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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.
  1,852 144 -
Comparison of visual outcomes and higher order aberrations of wavefront-optimized and wavefront-guided myopic laser in-situ keratomileusis
Asmaa Hassan, Tamer Massoud, Gamal Nouby, Ahmed Fathlla
January-June 2017, 23(1):1-10
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.
  1,081 161 -
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.
  694 123 -
Efficacy of topography-guided femtosecond laser-assisted intrastromal corneal rings implantation in patients with keratoconus
Abdel Hamid El Hofi, Hazem Kandil, Ahmed Shama, Riham George
July-December 2017, 23(2):66-71
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.
  678 65 -
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.
  610 80 -
Patient satisfaction after femtosecond-assisted intracorneal ring segment implantation in the treatment of keratoconus
Alaa Ghaith, Mohamed Sobhy, Mohsen Abou Shousha, Amr El Kamshoushi
January-June 2017, 23(1):11-16
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%).
  583 100 -
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.
  604 71 -
Evaluation of two scheimpflug camera-based devices in the analysis of keratoconus
Alaa A Gaith, Amr A El kheir, Mohamed W Elkateb, Sally F Elseheimy
January-June 2017, 23(1):23-28
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.
  568 93 -
Corneal parameters among normal Egyptians with Pentacam Scheimpflug camera
Mona A Kader, Ayman Fawzy
January-June 2017, 23(1):17-22
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.
  533 91 -
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.
  518 83 -
ORIGINAL ARTICLES
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.
  515 81 -
Trends of glaucoma surgery at a tertiary referral glaucoma clinic in Alexandria University Hospital
Hesham Swelam, Nader H Bayoumy
January-June 2017, 23(1):29-33
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.
  503 84 -
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.
  494 85 -
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.
  479 78 -
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.
  392 62 -
Epithelium-off versus epithelium-on corneal collagen cross-linking with accelerated UV − a protocol for treatment of keratoconus
Mohamed El-Kateb, Magdi M Mostafa, Kamel A Soliman, Samir Y Saleh
July-December 2017, 23(2):39-48
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.
  373 71 -
Comparison of predictability of intraocular lens power calculation formulas for axial hyperopic patients undergoing cataract surgery using intraocular lens master
Mohamed A El Samadony, Tarek A Hafez, Hany A Helaly, Mohamed M Rafik
July-December 2017, 23(2):49-53
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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Early versus late postoperative ocular alignment following bilateral lateral rectus recession in children with intermittent exotropia
Sara Elhomosany, Tamer Massoud, Amgad Dwidar, Ahmed Elmassry
January-June 2017, 23(1):34-38
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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Soft cataract: improving surgical safety with modified phacoemulsification
Amarendra Deka
July-December 2017, 23(2):54-56
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
Ahmed S Mohamed, Ahmed M Eid, Ezz El-Din Galal Mohamed, Sherehan G Mohamed
July-December 2017, 23(2):57-65
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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Electrophysiological study of age-related macular degeneration
Mona A Kader
July-December 2017, 23(2):72-79
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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