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  Most popular articles (Since June 29, 2016)

 
 
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ORIGINAL ARTICLES
Measurement of White-to-White Distance Using Pentacam Scheimpflug Imaging versus IOLMaster
Mohammed W Elkateb, Hesham S Swelem
January-June 2016, 22(1):10-14
DOI:10.4103/1687-6997.194365  
Purpose The aim of this study was to assess white-to-white (WTW) horizontal corneal diameter using Pentacam versus IOLMaster and determine whether the two instruments were interchangeable. Patients and methods Twenty eyes were included in this prospective clinical study conducted in I-care Eye Centre, Alexandria. Measurement of WTW horizontal corneal diameter was taken using Pentacam (internal and external measurements) and IOLMaster. Results The mean WTW measured using IOLMaster was 11.66 ± 0.27 mm, ranging from 11.30 to 12.30 mm. The mean WTW externally using Pentacam was 11.93 ± 0.43 mm, ranging from 11.01 to 12.66 mm. The mean WTW internally using Pentacam was 11.20 ± 0.39 mm, ranging from 10.56 to 11.93 mm. The diameters measured using IOLMaster were significantly less than that measured using Pentacam externally and significantly more than that measured using Pentacam internally. There was no correlation between WTW measured using the two machines. Conclusion Although horizontal corneal diameter (WTW) can be measured using Pentacam or IOLMaster, WTW measurement is significantly different between the two instruments and they should not be used interchangeably. Pentacam measurement depends on manual placement of calipers on the Scheimpflug digital image.
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Evaluation of the Posterior Hyaloid Changes Following Intravitreal Injection of Ranibizumab for Diabetic Macular Edema
Dalal A Shawky, Samir M El-Baha, Mohsen A Abou Shousha, Tamer M El-Ashmawy
January-June 2016, 22(1):21-29
DOI:10.4103/1687-6997.194364  
Purpose The aim of this work was to evaluate the posterior hyaloid changes and the effect on the vitreomacular relationship following intravitreal injection of ranibizumab (lucentis) for DME in diabetic patients attending the outpatient clinic of the Ophthalmology Department in Alexandria Main University Hospital. Patients and methods The study included 40 eyes. All of them received a baseline injection of 0.5 mg of intravitreal ranibizumab under sterile conditions. The injection was performed under topical anesthesia, with or without sedation. Further injections were administered Pro Re Nata (PRN ‘as required’) as decided in each subsequent follow-up visit if central retinal thickness remained 300 μm or greater or if there was a decrease in best-corrected visual acuity due to DME progression, confirmed with clinical evaluation and/or optical coherence tomography or other anatomic and clinical assessments. Results There were 12 male (54.2%) and 10 female patients (45.5%) between 45 and 71 years of age, with a mean value of 63.2 ± 12.6. There were five patients (22.7%) with type I and 17 patients (77.3%) with type II DM. The duration of DM was less than 10 years in six patients (27.3%) and more than 10 years in 16 patients (72.7%); it ranged between 9.5 and 20 years, with a mean value of 15.11 ± 7.98 years. HbA1c ranged from 7.11 to 8.25, with a mean value of 7.72 ± 0.892, and baseline visual acuity (TTDRS) ranged from 7.11 to 8.25, with a mean value of 53.13 ± 12.22. Baseline central macular thickness ranged from 301.0 to 525.0, with a mean value of 413.0 ± 107.0. No vitreous separation (category 1) was observed in 19 cases (47.5%), partial vitreomacular separation (VMS) (category 2) was observed in 12 cases (30%), vitreofoveal attachment with no traction (category 3) in seven cases (17.5%), and finally vitreofoveal attachment with traction (dome-shaped profile) (category 4) was observed in two cases (5%). No changes in vitreomacular relationship was seen in 16 cases (40%), partial VMS was seen in six cases (15%), vitreofoveal attachment with no traction was seen in eight cases (20%), vitreofoveal attachment with traction (dome-shaped profile) in three cases (7.5%), and complete VMS was seen in seven cases (17.5%). There was a statistically significant difference with regard to number of changes in VMR, partial VMS, vitreofoveal attachment with no traction, and vitreofoveal attachment with traction (dome-shaped profile). There was a statistically significant difference with regard to partial VMS, vitreofoveal attachment with no traction, and vitreofoveal attachment with traction (dome-shaped profile). There was a statistically significant relation between the number of injections and the outcome; the higher the number of injections, the better is the outcome.
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Ultrathin Descemet's Stripping Automated Endothelial Keratoplasty Using the Double-pass Technique with the Microkeratome versus Standard Descemet's Stripping Automated Endothelial Keratoplasty
Ossama El Hadad, Massimo Busin, Tamer Massoud, Silvana Madi
January-June 2016, 22(1):1-9
DOI:10.4103/1687-6997.194367  
Purpose The aim of the present study was to compare the results of Descemet's stripping automated endothelial keratoplasty (DSAEK) and ultrathin Descemet's stripping automated endothelial keratoplasty (UT-DSAEK) that were performed with a standardized technique at a single institution. Design The present study was designed as a single-center, prospective, randomized nonblinded study. Participants and methods Sixty-one and 51 eyes underwent DSAEK and UT-DSAEK, respectively, for any endothelial disease at the ‘Villa Igea’ Center. Patients with pre-existing ocular comorbidity that impacted visual potential such as macular degeneration, amblyopia, advanced glaucoma, and other optic neuropathies were excluded from the study. Best-corrected visual acuity (BCVA) (in Snellen acuity chart) was obtained and specular microscopy of donor corneal tissue was performed before surgery. Postoperative complications, BCVA, and the percent of endothelial cell loss (ECL) recorded at 1, 3, 6 months, and 1 year were compared. Main outcome measures Visual acuity improvement, ECL, intraoperative postoperative complications, iatrogenic primary graft failure, and rebubbling were the main outcome measures in this study. Results Mean ± SD BCVA improved from 0.17 ± 0.13 and 0.19 ± 0.13 before surgery to 0.75 ± 0.18 and 0.88 ± 0.19 at 1 year after DSAEK and UT-DSAEK, respectively (P = 0.001). ECL was 33.88 ± 17.74% after DSAEK and 36.37 ± 13.10% after UT-DSAEK (P = 0.4080). There were no iatrogenic primary graft failures after the two procedures but there were two late endothelial failures after DSAEK. Rebubbling was performed for four of 51 eyes after UT-DSAEK and for none after DSAEK (P = 0.04). Conclusion Compared with DSAEK, UT-DSAEK provided better visual recovery and comparable ECL. The UT-DSAEK group had a higher percentage of rebubbling procedures but less rejection and failure rate.
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Comparison between Intracameral Adrenaline Injection in Addition to Topical Mydriatics and Topical Mydriatics only in Phacoemulsfication Surgery
Ossama H El Haddad, Tarek Abdelrazek Hafez, Hany A Helaly, Nesma Y.A. El-Morsy
January-June 2016, 22(1):15-20
DOI:10.4103/1687-6997.194366  
Purpose The aim of the present study was to compare the pupil diameter in cases injected with intracameral adrenaline intraoperatively, in addition to topical mydriatics, and cases that received topical mydriatics only. In addition, this study aimed at assessing the systemic and local side effects of the two techniques. Patients and methods The study was conducted on a total of 80 consecutive eyes that underwent phacoemulsification surgery. Patients with different types of cataract requiring phacoemulsification were included in this study. The patients were randomized and divided into two groups. The first group (50 cases) received intraoperative bolus adrenaline injection intracameraly, in addition to preoperative topical mydriatics. The pupil diameter was measured twice, once after topical mydriatics and the second time after intracameral adrenaline injection. The second group (30 cases) received benoxinate hydrochloride 4 mg (Benox) preoperatively as a topical anesthetic, and tropicamid 1% (Mydriacil) as mydriatic. The pupil diameter was measured by using a squint caliper after mydriacyl. Results The mean preoperative pupil diameter in the first group was 6.76 ± 0.90 mm. Patients in the first group had smaller pupils. The mean preoperative pupil diameter in the second group was 8.07 ± 0.68 mm. The difference between the two groups was statistically significant. On the other hand, the mean pupil diameter after intracameral adrenaline injection was 7.91 ± 1.01 mm, which was statistically different as adrenaline dilated the pupil. Conclusion The present study revealed better pupil dilatation in cases with narrower pupil when injected with intracameral adrenaline than in cases with topical mydriatic only, with no local or systemic side effects.
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Visual and astigmatic outcomes in manual small-incision cataract surgery versus phacoemulsification
Maged Khalaf, Kholoud Mohamed, Mohamed Anbar, Hatem Ammar
July-December 2016, 22(2):37-41
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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Intraoperative outcome of deep anterior lamellar keratoplasty using femtosecond laser versus manual trephine
Ahmad S Khalil, Ashraf Bori
July-December 2016, 22(2):31-36
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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Crater-and-divide technique for phacoemulsification of hard cataract
Karim M Nabil
July-December 2016, 22(2):50-53
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
Electric cataract: a report of two cases and a review of the literature
Manisha Rathi, Nikunj Bhatt, CS Dhull, Sumit Sachdeva, Jitender Phogat
July-December 2016, 22(2):54-55
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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ORIGINAL ARTICLES
β-Blocker versus triamacinolone acetate in the treatment of infantile periocular hemangioma
Mona Abdel Kader, Ayman Mohamed Fawzy
July-December 2016, 22(2):42-49
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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