• Users Online: 166
  • Home
  • Print this page
  • Email this page
Home Current issue Ahead of print Search About us Editorial board Archives Submit article Instructions Subscribe Contacts Reader Login
Export selected to
Endnote
Reference Manager
Procite
Medlars Format
RefWorks Format
BibTex Format
  Access statistics : Table of Contents
   2013| July-September  | Volume 106 | Issue 3  
    Online since February 28, 2014

 
 
  Archives   Previous Issue   Next Issue   Most popular articles   Most cited articles
 
Hide all abstracts  Show selected abstracts  Export selected to
  Viewed PDF Cited
ORIGINAL ARTICLES
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).
  4,841 222 -
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.
  4,138 203 -
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.
  2,879 203 -
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.
  2,543 168 1
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.
  2,102 208 2
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.
  1,886 192 -
Evaluation of retinal nerve fiber layer thickness in diabetic retinopathy by optical coherence tomography after full scatter panretinal argon laser photocoagulation
Faried M Wagdy, Hoda M El Sobky, Abd El-Rahman E Sarhan, Mohammed A Hafez
July-September 2013, 106(3):153-158
DOI:10.4103/2090-0686.127365  
Purpose The aim of this study was to evaluate the retinal nerve fiber layer (RNFL) thickness after full scatter panretinal argon laser photocoagulation in diabetic patients using optical coherence tomography. Patients and methods This study was carried out on 40 eyes of 22 patients with the clinical diagnosis of severe nonproliferative and proliferative diabetic retinopathy treated by full scatter panretinal photocoagulation at the ophthalmic diagnostic laser unit, Menoufiya University Hospital. Results Follow-up up to 6 months indicated that the percentage reduction in the average RNFL thickness after 6 months of laser treatment was 28.9%, which was statistically significant (P = 0.041). This reduction in the RNFL thickness varied from one retinal quadrant to another, with the most significant change taking place in both the nasal and the inferior quadrants. Conclusion In the treatment of diabetic retinopathy, maximal effect with lowering number of shots as much as is necessary to avoid decrease RNFL thickness to great degree and so avoiding the optic disc pallor and optic atrophy.
  1,619 183 1
Role of focal laser ablation in the treatment of type 1 idiopathic juxtafoveolar retinal telangiectasis
Hesham Elmazar
July-September 2013, 106(3):183-187
DOI:10.4103/2090-0686.127390  
Introduction Idiopathic juxtafoveolar retinal telangiectasis (IJRT) is a retinal vascular anomaly characterized by irregular dilation and incompetence of retinal vessels. Although the etiology of the condition is unknown, its various presentations have been characterized into three groups. Treatment is based mainly on disease classification and includes laser photocoagulation and observation besides other modalities. Aim The aim of the work was to study the role of focal laser treatment for type 1 IJRT. Patients and methods A retrospective noncomparative study was carried out at the Ophthalmology Department, Menoufia University, Egypt, during the period from January 2007 to December 2011, wherein four patients (three male and one female) diagnosed with type 1 (exudative) IJRT on the basis of fluorescein angiography and after ruling out other causes were included in the study. Four eyes with macular edema and exudation were subjected to focal laser treatment (double-frequency YAG) with green laser (wavelength 532 nm). The follow-up period after laser treatment extended from 6 to 24 months. Results Four patients diagnosed with type 1 IJRT were included in the study (three male and one female). Their age ranged from 40 to 42 years, with a mean age of 40.75 years. Focal double-frequency YAG green laser (wavelength 532 nm) treatment resulted in the reduction of both macular edema and exudation with improvement in visual acuity from one to two lines on follow-up. Conclusion Focal laser treatment of type 1 IJRT lesions proved to be effective. The treatment is a safe method for managing leakage and stabilizing vision.
  1,502 99 -
Scleral buckling for the management of inferior stationary long-standing rhegmatogenous retinal detachment in the juvenile age group
Ahmed Abdel Azim Abdel Kader, Ahmed El-Sawy Habib
July-September 2013, 106(3):180-182
DOI:10.4103/2090-0686.127382  
Design A retrospective noncomparative interventional clinical case series was performed between 2009 and 2012. Patients and methods Fourteen eyes of 14 young patients with chronic inferior rhegmatogenus retinal detachment showing focal proliferative vitreoretinopathy, subretinal bands, demarcation line, and inferior retinal breaks were managed with a segmental circumferential inferior 180 silicone tire and a 360 encircling circumferential band. Results Anatomical success was achieved in 13 eyes (92.86%), improved vision in nine eyes (64.29%), and stationary vision in five eyes (35.71%). Conclusion Scleral buckling proved safe and effective in the management of long-standing rhegmatogenous retinal detachment in a juvenile age group with subretinal fibrosis and focal surface proliferative vitreoretinopathy.
  1,480 106 -
Long-term effect of intravitreal dexamethasone implant (Ozurdex) in the treatment of resistant diabetic macular edema
Abdelrahman G Salman
July-September 2013, 106(3):194-198
DOI:10.4103/2090-0686.127404  
Aim To evaluate the long-term safety and efficacy of Ozurdex in patients with resistant diabetic macular edema. Design A comparative, randomized, prospective, interventional case series. Patients and methods Fifteen patients with bilateral resistant diabetic macular edema were enrolled in this study. Eyes were randomized into right eyes that received intravitreal dexamethasone implant 0.7 mg (Ozurdex) and left eyes that received intravitreal bevacizumab injection 1.25 mg/0.05 ml. Outcome measures included the change in the best-corrected visual acuity (BCVA), the central macular thickness (CMT) on optical coherence tomography, and the intraocular pressure at 6 and 12 months after injection. Repeated injections were given in both groups when needed. Results The mean age of patients was 52.7 ± 2.1 years. The mean duration of diabetes mellitus was 15.2 years. In the Ozurdex group, the preoperative mean CMT was 535.2 μm, which improved to 198 and 230 μm at 6 and 12 months, respectively, and the preoperative mean BCVA was 0.80 log MAR units, which improved to 0.30 and 0.40 log MAR units at 6 and 12 months, respectively, with mean number of injections of 1.8 (range, 1-3) over 1 year. The intravitreal bevacizumab injection group improved from a mean preoperative CMT of 562.4 to 212 and 266 μm at 6 and 12 months, respectively, and the preoperative mean BCVA was 0.70 log MAR units, which improved to 0.30 and 0.40 log MAR units at 6 and 12 months, respectively, with mean number of injections of 5.4 (range, 4-8) over 1 year. Conclusion Ozurdex is an effective and safe alternative tool in the management of resistant diabetic macular edema. It can be considered as an off-label treatment with less frequent injection than intravitreal bevacizumab injection. Larger multicenter studies with a longer follow-up period are required.
  1,434 149 -
Autologous serum eyedrops versus systemic doxycycline and topical corticosteroids in the treatment of recurrent corneal erosion
Haitham Y Al-Nashar, Ezzat A. I. Shahien, Marwa A Atya
July-September 2013, 106(3):206-209
DOI:10.4103/2090-0686.127406  
Purpose The aim of the study was to evaluate the efficacy of autologous serum eyedrops for the treatment of recurrent corneal erosion when compared with systemic doxycycline and topical steroids. Patients and methods In this prospective study, 27 eyes of 20 patients with recurrent corneal erosion were divided into two groups. In group A (14 eyes), the patients were treated with autologous serum eyedrops and in group B (13 eyes), the patients were treated with systemic doxycycline and topical steroids. In group A, autologous serum eyedrops were administered five times daily. Serum eyedrops were prepared by obtaining 50 ml of patient's blood and allowing it to clot, and the serum was obtained by centrifugation for 15 min. Detailed informed consent was obtained from all patients before the study. Patients in group B received oral doxycycline (50 mg) twice daily and topical fluoromethalone (0.1%) three times daily. The two groups were followed up for 6 months and were compared for the signs of relapse or recurrence of corneal symptoms and for any ocular complications. Results The study included 27 eyes of 20 patients (age range: 10-45 years). Eleven eyes in group A (78.5%) had complete healing of erosions with no relapse of the disease during the follow-up period. Two eyes (14.3%) presented with a recurrence after the end of the treatment and one eye (7.1%) failed to heal. No ocular complications were detected during the follow-up. In group B, eight eyes (61.5%) showed complete healing with no relapse of the disease during the follow-up period and one eye (7.7%) failed to heal. Four eyes (30.7%) presented with a recurrence after the end of the treatment, with a significant difference compared with group A (P = 0.02). One patient in group B showed an increase in intraocular pressure in the follow-up period. Conclusion This study suggests that the treatment of recurrent corneal erosion with autologous serum eyedrops gives the same results as with the treatment with systemic doxycycline and topical steroids, with low recurrence rate and less complication.
  1,414 126 -
Ranibizumab versus bevacizumab in choroidal neovascular membrane: Is it worth it?
Abeer Khattab
July-September 2013, 106(3):138-145
DOI:10.4103/2090-0686.127356  
Purpose The aim of this study was to compare the short-term outcomes of administration of intravitreal ranibizumab (IVR) and intravitreal bevacizumab (IVB) in the treatment of neovascular age-related macular degeneration (AMD). Design This study is a clinical interventional randomized comparative study. Patients and methods This randomized clinical trial was performed on 24 eyes of 24 patients with subfoveal and juxtafoveal choroidal neovascularization secondary to AMD. The eyes were randomly assigned to receive 0.5 mg IVR (group 1; 12 eyes) or 1.25 mg IVB (group 2; (12 eyes). Best-corrected visual acuity (BCVA) was assessed, optical coherence tomography was carried out at baseline and repeated at all postoperative follow-up intervals (1 week and 1, 3, and 6 months), and fluorescein angiography was performed at baseline and repeated 1 month after treatment. Results In group 1, the mean age was 62.42 ± 6.75 years (range 51-70 years) and seven of the patients were male (58.33%). In group 2, the mean age was 62.083 ± 7.96 years (range 50-75 years) and four of the patients were male (33.33%). At the sixth month postoperatively, BCVA logMAR significantly improved from 1.01 ± 0.26 (range 1.5-0.7) to 0.82 ± 0.18 (range 1.2-0.5; P = 0.001) in group 1 and from 0.98 ± 0.279 (range 1.4-0.5) to 0.81 ± 0124 (range 1.0-0.7; P = 0.004) in group 2. At 6 months postoperatively, the mean ± SD central macular thickness reduced from 363.33 ± 27.16 μm at baseline (range 319-405 μm) to 291.67 ± 25.79 μm (range 243-335 μm) in group 1 (P = 0.00), whereas in group 2, the mean ± SD central macular thickness moderately reduced from 362.5 ± 20.26 μm at baseline (range 339-400 μm) to 294.17 ± 29.62 μm (range 257-350 μm) at 6 months postoperatively (P = 0.00). There were no significant systemic or ophthalmological adverse effects in either group. Conclusion Both ranibizumab and bevacizumab are equally safe and effective treatment options as intravitreal injections in the treatment of CNVM due to AMD.
  1,236 134 -
Triple intravitreal bevacizumab, sub-Tenon's triamcinolone, and panretinal photocoagulation in Eales' disease
Abeer Khattab, Magda Turkey
July-September 2013, 106(3):172-179
DOI:10.4103/2090-0686.127380  
Introduction Eales' disease (ED) is an idiopathic inflammatory vasoproliferative retinal disease primarily affecting the peripheral retina of young and apparently healthy adult men, mostly from the Indian subcontinent. It is characterized by peripheral retinal inflammation, retinal neovascularization, and recurrent vitreous hemorrhage, with or without retinal detachment. Objective This study was carried out to evaluate triple therapy, with intravitreal bevacizumab (IVB), posterior sub-Tenon's (SBT) triamcinolone, and panretinal photocoagulation (PRP), in ED patients with vitreous hemorrhage and its associated vasculitis, neovascularization, and macular edema. Design This was a prospective, interventional case series. Patients and methods This study included 20 eyes of 20 patients with vitreous hemorrhage because of ED. Preoperative evaluation included patient age, sex, race, medical history, medications, complete ophthalmological examination, and diagnostic laboratory evaluation. All eyes were treated with IVB, posterior SBT triamcinolone, and PRP. The follow-up period was up to 6 months. The main outcome measures were visual acuity, intraocular pressure changes, and recurrence of vitreous hemorrhage. Results A statistically significant improvement in visual acuity was observed at 1 week and 1, 3, and 6 months postoperatively. There was no statistically significant change in intraocular pressure at any of the postoperative follow-up intervals. There was no intraoperative or postoperative complication. None of the patients included had any recurrence during the follow-up. Conclusion The triple therapy with IVB, posterior SBT triamcinolone, and PRP seems to be effective in the treatment of ED patients with dense vitreous hemorrhage and its associated vasculitis, neovascularization, and macular edema.
  1,235 104 -
Intravitreal bevacizumab (Avastin) with peripheral retinal cryotherapy for patients with posterior retinopathy of prematurity and vitreous hemorrhage
Mohammad M. K. Diab
July-September 2013, 106(3):129-133
DOI:10.4103/2090-0686.127351  
Purpose To report the short-term anatomic response of intravitreal bevacizumab (Avastin) and peripheral cryotherapy for the treatment of posterior retinopathy of prematurity (ROP) with vitreous hemorrhage in a small series of patients. Patients and methods This was a retrospective study that included 19 eyes of 14 premature babies with posterior ROP and vitreous hemorrhage in whom conventional laser treatment could not be applied. Patients received an intravitreal injection of bevacizumab (Avastin) together with peripheral retinal cryotherapy. Results Vascularization began to regress within a few days after the injection, but vitreous hemorrhage absorbed more slowly. Repeat intravitreal injections of bevacizumab were administered in eight eyes within 1 month from the first injection. There were varying development of tractional retinal detachments in two of the eyes, but the ROP component quieted in all cases. Conclusion Off-label use of intravitreal bevacizumab with peripheral retinal cryotherapy appears to be useful as a treatment for posterior ROP when laser treatment is precluded. It improves dilatation, regressing and quiescent the disease, and improves visibility.
  1,011 114 -
Macular functional and anatomical ring maps in patients with best vitelliform macular dystrophy
Dalia Sabry, Kamal Enam
July-September 2013, 106(3):163-167
DOI:10.4103/2090-0686.127376  
Purpose This study aimed at assessing the macular anatomical and functional changes in patients having different stages of best vitelliform macular dystrophy (BVMD). Design This is a retrospective noncomparative case series. Materials and methods The study included patients in different stages of BVMD. All patients had a solitary lesion involving the fovea. They underwent complete ophthalmic evaluation, fluorescein angiography (FA), optical coherence tomography (OCT), and multifocal electroretinography (mfERG). The results were compared with those of an age-matched and sex-matched control group. Results This study included 14 eyes from 10 patients belonging to seven families. The mean log MAR BCVA was 0.5 ± 0.1 with significant reduction compared with the control group (P = 0.05). Both FA and OCT scans showed changes confined to the lesion only. OCT showed a significant increase in thickness in the foveal and perifoveal rings (P = 0.0003 and 0.05, respectively). Multifocal ERG showed significant changes between the study and control groups in the three rings (P = 0.0001 for both amplitude and implicit time for ring 1; P = 0.05 for the other two rings). Conclusion In different stages of BVMD with solitary lesions involving the fovea, the integrated FA and OCT findings were very helpful in the diagnosis; however, their changes were confined to the lesions only. Multifocal ERG revealed reduction of the cone function all over the macula, which was most evident centrally.
  980 72 -
Anatomical and functional changes in the cornea and retina after ultraviolet-A riboflavin cross-linking in patients with keratoconus
Kamal Enam, Eman Azmy, Abd El-monem Abou El-Fetouh
July-September 2013, 106(3):210-216
DOI:10.4103/2090-0686.127407  
Purpose The aim of this study was to evaluate the efficacy of corneal collagen cross-linking in stabilization of the keratoconus and the safety of the procedure in the cornea and retina. Design This study is a prospective interventional case series study. Patients and methods The study included 19 eyes of 19 patients with grade II-III keratoconus. All of them were treated with riboflavin ultraviolet-A collagen cross-linking. The patients were followed up monthly for 6 months. Examination of each patient included evaluation of the uncorrected visual acuity, best-corrected visual acuity, and spherical equivalent; endothelial cell counting; anterior segment optical coherence tomography using a corneal Scheimpflug camera; posterior segment assessment by fluorescein angiography; posterior segment optical coherence tomography; and multifocal electroretinography. Results Uncorrected visual acuity and best-corrected visual acuity showed statistically significant improvement. The mean improvement in spherical equivalent was 1.5 (΁1.0) D. The K-value at the apex significantly decreased (the mean decrease was 1.40 D). There was a significant decrease in the corneal pachymetry at the thinnest location at the first month postoperatively; however, at 3 months postoperatively, the corneal pachymetry increased gradually, reaching stability at the end of the follow-up period. There was a significant increase in the mean intraocular pressure of the treated eyes. Of the treated eyes, 13 showed a demarcation line at a depth of 300 ΁ 10.5 mm. The preoperative mean endothelial cell count showed a statistically significant decrease. Retinal fluorescein angiography, optical coherence tomography, and multifocal electroretinography at the foveal ring showed no abnormalities in the riboflavin-treated eyes. Conclusion Corneal collagen cross-linking is an effective procedure in stopping the progress of keratoconus and is safe for both anterior and posterior segments.
  937 96 -
Temporarily attached conjunctival flap for primary pterygium surgery
Sameh Saleh, Ayman A Ghafar
July-September 2013, 106(3):217-221
DOI:10.4103/2090-0686.127409  
Purpose The aim of the study was to evaluate the safety and outcomes of recurrent pterygium excision with a temporarily attached rotational conjunctival flap. Patients and methods In an interventional case series, consecutive patients with recurrent pterygium underwent surgical excision with temporary attachment of a rotational conjunctival flap onto bare sclera. Patients were followed up for 6-12 months and the results were evaluated in terms of recurrent pterygium growth and complications. Results Thirty eyes from 30 consecutive patients (19 male and 11 female) of a mean age of 43.3 ΁ 10.8 years were operated upon. The pterygia extended 4.6 ΁ 1.2 mm (range 3-6 mm) onto the corneas. Two eyes (6.6%) showed recurrent pterygium growth. One eye (3.3%) developed conjunctival granuloma, which eventually required excision, leading to complete resolution. Conclusion Pterygium excision with a temporarily attached rotational conjunctival flap is a safe, easy, and effective surgical technique in the management of recurrent pterygium and has a low recurrence rate.
  883 106 -
Evaluation of bleb parameters using ultrasound biomicroscopy and its correlation to intraocular pressure control following trabeculectomy with adjuvant mitomycin C in high-risk glaucoma patients
Ahmed A Abdel-Kader, Riham S.H.M. Allam
July-September 2013, 106(3):159-162
DOI:10.4103/2090-0686.127371  
Purpose The aim of this study was to study the relationship between bleb parameters (height and extent) evaluated using ultrasound biomicroscopy and intraocular pressure (IOP) after subscleral trabeculectomy with mitomycin C in high-risk glaucoma patients. Design This was a prospective interventional observational uncontrolled study. Patients and methods Forty eyes of 26 patients with chronic glaucoma with uncontrolled IOP undergoing subscleral trabeculectomy with intraoperative mitomycin C (0.4%) applied for 2 min were followed up for 3 months. An ultrasound biomicroscopy was performed at day 90 to measure the bleb height and extent and a correlation was found between the mean IOP, the percent reduction in IOP, and the bleb height and extent at the same interval. Results The mean bleb height was 1.065 ± 0.991 mm (range 0-3.6 mm) and the mean bleb horizontal extent was 3.214 ± 1.997 mm (range 0-7.9 mm). A moderate positive linear correlation was observed for bleb horizontal extent between 1.8 and 4.97 mm and percentage change in IOP [ΔIOP (%), r = 0.374], and the results were statistically significant (P = 0.054). In terms of bleb height, the correlations with IOP and ΔIOP were found to be weak and of were not statistically significant. Conclusion We concluded that bleb extent is more representative of bleb function than bleb height and it appears that the percent reduction in IOP is more influenced by the bleb dimensions than the mean IOP.
  854 110 -
Safety and efficacy of phacoemulsification in the vitreous cavity for dropped nuclear fragments
Mohammed M Elwan
July-September 2013, 106(3):146-149
DOI:10.4103/2090-0686.127359  
Purpose The aim of this study was to evaluate the safety and efficacy of intravitreal phacoemulsification for dropped nucleus or nuclear fragments into the vitreous cavity. Materials and methods This was a prospective interventional study that included 25 patients with dropped nuclear fragments after phacoemulsification; before vitrectomy, all patients were subjected to a full ophthalmological examination including visual acuity, intraocular pressure, anterior segment examination, fundus examination, and then after standard pars plana vitrectomy, a phaco tip devoid of its sleeve was used, and intraoperative and postoperative complications were recorded. Results Twenty-five patients, mean age 63.1 ± 3.3 years, were studied. The median interval between nuclear drop and vitrectomy was 14 days. The mean follow-up period was 114.3 ± 34 days. Best-corrected visual acuity (BCVA) improved significantly from a preoperative mean value of 0.008 ± 0.009 to a postoperative mean value of 0.08 ± 0.05. Intraoperative complications were two cases of retinal breaks. Postoperative complications were transient ocular hypertension in three patients, transient hypotony in four patients, and vitreous hemorrhage in three eyes that resolved spontaneously. Conclusion Intravitreal phacoemulsification for dropped nucleus or nuclear fragments is safe and effective and resulted in visual improvement.
  861 83 -
Comparison of the effects of multiple intravitreal bevacizumab injections and single triamcinolone acetonide injection in diabetic macular edema
Hossam Y Abouelkheir, Mohammed M Elwan
July-September 2013, 106(3):134-137
DOI:10.4103/2090-0686.127355  
Purpose The aim of this study was to compare the effects of a single intravitreal injection of triamcinolone acetonide versus three consecutive monthly intravitreal injections of bevacizumab for the treatment of diabetic macular edema. Patients and methods In this prospective, randomized study, patients were divided into two groups: 15 eyes that were treated with three consecutive monthly intravitreal injections of 1.25 mg bevacizumab (bevacizumab group) and 15 eyes treated with single intravitreal injections of 4 mg triamcinolone acetonide (triamcinolone group). Changes in the best-corrected visual acuity (BCVA), intraocular pressure, and optical coherence tomography measurements were evaluated in both groups. Follow-up visits up to 3 months from baseline were reported. Results The bevacizumab group showed a significant decrease in the median central foveal thickness from 236 μm ± 91.5 to 221 μm ± 43.5 after 3 months (P < 0.05). The triamcinolone group also showed a significant reduction in central foveal thickness from 339 μm ± 130.5 to 273 μm ± 84.5 (P < 0.05). The bevacizumab group showed an increase in the BCVA from a median of 0.8 ± 0.45 logMAR to a median of 0.48 ± 0.3 logMAR after 3 months (P < 0.05). The triamcinolone group also showed an increase in BCVA from a median of 0.7 ± 0.18 logMAR to a median of 0.3 ± 0.41 logMAR (P < 0.05). Statistical analysis showed no significant difference between both groups at 3 months. Conclusion A single intravitreal injection of triamcinolone acetonide is as effective as three consecutive monthly intravitreal injections of bevacizumab for the treatment of diabetic macular edema.
  757 104 -