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   Table of Contents - Current issue
Coverpage
July-December 2018
Volume 24 | Issue 2
Page Nos. 35-64

Online since Wednesday, December 18, 2019

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ORIGINAL ARTICLES  

A novel refractive nomogram for the Custom-Q laser-assisted in-situ keratomileusis treatment of myopia p. 35
Ahmad Saeed
DOI:10.4103/JCRS.JCRS_1_19  
Background To describe a new refractive nomogram to be used during the Custom-Q myopic laser-assisted in-situ keratomileusis (LASIK) ablation that seeks to minimize the postoperative spherical aberration (SA). This nomogram aims to avoid postoperative changes in target refraction that usually occur with customization of the Q value. This was a prospective controlled interventional case series. Materials and methods A total of 40 myopic patients (−1.00≤−8 D) were enrolled in this study. The right eyes of all patients were considered as the study group, where we targeted an ideal Q value of −0.45 during LASIK ablation. The corrected refractive error in the right eye was modified according to the new refractive nomogram to avoid the postoperative change in target refraction that occurs with the change in Q value. The left eyes of the same patients were considered as the control group with neither change in the Q value nor modification in the corrected refractive error. The classic outcome parameters such as visual acuity, cycloplegic refraction, as well as Q values and SAs were assessed and compared between the two groups preoperatively and at 1 month postoperatively. The LASIK machine involved in the treatment was The Allegretto Wave Eye-Q 400 Hz. Results There were no statistically significant differences (P>0.05) between the two groups regarding the postoperative visual acuity and refraction at 1 month. On the contrary, there were statistically highly significant differences (P<0.001) between the two groups regarding postoperative Q value and SA at 1 month postoperatively. Conclusion The new refractive nomogram used with the Q factor customized myopic LASIK ablation, which targets an ideal Q value to minimize the SA as much as possible, appears to be efficient in avoiding postoperative changes in target refraction that occur with customization of the Q value.
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Corneal endothelial changes after laser-assisted in situ keratomileusis combined with high-fluence cross-linking p. 42
Mohammed A Tohamy, M. Salah, Ahmed M Sabry, Ahmed M Eid
DOI:10.4103/JCRS.JCRS_3_19  
Purpose To evaluate corneal endothelial cells before and after laser-assisted in situ keratomileusis (LASIK) combined with accelerated, high-fluence collagen cross-linking (CXL) in myopic patients. Patients and methods In a prospective comparative nonrandomized interventional case series study, 60 myopic eyes of 30 patients (seven males and 23 females) with age ranged from 18 to 35 years were distributed into two groups. Group A included 30 eyes of 15 patients, treated by LASIK, whereas group B included 30 eyes of 15 patients treated by LASIK associated with high-fluence CXL. All patients were subjected to preoperative and 3- and 6-month postoperative evaluation of corneal endothelial profile using specular microscope. Results Qualitative and quantitative analysis of the corneal endothelial cells comparing the two groups showed statistically significant changes in endothelial cell density (P=0.040) at 3-month follow-up after the procedure, which improved to reach a value close to preoperative values, with no significant changes between the two groups at 6-month follow-up (P=0.081). There was no significant change in polymegathism or coefficient of variation and in the percentage of hexagonal cells (pleomorphism) in each group and in comparing between the two groups at 3- and 6-month follow-up. Conclusions LASIK with high-fluence CXL is safe and has no adverse effect on corneal endothelium.
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Comparison between LENSTAR and VERION in toric intraocular lens power calculation p. 47
Abdel H El Hofi
DOI:10.4103/JCRS.JCRS_5_19  
Purpose To compare and assess the accuracy of both Lenstar T-cone toric platform and Verion in toric intraocular lens (IOL) power calculation regarding postoperative refraction. Design The study design was a retrospective one. Participants and methods A total of 33 eyes (33 patients) with astigmatism at least 1 D underwent cataract surgery. The eyes included in the study were divided into two groups. Group 1 included 17 eyes where IOL was implanted according to Verion IOL power calculations, and group 2 included 16 eyes where IOL was implanted according to Lenstar T-cone power calculations. The keratometric readings of the 33 eyes of both devices were compared. Postoperative manifest refraction data of all patients that were taken 1 month postoperative were collected. The manifest postoperative refraction values of both groups were compared with both the expected refraction predicted by Lenstar toric T-cone and with that of the Verion. Results There were no statistical differences between the two devices used in this study regarding keratometric values. There were no statistical differences between the two devices used in this study regarding neither the final residual postoperative spherical refractive error nor the final residual postoperative cylindrical refractive error, nor the final residual postoperative spherical equivalent. Conclusion Both the Lenstar LS 900 T-cone biometer and the Verion image-guided system provide excellent, accurate, reproducible, and comparable postoperative results.
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Corneal endothelial cell changes following Femtosecond laser - assisted cataract surgery versus phacoemulsification p. 53
Abdel H El Hofi
DOI:10.4103/JCRS.JCRS_6_19  
The aim Is to compare the safety of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification on the corneal endothelial cell changes. Method Prospective, randomized study of 30 eyes underwent femtosecond laser-assisted cataract surgery and 30 eyes underwent conventional phacoemulsification between January and September 2016 at a private ophthalmology clinic in Alexandria. Femtosecond laser-assisted cataractsurgery involved cornealincision, anteriorcapsulotomy, and lens fragmentation based on optical coherence tomography-guided treatment mapping. Conventional procedure involved manual continuous curvilinear capsulorrhexis. Both procedures were completed by means of standard phacoemulsification and insertion of an intraocular lens. Endothelial cell count was measured with a Tommy EM 3000 Specular microscope preoperatively and 1 and 3 month postoperatively. Results Central corneal thickness in femtosecond lasr assisted cataract surgery (FLACS) group was 545.87±29.045 μm, whereas in phaco group was 541.43±36.606 μm, with no statistically significant difference between the two groups preoperatively and 1 week postoperatively. Effective phacoemulsification time was reduced by 52% in the FLACS group (P<0.0001), and cumulative dissipated energy was reduced by 45% in FLACS group (P<0.0001). A larger amount of fluid was used in conventional haco surgery (CPS) more than FLACS, with a statistically significant difference (regarding using divide-and-conquer technique in conventional phaco group in phaco one step) (P<0.05). There was no significant change in corneal endothelial cell count between the two groups. Conclusions Femtosecond laser-assisted cataract surgery appears to be as safe as conventional cataract surgery regarding central corneal thickness and corneal endothelial cell count with lower effective phacoemulsification time and cumulative dissipated energy in femtosecond laser-assisted cataract surgery.
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Comparative study between conventional scleral and suprachoroidal buckling in management of primary rhegmatogenous retinal detachment p. 58
Tamer M Ibrahim, Ashraf Shaaban Shaarawy, Ehab N El Rayes, Amr Saad Bessa
DOI:10.4103/JCRS.JCRS_6_18  
Aim The aim of the work was to compare the anatomical and visual outcomes of conventional scleral buckling with suprachoroidal buckling in the management of uncomplicated primary rhegmatogenous retinal detachment with peripheral retinal breaks. Method A prospective randomized interventional case series of 30 cases of Primary uncomplicated rhegmatogenous retinal detachment with peripheral retinal breaks. Patients were equally distributed into two groups. Group A managed with conventional scleral buckling with 360 circumferential or Localized buckles. Group B managed with suprachoroidal buckling with injection of sodiumhyaluronate14 mg/ml into the suprachoroidal space using specially designed cannula. Results In group A,13 cases out of 15 achieved single-surgery attachment with success rate of 86% compared to12 out of 15 cases in group B with attachment rate of 80%. No statistical significance was found between the two groups.With respect to functional success,the visual acuity of patients of scleral buckling improved from a mean of 0.08±0.08 preoperatively to 0.33 to 0.33±0.22 postoperatively. Patients underwent suprachoroidal buckling improved from a mean of 0.12±0.11 preoperativelyto 0.36 to 0.36 to 0.36 to 0.36±0.19 postoperatively. Significant myopic shift was noted in patients of scleral buckling of mean of −2.48±0.83 D as compared with −0.58±0.56 D in suprachoroidal buckling. Conclusion Suprachoroidal buckling technique shows non inferior results in management of cases of Primary rhegmatogenous retinal detachment in comparison with scleral buckles,with suprachoroidal buckling less changes in refraction as compared with scleral buckles.
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