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  Citation statistics : Table of Contents
   2015| July-December  | Volume 16 | Issue 2  
    Online since October 28, 2015

 
 
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ORIGINAL ARTICLES
Trabeculectomy augmentation in primary open-angle glaucoma: Mitomycin-C versus Ologen implant
Tamer I Salem, Tarek N Attia, Salah A Mady, Asaad A Ghanem
July-December 2015, 16(2):70-76
DOI:10.4103/1110-9173.168534  
Introduction Trabeculectomy is the most commonly performed surgical intervention to reduce intraocular pressure (IOP) for medically uncontrolled glaucoma. Different augmentation procedures have been proposed to increase success rate and reduce postoperative complications. Purpose The aim of this study was to evaluate the results of different augmentation procedures used with trabeculectomy in patients with primary open-angle glaucoma. Patients and methods The study included 60 patients. Patients were randomly divided into three groups: the first group underwent trabeculectomy with low-dose mitomycin-C (MMC) (0.1 mg/ml); the second group underwent trabeculectomy with collagen matrix implant (Ologen) TM; and the third group underwent trabeculectomy with both low-dose MMC and Ologen implant. IOP was the primary outcome measure and the target level was set at less than 18 mmHg. Secondary outcome measures included bleb evaluation, number of glaucoma medications, and frequency of postoperative adjunctive procedures and complications. Results Postoperatively, there was a significant decrease in IOP in all studied groups when compared with their corresponding preoperative values, and there was no significant difference between the studied groups at any point of time except at 1 month, when there was a significant decrease in IOP in the MMC group compared with the Ologen or Ologen plus MMC groups. In addition, the Ologen plus low-dose MMC group had better bleb scoring. There was no significant difference between the groups as regards complications. The success was complete in 46 cases (76.7%), and qualified success was reported in 14 cases (23.3%). Complete success was equally reported in the MMC group and in the Ologen plus MMC group (85.0%), whereas it was 60.0% in the Ologen group. Conclusion Both MMC and Ologen appear to be safe, effective, and promising as augmentation procedures with trabeculectomy in patients with primary open-angle glaucoma.
  2 2,165 249
N-butyl-2-cyanoacrylate tissue adhesive versus subcuticular skin closure in external dacryocystorhinostomy
Dikran G Hovaghimian, Khaled A Abou Sedira, Mohamed Y Farag
July-December 2015, 16(2):97-102
DOI:10.4103/1110-9173.165062  
Purpose The aim of this study was to compare the surgical efficacy and aesthetic outcome of using tissue adhesive N-butyl-2-cyanoacrylate 'Histoacryl' with subcuticular suture closure of skin incision in external dacryocystorhinostomy (DCR). Design The present study was conducted as an interventional study. Patients and methods A total of 60 chronic dacryocystitis patients undergoing DCR procedures at the Research Institute of Ophthalmology were included. The patients were randomly selected, irrespective of age, sex or race, and were divided into two groups of 30 patients each. A classic external DCR was done for all the patients. At the completion of the surgery, the skin incisions in group 'A' were closed with vicryl 6/0 subcuticular suture, whereas in group 'B' N-butyl-2-cyanoacrylate 'Histoacryl' (FDA approved) tissue adhesive was used to close the skin incisions. No subcutaneous sutures were placed to approximate the wound edges. After 20 s of drying time the adhesive was applied for the second time. All the patients were followed up on the first day, fourth day, first week, second week, first month, and then monthly thereafter for 6 months. The time of suturing the wound and the time of application of the tissue adhesive was recorded for all the patients in both groups. During follow-up the wound was examined for evidence of infection, pain and discharge, and an inquiry was carried out for patient satisfaction. Photographs of the wounds were taken at every visit. The photographs were then shown to a senior surgeon, who was oblivious of the method of closing the wound, and rated the quality of skin incision according to 'WES scale'. Results No intraoperative wound complications were encountered in any patient. Statistical analysis of the data available, at 1 month, showed no statistically significant differences between the two groups as regards duration of healing, inflammation or final incision appearance as rated by the senior surgeon. Skin closure time averaged 61 s in subcuticular suture and 52 s in N-butyl-2-cyanoacrylate skin glue, which was statistically insignificant. Conclusion Using N-butyl-2-cyanoacrylate glue is an effective and a reliable method for skin closure, yielding similar aesthetic results as skin closure with subcuticular sutures in clean incision for external DCR surgery. It is safe, quick, does not compromise wound integrity, is adequately tolerated by the patients and could be considered an excellent alternative and an improvement on the traditional method of wound closure, providing high level of satisfaction for both patient and surgeon.
  1 4,646 316
Short-term results of intravitreal ranibizumab injection in eyes with diabetic macular edema
Ahmed Sharaf, Khaled S Nabawi, Tarek M Shalaby, Hesham S Swelem
July-December 2015, 16(2):77-83
DOI:10.4103/1110-9173.168536  
Purpose The aim of the study was to investigate the 1-week and 1-month effects of intravitreal injection of ranibizumab on central macular thickness (CMT) and visual acuity (VA) in patients with diabetic macular edema (DME). Patients and methods In this nonrandomized clinical study, 71 eyes of 62 patients with DME received intravitreal ranibizumab. VA and macular edema were assessed preoperatively and at 1 week and 1 month after injection. Eyes were subgrouped by spectral domain optical coherence tomography (SD-OCT) findings into spongiform edema, cystoid, serous retinal detachment, and tractional. Results Overall, the mean preinjection CMT was 432.0 ± 144.0 μm (range 202.0-846.0 μm); at 1 week it was 369.0 ± 99.33 μm (range 198.0-656.0 μm) with 11.54% improvement (P < 0.001), and at 1 month it was 341.0 ± 88.66 μm (range 191.0-608.0 μm) with 17.96% improvement (P < 0.001). Thirteen eyes with spongiform edema had a significant decrease in CMT (298-285-272 μm) (P = 0.001), yet had nonsignificant vision improvement. CMT decreased significantly in 42 eyes with cystoid edema (439-358-332 μm) (P < 0.001) and in 14 eyes with serous retinal detachment (476-447-386 μm) (P = 0.002). VA significantly improved in the latter two groups. Two eyes with tractional element showed no significant change in CMT and a significant drop in vision. Conclusion Intravitreal ranibizumab is effective in improving VA and decreasing macular edema after 1 week and 1 month after injection; except in eyes with tractional element, which can worsen. Eyes with cystoid edema or serous detachment exhibit significant improvements in both VA and CMT, whereas those with spongiform thickening show significant decrease in CMT without concomitant visual improvement. Therefore, patients could be counseled about the short-term changes in vision and macular edema depending on their SD-OCT-based subtype of DME.
  - 1,526 140
Pars plana vitrectomy with endolaser barrage 360° versus pars plana vitrectomy with scleral buckle for treatment of primary retinal detachment with inferior breaks
Mahmoud A Al-Aswad, Hesham A Enany
July-December 2015, 16(2):84-88
DOI:10.4103/1110-9173.165059  
Purpose The aim of the study was to compare intraoperative and postoperative complications and the recurrence rate after pars plana vitrectomy (PPV) with endolaser barrage 360° compared with PPV with scleral buckle (SB) for primary retinal detachment (RD) with inferior breaks. Patients and methods This prospective randomized study evaluated postoperative results in 40 patients with primary RD with inferior breaks. They presented with primary RD with inferior breaks and were divided into two groups, each group including 20 patients; the first group was treated by means of PPV with endolaser barrage 360°, and the second group was treated by means of PPV with SB. Intraoperative and postoperative complications and recurrence rate were recorded. Follow-up was carried out for 3 months. Results The mean age of patients in the first group was 56.2 years, whereas the mean age of patients in the second group was 55.3 years. Recurrent RD occurred in 10% of cases in the first group and in 5% of cases in the second group. Success rate was 90% (18 of 20 cases) in the first group and 95% (19 of 20 cases) in the second group. Conclusion Acceptable success rates can be achieved using PPV with endolaser barrage 360° to treat RD with inferior breaks. Supplementary SB is unnecessary to support the inferior retina as endolaser barrage with silicon oil and good positioning achieve tempo nade of the inferior breaks satisfactorily. Further, PPV with endolaser barrage 360° has fewer intraoperative and postoperative complications compared with PPV with SB.
  - 2,270 147
Punctotomy augmented by the use of perforated punctal plugs for the management of canaliculitis
Ayman Abd El Ghafar, Hossam Al-Sharkawy
July-December 2015, 16(2):89-92
DOI:10.4103/1110-9173.168537  
Purpose The aim of this study was to evaluate the use of perforated punctal plugs with punctotomy for the management of canaliculitis with preservation of punctal and canalicular patency. Patients and methods This was a prospective interventional case series including 12 consecutive patients with unilateral canaliculitis. Punctotomy was performed for all cases with curettage of canalicular contents followed by application of a perforated punctal plug. Plugs were removed after 3 months and all patients were followed up for 6 months. Results This study included 12 cases of canaliculitis, eight female (66.7%) and four male (33.3%), with a mean age of 60.33 ± 4.6 years (ranging from 48 to 73 years). The lower canaliculus was affected in 83.33% of cases, whereas the upper canaliculus was affected in 16.67% of cases. Sulfur granules were present in six cases (50%) and six cases (50%) were negative. Gram staining of the expressed contents revealed the following: 50% Actinomyces israelii, 30% Staphylococcus aureus, and 20% mixed infection. Improvement in inflammation and epiphora occurred in 11 cases (91.67%), whereas persistence of epiphora occurred in one case (8.33%). One case (8.33%) showed inflammatory granuloma at the site of punctotomy and one case (8.33%) showed extrusion of the plug after 1 month of surgery. Conclusion This study showed that punctotomy combined with implantation of perforated punctal plug is an effective technique for the management of canaliculitis, with improvement in manifestations and preservation of punctal and canalicular patency.
  - 3,496 194
Endoscopic-guided probing for the management of congenital nasolacrimal duct obstruction
Ayman E Abd El Ghafar
July-December 2015, 16(2):93-96
DOI:10.4103/1110-9173.168539  
Purpose This study aimed to assess the value of direct visualization during probing of congenital nasolacrimal duct obstruction using nasal endoscopy and its effect on the success rate. Patients and methods This is a prospective interventional case series including 34 eyes of 26 patients who presented with congenital nasolacrimal duct obstruction and treated with probing under direct visualization using nasal endoscopy. Observations were recorded. Results This prospective interventional case series included 10 female children (38.46%) and 16 male children (61.54%), mean age 15.6 ± 2.1 months. Endoscopic-guided probing achieved a success rate of 94.12%. Endoscopy indicated a stenotic valve and membrane in 82.36%, elastic membrane in 5.88%, submucosal false passage in 5.88%, bony obstruction in 2.94%, and tight inferior turbinate in 2.94% of the patients. Conclusion Endoscopic-guided probing transfers probing from a blind procedure to a visualized one, diagnoses the cause of obstruction and false passage, and enables intraoperative readjustment of false passage; this in turn increases the success rate.
  - 1,739 114
One-year results of the triple procedure for primary pterygia
Hisham A Saad, Ahmed M Ghoneim, Waleed A Allam
July-December 2015, 16(2):45-49
DOI:10.4103/1110-9173.168526  
Purpose The aim of this work was to study the effectiveness and potential complications of adjunctive intraoperative mitomycin-C (MMC) application combined with limbal-conjunctival autografting after primary pterygium excision. Patients and methods Fifty-seven eyes of 43 patients with primary pterygia were randomized to receive pterygium excision, followed by either a free conjunctival autograft (control group, n = 27) or an adjunctive intraoperative MMC 0.02% application for 2 min and limbal-conjunctival autograft (triple procedure group, n = 30). All patients were followed for 12 months. Results After 1 year, the recurrence rate was 14.81 and 0% in the control and the triple procedure groups, respectively (P < 0.05). Most complications were transient and mild. The duration of surgery was significantly shorter in the control group (P < 0.01). The surgery did not significantly alter the corrected distance visual acuity or the average absolute astigmatism in either group. Conclusion Simple excision of pterygium combined with adjunctive intraoperative MMC 0.02% application for 2 min and limbal-conjunctival autografting is a safe and effective way of treating primary pterygia.
  - 2,319 4,236
Macular and retinal nerve fiber layer thickness changes after small-incision lenticule extraction and femto-LASIK
Asaad A Ghanem, Salah A Mady, Tarek N Attia, Tamer I Salem
July-December 2015, 16(2):50-57
DOI:10.4103/1110-9173.168528  
Introduction Femtosecond laser flap creation exerts less intraocular pressure (IOP) fluctuation but requires more procedural time compared with microkeratome flap creation. This IOP elevation during suction may affect the macular and retinal nerve fiber layer thickness that can be assessed with optical coherence tomography. Purpose The aim of this study was to compare the influence of the transient elevation of IOP during suction on the macular and retinal nerve fiber layer thickness after small-incision lenticule extraction (SMILE) and femtosecond laser-assisted in-situ keratomileusis (femto-LASIK). Patients and methods A total of 80 and 75 eyes that received SMILE and femto-LASIK procedures for myopia and myopic astigmatism, respectively, were enrolled in this study. Spectral-domain optical coherence tomography was used to measure macular and peripapillary retinal nerve fiber layer thickness preoperatively, at 1 week, and 1, 3, and 6 months postoperatively. Results The study included 155 eyes. In both the SMILE group and the femto-LASIK group, the mean foveal, parafoveal, and perifoveal retinal thickness did not change significantly from the preoperative to any postoperative timepoint (P > 0.05). The mean foveal retinal thickness was significantly greater in the femto-LASIK group than in the SMILE group (P<0.05). The retinal nerve fiber layer thickness did not change significantly from the preoperative to any postoperative timepoint in either group (P > 0.05). The differences in the retinal nerve fiber layer between the SMILE group and the femto-LASIK group were not statistically significant at any follow-up visit (P > 0.05). Conclusion Both SMILE and femto-LASIK procedures had no significant effects on the macular and retinal nerve fiber layer thickness postoperatively.
  - 2,290 1,294
Efficacy and safety of the use of freeze-dried (lyophilized) amniotic membrane transplantation with combined trabeculotomy-trabeculectomy for congenital glaucoma
Salah M Al-Mosallamy
July-December 2015, 16(2):58-64
DOI:10.4103/1110-9173.165060  
Purpose The aim of the study was to evaluate the outcome of the surgical technique that utilizes freeze-dried (lyophilized) amniotic membrane transplantation (AMT) with combined trabeculotomy-trabeculectomy in cases of primary congenital glaucoma with respect to its efficacy and complications. Patients and methods This was a prospective controlled study that included 25 eyes of 19 patients with primary congenital glaucoma. The patients were categorized into two groups: group I included 14 eyes that were treated with combined trabeculotomy-trabeculectomy with AMT and group II included 11 eyes that were treated with combined trabeculotomy-trabeculectomy without adjunctive (control group). Results Nineteen patients were included in the study: 13 were male and six were female. The mean age was 6.2 ± 3.5 months and 5.7 ± 2.9 months in groups I and II, respectively; there were no statistically significant differences between groups I and II regarding the patient demographics and preoperative characteristics. The surgical outcome of the two groups showed that absolute success was achieved in 71.4% and qualified success in 14.3% in group I, and in group II absolute success was achieved in 45.5% and qualified success in 27.2%. This difference was highly significant in terms of absolute success and significant in terms of total success between the two groups. The mean intraocular pressure (IOP) in this study was markedly decreased from preoperative values in both groups during postoperative follow-up visits, with statistically significantly lower IOP in group I than in group II at all postoperative visits. The complications encountered were hyphema in 28.6% of patients in group I and in 27.3% of patients in group II. Shallow anterior chamber associated with hypotony occurred in 21.4 and 18.2% of patients in groups I and II, respectively. One case in each group developed serous choroidal detachment. Flat nonfunctioning bleb with high IOP occurred in 14.3% of patients in group I and in 27.3% in group II. The complication rates were statistically insignificant between the two groups. Conclusion AMT-enhanced combined trabeculotomy-trabeculectomy appears to be an effective procedure for the treatment of primary congenital glaucoma with better long-term control of IOP and without added complications.
  - 2,110 551
Comparison between trabeculectomy with Ologen implant and trabeculectomy alone in open-angle glaucoma
Tharwat H Mokbel, Mohamed A El-Malah, Hossam T Al-Sharkawy
July-December 2015, 16(2):65-69
DOI:10.4103/1110-9173.168532  
Purpose The aim of this study was to compare surgical outcomes of trabeculectomy with Ologen implant to trabeculectomy alone in terms of intraocular pressure (IOP), postoperative medications, bleb function, and postoperative complications in open-angle glaucoma. Patients and methods Setting : Mansoura Ophthalmic Centre and Al-Azhar University Hospital, Egypt. Design: Prospective study. Forty-two eyes of 30 patients with primary open-angle glaucoma (34 eyes, 80.95%) or pseudoexfoliation glaucoma (eight eyes, 19.05%) were included in this study. Twenty-one eyes were treated by subscleral trabeculectomy with a subconjuctival implant of Ologen over the closed scleral flap (Ologen or study group) and the other 21 eyes were treated by subscleral trabeculectomy alone (control group). One-year follow-up was completed for all eyes. Results Preoperatively, the mean IOP was 29.51 ± 2.85 mmHg in the Ologen group and 30.64 ± 2.36 mmHg in the control group. Postoperative mean IOP was13.26 ± 2.45 mmHg in the Ologen group and 16.85 ± 3.56 mmHg in the control group (P = 0.031). The mean number of postoperative antiglaucoma medications in the Ologen group was 0.43 ± 0.59 compared with 1.06 ± 0.85 drugs in the control group (P = 0.005). Conclusion The new degradable collagen implant (Ologen) improves and normalizes filtering surgical wound healing with more loosely organized and healthy bleb tissue and better IOP control than blebs formed with trabeculectomy alone in primary open-angle and pseudoexfoliation glaucomas.
  - 1,830 263
RETINAL IMAGING SECTION
Geographic atrophy of the macula
Alaa M Fadel
July-December 2015, 16(2):103-104
DOI:10.4103/1110-9173.165061  
Geographic atrophy of the macula is a late form of dry AMD. Changes found on optical coherence tomography imaging (OCT) include Retinal Pigment Epithelium (RPE) atrophic changes and window defects, with a pronounced photorecetor layer damage.
  - 1,380 85