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ORIGINAL ARTICLES
Possible changes in intraocular pressure measurements after corneal collagen cross-linking with riboflavin and ultraviolet A in eyes with keratoconus
Iman M Eissa, Mostafa A El-Husseiny, Ahmad Ismail
July-September 2013, 106(3):168-171
DOI:10.4103/2090-0686.127378  
Purpose The aim of the study was to determine the possible effect of corneal collagen cross-linking (CXL) with riboflavin and ultraviolet A on intraocular pressure (IOP) measurements using Goldmann applanation tonometry (GAT) in eyes with keratoconus. Design The study was designed as a prospective case series and conducted in Al Haram Eye Center and RCC Hospital, Giza, Egypt. Materials and methods This noncomparative study measured IOP using GAT before CXL and at 3, 6, and 12 months after CXL. Results The study evaluated 49 eyes (40 patients). There was a statistically significant increase in the measured IOP at 3, 6, and 12 months after CXL (P<0.001). The mean preoperative IOP was 11.2 mmHg (1.29 SD), whereas the mean postoperative IOP was 12.24 mmHg (1.13 SD) at 3 months, 12.37 mmHg (1.13 SD) at 6 months, and 12.55 mmHg (1.12 SD) at 12 months. We also found a direct correlation between preoperative central corneal thickness and IOP measurements at postoperative examinations. However, postoperative IOP measurements were not correlated with patient age, sex, or preoperative keratometric readings. Conclusion After riboflavin-ultraviolet A CXL in eyes with keratoconus, there was a significant increase in IOP measured using GAT, which was probably caused by an increase in corneal rigidity and not a true increase.
  3,356 111 -
Botulinum toxin A-induced ptosis: A safe and effective alternative to surgical tarsorrhaphy for corneal protection
Hany A Khairy
January-March 2014, 107(1):20-22
DOI:10.4103/2090-0686.134937  
Aim The aim of the study was to evaluate the corneal protective effect of botulinum toxin A-induced ptosis in the treatment of various corneal pathological conditions in which surgical tarsorrhaphy was indicated. Patients and methods This prospective study included 25 eyes (25 patients) with various ocular conditions in which surgical tarsorrhaphy was indicated, and it was replaced by botulinum toxin A injection. Corneal pathology included 16 patients with resistant fungal ulcers, four with persistent corneal epithelial defect, one with central corneal melt due to rheumatoid arthritis, and four with Bell's palsy. Patients were injected with a dose of 5 U of Botox A using a 26-G insulin syringe. Patients were followed up daily during the first week, and if they did not achieve complete closure of the lid aperture repeat injection of 5 U was given. Results All patients had complete ptosis; however, six (24%) required repeat injection after 1 week. Superior rectus underaction was not recorded in any patient. Corneal pathology was improved in all, but one patient had corneal melt secondary to rheumatoid arthritis and required a tectonic corneal graft. The main duration for complete ptosis to develop was 6.8 ± 1.96 days (range 5-12 days). The duration for induced ptosis to recover was 55.64 ± 10.24 days (range 44-66 days). Conclusion Botulinum toxin A-induced ptosis is a good alternative to surgical tarsorrhaphy as a means of corneal protection in various forms of corneal pathology.
  1,819 135 -
Misdirection (aberrant regeneration) of the third cranial nerve
Sayed A Sayed, Mahmoud Rabea
July-September 2013, 106(3):150-152
DOI:10.4103/2090-0686.127361  
Purpose Head trauma can lead to aberrant regeneration of the third cranial nerve (oculomotor nerve). Background Aberrant regeneration of the third cranial nerve is most commonly due to its damage by trauma. Case report We report here the case of a patient who, following severe head injury, suffered from diplopia, abnormal deviation of the right eye (exotropia, moderate limitation in elevation and adduction), and overaction of the left lateral rectus. Neither ptosis nor limitation of sursumduction was seen in the right eye. Surgery was carried out for relieving diplopia due to aberrant regeneration of the third cranial nerve affecting the right eye. Right medial rectus resection (7 mm) and left lateral rectus recession (9 mm) were performed. Diplopia disappeared in the sixth week after operation. Conclusion Traumatic third nerve palsy may result in aberrant regeneration of the third cranial nerve. The full-blown features of this syndrome may or may not be present. Diplopia was relieved by performing surgery in both the affected eye (right medial rectus resection) and the healthy eye (left lateral rectus muscle recession).
  1,827 105 -
Corneal intrastromal MyoRing implantation in keratoconus treatment
Ahmed M Saeed
April-June 2014, 107(2):106-112
Purpose The aim of this study was to evaluate the efficacy and safety of MyoRing implantation into a corneal stromal pocket using the corneal intrastromal implantation system for keratoconus (KC) treatment. Patients and methods This nonrandomized prospective clinical trial included 22 eyes of 22 KC patients. The MyoRing was inserted into a 300-μm corneal pocket centered on the corneal reflex. Follow-up for 6 months with measurement of uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), and Pentacam corneal imaging was performed. Any surgical complication was reported. Results There was a high statistically significant improvement in UCVA, BCVA, K1 , K2 , and Km when comparing preoperative with all postoperative values (P < 0.001). The mean UCVA increased from 0.12 ± 0.17 to 0.5 ± 0.24 and the mean BCVA from 0.3 ± 0.143 to 0.7 ± 0.22 at 6 months postoperatively (P < 0.001). The mean K1 , K2 , and Km values decreased from 48.45 ± 3.79, 54.46 ± 3.94, and 51.31 ± 3.56 to 45.79 ± 2.97, 42.56 ± 3.17, and 49.07 ± 3.33, respectively, at 6 months postoperatively. Meanwhile, no statistically significant changes in the mean corneal astigmatism and thinnest location values were reported (P > 0.05). Three patients with severe KC underwent position adjustment of the implant. No detectable intraoperative or postoperative complications were observed in any of the cases. Conclusion MyoRing intrastromal implantation could represent an efficient, safe, modifiable, and simple therapeutic option for KC management.
  1,757 127 -
Inferior rectus tucking versus combined superior rectus recession with posterior fixation suture (faden) for the treatment of dissociated vertical deviation without inferior oblique overaction
Mohamed Mostafa K Diab
October-December 2013, 106(4):239-244
DOI:10.4103/2090-0686.131573  
Purpose To compare the efficiency of inferior rectus tucking versus combined superior rectus recession with posterior fixation suture (Faden) for the treatment of dissociated vertical deviation (DVD) without inferior oblique overaction. Patients and methods In this prospective study, 50 consecutive patients with DVD and without inferior oblique overaction were allocated randomly in their order of presentation to two groups; each group included 25 patients. The patients in group I were subjected to combined bilateral superior rectus recession and the Faden procedure (posterior fixation) and the patients in group II were treated by bilateral inferior rectus tucking (plication). Results DVD improved significantly (P < 0.05) in the two groups of the study. In group I, the mean vertical deviation improved from 18.21 ± 4.73 prism diopter (PD) preoperatively to 7.82 ± 5.61 PD 9 months after surgery (P < 0.05), with a mean correction of vertical deviation of 10.21 ± 3.52 PD and a mean correction of asymmetry of 2.1 ± 1.6 PD. Four patients needed inferior rectus tucking for residual or recurrent manifest DVD. In group II, the mean vertical deviation improved from 17.97 ± 6.89 PD preoperatively to 6.97 ± 5.46 PD 9 months after surgery (P < 0.05), with a mean correction of vertical deviation of 11.34 ± 2.71 PD and a mean correction of asymmetry of 2.5 ± 1.3 PD. Five patients needed inferior rectus retucking for residual manifest DVD. Conclusion Inferior rectus tucking is as effective as superior rectus recession with posterior fixation sutures for the primary treatment of DVD without inferior oblique overaction. Inferior rectus tucking can also be used effectively for the treatment of residual and recurrent DVD; further studies are recommended in this field.
  1,736 82 -
Preperiosteal suborbicularis oculi fat lift blepharoplasty
Sherif Elwan, Saad Rashad, Thanaa H Mohammed, Yousra A Farweez
October-December 2013, 106(4):223-225
DOI:10.4103/2090-0686.131560  
Aim The aim of this study was to determine the effect of preperiosteal suborbicularis oculi fat (SOOF) lift blepharoplasty in the treatment of tear-trough (nasojugal) deformity. Patients and methods A prospective interventional case study was carried out on 10 eyelids (five patients; four women and one man), age range 40-70 years (mean ± SD, 58.0 ± 11.0); all of them had tear-trough deformity as a part of midfacial aged appearance with prolapsed orbital fat. A preperiosteal SOOF lift blepharoplasty was performed under local or general anaesthesia, adding a preseptal orbicularis oculi muscle sling and lateral canthal resuspension in cases of lower lid laxity. The tear-trough deformity was observed objectively and subjectively, and reported over the following 6 months. Results All patients showed improvement in the tear-trough deformity 1 month postoperatively. None of the patients required repeat surgery at the end of the follow-up period (6 months). Early postoperative complications (1 day postoperative) included periorbital oedema, ecchymosis and conjunctival chemosis (10 eyes, 100%), subconjunctival haemorrhage (two eyes, 20%), brownish skin pigmentation (four eyes, 40%) and epiphora (four eyes, 40%). Lid retraction was observed in one eyelid (10%, 1 month postoperative) and numbness of the ipsilateral cheek in six eyelids (60%). Conclusion SOOF elevation can be used as a part of a routine lower lid blepharoplasty for the treatment of the tear-trough deformity. It may be considered a safe addition to other techniques of midfacial rejuvenation.
  1,055 726 -
Nonincisional (threading) levator plication in mild and moderate blepharoptosis: a novel technique
Mohsen S Badawy, Osama M El Nahrawy, Ahmed A Abdelghany, Heba M Khalaf
July-September 2014, 107(3):191-199
DOI:10.4103/2090-0686.148171  
Purpose The aim of this study was to evaluate our technique of nonincisional (threading) levator plication operation in cases of mild to moderate blepharoptosis. Setting Ophthalmology Department, Suez Canal University Hospital, Ismailia, Egypt. Design This study was interventional in design. Patients and methods We perform nylon threading 7/0 through the skin using a guiding syringe needle gauge no. 21 and the superior levator palpebral muscle and Mόller's muscle are tucked in by sutures guided to the tarsus surface; then, threads are tightened till the lid margin is elevated to the correct level, and the thread is knotted and inserted under the skin and orbicularis muscle. A total of 21 eyelids of 18 patients were subjected to this procedure. Results A total of 18 patients (12 male and six female, mean age 40 years) were studied. Nineteen eyelids were normally corrected or within 0.5 mm of normal, yielding a success rate of 90.5%. One (4.8%) patient was elevated within 1 mm of normal, and it was accepted. One (4.8%) eyelid was undercorrected and it wasn't accepted. An excellent lid contour was noted in all cases, except one, in whom a slight irregularity of the lid margin was observed, which was corrected spontaneously within 1 month. Conclusion The nonincisional (threading) levator plication technique is a safe and effective surgery for the treatment of mild to moderate blepharoptosis. It has a high success rate and good cosmetic outcome.
  1,644 109 -
The visual outcome of anisometropic amblyopia after laser-assisted in-situ keratomileusis surgery
Hussien S El-Nahas, Mervat E Elgharieb, Yasser M Khalifa, Sarah A Abou El-Ela
July-September 2013, 106(3):123-128
DOI:10.4103/2090-0686.127344  
Purpose To evaluate the visual outcomes of patients with anisometropic amblyopia after laser in-situ keratomileusis (LASIK) surgery. Patients and methods LASIK was performed in 24 anisometropic amblyopic eyes of 24 patients. All eyes were amblyopic and received the standard amblyopia treatment (occlusion and/or optical penalization). The mean age of the patients was 21.62 ± 9.55 SD years, ranging from 6 to 42 years. The mean myopic error ± SD was -5.7 ± 2.25 (range from −11.5 to −3.25) and the mean hypermetropic ± SD was +3.5 ± 0.95. Results The preoperative mean uncorrected visual acuity ± SD was 0.11 ± 0.06 and became 0.56 ± 0.18, whereas the preoperative mean best corrected visual acuity was 0.39 ± 0.13 and became 0.57 ± 0.17 6 months postoperatively. Uncorrected visual acuity of all patients improved significantly about three or more lines in Snellen's chart. The best corrected visual acuity of about 79% of the patients improved by one or more lines in Snellen's chart. Conclusion LASIK is an effective option for the correction of high myopic or hypermetropic anisometropia. Recommendations LASIK surgery could be recommended in all types of anisometropic amblyopic patients in whom traditional management failed and who were intolerable to glasses or contact lenses. Amblypoia management should be continued postoperatively. Further studies are recommended to assess factors affecting anisometropic amblyopia management by LASIK, such as age, refraction, depth of amblyopia and response to conventional therapy.
  1,631 120 -
Long-term visual performance of AT LISA 909M multifocal toric intraocular lenses
Abdelrahman G Salman
July-September 2013, 106(3):199-205
DOI:10.4103/2090-0686.127405  
Purpose The aim of the study was to analyze the subjective and objective visual and astigmatic effect of AT LISA 909M multifocal toric intraocular lenses (IOLs) for far and near vision after 1 year of implantation. Design This is a prospective nonrandomized interventional case series. Methods After cataract surgery with implantation of AT LISA 909M multifocal toric IOLs, the visual, refractive, and corneal topographic outcomes, lens rotation, contrast sensitivity, and patient satisfaction were evaluated over 12 months and analyzed. Refractive astigmatic changes (target-induced astigmatism, surgically induced astigmatism, difference vector, magnitude of error, and flattening effect) were analyzed using the Alpins vectorial method. Results The study enrolled 22 eyes (11 patients). Postoperatively, a significant reduction was observed in the refractive cylinder (P < 0.05) with an associated visual improvement in distance (P < 0.001) and near (P < 0.05) vision. Spectacle independency for distance and near vision was achieved in 95 and 90% of patients, respectively. After 1 year, significant stability of the IOL and patient satisfaction were observed for both distance and near vision. The Alpins correction index was +1.02. Conclusion The AT LISA 909M multifocal toric IOL resulted in long-term visual improvement in distance and near vision with good predictability in eyes with moderate-to-high corneal astigmatism undergoing cataract surgery.
  1,612 98 -
Retropupillary fixation of iris-claw intraocular lens versus trans-scleral suturing fixation for aphakic eyes without capsular support
Dina Mohammad Rashad, Omar Mohammad M Afifi, Gamal A.M. Elmotie, Hatem Amin Khattab
October-December 2015, 108(4):157-166
DOI:10.4103/2090-0686.174638  
Purpose The aim of this work was to compare retropupillary fixation of an iris-claw intraocular lens (IOL) (Verisyse) with trans-scleral suturing fixation for aphakic eyes without sufficient capsular support as regards the safety and complications of the procedure. Design This study was an interventional comparative prospective one. Patients and methods A total of 42 aphakic eyes of 40 patients were divided into two equal groups: 21 eyes were offered iris-claw IOL and 21 eyes were implanted with scleral-fixed IOL. Intraoperative data (mainly surgical time and intraoperative bleeding) and postoperative data [mainly corrected distance visual acuity (CDVA), intraocular pressure, and postoperative complications] were compared between the two groups during the follow-up period (first day,1 week, 2 weeks,1 month, and after 3 months). Results The mean surgical time in the iris-claw group was 24.77 ± 4.8 min, whereas the mean surgical time in the scleral fixation group was 67.09 ± 8.1 min, with a statistically significant difference between the two groups. On the first postoperative day, the CDVA ranged from 0.06 to 0.5 in the iris-claw group, with a mean of 0.22 ± 0.116, and it ranged from 0.05 to 0.15 in the scleral fixation group, with a mean of 0.10 ± 0.032; there was a statistically significant difference between the groups (P = 0.00021). However, after the first 3 months postoperatively, the CDVA ranged from 0.25 to 1.0 in the iris-claw group, with a mean of 0.51 ± 0.25, and it ranged from 0.15 to 0.6 in the scleral fixation group, with a mean of 0.42 ± 0.16; there was no statistically significant difference between the two groups (P = 0.152). On the first postoperative day, the mean intraocular pressure in the iris-claw group was 15.62 ± 2.59 mmHg, whereas in the scleral fixation group it was 19.62 ± 3.94 mmHg, with a statistically significant difference between the two groups (P = 0.00038). The iris-claw group showed higher rates of anterior chamber reaction, pupillary distortion, and cystoid macular edema postoperatively. In contrast, the rates of corneal edema, vitreous hemorrhage, and conjunctival erosion were higher in the scleral fixation group. Conclusion From our results, it is evident that iris-claw IOLs have now matured to a stage when they can be used with considerable safety and efficacy. The new designs, as well as the evolution of surgical techniques and instrumentation, have made them the best option for primary or secondary implantation in aphakic eyes. The surgical procedure is easier, shorter, and safer than those used for scleral-sutured IOLs.
  839 800 -
Quantitative assessment of optic disc edema using spectral domain optical coherence tomography
Ahmed Mohamed Kamal Elshafei, Raafat Mohyeldeen Abdelrahman, Heba Radi AttaAllah
April-June 2014, 107(2):49-54
DOI:10.4103/2090-0686.140626  
Introduction Optic disc edema (ODE) can be caused by a variety of conditions including pseudotumor cerebri, hypertension, diabetes, uveitis, anemia, lymphoma, and papillitis. Improvement in the quality of optical coherence tomography (OCT) can support the diagnosis and management of ODE. OCT may help in this diagnosis by showing peripapillary retinal nerve fiber layer (RNFL) thickening. Aim of the work To evaluate quantitative assessment of optic disc edema by measuring peripapillary nerve fiber layer (RNFL) thickness, and peripapillary maximum neurosensory retinal (MNSR) thickness in the four quadrants using spectral domain OCT. Patients and methods The study was done in El-Minya Investigation Eye Center between May 2012 and May 2013. The study included 21 eyes of 16 patients with optic disc edema and 20 eyes of 11 normal control persons. Both patients and normal control were examined by spectral domain OCT, two sets of measurements were evaluated and compared: Peripapillary RNFL thickness measurement in four quadrants using the standard optic disc cube 200 × 200 acquisition protocol, spectral domain OCT, Peripapillary maximum neurosensory retinal thickness (MNSR) in four quadrants using high definition 5 line images. Results In ODE group, 21 eyes of 16 patients were evaluated. The control group included 20 eyes of 11 normal subjects. The Mean average peripapillary RNFL was 93.1 ± 8.2 in control group 132.3 ± 46 µ in mild ODE, 139.4 ± 29.2 µ in moderate ODE and 264.2 ± 116.9 µ in severe ODE. The mean average peripapillary MNSR in the four quadrants was 350.1 ± 36.3 µm in control group, 458.7 ± 37.3 µm in mild ODE, 634.4 ± 35.01 µm in moderate ODE and 968.3 ± 245 µm in severe ODE. Conclusion There was a statistically significant increase in mean RNFL thickness and mean MNSR in four quadrants in all grades of ODE group compared with the control group (P = 0.001). There was a strong positive correlation (r = 0.89, P = 0.001) between the mean MNSR and the mean RNFL in eyes with ODE.
  1,511 103 -
Classification and management of ectropion with medial canthal tendon laxity
Hesham A Ibrahim, Heba N Sabry
October-December 2014, 107(4):263-267
DOI:10.4103/2090-0686.150684  
Purpose Lower eyelid ectropion is usually accompanied by a variable degree of medial and lateral eyelid laxity. This work investigates a clinical evaluation scheme and a surgical plan to repair ectropion associated with different stages of such associated laxity. Patients and methods Forty-two procedures on 30 patients with lower eyelid ectropion associated with variable degree of medial palpebral ligament laxity were performed on the basis of the ectropion classification and management protocol described in this work. Patients were followed up for at least 6 months postoperatively. Results Firm medial eyelid fixation against lateral traction and correction of ectropion were achieved in all cases. Epiphora was cured in 26 eyes. The planned cosmetic outcome was achieved in 28 cases. Conclusion Individualizing the surgical repair for involutional ectropion on the basis of the clinical findings is cosmetically and functionally rewarding.
  1,296 101 -
Efficacy of gabapentin versus pregabalin in pain control during and after panretinal laser photocoagulation
Hazem A Hazem, Jehan A Sayed
January-March 2014, 107(1):28-32
DOI:10.4103/2090-0686.134940  
Purpose The aim of the study was to compare the analgesic efficacy and safety of pretreatment with oral gabapentin and its newer analog pregabalin for pain control during and after panretinal laser photocoagulation (PRP). Patients and methods The study included 60 eyes of 60 patients with proliferative diabetic retinopathy who were aged between 18 and 60 years and were candidates for PRP. Thirty patients (group A) received gabapentin 600 mg orally and group B received pregabalin 150 mg orally 2 h before PRP. Before sessions, all patients were instructed how to assess their pain level using the visual analog scale (VAS), and sessions were performed by the same ophthalmologist using as similar parameters as possible for each treatment plan. Blood pressure and heart rate were recorded just before, during, and immediately after each treatment session, and the VAS rates during (VAS I), 15 min after (VAS II), and 2 h after PRP session (VAS III) were collected; side effects for the study drugs were recorded for the same amount of time. Results The mean age was 49.47 ± 7 years in group A and 50.33 ± 10 years in group B. The mean duration of session was 12 ± 1.8 min in group A and 11 ± 1.3 min in group B. Systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure were significantly increased during sessions compared with baseline values in group A, whereas the increase in these parameters was not significant in group B. The median VAS both during the session (VAS I) and 15 min after the session (VAS II) was significantly lower in group B compared with group A, with no significant difference in the median pain score 2 h after session (VAS III) between both groups. The incidence of sedation and dizziness was significantly lower in group A compared with group B. More frequent nausea and vomiting were observed in group A compared with group B; however, this was not statistically significant. Conclusion In patients undergoing PRP, lower degree of pain associated with a better hemodynamic response was reported in those treated with preemptive 150 mg pregabalin compared with 600 mg gabapentin, suggesting that pregabalin may be better recommended for pain control during and immediately after PRP sessions.
  1,202 105 -
Trabeculectomy assisted by collagen matrix implant (Ologen) in primary congenital glaucoma
Momen M Hamdi
July-September 2013, 106(3):188-193
DOI:10.4103/2090-0686.127398  
Purpose The primary objective of the study was to evaluate the efficacy and safety of collagen matrix (CM) Ologen in subscleral trabeculectomy (SST) for the treatment of primary congenital glaucoma (PCG). Patients and methods Three children with PCG were operated upon with SST assisted by Ologen. The CM was inserted over the scleral flap under the fornix-based conjunctival flap. Tight closure of the conjunctiva was performed. The first child was a 3-year-old boy with left PCG not operated upon, with intraocular pressure (IOP) of 45 mmHg. The second infant was 7 months old with left recurrent PCG after failed SST with antifibrotic agent mitomycin-C followed by needling performed twice; IOP was 30 mmHg under medications. The third child was a 7-year-old girl with right recurrent PCG after SST at the age of 25 days; IOP was 28 mmHg under medications. Follow-up was planned under general anesthesia at 1 week, 1, 3, and 6 months. Parameters used were IOP measurement, corneal diameter, corneal clarity, cup-disc ratio, and state of the bleb. Photographs were taken at different visits to assess the shape, extent, and vascularity of the bleb. The definition of success was as follows: (1) Full success: IOP less than 15 mmHg without medications; clear cornea. (2) Satisfactory success: IOP less than 21 mmHg without medications; clear cornea. (3) Poor success: IOP less than 21 mmHg with medications. (4) Failure: IOP more than 21 mmHg. Results SST with Ologen in the first two children was successful, with an IOP of 17 mmHg in the first child (satisfactory success) after 8 months and 11 mmHg in the second child (full success) after 6 months. Corneal clarity improved and its diameter decreased in both cases. In the third child, the result was 'poor success' with an IOP of 15 mmHg under one medication at 6-months follow-up. Conclusion Biodegradable CM (Ologen) can be used in PCG to reduce the surgical risks and complications of SST with mitomycin-C in infants. It is also an easier and safer alternative compared with glaucoma valve implants.
  1,104 127 1
Corneal indentation versus anterior chamber paracentesis as an adjuvant to medical treatment in controlling acute primary angle-closure glaucoma
Lamia S Elewa, Yasser A Elzankaloni, Hazem Elkholefy
July-September 2014, 107(3):142-147
DOI:10.4103/2090-0686.148114  
Purpose The aim of this study is to evaluate the therapeutic efficiency of the noninvasive corneal indentation (CI) procedure versus anterior chamber paracentesis (ACP) as an adjuvant to classic medical treatment in patients with acute primary angle-closure glaucoma (PACG). Design This was a prospective, interventional, comparative study. Place Ain-Shams university hospitals and Elmaghrabi eye institutes. Patients and methods We included 30 eyes of 30 patients who had an attack of acute PACG and presented to us within the first 24 h. All patients received mannitol infusion (20%, 300 ml) as the first line of treatment. CI using Posner gonioprism was applied in 10 eyes (group I), ACP was performed in 10 eyes (group II), and 10 patients received only medical treatment (group III). The severity of pain, intraocular pressure (IOP), best-corrected visual acuity, corneal edema, and pupil size were assessed at multiple time points. The waiting time for laser peripheral iridotomy (LPI) was recorded. All patients were followed up for a minimum of 6 weeks. Results Pain relief was achieved rapidly in group II, where IOP reduction was 31% (IOP was 22 ± 11.5 mmHg) and 64% (IOP was 19 ± 7.6 mmHg) at 30 min and 2 h of follow-up, respectively. The grade of corneal edema in group II was 0.8 ± 1.3 and 0.5 ± 0.5 at 30 min and 2 h, respectively, which was significantly lower compared with both group I and III (P < 0.005). This facilitated early LPI (6 ± 2 h) in group II. However, in terms of IOP and best-corrected visual acuity, all the groups showed the same results at 12 h. Conclusion CI is a noninvasive and easy adjuvant method of reducing elevated IOP in the setting of PACG; improves corneal clarity and enables LPI. ACP restores corneal clarity faster and would be the choice for selected patients for whom medical therapy is restricted. Medical therapy alone shows a delay in controlling acute PACG and is rather exhausting for the patient.
  1,147 83 -
Evaluation of the treatment of retinopathy of prematurity in preterm infants in Alexandria University Hospital
Ahmad M Bedda, Nehal M Abd El-Monem Al-Shakankiry, Ahmed M Abd-Elhady, Islam S Hamdy Ahmad
April-June 2014, 107(2):70-77
DOI:10.4103/2090-0686.140637  
Purpose The aim of this study was to document the treatment activities of retinopathy of prematurity (ROP) in the Ophthalmology Department in the Main Alexandria University Hospital during an 18-month period. Patients and methods Infants at risk of ROP were detected during screening of infants at the El-Shatby University Hospital or referred to the Pediatric Ophthalmology Clinic of Main Alexandria University Hospital from any other hospitals for screening or treatment. Screening of infants at risk, classification of findings according to the International Classification of Retinopathy of Prematurity, follow-up fundus examination as needed and treatment by indirect laser ophthalmoscopy, intravitreal ranibizumab injection, or surgical treatment as indicated were carried out. Results In the present study, we found 73 infants (33.74% of the screened infant) suffering from ROP out of 223 preterm infants screened; out of those with ROP, 26 infants had ROP requiring treatment (35.61% of the infants with ROP and 11.66% of the total number of infants screened for ROP); 28 eyes of 14 infants (53.85% of the treated eyes) were treated by ablative indirect laser ophthalmoscopy, 20 eyes of 10 infants (30.77% of the treated eyes) were treated with an intravitreal injection of 0.25 mg in 0.025 ml ranibizumab, two eyes of two infants had lens-sparing pars plicata vitrectomy, and one eye had lensectomy vitrectomy. Conclusion In this study, we document the activities of the treatment of ROP in Alexandria University Hospital; although we apply different modalities of treatment, yet we have a long way to go through to improve the screening and treatment services provided to infants in our hospital.
  1,131 94 -
Analysis of 2-year corneal cross-linking results in keratoconus patients
Mohammed I Hafez
October-December 2014, 107(4):226-231
DOI:10.4103/2090-0686.150659  
Purpose To analyze the results of 2 years of corneal collagen cross-linking (CXL) for the treatment of keratoconus and to detect the efficiency of this procedure. Design This was a retrospective noncomparative study. Patients and methods A total of 58 eyes of 40 keratoconus patients were subjected to CXL. Epithelium-off CXL was the only procedure performed for all cases. The preoperative and postoperative measures included uncorrected visual acuity, best-corrected visual acuity (BCVA), fundus examination, slit-lamp examination, pachymetry, keratometry, refractometry, and corneal topography. All eyes included in this study were followed up at 1, 3, 6, 12, and 24 postoperative months. All preoperative and postoperative data of all eyes were collected, revised, and analyzed. Results This study showed that uncorrected visual acuity improved by at least one line in 70.7% of the eyes in the study, but remained stable in 22.4% of the eyes in the study. BCVA improved by at least one line in 53.4% of the eyes in the study, but remained stable in 36.2% of the eyes in the study. Astigmatism remained stable in 86.2% of the eyes in the study and decreased by a mean of 1.20 D in 13.8% of the eyes in the study. The average keratometry (K) decreased by more than 1 D in 74.1% of the eyes in the study, but remained stable in 13.7% of the eyes in the study. The maximum K value decreased by a mean of 2.47 D in 55.1% of the eyes in the study, but remained stable in 38% of the eyes in the study. The K value of the apex decreased by a mean of 2.73 D in 65.5% of the eyes in the study, but remained stable in 25.9% of the eyes in the study. Conclusion This study proved that corneal cross-linking is beneficial both as a visual-preserving and as a visual-improving procedure. K readings are the main indicator of the success or the failure of the procedure. Central corneal thickness can be an indicator of improvement; there is a reciprocal relationship between the central corneal thickness and the BCVA. The best chance is for patients with corneal thickness more than 400 μm. It is advised that the refractive surgeon should store the riboflavin in the refrigerator from +4°C to +8°C and discard it immediately after surgery. The use of steroid from the first postoperative day was helpful. Most postoperative visual improvements resulted from a decrease in myopia, whereas there was no remarkable improvement in astigmatism.
  1,101 101 -
Clinical outcome of preoperative and intraoperative intravitreal injection of bevacizumab as an adjunct to vitrectomy in the treatment of proliferative diabetic retinopathy
Mohamed Farouk Sayed Othman, Hossam M Moharram, Raafat Mohy Eldin
January-March 2014, 107(1):5-9
DOI:10.4103/2090-0686.134924  
Objective The aim of this study was to evaluate the safety and clinical efficacy of an intravitreal injection of bevacizumab in pars plana vitrectomy (PPV) for complicated proliferative diabetic retinopathy (PDR). Patients and methods The study included 20 eyes of 20 patients (25-68 years old) with complicated PDR. All patients underwent 23-G PPV, and all of them received an intravitreal injection of 1.25 mg bevacizumab 1 week before planned vitrectomy and at the end of surgery. Results The mean surgical time was 60.5 ± 20.2 min (range 40-95 min). Iatrogenic breaks were reported in four eyes (20%) and silicone oil was used in these cases (20%). Final visual acuity showed improvement in 17 eyes (85%), whereas postoperative best-corrected visual acuity remained unchanged in three eyes (15%). The mean preoperative corrected visual acuity was 1.47 ± 0.73 logMAR units. A statistically significant increase in the mean corrected visual acuity was observed in all study eyes at 3 months after surgery (0.60 ± 0.48 logMAR units; P < 0.001). There were no cases with postoperative bleeding. Conclusion Injection of bevacizumab, 1.25 mg (0.05 ml), 1 week before PPV and at the end of operation is safe and effective, resulting in a decrease in the operation time, iatrogenic retinal breaks, intraoperative and postoperative bleeding, and improved visual acuity in PDR patients.
  1,080 115 -
Transepithelial photorefractive keratectomy with adjunctive mitomycin-C for correction of residual myopia after LASIK
Waleed A Ghobashy, Ahmad A Abdel Ghani
January-March 2014, 107(1):41-44
DOI:10.4103/2090-0686.134949  
Purpose The aim of the study was to evaluate the efficacy and safety of transepithelial photorefractive keratectomy (trans-PRK) with adjunctive mitomycin-C (MMC) over laser in-situ keratomileusis (LASIK) flaps for the treatment of residual myopia following LASIK. Materials and methods In this single-center, retrospective clinical study, 12 eyes of nine patients (mean age 32.67 ± 2.8 years) who were administered MMC (0.02%, 20 s) during trans-PRK for the treatment of residual myopic error with a mean spherical equivalent of -1.00 ± 0.69 D following myopic LASIK were evaluated. The retreatment procedures were performed after an average of 13.67 ± 1.15 months of primary LASIK using Schwind Amaris 500E excimer laser, with trans-PRK plate form. All patients underwent slit-lamp microscopy, manifest and cycloplegic refraction, Sirius 3D corneal analysis, merging Scheimpflug technology with Placido topography, pachymetry, pupillometry, and wavefront analysis preoperatively and postoperatively. All patients underwent follow-up on day 1, at 1 week, and at 1, 3, and 6 months. Results Mean time between LASIK and PRK retreatment was 19.2 months (range 13-39 months). No intraoperative or postoperative complications occurred during primary LASIK or trans-PRK retreatment. Mean spherical equivalent refraction of attempted correction with PRK was -1.58 D (range -0.50 to -2.25 D). By the end of sixth postoperative month, the average uncorrected visual acuity improved from 0.48 (range 0.15-0.7) to 0.7 (range 0.3-1.0). All eyes showed improvement in uncorrected visual acuity. Four eyes had subjective improvement of glare symptoms. None of the eyes in the cohort developed postoperative haze or any complications. Conclusion Trans-PRK with adjunctive MMC is a safe and effective option for correction of residual myopia following LASIK.
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Modified trabeculectomy with an extended subscleral tunnel: could it be a secure way toward successful glaucoma surgery?
Ahmed M Saeed, Sameh Saleh
April-June 2014, 107(2):97-105
DOI:10.4103/2090-0686.140648  
Purpose The aim of this study was to describe a modified surgical technique of an extended subscleral tunnel (ESST) with adjunctive application of mitomycin-C (MMC) and to evaluate its safety and efficacy in long-term intraocular pressure (IOP) control in glaucoma patients. Patients and methods This was a randomized-controlled prospective clinical trial that included 54 eyes of 46 patients diagnosed with primary open-angle glaucoma. They were divided into two equal groups: the 'trabeculectomy with adjunctive MMC' treatment, group A, and the 'modified trabeculectomy with adjunctive MMC and ESST' treatment, group B. Ultrasonic biomicroscopy measurement of the aqueous drainage route was performed at 12 and 24 months postoperatively. The main outcome results included the cumulative probability of surgical success, IOP values, and the number of antiglaucoma drugs needed. Results Group B achieved a cumulative probability of complete success of 0.68 and qualified success of 0.96 at the end of the 24-month study period; however, group A achieved a cumulative probability of complete success of 0.44 and qualified success of 0.84. Group B succeeded in achieving lower mean IOP values than group A, with fewer antiglaucoma drugs at all postoperative visits, but this was not statistically significant (P > 0.05). The aqueous drainage route was always larger in group B and there was a statistically significant decrease in its size only in group A (P = 0.036). Group B achieved statistically significant fewer early and late postoperative complications and also required fewer additional interventions compared with group A (P = 0.029). No significant adverse effects were caused by this modified combined technique. Conclusion Modified trabeculectomy with ESST combined with adjunctive MMC could be an efficient, safe, familiar, and applicable treatment technique for a successful trabeculectomy. It may provide a favorable long-term outcome, representing a simple novel way of performing successful glaucoma surgery.
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Transepithelial photorefractive keratectomy versus conventional alcohol-assisted photorefractive keratectomy for correction of mild and moderate myopia
Waleed A Ghobashy, Mohamed E Shahin, Karem A Kolkailah
January-March 2014, 107(1):1-4
DOI:10.4103/2090-0686.134922  
Purpose The aim of the study was to compare both transepithelial photorefractive keratectomy (trans-PRK) and PRK for correction of mild and moderate myopia with respect to effectiveness, visual recovery pain, and safety. Materials and methods In this prospective case-control series, group I with 24 myopic eyes (12 patients) with spherical equivalent -1.00 to -6.00 D underwent trans-PRK using Schwind Amaris 500E excimer laser, with trans-PRK plate form. A case-adjusted group II (the control group) with 24 myopic eyes (12 patients) with spherical equivalent -1.00 to -6.00 D underwent alcohol-assisted PRK using Visx S4 excimer laser. Uncorrected visual acuity (UCVA) was measured on the first day, at first week, 1 month, and 6 months along with manifest refraction. Postoperative pain was assessed using visual analog scale. Occurrence of complications was documented. Results Patients in group I showed faster visual recovery with a mean UCVA of 0.3 on the first postoperative day compared with those in group II (0.2); however, both groups reached a mean UCVA of 0.9 by the end of sixth month. Manifest refraction was comparable in both groups. Pain was significant in group II with a score of 4 on the first day declining to 0 by the end of the first week compared with group I with a mean pain score of 3 on the first day and 0 by the end of day 4. No complications were recorded in either of the two groups along the study time. Conclusion Trans-PRK may offer a safe, less painful, and effective alternative to alcohol-assisted PRK in the treatment of mild and moderate myopia, especially in cases of thin cornea.
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Combined intracameral and intravitreal bevacizumab injection in Neovascular Glaucoma
Abeer Khattab, Eman Azmy
July-September 2013, 106(3):117-122
DOI:10.4103/2090-0686.127340  
Purpose The aim of this study was to assess the efficacy and safety of combined intracameral and intravitreal injection of bevacizumab followed by panretinal photocoagulation (PRP) in the treatment of neovascular glaucoma. Design This study is a prospective, interventional case series. Patients and methods This study is prospective observational case series of 23 eyes of 23 patients with different degrees of neovascular glaucoma (>22 mmHg) treated with simultaneous combined intracameral and intravitreal bevacizumab injection followed by PRP. Duration of follow-up was 3 months. The outcome measures were neovascular membrane extent, best corrected visual acuity (BCVA), and intraocular pressure (IOP) at the follow-up intervals. Results The degree of neovascular membrane extent decreased from a preoperative mean of 226.95 ± 97.34 to 58.96 ± 84.12 at 1 week postoperatively and 31.3 ± 51.54 at 1 month postoperatively. The preoperative mean IOP was 58.7 ± 16.2 mmHg; it decreased to 20.8 ± 9.99 mmHg at 1 week, 18.47 ± 5.6 mmHg at 1 month, 22.65 ± 8.7 mmHg at 2 months, and 25.34 ± 6.806 mmHg at 3 months postoperatively ( P remained ≤0.001 throughout the course of follow-up). In addition, BCVA showed noticeable improvement during the course of follow-up; the mean preoperative BCVA logarithm of minimal angle of resolution (BCVA logMAR) was 1.47 ± 0.511, which significantly improved to 1.29 ± 0.55, 1.16 ± 0.58, 1.15 ± 0.6, and 1.3 ± 0.56 at 1 week and 1, 2, and 3 months, postoperatively, respectively. Conclusion Combined intravitreal and intracameral injection with bevacizumab followed by PRP can be considered to be a very effective and safe IOP-lowering technique in the case of neovascular glaucoma.
  1,040 131 -
Role of pterygium in ocular dryness
Tamer H El-Sersy
October-December 2014, 107(4):205-208
DOI:10.4103/2090-0686.150654  
Aim of the work The aim of this study was to find out the relation between tear film function and pterygium. Patients and methods This study included 60 patients with unilateral pterygium from the outpatient clinic of October 6 University, with age ranging between 25 and 70 years. Pterygium was treated by simple excision in 20 eyes, by excision with B irradiation in 20 eyes, and with conjunctival autograft technique in the remaining 20 eyes. The results of tear break-up time (TBUT) and Schirmer-1 test were evaluated before and 6 months after surgery. We also included 25 healthy individuals as controls. Results This study included 60 patients (32 male and 28 female patients) with a mean age of 44.17 ± 9.25 years. Age and sex were not statistically different between the patients and controls (P = 0.24 and 0.96, respectively). The mean TBUT was 11.70 ± 2.16 s in control eyes (ranged from 8.5 to 16.0 s). However, in eyes with pterygium this value was markedly reduced to 5.91 ± 1.95 s. TBUT was statistically lower among patients compared with controls (P < 0.0001). The mean Schirmer-1 test result was 13.76 ± 2.06 mm (range 11-17 mm/5 min) in normal healthy eyes and 5.85 ± 1.86 mm (range 3-9.5 mm/5 min) in the eyes of patients with pterygium. The difference was statistically different between the patients and controls (P < 0.0001). Before surgery, the average TBUT was 5.90 ± 1.87 s. This was significantly prolonged to 7.95 ± 1.33 ± 6 months postoperatively (t = 9.97, P < 0.0001) in all our cases. Moreover, Schirmer-1 test was 6.29 ± 1.90 mm/5 min preoperatively and significantly prolonged to 9.67 ± 1.57 postoperatively (t = 27.23, P < 0.0001). Conclusion Ocular dryness in the presence of pterygium and its improvement after surgery favor the hypothesis that pterygium itself contributes to the phenomenon of disturbed tear film functions in such patients.
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The outcome of preoperative subconjunctival bevacizumab injection in pterygium surgery
Ahmed M.K. El Shafie, Ahmed S Mohamed, Mohamed F Sayed
April-June 2014, 107(2):113-116
DOI:10.4103/2090-0686.140643  
Objective The aim of this study was to evaluate the safety and the efficacy of subconjunctival injection of bevacizumab (Avastin) for the management of primary and recurrent pterygia and to estimate the recurrent rate of pterygia after surgery. Patients and methods The study included 60 eyes of 60 patients (45 male and 15 female), with a mean age of 41 ± 4.8 years. Forty patients (66.6%) had primary pterygia and the remaining 20 patients had recurrent pterygia after a previous surgery. A preoperative injection of bevacizumab was given at a dose of 1.25 mg (0.05 ml) 1 week before pterygium surgery was performed using the conjunctival flap technique. Twenty patients were enrolled as a control group and they were operated upon without preoperative bevacizumab injection. Mitomycin C (0.1 mg/ml) was used intraoperatively in recurrent cases. All patients were followed up for 3-6 months. Results Most of the patients (48.3%) had grade 2 pterygium. The average time for each procedure was 30 ± 15 min. No patient lost vision after the procedure. Recurrence was noted in five patients (8.3%), and all of them had primary pterygia. Conjunctival graft rejection occurred in three patients (5%); this graft rejection occurred in recurrent pterygia. Postoperative conjunctival vascularization occurred in four patients (6.7%), and this vascularization occurred in the recurrent cases. A significant improvement of visual acuity and corneal clearance was noticed in all patients. Conclusion Preoperative subconjunctival injection of bevacizumab reduces the recurrence rate of pterygium surgery as it reduces the vascular element of the pterygium. Intraoperative application of mitomycin C in addition to preoperative subconjunctival injection of bevacizumab reduces recurrence in recurrent pterygium cases. Further long-term, large-scale studies are recommended.
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Inferior limbal conjunctival autografting in primary pterygium
Farouk M Othman
April-June 2015, 108(2):43-46
DOI:10.4103/2090-0686.161385  
Objective The aim of this study was to evaluate the outcome of pterygium excision with conjunctival limbal autografting from the lower bulbar conjunctiva for the treatment of primary pterygium. Patients and methods This prospective analysis study included 60 eyes of 60 patients with primary pterygium treated by means of pterygium excision with conjunctival limbal autograft from the lower bulbar conjunctiva in El-Minia University Hospital. Patients were examined on the first day, the first week, at 2 weeks, and every month until the 12th month postoperatively. Outcomes were evaluated in terms of complications and recurrence. Results During the 12 months of follow-up, postoperative complications occurred in 18 (30%) patients. Recurrence occurred in one (1.7%) eye during the follow-up period. Conclusion In patients with primary pterygium, conjunctival limbal autografting from the lower bulbar conjunctiva is an effective technique with a low recurrence rate. It can be a suitable treatment for glaucomatous patients with pterygium to leave the upper bulbar conjunctiva untouched.
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