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   Table of Contents - Current issue
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July-December 2017
Volume 23 | Issue 2
Page Nos. 39-79

Online since Wednesday, August 1, 2018

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ORIGINAL ARTICLES  

Epithelium-off versus epithelium-on corneal collagen cross-linking with accelerated UV − a protocol for treatment of keratoconus p. 39
Mohamed El-Kateb, Magdi M Mostafa, Kamel A Soliman, Samir Y Saleh
DOI:10.4103/JCRS.JCRS_13_17  
Purpose Our purpose was to compare the efficacy of ‘epithelium-off’ and ‘epithelium-on’ cross-linking (CXL) in treatment of progressive keratoconus. Patients and methods This study included 48 eyes of 26 patients who met our inclusion criteria. The Epi-Off CXL group included 32 eyes of 17 patients, and the Epi-On CXL group included 16 eyes of nine patients. Preoperative assessments of uncorrected and best-corrected visual acuities, refractive errors, keratometry, and corneal tomography including pachymetry, were compared with the postoperative values. Results Preoperatively, there was a statistically nonsignificant difference between the two groups in all studied variables except for the pachymetry at thinnest location. In the Epi-Off group, there was a significant improvement of uncorrected visual acuity, best-corrected visual acuity, Kmax, and inferior–superior value at the 12-month visit. There was late significant worsening of the back elevation and spherical equivalent at the 12-month visit and also significant thinning of pachymetry at thinnest location associated with significant worsening of the average thickness increase. All other variables showed nonsignificant change (stabilization) at both postoperative visits. In the Epi-On group, there was significant thinning of pachymetry at thinnest location and stabilization of uncorrected corrected visual acuity, best-corrected visual acuity, K1, Kmax, (inferior–superior), Y-coordinate, and front elevation at both postoperative visits, and early stabilization with late worsening of all of other variables. Conclusion The Epi-Off CXL was found to be more superior to Epi-On CXL in terms of stabilization of progressive keratoconus but was inevitably associated with complications related to epithelial debridement.
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Comparison of predictability of intraocular lens power calculation formulas for axial hyperopic patients undergoing cataract surgery using intraocular lens master p. 49
Mohamed A El Samadony, Tarek A Hafez, Hany A Helaly, Mohamed M Rafik
DOI:10.4103/JCRS.JCRS_11_17  
Purpose The aim of this study was to compare the predictability of different intraocular lens (IOL) power calculation formulas [Sanders–Retzlaff–Kraff (SRK) II formula, SRK-T formula, Haigis formula, Hoffer Q formula] in axial hyperopic patients [axial length (AL) <22 mm] undergoing cataract surgery using IOL master. Patients and methods This study comprised 40 eyes of 26 patients who presented with cataract and axial eye length less than 22 mm. Before phacoemulsification and IOL implantation, AL measurement, keratometry measurement and anterior chamber depth measurement using the IOL master were done. IOL power was calculated using four different formulas (SRK-II, SRK-T, Haigis, Hoffer Q). Actual stabilized postoperative refraction (spherical equivalent) 1 month after surgery was measured and the accuracy of the four different formulas was compared. Differences between actual postoperative refraction and predicted refraction using the different formulas were analyzed. P value less than or equal to 0.05 was considered statistically significant. Furthermore, the percentage of eyes with mean absolute prediction error (MAE) within ±0.5 and ±1.0 diopter (D) for each formula was estimated, as well as the correlation coefficient (r) between the AL and MAE for each formula. Results There was a significant difference between the MAE of the four formulas, except there was no significant difference between the MAE of SRK-T and SRK-II. The Haigis formula had a smallest MAE of 0.47±0.36 D, then Hoffer Q with a MAE of 0.87±0.51 D, and then SRK-T with a MAE of 1.38±0.89 D. The SRK-II had the largest MAE of 1.70±1.06 D. The Haigis formula predicted more eyes with MAE within ±0.5 and ±1.0 D of the predicted spherical equivalent compared with other formulas. The correlation between AL and AE has shown a negative r value and P value of less than 0.05 for all formulas. Conclusion The Haigis formula provides more accurate results concerning the postoperative target of refraction in eyes with an AL of less than 22.0 mm. Hoffer Q could be also used as an alternative.
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Soft cataract: improving surgical safety with modified phacoemulsification p. 54
Amarendra Deka
DOI:10.4103/JCRS.JCRS_12_17  
Purpose The aim was to describe a modified stop and chop technique for managing soft cataract to improve surgical safety. Materials and methods Capsulorrhexis is performed as usual with a 27 G needle. A trench is fashioned using low ultrasonic power. Hydrodelineation is performed by a cannula introducing directly in central lens substance. Hydrodissection follows next and precise hydroprocedure is achieved. Nucleus is emulsified using ultrasound power and intraocular lens is implanted. Result This technique results in easy rotation and removal of the nucleus and the epinucleus using low phaco power. Conclusion This modified phacoemulsification technique is safe and very effective to emulsify soft to moderate hard cataract where direct chop would be difficult.
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Evaluation of postlaser in-situ keratomileusis corneal flap and bed thickness using anterior segment optical coherence tomography p. 57
Ahmed S Mohamed, Ahmed M Eid, Ezz El-Din Galal Mohamed, Sherehan G Mohamed
DOI:10.4103/JCRS.JCRS_15_17  
Purpose Aim of this work is to compare the thickness of the laser in-situ keratomileusis flap created by the mechanical microkeratome Moria M2110 and that created with the mechanical microkeratome Moria M290, using anterior segment optical coherence tomography (OCT) (anterior segment OCT 3D 2000 fluorescein angiography plus). Design This is a comparative prospective study. Patients and methods In our study, flaps were created using the mechanical Moria M2110 with medlogic plano head (intended flap 110 μm) in 38 eyes, and in the other 43 eyes, the flaps were created using mechanical microkeratome Moria M290. Flap thickness was measured using anterior segment OCT. Results In the Moria M2110 with medlogic-10 head created flaps, the mean flap thickness 2 mm nasal to the center, the mean flap thickness 2 mm temporal to the center, and the mean±SD central flap thickness were 135.9±6.4 mm (125–160 mm), 137±9 mm (125–163 mm), and 137.7±10.9 mm (125–164 mm), respectively, in right (OD) and 131.2±9.8 (115–152), 129.2±8.4 (116–152), and 131.2±9.8 (117–154), respectively, in left (OS). In the Moria M290-created flaps, the mean central flap thickness, the mean flap thickness 2 mm nasal to the center, and the mean flap thickness 2 mm temporal to the center were 118.4±11.9 (95–145), 118.5±11.9 (96–144), and 118±11.6 (99–145), respectively, in OD and 115.7±12.3 (99–140), 115.9±11.6 (100–139), and 115.8±11.4 (100–140), respectively, in OS. The deviation of the created flap thickness from the intended 110 μm was 27.67±10.87 in the M2110 created flap, whereas the deviation from the intended 90 μm thickness in M290 group was 28±11.67 (P=0.722). Conclusion Laser in-situ keratomileusis flaps created with the Moria M290 have thinner thickness, and more predictability and more perseverance of bed thickness than those created with the Moria M2110.
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Efficacy of topography-guided femtosecond laser-assisted intrastromal corneal rings implantation in patients with keratoconus p. 66
Abdel Hamid El Hofi, Hazem Kandil, Ahmed Shama, Riham George
DOI:10.4103/JCRS.JCRS_17_17  
Purpose The aim was to evaluate the efficacy of intrastromal corneal rings using femtosecond laser depending on the patient’s topography for the correction of keratoconus. Patients and methods This was a prospective interventional study. A total of 33 eyes of thirty-one patients with keratoconus, with mean age 26.85±6.59 years, were included in the study. Fourteen cases were male and 19 were female. Intrastromal corneal ring segments, Kerarings, were implanted for keratoconus correction after corneal tunnel creation with the aid of femtosecond laser (Fs200). Full ophthalmologic examination, including slit lamp biomicroscopy was done. Uncorrected visual acuity, manifest refraction, and best spectacle corrected visual acuity were also recorded. Pentacam and corneal topography were also done before and after the surgery. Results The mean age of the studied patients was 26.85±6.59 years. The mean uncorrected visual acuity before and after the procedure was 0.78±0.38 and 0.24±0.19, respectively. The mean BCVA before and after the procedure was 0.19±0.12 and 0.12±0.10, respectively. There was statistically significant difference between preoperative and postoperative mean sphere, cylinder, and spherical equivalent (P<0.001). There was significant decrease in the maximum k value and an increase in the center k value leading to a decrease in the mean maximum k–center k value from −6.05±3.42 preoperatively to −2.23±2.38 postoperatively. There was also significant decrease in the aberration coefficient value. Conclusion Kerarings in eyes with keratoconus improved postoperative topographic characteristics and visual acuity. Nomograms for intrastromal corneal ring segment insertion based on preoperative topography in addition to refraction are suggested, rather than relying primarily on refraction.
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Electrophysiological study of age-related macular degeneration p. 72
Mona A Kader
DOI:10.4103/JCRS.JCRS_4_17  
Purpose To evaluate the effects of age-related macular degeneration (ARMD) on electrophysiological tests and to correlate between electroretinogram (ERG) and optical coherence tomography. Patients and methods Fifty control participants (100 eyes) and 100 patients (100 eyes) with ARMD were examined clinically. ERG, multifocal electroretinogram (MFERG), standard ERG, fluorescein angiography, and optical coherence tomography were performed. Results ERG responses were decreased in all types of ARMD, especially in geographic atrophy. The amplitudes of scotopic ERG were slightly decreased, without a change in implicit times. The amplitudes of oscillatory potential were significantly decreased and photopic responses were also decreased in geographic atrophy, choroidal neovascularization, and pigment epithelium detachment. MFERG shows abnormalities not only in the central ring but also in all rings (central, paracentral, and peripheral). There were negative correlations between central macular thickness and the amplitude of MFERG of the central ring and a positive correlation between central macular thickness and latency of MFERG of the central ring in choroidal neovascularizations and pigment epithelium detachment. Conclusion Electrophysiological responses indicated a general reduction in retinal function in all parts of the retina (not only in the macula but in every part of the retina) in ARMD.
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