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   Table of Contents - Current issue
Coverpage
January-June 2017
Volume 23 | Issue 1
Page Nos. 1-38

Online since Friday, November 17, 2017

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ORIGINAL ARTICLES  

Comparison of visual outcomes and higher order aberrations of wavefront-optimized and wavefront-guided myopic laser in-situ keratomileusis p. 1
Asmaa Hassan, Tamer Massoud, Gamal Nouby, Ahmed Fathlla
DOI:10.4103/JCRS.JCRS_6_17  
To compare the visual and refractive outcomes of wavefront-optimized (WFO) ablations (wavelight allegretto) and wavefront-guided (WFG) ablations (VISX Custom Vue). Overall, two consecutive groups of eyes were treated for myopia and myopic astigmatism with laser in-situ keratomileusis. One group was treated with WFO ablation and the other group was treated with WFG ablation. Preoperative and 1, 3 and 6 months postoperative refractive evaluation (efficacy, safety, predictability, accuracy, stability, and refractive astigmatism), higher order aberrations (HOAs), and contrast sensitivity were analyzed. The WFO group comprised 20 eyes of 11 patients and the WFG group comprised 34 eyes of 17 patients. Postoperatively, the mean refractive spherical equivalent was −0.21±0.30 D in WFO group and −0.23D±0.57 D in WFG group. The mean values for postoperative uncorrected distance visual acuity were 0.93±0.15 and 0.96±0.16 in WFO and WFG groups, respectively. Safety index was 1.11 in WFO group and 1.17 in WFG group. Six months postoperatively, in WFO group, the induced HOA root mean square (RMS) was 0.25±0.21 μm (P=0.007), induced coma RMS was 0.07±0.23 μm (P=0.84), and induced spherical aberration RMS was 0.03±0.12 μm (P=0.467), whereas induced trefoil RMS was −0.09±0.23 μm (P=0.003). In WFG group, induced HOA RMS was 0.9±0.11 μm (P=0.002), induced coma RMS was 0.01±0.30 μm (P=0.065), and induced spherical aberration RMS was 0.09±0.17 μm (P=0.214), whereas induced trefoil RMS was 0.04±0.15 μm (P=0.005). Contrast sensitivity testing showed a statistically significant improvement in both groups at low spatial frequencies test. Both WFG and WFO showed comparable accuracy, efficacy, and safety with nearly equal induction of all HOA.
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Patient satisfaction after femtosecond-assisted intracorneal ring segment implantation in the treatment of keratoconus p. 11
Alaa Ghaith, Mohamed Sobhy, Mohsen Abou Shousha, Amr El Kamshoushi
DOI:10.4103/JCRS.JCRS_7_17  
Purpose The aim of this article is to evaluate patient satisfaction after femtosecond-assisted intracorneal ring segment (ICRS) implantation in the treatment of keratoconus. Patients and methods The study was carried out in two private eye centers and Department of Ophthalmology at Alexandria University. This study is a retrospective type. The study included 30 keratoconus patients with moderate to severe keratoconus and clear central cornea. All patients underwent KeraRings ICRS implantation. All patients answered a specially designed questionnaire to evaluate their visual function and satisfaction within a period of 6 months to 1 year postoperatively. The correlations between questionnaire scores and the clinical parameters were studied. Results The clarity of vision in general was good for 50% of the cases, acceptable for 26.7%, and bad for 16.7%. Regarding night vision, 40% of the patients complained of bad night vision; while for 46.7% of the patients it was acceptable. Additionally, the analysis revealed that regarding ‘reading’ 73.4% of patients were satisfied. Sixty percent of the patients were satisfied with their far vision, postoperatively. Ninety-three percent and 90% of the patients complained of glare and haloes, respectively; 12 patients complained of fluctuation of vision. Significant correlations were those of SEQ (spherical equivalent of manifest refraction) and Kmax at the sixth month with general satisfaction with P value less than 0.001 and 0.013, respectively. Conclusively 70% of the patients were satisfied after ICRS implantation. Conclusion Most patients (70%) are generally satisfied after ICRS implantation for the treatment of keratoconus. However, night vision disturbance, glare and haloes are the main complaints for a large number of them (about 90%).
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Corneal parameters among normal Egyptians with Pentacam Scheimpflug camera p. 17
Mona A Kader, Ayman Fawzy
DOI:10.4103/JCRS.JCRS_8_17  
Purpose The aim of the study was to evaluate the corneal parameters [anterior and posterior elevation, keratometry values in the steep (K1) and flat (K2) meridians, central corneal thickness, and thinnest location] among normal Egyptians of different age with Pentacam Scheimpflug camera and to detect repeatability of Pentacam. Patients and methods A total of 2000 randomly chosen participants representing normal Egyptian population presenting to the outpatient clinic of the Ophthalmic Center were included in the study. They were aged from 20 to 60 years and included both sexes. They were divided into four groups. All patients were examined by Pentacam Tomey TMS-5 (topographic modeling system). The technique was repeated three times for each eye on the same day and three times the next day by two different observers. Results There were statistically significant differences in anterior elevation, posterior elevation, central corneal thickness, thinnest location, and K2 between the four groups (P=0.02, <0.001, 0.001, 0.002, and 0.004, respectively). However, there was no statistically significant difference in K1 between the four groups (P=0.092). Coefficient of variation for K1 and K2 was 0.17 and 0.19, respectively. Conclusion There were increases in the values of posterior elevation, K1, and K2 with the aging process. Excellent intraobserver and interobserver repeatability for K1, K2, and pachymetry maps and poor intraobserver and interobserver repeatability for astigmatism axis were observed.
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Evaluation of two scheimpflug camera-based devices in the analysis of keratoconus p. 23
Alaa A Gaith, Amr A El kheir, Mohamed W Elkateb, Sally F Elseheimy
DOI:10.4103/JCRS.JCRS_9_17  
Purpose This study aimed to evaluate the measurements of the anterior segment of the eye by two Scheimpflug camera-based systems: the Pentacam HR imaging system and the Sirius imaging system in keratoconus patients. Patients and methods Keratoconus patients were recruited prospectively. Measurements with the Oculus Pentacam and with the CSO Sirius were performed according to the manufacturer’s instructions. For every eye, the following parameters were analyzed statistically. The anterior ketatometric reading of the flattest meridian K1, anterior K2, anterior mean K, anterior Kmax, pachymetry at the thinnest location, the highest anterior corneal elevation in the 3-mm pupillary area, the highest posterior corneal elevation in the 3-mm pupillary area, and the best-fit sphere for the anterior corneal surface and posterior corneal surface at the same diameter of analysis. Agreement between Sirius and Pentacam was assessed by calculating 95% limits of agreement and plotting Bland–Altman graphs. Results Fifty eyes from individuals (26 men, 24 women) aged 20–38 years were evaluated. The mean K1 difference between the measurements of both machines was −0.54±1.02 D. The mean K2 difference between the measurements of both machines was −1.40±1.53 D. The mean Kmax difference between the measurements of both machines was −0.60±2.38 D. The mean avgerage K difference between the measurements of both machines was −0.89±1.06 D. The mean thinnest location pachymetry difference between the measurements of both machines was 9.20±14.14 μm. The mean highest anterior elevation difference between the measurements of both machines was 6.86±11.43. The mean highest posterior elevation difference between the measurements of both machines was 20.52±21.32. The mean anterior best-fit sphere difference between the measurements of both machines was 0.14±0.13. The mean posterior best-fit sphere difference between the measurements of both machines was 0.16±0.16. The difference was statistically significant. Conclusion All the measurements between both Pentacam and Schwind Sirius showed a significant positive correlation, except for the highest anterior and posterior elevation measurements. Schwind Sirius produces keratometry measurements higher than Pentacam in keratoconus patients. However, corneal thickness, the radius of the best-fit sphere, and the highest anterior and posterior elevation measurements by Pentacam were higher than Schwind Sirius measurements. The differences between the measurements of Sirius and Pentacam were statistically significant. Therefore, it is recommended that the measurements of these devices not be used interchangeably.
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Trends of glaucoma surgery at a tertiary referral glaucoma clinic in Alexandria University Hospital p. 29
Hesham Swelam, Nader H Bayoumy
DOI:10.4103/JCRS.JCRS_5_17  
Context Glaucoma surgery aims to prevent visual loss from this blinding condition. Aim The aim of this research was to study the trends of glaucoma surgery in adults in a tertiary referral glaucoma centre in Alexandria University Hospital. Setting and design This is a retrospective study conducted in a tertiary referral glaucoma centre. Patients and methods Records of patients were retrospectively reviewed to study those undergoing surgery over a 10-year period from January 2007 to January 2017. The primary outcome measure was the intraocular pressure (IOP) − early postoperatively and at the last postoperative visit. Statistical method used The statistical methods were mean, SD, analysis of variance and post-hoc analysis. Results Sixty eyes of 51 patients underwent glaucoma surgery for uncontrolled IOP. Trabeculectomy was the most common procedure used, followed by synthetic Ahmed’s valve. Mean preoperative IOP ranged from 17 to 66 mmHg with a mean of 36.7±11.19 mmHg. Early postoperative pressure ranged from 0 to 40 mmHg with a mean of 13.6±8.77 mmHg. Last visit postoperative pressure ranged from 0 to 46 mmHg with a mean of 15.2±9.35 mmHg. Pressure decreased significantly both early and late postoperatively from the preoperative levels. There was no significant change of IOP between the early and last postoperative visits. Conclusion A marked decrease in mean IOP was achieved both early and late postoperatively. The issue of poor registry keeping together with incomplete data recording was outstanding and needs to be addressed by the governing bodies to allow more robust analysis and comparison of outcomes.
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Early versus late postoperative ocular alignment following bilateral lateral rectus recession in children with intermittent exotropia p. 34
Sara Elhomosany, Tamer Massoud, Amgad Dwidar, Ahmed Elmassry
DOI:10.4103/JCRS.JCRS_10_17  
Purpose The aim of this study was to determine the relationship between early and late postoperative motor outcomes in pediatric patients operated for intermittent exotropia. Patients and methods A prospective interventional study was performed on 50 consecutive pediatric patients with intermittent exotropia. All patients were treated with bilateral lateral rectus recession. Distance alignment was analyzed in all patients before and after surgery at week 1 and 6 months postoperatively. Successful results were defined as ocular alignment with exodeviation (tropia/phoria) equal to or less than 10Δ, or esodeviation (tropia/phoria) equal to or less than 5Δ. Results A total of 50 patients, 30 (60%) female and 20 (40%) male, were included in this study with a mean age of 5.27±2.92 (0.8–10) years. Mean preoperative angle of deviation was 33.8±5.63Δ (20–45Δ). Bilateral lateral rectus recession was performed in all patients. Regarding the late outcomes analyzed at 6 months postoperatively, it is reported that 33 (66%) patients had favorable outcomes, 12 (24%) patients were undercorrected, and five (10%) cases were overcorrected. A good late outcome had initial alignment of 4.52±7.43 PD of esotropia, whereas patients with late postoperative undercorrection had an average initial postoperative alignment of −2.36±4.18 PD. The differences in average initial alignments were statistically significant between each of the groups (P<0.01). However, the average initial postoperative alignment in the overcorrected group was 7±9.9, which was statistically nonsignificant (P=0.655). Conclusion Initial postoperative overcorrection (0–9Δ) esotropia is desirable in the treatment of patients with intermittent exotropia; however, longer duration of follow-up is required to emphasize this relationship.
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