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   Table of Contents - Current issue
Coverpage
July-December 2016
Volume 22 | Issue 2
Page Nos. 31-55

Online since Wednesday, May 17, 2017

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ORIGINAL ARTICLES  

Intraoperative outcome of deep anterior lamellar keratoplasty using femtosecond laser versus manual trephine p. 31
Ahmad S Khalil, Ashraf Bori
DOI:10.4103/JCRS.JCRS_9_16  
Purpose The aim of this study was to compare the intraoperative data of femtosecond laser-assisted deep anterior lamellar keratoplasty (F-DALK) with those of manual trephine deep anterior lamellar keratoplasty (M-DALK). Setting The study was conducted in a single private centre (Alfat’h Eye Hospital). Design This is a nonrandomized comparative retrospective, single private centre clinical study. Materials and Methods The study was conducted between February 2013 and March 2016 on 40 eyes that underwent M-DALK and 24 eyes that underwent F-DALK, including moderate-to-advanced keratoconus (KC) intolerant to contact lenses, superficial corneal opacities or degenerations, and stromal corneal dystrophies (e.g. macular dystrophies, etc.) with best spectacle corrected visual acuity (BSCVA) less than or equal to 6/60 (0.1), and excluding those with KC (with acute hydrops or posthydrops scars), corneal opacities or corneal dystrophies involving the endothelium. The intraoperative data were retrieved and analysed. Results F-DALK had fewer intraoperative complications compared with M-DALK, such as the decentred cut, which was 0% in F-DALK versus 1/40 (2.5%) in M-DALK, with a statistically significant difference in the overall intraoperative complications between the two procedures (P=0.004). Conclusion The F-DALK technique results in fewer intraoperative complications such as the inadvertent premature entry of the anterior chamber, a better centration of the cuts in patients with KC, and more success of the big bubble formation and thereby less conversion to penetrating keratoplasty or to manual dissection, which has a lower visual outcome.
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Visual and astigmatic outcomes in manual small-incision cataract surgery versus phacoemulsification p. 37
Maged Khalaf, Kholoud Mohamed, Mohamed Anbar, Hatem Ammar
DOI:10.4103/JCRS.JCRS_10_16  
Background The aim of this study was to compare the visual and astigmatic outcomes following manual small-incision cataract surgery (MSICS) versus phacoemulsification (PHACO) and to calculate the surgically-induced astigmatism (SIA) following both techniques. Patients and methods The study was conducted on 64 eyes of 63 consecutive patients with cataract who underwent either PHACO surgery (group 1; n=32) or MSICS (group 2; n=32). Patients were examined at day 1, 1 week, 1 and 3 months postoperatively. The basic postoperative parameters were uncorrected and best-corrected visual acuity. SIA was calculated using SIA calculator, version 2.1, in which the preoperative and postoperative K-readings and their axes were used. Results In the last postoperative visit after 3 months, the uncorrected visual acuity ranged between 6/18 and 6/9 in both groups. The visual acuity was markedly improved at 3 months of follow-up in comparison with preoperative status (P<0.0001) and in comparison with early postoperative status (P<0.0001). The PHACO group had a better visual acuity at 3 months of follow-up (P<0.01). After 3 months of follow-up, the mean SIA was 2.08 in the PHACO group, whereas it was 2.96 in the MSICS group. There was no statistically significant difference in either the amount (P=0.166) or the axis (P=0.195) of SIA between patients treated with PHACO and patients treated with MSICS. Conclusion MSICS is an effective, fast and economical technique and should be considered as an alternative to PHACO in certain cases.
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β-Blocker versus triamacinolone acetate in the treatment of infantile periocular hemangioma p. 42
Mona Abdel Kader, Ayman Mohamed Fawzy
DOI:10.4103/JCRS.JCRS_1_17  
Purpose The aim of this study was to evaluate the effectiveness of systemic and intralesional β-blockers in the treatment of periocular infantile capillary hemangiomas and to compare the effect of intralesional triamcinolone acetonoid injection and β-blockers. Patients and methods Totally, 60 patients with infantile periocular hemangioma were included in the study and were divided into three groups. Group 1 included 20 patients treated with systemic β-blocker. Group 2 included another 20 patients treated with intralesional triamcinolone acetate. Group 3 included 20 patients treated with intralesional β-blocker. Results In group 1, 55% of patients showed excellent response, 30% of patients showed good response, 10% of patients showed fair response, and 5% of patients showed poor response. In group 2, 50% of patients showed excellent response, 35% of patients showed good response, 15% of patients showed fair response, and no patients showed poor response. In group 3, 40% of patients showed excellent response, 25% of patients showed good response, 25% of patients showed fair response, and 10% of patients showed poor response. Conclusion Systemic propranolol is a good alternative for treating periorbital infantile hemangiomas. Systemic propranolol is superior to intralesional steroid because systemic propranolol has fewer side effects. Propranolol provides a more safe and effective modality of treatment of periocular infantile capillary hemangioma with a lower incidence of systemic side effects.
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Crater-and-divide technique for phacoemulsification of hard cataract p. 50
Karim M Nabil
DOI:10.4103/JCRS.JCRS_2_17  
Purpose The aim of this study was to evaluate a new technique for safe phacoemulsification of sizable, tough, leathery nuclear cataracts. Patients and methods Thirty eyes of 22 patients with hard cataract, recruited from the Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt, were included in the study. Informed consent was obtained from all patients. All surgeries were performed by the same surgeon (K.M.N.). A wide crater around 5.0 mm in diameter was created by down-slope carving up to 90% of the thickness of the nucleus, leaving the peripheral nuclear rim untouched. The phaco probe was applied at one edge of the crater without vacuum, and a spatula was applied at the opposite crater edge. The phaco probe and the spatula were pushed simultaneously in opposite directions toward the lens periphery, dividing the remaining nuclear rim into two halves. Each half, consisting of a thin nuclear rim, was withdrawn with high vacuum and emulsified in the suprabagal space. Results Intact posterior capsule was achieved in all cases. Clear cornea was reported on the first postoperative visit in 24 eyes and negligible postoperative early corneal edema in six eyes. Conclusion Our novel crater-and-divide phacoemulsification technique permits uneventful phacoemulsification of hard cataracts.
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CASE REPORT Top

Electric cataract: a report of two cases and a review of the literature p. 54
Manisha Rathi, Nikunj Bhatt, CS Dhull, Sumit Sachdeva, Jitender Phogat
DOI:10.4103/JCRS.JCRS_6_16  
We report two cases of electrical cataract developing after a high-voltage electric shock. Both patients had undergone cataract extraction and posterior chamber intraocular lens implantation, both of them achieved visual acuity of 6/6. Most of the times outcomes after the cataract surgeries are excellent provided that other ocular structures are undamaged. Anterior subcapsular opacity may hamper the lens nutrition and lead to cataract formation.
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