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Table of Contents - Current issue
April-June 2022
Volume 23 | Issue 2
Page Nos. 61-140
Online since Wednesday, June 29, 2022
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ORIGINAL ARTICLES
Effect of eyelid-warming device on meibomian gland dysfunction
p. 61
Eman H Albehwar, Heba M Shafik, Amr Awara, Osama E Shalaby
DOI
:10.1353/djo.djo_44_21
Background
Meibomian gland dysfunction (MGD) has a significant effect on patients’ quality of life. Despite the numerous treatment options, it is still difficult to obtain complete relief of signs and symptoms. Blephasteam is an eyelid-warming device that is easy to use and standardized for treatment of MGD.
Objective
This study aimed to evaluate of the effect of Blephasteam on MGD compared with the traditional warm compresses.
Patients and methods
This is a prospective comparative interventional study that included 40 eyes of 20 patients with MGD. Patients were subdivided into two groups: in group I, warm compresses were applied to the eyelids twice daily for 20–30 min for 2 weeks, whereas in group II, the patients used the Blephasteam device three sessions per week for 2 weeks. Both groups received treatment by systemic tetracycline, topical antibiotic and steroid, and preservative-free artificial tears eye drops for 2 weeks. The patients were assessed before treatment and after 2 weeks, 1 month, and 3 months using the Standard Patient Evaluation of dry Eye Disease questionnaire for dry eye, breakup time test (invasive and noninvasive; IBUT and NIBUT), and the shape of the lipid layer of the tear film by a tearscope.
Results
Both groups showed statistically significant improvement regarding the dry eye symptoms, IBUT and NIBUT, and the lipid layer interferometry. However, the follow-up visits showed statistically significant better results in group II than in group I for the Standard Patient Evaluation of dry Eye Disease questionnaire (
P
=0.044, 0.001, and 0.001, respectively). In addition, the IBUT was statistically significantly better in group II than in group I during the follow-up (
P
=0.014, 0.007, and 0.002, respectively) as well as the NIBUT (
P
=0.043,
P
<0.001, and
P
<0.001, respectively). There was no statistically significant difference in interferometry between the two groups during the follow-up.
Conclusions
Both traditional warm compress and Blephasteam were effective in MGD treatment, but Blephasteam was more effective.
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Comparison between therapeutic effects of 0.18% sodium hyaluronate and 1% carboxymethyl cellulose on ocular surface damage induced by anti-glaucoma medications
p. 69
Meemansha Maheshwari, Amit K Jain, Naveen K Singh, Neha Singh, Tirupati Nath
DOI
:10.4103/djo.djo_71_21
Purpose
This study was conducted to compare the therapeutic effect of 1% carboxymethyl cellulose (CMC) and 0.18% sodium hyaluronate (SH) on ocular surface damage induced by various anti-glaucoma medications.
Patients and methods
The study included 100 patients who were diagnosed as having primary open-angle glaucoma, normal tension glaucoma, or ocular hypertension and were on anti-glaucoma drugs. The patients were divided in two groups: group A patients received 1% CMC, whereas group B patients received 0.18% SH for 3 months. The severity of ocular surface disease symptoms was assessed by the ocular surface disease index (OSDI) questionnaire. Ocular examination with tear film break-up time, fluorescein staining, Schirmer’s test, and conjunctival impression cytology was performed sequentially on days 0, 30, and 90.
Results
Both CMC-treated and SH-treated groups showed improvement in the OSDI scores at days 30 and 90. However, the OSDI scoring was statistically significantly better in the SH group at both follow-up intervals (
P
<0.05). Fluorescein staining improved significantly with SH compared with CMC at day 30 (
P
<0.03). Schirmer’s test, tear film break-up time, and conjunctival impression cytology improved in both drugs. However, the difference was not statistically significant (
P
>0.5).
Conclusion
Both SH and CMC improved the symptoms and signs of ocular surface damage caused by the preservatives used in anti-glaucoma medication. However, SH showed faster efficacy than the CMC-based formulation.
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Serum vitamin D level and micro-ribonucleic acid-146a expression pattern in dry eye disease associated with rheumatoid arthritis in an Egyptian population
p. 75
Shireen M Shousha, Nehal EL-Ghobashy, Maha Alhelf, Dalia Abd El-kareem, Pavly Moawad
DOI
:10.1353/djo.djo_41_21
Aim
The aim of this research was to study serum vitamin D and micro-ribonucleic acid-146a (miRNA-146a) expression in dry eye disease (DED) associated with rheumatoid arthritis (RA) and their clinical correlations to DED parameters.
Setting and design
This is an observational cross-sectional study that was conducted at Cairo University, Cairo, Egypt.
Patients and methods
The study participants were divided into three groups: group A, DED/RA (
n
=35); group B, non-DED/RA (
n
=36); and group C, non-DED/non-RA (
n
=35). All participants were assessed for ocular surface disease index, tear breakup time (TBUT), serum level of vitamin D, and miRNA-146a expression. In the DED group (with TBUT˂10 s), DED evaluation was performed, including Schirmer I test, corneal and conjunctival scoring, and impression cytology.
Results
The mean serum vitamin D level was 17.1±16.2 ng/ml in group A, 35.1±13.4 ng/ml in group B, and 38.1±8.7 ng/ml in group C, with a statistically significant difference (
P
˂0.001). The mean miRNA-146a expression was 4.7±1.5 in group A compared with 4.8±1.8 in group B (
P
=0.959) and 1.0±0.1 in group C (
P
˂0.001, compared with each of groups A and B). In group A, serum vitamin D level showed a significant moderate negative correlation to each of impression cytology grading (
r
=−0.456,
P
=0.019) and miRNA-146a expression (
r
=−0.387,
P
=0.041). Both serum vitamin D and miRNA-146a expression showed nonsignificant correlations to ocular surface disease index, TBUT, Schirmer I test, and corneal and conjunctival scoring.
Conclusion
DED associated with RA showed a statistically significantly lower serum level of vitamin D, which was negatively correlated to impression cytology grading and miRNA-146a expression. Expression of miRNA-146a did not differ between the dry eye and non-dry eye RA groups.
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Efficacy and safety of intrastromal injection of amphotericin B combined with autologous serum eye drops in resistant fungal corneal ulcers
p. 83
Marwa A.M Aboelenein, Doaa A Mahmoud, Wafaa A Madbouly
DOI
:10.4103/djo.djo_55_21
Abstract
Aim
The aim was to evaluate the efficacy of a combination of intrastromal injections of amphotericin B (AmB) and autologous serum eye drops (ASED) in the treatment of resistant fungal keratitis.
Patients and methods
This is a prospective nonrandomized study that evaluated 15 eyes of 15 patients with resistant fungal corneal ulcers not responding to conventional medical treatment treated with intrastromal AmB injection (25 µg/ml) combined with the use of ASED. The efficacy, complications, and outcomes were evaluated.
Results
Patients showed marked improvement in symptoms (e.g. pain, discharge, photophobia, and lacrimation) in 12 cases (80%) by the second week after injection and total disappearance of symptoms in all patients by the second month. By the second week, three eyes (20%) showed complete ulcer healing, at the first month eight eyes (53.3%), at the second month 12 eyes (80%), and at the third month 15 eyes (100%) showed complete ulcer healing. The procedure was performed successfully, and no severe intraoperative or postoperative complications were observed except two patients develop minimal intrastromal bleeding which resolved. All the study cases underwent use of ASED after the intrastromal injection to accelerate ulcer healing, alleviate corneal irritation, and reduce inflammatory reactions and all of them showed rapid improvement of symptoms, for example, pain and good ulcer-healing process.
Conclusion
Combination of intrastromal injection of AmB and autologous serum eye drops is a promising, safe, and effective technique for the management of resistant fungal corneal ulcers not responding to conventional medical treatment. ASED shows good results in improving epithelial healing, alleviating corneal irritation, and in reducing inflammatory reactions.
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Risk factors for ectasia after laser in situ keratomileusis in an Egyptian population sample
p. 89
Hebatallah M.T Abdelmoneim, Khaled Abdelazeem, Gamal Nouby, Mohamed Tarek Abdelmoneim, Ahmed M.F Fathalla
DOI
:10.4103/djo.djo_70_21
Purpose
The aim of this study was to determine the prevalence and risk factors of post-laser in situ keratomileusis (post-LASIK) ectasia in an Egyptian population sample.
Design
This is a retrospective case–control study.
Patients and methods
The study included 44 patients, who were classified into two groups. The first group (post-LASIK ectasia) included 31 eyes (18 patients) and the second group (LASIK without complications) included 52 eyes (26 patients). The comparison between the two groups included the pre-LASIK refractive error, corrected distance visual acuity (CDVA), corneal curvature, corneal thickness, corneal elevations, ectasia risk scoring, flap thickness, and residual stroma after LASIK. We also evaluated the changes that occurred in patients with ectasia in comparison to their pre-LASIK parameters.
Results
The prevalence of post-LASIK ectasia was 0.22%. The degree of myopia, astigmatism, maximum keratometry reading (K-max), ectasia risk scoring, and flap lift for retreatment were significantly higher in the ectasia group compared with the control group (
P
=0.041, 0.006, 0.016, 0.038, and 0.017, respectively), while the CDVA and residual stroma after LASIK were significantly less in the ectasia group (
P
=0.039 and 0.003, respectively). There was a statistically significant increase in astigmatism and change in its type and increased K-max and corneal elevations after ectasia.
Conclusions
The degree of myopia, astigmatism, CDVA, K-max, ectasia risk scoring, residual stroma after LASIK, and retreatment are risk factors for ectasia development.
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OKULIX ray-tracing software versus third generation formulas: compatibility or superiority?
p. 98
Karim M. Nabil
DOI
:10.4103/djo.djo_77_21
Purpose
The aim of this retrospective study was to compare the accuracy of intraocular lens (IOL) power calculation using the OKULIX ray-tracing software compared with third generation IOL power calculation formulas.
Patients and methods
The study included 80 consecutive eyes of 80 patients (26 males and 54 females, with a mean age of 58.8±15.1 years), for whom phacoemulsification and IOL implantation was performed following biometry using the OKULIX ray-tracing software and third-generation IOL power calculation formulas for IOL power calculation. Accuracy of IOL power calculation was investigated by subtracting the attempted and achieved spherical equivalent 1 month postoperatively and was recorded as the mean absolute error.
Results
OKULIX ray-tracing software calculated IOL power was 17.1±8.5 diopters (D), which was statistically significantly different from Sanders, Retzlaff, Kraff (SRK)-T, Hoffer Q, SRK II, and Holladay formulas (16.7±8.3, 16.6±8.7, 16.8±8, and 16.7±8.5 D, respectively,
P
<0.001). The OKULIX ray-tracing software mean absolute error was 0.2±0.2 D, which was statistically significantly less than that of the SRK-T, Hoffer Q, SRK II, and Holladay formulas (0.5±0.5, 0.6±0.5, 0.8±0.7, and 0.6±0.5 D, respectively,
P
<0.001).
Conclusions
The OKULIX ray-tracing software seems to deliver reliable and more accurate results in comparison to the third generation IOL power calculation formulas.
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Double-flanged 6/0 polypropylene suture versus flanged haptic technique for intraocular lens fixation
p. 103
Tamer G Elsayed, Mohammed A Hegab, Haitham Y Al-Nashar, Reem A.K Dessouky
DOI
:10.4103/djo.djo_64_21
Background
Aphakia due to inadequate capsular support is a well-known complication of cataract surgery. Secondary intrascleral IOL fixation is favoured by many surgeons to overcome this problem. However, the technique of intrascleral fixation of the IOL still remains controversial and no single technique is considered ideal.
Aim
The aim of this study was to compare the clinical outcome of double-flanged 6/0 polypropylene (prolene) suture and flanged haptic technique for intraocular lens fixation in patients with aphakia and inadequate capsular support.
Patients and methods
This is a retrospective, nonrandomized, comparative study. The study included 50 eyes of 50 patients with aphakia and inadequate capsular support. They were divided into 2 groups: 25 eyes underwent the double-flanged 6/0 polypropylene suture technique (group I) and 25 eyes underwent the flanged haptic-fixation technique (group II). All patients were subjected to complete preoperative ophthalmic evaluation. The mean operative time was calculated for each method. Postoperatively, the best-corrected visual acuity (BVCA), endothelial cell count, and intraocular pressure were measured at 1-week, 1-month, 3-month, and 6-month intervals. Any intraoperative or postoperative complications were recorded.
Results
Both groups showed statistically significant improvement in BVCA at 1 week, 1 month, 3 months, and 6 months postoperatively compared with the preoperative BVCA (
P
<0.001). The mean operative time was significantly shorter in group II than in group I (12.3±1.93 min vs. 21.8±2.5 min, respectively,
P
<0.001). Differences in the mean endothelial cell counts and mean intraocular pressure values at 1 week, 1 month, 3 months, and 6 months postoperatively were not statistically significant within or between groups (
P
>0.05). Furthermore, there were no statistically significant differences in the frequency of intraoperative or postoperative complications between the 2 groups (
P
>0.05).
Conclusions
Both surgical techniques showed similar outcomes in the treatment of aphakic patients without capsular support, each with unique benefits. The double-flanged 6/0 polypropylene suture technique has a shorter learning curve and variable intraocular-lens options, while the flanged haptic technique is a faster procedure in the hands of experienced surgeons.
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Screening for preclinical chloroquine maculopathy using microperimetry and spectral domain optical coherence tomography
p. 112
Noha Ahmed Edris, Marina Maher Rizkalla, Mohamed Mahmoud Khafagy, Soheir Mohamed Esmat
DOI
:10.4103/djo.djo_67_21
Objective
The aim of this study was to evaluate the role of microperimetry and spectral domain optical coherence tomography (SD-OCT) in screening of preclinical chloroquine maculopathy in rheumatoid arthritis (RA) patients.
Study design
This is a cross-sectional comparative study.
Patients and methods
The study included 20 eyes of RA patients treated with chloroquine for more than 1 year (Group A), and 20 eyes of RA patients not treated by chloroquine (Group B). All patients were subjected to full ophthalmological examination, imaging with SD-OCT, and microperimetry. The study group ranged in age from 40 to 65 years with normal fundus.
Results
The mean central foveal thickness was found to be thin both in Group A (178.25±33.27 μm) and Group B (180.15±36.56 μm), with a statistically nonsignificant difference between the two groups (
P
=0.864). The mean parafoveal thickness was thinner than normal in both groups in all quadrants (
P
<0.05), whereas the perifoveal thickness in both groups showed no statistically significant difference (
P
>0.05) in all quadrants. The mean test score perimetry and the mean foveal sensitivity were decreased in Group A (11.12±4.11 and 11.73±3.92, respectively) compared with Group B (12.86±2.14 and 13.10±2.48, respectively), but the difference was not statistically significant (
P
=0.104 and 0.194, respectively).
Conclusion
Retinal thinning in the form of foveal and parafoveal thinning was detected by SD-OCT in patients of both groups, whereas decreased macular sensitivity was detected in the chloroquine group only with normal macular sensitivity in the nonchloroquine group as detected by microperimetry.
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Ocular morbidity among adult patients with chronic leukemia presenting to tertiary hospitals in Jos, North-Central Nigeria
p. 119
Ruth J Alfin, Alice V Ramyil, Obadiah D Damulak
DOI
:10.4103/djo.djo_63_21
Background
Chronic leukemia is the most common leukemia subtype seen among adults in Jos, Nigeria, with few reported isolated cases of ocular morbidity. There are no published comprehensive data on adult leukemic ophthalmopathy from this region.
Aim
The aim of this study was to determine the prevalence, pattern, and causes of visual impairment (VI) among adult patients with chronic leukemia in Jos, North-Central Nigeria.
Patients and methods
The study included adult patients diagnosed with either chronic myeloid leukemia or chronic lymphocytic leukemia, confirmed by bone marrow biopsy, in two tertiary hospitals in Jos, North-Central Nigeria, between January 2016 and June 2017. Visual acuity was assessed and categorized using the International Classification of Diseases. Detailed ocular examination was carried out and causes of vision loss were noted.
Results
A total of 104 eyes of 52 patients were examined within the study period. The mean age of the patients was 45±17.7 years, and 35 (67.3%) patients were males. The majority (63.4%) of the participants had chronic myeloid leukemia. Ocular disorders were present in 32 (61.5%) of all patients, and 10 (19.2%) patients were visually impaired. Of these, nine (90.0%) had moderate VI due to refractive errors, cataract, glaucoma, and disk swelling; and one (10.0%) person was bilaterally blind from exudative retinal detachment and vitreous hemorrhage. Only 27% of all causes of VI were leukemia specific and included disk swelling, exudative retinal detachment, and vitreous hemorrhage.
Conclusion
Although ocular disorders were frequent among adults with chronic leukemia in Jos, the magnitude of vision loss from chronic leukemia-specific ocular disorders was low.
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Anchored absorbable versus conventional nonabsorbable sutures in hang-back medial rectus muscle recession for large-angle esotropia
p. 125
Ibrahim A Elsaadani, Taher Eleiwa, Ahmed A Khater
DOI
:10.1353/djo.djo_45_21
Purpose
The aim of this study was to compare the clinical safety and efficacy of the anchored hang-back technique (HBT) to the HBT using nonabsorbable sutures in bilateral medial rectus recession (BMR) for large-angle esotropia (ET).
Design
This is a prospective comparative interventional study.
Patients and methods
The study included 81 patients with concomitant ET who were indicated for BMR of at least 6 mm. The patients were randomly assigned to have either (a) anchored HBT-BMR using absorbable 6–0 polyglactin 910 suture or (b) conventional HBT-BMR using nonabsorbable 6–0 polyester suture. Postoperatively, angles of deviation were measured for both near and far at 1 week and at 2 and 6 months. Success was defined as alignment within 10 prism diopters (PD) of orthotropia by the end of 2 months.
Results
Nonabsorbable HBT was used in 42 patients, whereas the anchored HBT was used in 39 patients. The mean preoperative angles of deviation for near and far were 60.9 and 58.7 PD, respectively, in the nonabsorbable group, compared with 61.7 and 58.8 PD, respectively, in the anchored group (
P
>0.05). By the sixth postoperative month, the mean angles for near and far in the nonabsorbable group were 8.1±0.6 PD of exotropia (XT) and 8.3±1.2 PD of XT, compared with 9.9±0.03 and 9.5±1.2 PD of XT in the anchored group, respectively. Repeated measures analysis of variance showed insignificant differences in the near and far angles between both groups. The success rate was 92.8% (39/42) in the nonabsorbable group compared with 89.7% (35/39) in the anchored group (
P
=0.32).
Conclusion
Anchored HBT was as safe and effective as nonabsorbable HBT in BMR for large-angle ET.
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Quantitative assessment of xanthelasma palpebrarum treated by argon laser photocoagulation using ImageJ software
p. 131
Moustafa A Salamah, Tamer G Elsayed
DOI
:10.4103/djo.djo_62_21
Purpose
The aim of this study was to evaluate the effect of argon laser photocoagulation on xanthelasma using ImageJ software.
Patients and methods
The study included 41 eyes of 23 patients (49 individual xanthelasmic lesions). All lesions were treated by a single session of argon laser photocoagulation. The lesions were assessed prelaser and postlaser using ImageJ software.
Results
All xanthelasmic lesions improved in height and color. The pretreatment mean height in ImageJ was 168.93±11.64 pixels, while the mean posttreatment height was 131±8.39 pixels (
P
<0.001). The color moderately improved in 24.4% of the cases and markedly improved in 68.3% of the cases.
Conclusion
Argon laser treatment of xanthelasma is a safe and effective treatment modality. This finding was documented using ImageJ software.
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Lateral tarsal strip vs. lower lid retractors reinsertion for treatment of involutional entropion
p. 136
Ezzeldin R Ezzeldin
DOI
:10.4103/djo.djo_65_21
Purpose
The aim of this study was to report the clinical efficacy of lateral tarsal strip (LTS) procedure for correction of senile entropion compared with lower lid retractors reinsertion.
Patients and methods
This is a retrospective comparative, nonrandomized interventional study that was conducted on patients attending the outpatient clinic of the Ophthalmology Department in Al Azhar University Hospital (Damietta branch), Damietta, Egypt, during the period from February 2019 to April 2021. The study recruited 56 lower eyelids of 44 patients who had involutional entropion; 12 of them were bilateral. In 29 eyelids, LTS procedure (group 1) was performed, whereas 27 eyelids were treated by lower lid retractors reinsertion (group 2).
Results
There were no statistically significant differences between the two groups regarding age, sex, and laterality. Regarding the postoperative correction of entropion, the first group (treated by LTS procedure) achieved a 100% success rate, whereas the second group (treated by lower lid retractors reinsertion) had a success rate of 81.5%, with a statistically significant difference (
P
=0.015). Although lid lag occurred only in the second group, it was not statistically significant.
Conclusion
The advantages of the LTS procedure over the lower lid retractors reinsertion are less risk of undercorrection and good cosmetic acceptance of the lid margin because of the stability of the lid margin that is achieved by the LTS procedure.
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