluation of the dual staining technique for complete removal of idiopathic epimacular membranes
Ahmed M Abdel Hadi
January-March 2015, 108(1):10-14
This study tries to evaluate the usefulness of the dual staining first with Triamcinolone acetonide (TA) to effectively visualize and remove the fibrous component of idiopathic epimacular membrane (EMM) and then with brilliant blue G (BBG) to selectively remove the internal limiting membrane (ILM). The primary outcome was the visual acuity improvement and the concomitant decrease in the central macular thickness (CMT) after surgery, and the secondary outcome was the condition of the ILM after this dual staining.
Subjects and Methods
A prospective, non-randomized, observational cohort study including 15 eyes .The inclusion criterion was a clinically detectable idiopathic EMM diagnosed by fundus examination or optical coherence tomography (OCT), causing a decrease of visual acuity. The exclusion criteria included prior intravitreal injection of TA or antivascular endothelial growth factor, ocular inflammation or prior trauma. During a standard 23 G vitrectomy, peeling the EMM was carried out after administration of TA, BBG (0.25 mg /mL) was injected onto the retinal surface utilizing the ''dry method'' or the ''air-filled technique''. Both stains will be completely washed out immediately. Then the surgeon recorded the characteristics of the underlying ILM before peeling. Postoperatively the patients were followed up at 1 day, 1 week, 1 month and at 6 months. Primary and secondary outcomes were recorded.
Our patients included 8 (53.3%) females and 7 males (46.7%). A single surgeon performed all surgeries. TA was used to identify the posterior hyaloid in all 14 cases (93.3%) with no prior vitreous surgery and to effectively visualize and remove the idiopathic EMM in all 15 cases. Three (20%) of the cases had EMM remnants after BBG staining. When this dye was used to stain the ILM during surgery, the unstained EMM clearly stood out against the ILM, which was stained blue. After EMM peeling, all of the eyes had residual ILM except one (6.3%). In all eyes, the surgeon was unable to determine the status of the ILM before BBG staining. The ILM was present and damaged in 8 eyes (53.3%), while it was present and undamaged in 6 (40%). The mean preoperative CMT in eyes were the ILM was found to be damaged on table was 565.3 ± 79.9 μm, while the mean preoperative CMT in eyes were the ILM was undamaged was 446.6 ± 34.4 microns, this was statistically significant (
= 0.005). At 6 months, decimal BCVA improved from 0.18 ± 0.06 at baseline to 0.53 ± 0.11 (
= 0.005). Again at 6 months, the CMT also improved from 506.2 ± 90.03 ΅m at baseline to 365.8 ± 53.3 μm (
< 0.001) but none of the cases had a normal foveal contour.
In conclusion, dual staining starting with TA effectively led to adequate visualization and removal of the posterior hyaloid as well as the fibrous component of the idiopathic EMM. The subsequent BBG administration in an air filled vitreous (the dry technique) helped selective removal of the ILM with no deleterious effects on the functional or the anatomical outcomes of the procedure as demonstrated by the significant improvement in both the BCVA and the CMT 6 months after surgery.
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